In this episode of the FYX hosted by wellness coach Krysta Huber, Dr. Casey Means tackles pressing questions about metabolic health. From the inner workings of insulin to the wild west that is food marketing, she unveils the true definition of health and how biowearables like Levels can help achieve it.
The pros and cons of caffeine
While caffeine contains antioxidants, it can also cause glucose to spike.
Caffeine, in its own right, can actually raise our blood sugar levels through cortisol, so that caffeine can stimulate those stress hormones, cortisol, and other catecholamine hormones. What those do in the body, those stress hormones is they tell our body that we’re under threat and we probably need to mobilize something to manage that threat. What it does to help us is it tells our liver to actually breakdown stored glucose and send that glucose into the bloodstream to essentially fuel our muscles and our brain for whatever threat is causing stress. So caffeine mimics this, even if there’s not a stressor. It makes our body think there’s one and causes that glucose to be released in the bloodstream… However, if you look at the research, this is interesting, of all people who drink coffee and metabolic health, people who tend to drink a little bit of coffee actually seem to have better long-term metabolic health, which is fascinating, because it does cause a glucose rise. But if you look at the large epidemiologic studies, it seems to be protective and it may be because coffee is such a rich source of antioxidants and it really is potent in that regard.
The role of blood sugar
One of the fundamental building blocks of the body is our blood sugar, and our Western diets are wreaking havoc.
Why is blood sugar so involved with so many different things? It’s because it’s a substrate, it’s a building block of a totally fundamental process in the body, which is metabolism. Metabolism is fundamentally how we produce energy from our food and our environment, and we have like 30 trillion cells in the body. Every single one of them, to do anything, needs energy. So when we have a problem producing or managing energy, it can affect any cell type anywhere in the body and that’s why when these processes are screwed up, which our Western diet and lifestyle are screwing them up in a way that we’ve never been able to screw it up this much before, because we haven’t had access to all this crazy food and the chronic low grade stress and the chronic sleep deprivation and the sedentary behavior, and all these things are gumming up all these systems that basically break a core, core pathway in the body that lets every cell type function.
How we become insulin resistant
Eating too many refined carbs and sugars overload the body and lead to resistance.
Over time, as we eat so many refined carbohydrates, refined sugars, which are making up the vast majority of calories Americans eat these days, we spike that insulin over and over and over again. We give this signal to the body. We have so much blood sugar, we need to get it into the cells. That insulin, over time, it’s just pounding the cells saying, “Take up this glucose. Take up this glucose,” and the cells actually has a protective mechanism to say, “Stop, I can’t take any more glucose.” They become what’s called insulin resistant. Then the body has to produce more insulin to drive the glucose in there. Over time, that process gets out of hand and you’ve got high insulin levels. Your glucose levels are rising.
Other factors that impact insulin
In addition to refined carbs, things like sleep and stress can also make us more insulin resistant.
There are a lot of other things that can make ourselves less sensitive to insulin and become more insulin resistant aside from just that constant barrage of carbohydrates. That’s things like sleep deprivation. Sleep deprivation, one night of sleep deprivation makes us more insulin resistant. Things that cause oxidative stress and free radicals in the body like these refined, processed seed oils and vegetable oils that we’re eating that are easily oxidized, that can cause problems with our body’s ability to basically convert glucose to energy. Chronic stress and cortisol can also do that. So it’s not just the food, it’s this holistic life that we’re leading that tells the body, “There’s a problem. This is not normal,” and shuts down some of these really important systems.
The wild west of food marketing
Simply put, don’t trust what’s on the package. Eat healthy whole foods for the best result.
The thing about the food industry and food marketing, it’s just a fairly unregulated industry. These boxes of food can say anything they want and so you walk into the store and it’s like almost everything is marketed as healthy. It’s like it’s either organic or it’s keto or paleo, or it’s low sugar. There’s just a claim on every box. How the heck do you really know like what is going to make me fundamentally healthy, which is synonymous with metabolically healthy. By having a continuous glucose monitor or other tracking that lets you see in your body how that food impacted you and your blood sugar in real-time, you can really cut through a lot of that marketing BS and really understand, “Okay, this food is affecting me in an extreme way in terms of my glucose and this one is not, so I’m going to choose the one that’s not, or I’m going to modify the one that is to try and have it have a lower impact.”
High blood sugar is a delayed reaction
By the time your blood sugar is measurably unhealthy, the problem has been brewing for years.
Once you walk into the doctor’s office and your blood sugar is above 100, which is in the pre-diabetic range, there have been problems probably going on for over a decade. So that’s what I think is important to know. So there’s physical clues that something could be going on and a problem with your insulin, like having difficulty losing weight, being overweight or obese, having issues we know are associated with metabolic dysfunction like infertility caused by polycystic ovarian syndrome or early erectile dysfunction, or potentially if your mood … if there’s issues with depression and anxiety that that treatment modalities aren’t working for, it could be that metabolic dysfunction is contributing to those things. Or, your doctor tells you that your liver numbers are up and you don’t really know why. There’s all these subtle clues that should help people dig deeper, but often, in the medical system, we’re not going to pursue those things.
Health = micro decisions
Home testing will allow us to truly understand health, which consists of our daily decisions, not medical interventions.
Health is not generated from a pill. Health is not generated from surgery. Health is not generated in a doctor’s office. Health is generated from the hundreds of micro decisions we make every day out of the doctor’s office, in our homes, in what we choose to eat, when we choose to eat, how we exercise, how we sleep, how we manage stress, the toxins we’re exposed to, how our microbiomes are doing, what our micronutrients status is. That’s where health comes from. That’s where we build our body. o that is very complex and hard to control, and that’s why I think this movement of home testing, things like direct to consumer lab, testing like Everlywell and others, and then, of course, biomarker tracking at home like the Whoop strap, you’ve got the Apple Watch on, we’ve got continuous glucose monitors on. People are measuring their heart rate variability. That’s this reflection of the micro decisions and gives us this ability to have this empowerment so we can understand our bodies.
The levers of health
Not everyone can have perfect diet, sleep, and exercise every single day. If one lever is off, try to focus on another.
There’s a lot of different opportunities to basically tweak and knobs to turn to up-level. So if today’s not the day that you can move a bunch or work out, then really try and focus on sleep that night. If this is a day that you are going to be at a family dinner and you’re going to be eating a ton of carbohydrates, then walk beforehand or bring some chia seeds and sprinkle them on top so you’ve got a little bit more fiber, I don’t know. It’s like about building that holistic lifestyle, but it doesn’t necessarily mean that, “Oh my gosh, I’ve got to eat perfect on everything.” It’s more that there’s a lot of levers to pull that we can use to be our healthiest.
Glucose is an early alarm bell
When measured with a biowearable, your glucose levels can clue you in to early warning signs of poor health in action.
You could go along for your whole 20s and even your 30s, like spiking crashing, spiking, crashing, and compensate, like take a nap, drink more coffee. You’re working out a ton and so maybe you’re not like gaining a ton of weight, but you’re having trouble with like a little bit of belly fat, and you just don’t put it together. But then 10 years passed and it’s like, “Wait, my glucose has been creeping up all those years.” So it’s like this early alarm, like early warning system so you don’t get caught up in being shocked down the road with a real overt manifestation when there’s just been these like subtle, barely perceptible symptoms that you’ve thought were just normal all along the road.
The Levels mission
Summed up succinctly, Levels hopes to reverse the metabolic epidemic that is plaguing the Western world.
Our mission is to reverse the metabolic disease epidemic through personal empowerment, with data and by helping people understand their bodies. So that’s the long-term mission. I mean, that’s what we’re striving for. I think one of the things I’m most excited about in terms of our company and where this is going is building community around this. I think right now the experience with Levels is a bit more isolated and personal and people definitely share on social, but how could we learn from each other? Your experience, I’m sure if you shared some of your data, I could learn so much from it and vice-versa. So giving people the opportunity to share and create community around that and learn from each other is awesome. Especially with food, it’s like infinite options, and how cool would it be if someone who responds really similarly to me in terms of glucose and has similar lifestyle and age, potentially, if I can learn from what’s working for them so I don’t have to reinvent the wheel myself.
Dr. Casey Means: That’s something that a lot of people in the research and the medical space are trying to fix, like how do we do better nutrition and lifestyle research, because we know that the chronic killers of Americans these days are related to diet and lifestyle, and are largely preventable, and are taking up the majority of our healthcare costs, chronic lifestyle diseases. So we need to have better research because once we have the research, once we have the evidence, it trickles down into medical education, and then trickles down into practice. So there’s this just this bias based on a lot of factors for this more reactive name it, drug it, cut it out mindset. It’s a bit more efficient. But I think many of us know, as physicians, like that’s not the answer because health is not generated from a pill. Health is not generated from a surgery. Health is not generated in a doctor’s office. Health is generated from the hundreds of micro-decisions we make every day out of the doctor’s office, in our homes, in what we choose to eat, when we choose to eat, how we exercise, how we sleep, how we manage stress, the toxins we’re exposed to, how our microbiomes are doing, what our micronutrient status is. That’s where health comes from.
Narrator: Let’s link up with Krysta on the FYX. She’s a wellness coach with a focus on mental well-being and physical strength.
Krysta Huber: What’s up FYX listeners. It’s your host Krysta, welcoming you to Episode 29 of the show, where I had an amazing conversation with one impressive woman, Dr. Casey Means, who is a Stanford-trained physician and the chief medical office, and one of the co-founders of a very cool, new, emerging metabolic health company called Levels. Over the past few weeks, I have had the opportunity to actually test the Levels product myself and I’m very excited to share with all of you FYX listeners that you’ll have the opportunity to do so by following the link that I will share at the end of this introduction as well as down in the show notes.
Krysta Huber: So this chat is all about your glucose. What is it? Why is it measured when you go to the doctor’s office once a year? They run a set of lab work and may or may not give you some insight into whether you should care about that number. Dr. Casey breaks all of that down in today’s conversation. I also weave in a little bit of my own takeaways from tracking this information over the course of the past month or so, and it’s been really interesting because this led to a broader conversation about biofeedback, in general, and why we should pay attention to more than just what we’re eating, and specifically how we’re preparing foods, timing them around workouts, and second-guessing some of the marketing around foods that are seemingly healthy, but when you put them up against using some of the compare features and other cool tools of the Levels app, assessing whether that’s the healthiest option for your body.
Krysta Huber: Dr. Casey also shed some very interesting light into why medical training has so traditionally been a reactionary type of approach and positive signs that we’re moving to a preventative care world thinking, sick care versus well care and how can we focus more on well care? Levels’ mission is certainly supporting that effort, and I think it goes hand in hand with a lot of the other tracking and tools and information we’re seeing in terms of companies like Whoop and testing your day strain, ordering, tracking, sleep, and just being able to have all this information collectively can be a very valuable tool into your health. But more specifically, with Levels, we’re looking at an internal biofeedback marker. It has a little tiny needle … it doesn’t hurt, I can tell you from personal experience … that is legitimately going under your skin and monitoring a marker inside your body, which is just really cool. The fact that we’re able to now do those sorts of things at home is fascinating and just exciting.
Krysta Huber: All that said, though, Dr. Casey agreed with this and something that I really wanted to preface the entire conversation with is that if you’re listening to this and you’re thinking to yourself, “Wow, I have so many different avenues that I want to approach in terms of improving my health, and you’re telling me that I got to track yet another thing,” this is not the only indicator of assessing where your health is. It’s a relative piece of information and it matters in the context of who you are as an individual and it can be helpful in having a doctor or a coach, someone you’re working with and improving your health or your physical fitness, your nutrition, whatever it is, to have additional data, but just like all the other examples that I listed in terms of these other tracking devices and products, it still is yet another piece of data and we want to make sure we’re putting it into the context of the bigger picture specific to you.
Krysta Huber: If, after listening to this episode, you’re interested in checking out Levels for yourself, you as a FYX listener will have the opportunity to jump the waitlist. The company is still in beta testing so they’re only offering early access to the program. Right now, it has a wait list of over 125,000 people. But I have a special link that will be shared down in the show notes and that is levels.link/fyx. Remember, it’s F-Y-X. It’s now live and if you head over to that, you’ll be able to skip the line and participate in the early access program.
Krysta Huber: I will be documenting a little bit more on my Instagram page, @thekrystahuber, about some of the specific feedback I’ve gotten by monitoring my glucose through Levels over the past several weeks. If you have any questions about it, don’t hesitate to reach out to me there. It’s been a really cool deep dive if you’re into that nerdy stuff, like I am, and I know that Dr. Casey would love to hear from you as well. If you have questions, if you’re interested, be sure to reach out to her. With that, let’s turn the mic over to Dr. Casey.
Krysta Huber: Who is Dr. Casey Means? Why should we care about you? You have such an impressive resume, I want you to brag about yourself for a little bit.
Dr. Casey Means: Thank you so much for having me, Krysta. So my name is Dr. Casey Means, and I am the co-founder and chief medical officer of metabolic health company Levels. I am a metabolic health-focused physician and my practice and my entrepreneurial work and my academic work all focuses on helping people understand their bodies better and really learn about how our food and lifestyle choices are affecting our foundational health so that we can work to really optimize that and live our best lives. I am a surgeon by training. I actually trained as an ear, nose, and throat surgeon, head and neck surgeon. In my time doing that, I really learned that so much of the way we’re practicing medicine in the United States is really reactive. We wait until disease emerges before we intervene and surgery is a pretty extreme intervention. It’s quite morbid.
Dr. Casey Means: So it really inspired me to think deeply about how to be more proactive about health. Is there anything that we can do, choices that we can make that can help keep us out of the operating room? So that really drove me to explore that, really dive into the functional medicine and precision medicine world, and really think about what are the triggers of disease. So much of ENT disorders like sinusitis and thyroiditis and laryngitis, all these -itises are inflammatory disorders, and just really thinking through what are the triggers of inflammation. We know that so much of that is our industrialized diet and the chronic stressors that we’re under these days, living in the modern Western world.
Dr. Casey Means: So I really got interested in how can we help people, empower people to understand how the choices they’re making impact their health. So that led me to becoming a founder of a company Levels, which does exactly that. We have a metabolic awareness program that gives people a wearable called the continuous glucose monitor that gives them real-time feedback on exactly how their dietary choices and other lifestyle choices are affecting their blood glucose levels, their blood sugar in real-time, and blood sugar is a real key marker of our metabolism, and when it’s out of whack, it can generate that inflammation and that metabolic dysfunction that can be a root cause of so many of the conditions and the symptoms that we’re seeing today. So it’s really closed loop biofeedback on an internal biomarker that changes throughout the day based on how we’re living, what we’re eating, and what we’re doing.
Dr. Casey Means: So I’m also an editor for the International Journal of Disease Reversal and Prevention. So that’s really the way in which I try and facilitate more of the academic work that goes into disease reversal and prevention. I practice, really, a metabolic-focused functional medicine in my personal private practice.
Krysta Huber: You have clearly a wealth of knowledge. We have so much to get into, but before we do, I’d like to keep it a little light to kick off my episodes. I’m a big coffee drinker, love my caffeine. I will say, based on stress levels and cortisol and all of that science I’ve been working on, trying to cut it back a little bit. My nutrition coach is going to listen to this and she’s going to be like, “Yes, you are,” and I’m glad that you said that. So I always ask all of my guests, what’s your go-to coffee order? I think for you, to keep it on theme of our topic today, I’d love to know if in your experience of using Levels yourself and wearing the glucose monitor, if you’ve maybe changed your coffee habits in any way over the past year?
Dr. Casey Means: Such a great question, and it’s funny that you’re asking this because I’m actually sitting next to a huge box of a coffee sampler that I’m doing on a team retreat in a couple of days.
Krysta Huber: Nice. Perfect.
Dr. Casey Means: We’re a team that really loves coffee, and so we’re going to be doing a tasting remotely, which I’m really excited about.
Krysta Huber: That’s so fun.
Dr. Casey Means: So I’m a coffee lover, but I don’t drink caffeine.
Krysta Huber: Okay.
Dr. Casey Means: So I go for the Nespresso every morning, I have a decaf organic pod, and the reason I don’t do caffeine is all related to, really, metabolic health. So, for me, I know that drinking caffeine impacts my sleep, even if it’s 12 or 14 hours later, and I tend to just sleep more soundly when I don’t have caffeine, so that’s number one. We know that sleep interruption and lack of quality sleep has a profound impact on our ability to produce energy in the body, which is metabolism. So that’s one reason. Then the second reason is that caffeine, in its own right, can actually raise our blood sugar levels through cortisol, so that caffeine can stimulate those stress hormones, cortisol, and other catecholamine hormones. What those do in the body, those stress hormones is they tell our body that we’re under threat and we probably need to mobilize something something to manage that threat. What it does to help us is it tells our liver to actually breakdown stored glucose and send that glucose into the bloodstream to essentially fuel our muscles and our brain for whatever threat is causing stress. So caffeine mimics this, even if there’s not a stressor. It makes our body think there’s one and causes that glucose to be released in the bloodstream.
Dr. Casey Means: So that’s something that you’ll see when wearing a continuous glucose monitor-
Krysta Huber: I’ve definitely seen that, yeah.
Dr. Casey Means: You’ll often see like a tiny little bump when you have caffeine, and I think it all has to be taken in context. Let’s say, right after you have that coffee, you go take a power walk or you go do a run or some sort of activity where you’re actually going to utilize that glucose, that’s one thing, because you’re actually going to process it then. If you’re going to just be sitting at your desk, then I prefer to not have that extra glucose floating around and the subsequent insulin release that might happen for that. So I avoid it for that reason.
Dr. Casey Means: However, if you look at the research, this is interesting, of all people who drink coffee and metabolic health, people who tend to drink a little bit of coffee actually seem to have better long-term metabolic health, which is fascinating, because it does cause a glucose rise. But if you look at the large epidemiologic studies, it seems to be protective and it may be because coffee is such a rich source of antioxidants and it really is potent in that regard, and buffering oxidative stress through antioxidants is actually quite productive against mitochondrial dysfunction and metabolic dysfunction. So it seems like that benefit might outweigh that tiny impact on glucose that it has through the cortisol pathway.
Dr. Casey Means: So I think, big picture, if you’re someone who does drink caffeinated coffee, probably safe to continue to do so over the long-term, but keep it fairly minimal. You don’t want to be having like five or six cups a day, which is just like stress response throughout the whole day. Probably one cop or so of a really high quality coffee … I say high quality because that’s probably going to have the most antioxidants … that would be my recommendation. Then for people who don’t drink caffeine, I would say it’s not worth starting in order to get that antioxidant benefit. I would probably just focus on other source of antioxidants. If you’re not a coffee drinker, green tea, which has a little bit of caffeine, but also super potent antioxidants, also seems to be productive in terms of metabolic health. So one or two cups of green tea per day is filled with a lot of those chemicals that can be productive against oxidative stress and mitochondrial dysfunction.
Krysta Huber: You hit some really great points there on both positive and negative aspects, which I appreciate because I think there’s so much conversation around coffee and a lot of times we hear, “Oh, it’s really great for your health. It’s great for dieting,” and in a very generalized way. But then I think there’s also the jump to be like, “Oh, coffee’s bad, coffee’s bad,” because everybody’s doing everything in excess, right? So I think the context of all of this, and I’m sure will be a theme of this conversation, is just like this is really individualized and specific to the person. I imagine that, that is something that’s top of mind for you all the time when you are thinking about what Levels wants to do as a company, conversations you’re having in podcast interviews, or whatever it is.
Krysta Huber: So before we dive into like what are some of the effects and why should we care about monitoring our glucose, let’s just start with like glucose as its function in the body. I think it’s important to educate the listener and understanding, okay, we’re starting to see more of a emphasis on glucose monitoring, but it’s been around for a while and people only think about it in the context of diabetes. I mean, I didn’t share with you too much before we hit the record button about my personal experience in wearing the glucose monitor so far, but it’s been really interesting because I’ll be in the gym or like out getting coffee or something and once in a while, somebody will approach me and ask me what’s in my arm and they immediately assume that I’m diabetic. Then when I tell them, “Oh, I don’t have diabetes. I’m just doing this for the sake of learning more information and seeing how my body responds to glucose,” it opens up the door for a very fascinating conversation about why we should care about these things in general when it comes to our health.
Krysta Huber: So I know I just said a lot, but to kick it off, let’s talk about glucose. Like, why does it matter as something we need to monitor in our health when we go to the doctor’s office? Why is that something that’s showing up on our blood work?
Dr. Casey Means: Yeah, such a great question. So simply put, getting our blood sugar and our blood glucose, keeping it in a stable and healthy range throughout our lifetime, is essentially required for optimal health and longevity. If we want to just immediately improve our daily functioning, our energy, our performance, and our risk for long-term disease, keeping our blood sugar in a stable and healthy range is one of the best ways that we can do that because we know that erratic blood sugar or high blood sugar, essentially the body poorly processing blood sugar, blood glucose, is associated with 8 of the 10 leading causes of death in the United States.
Dr. Casey Means: Like, we have 128 million Americans, almost 40% of the country, who have prediabetes or type two diabetes, which are blood sugar disorders that are largely preventable and this is how we’re living in the modern world and having that issue, that type two diabetes, and, more generally, metabolic dysfunction, issues with the way that we’re processing blood sugar, that just puts us at risk for so much. That’s related to the development of cancer; the development of Alzheimer’s dementia, which is now being called type three diabetes; the development of heart disease, stroke, chronic liver disease, chronic kidney disease, preventable blindness, depression, anxiety, infertility, erectile dysfunction, so much more.
Dr. Casey Means: So the question is why, like why is blood sugar so involved with so many different things? It’s because it’s a substrate, it’s a building block of a totally fundamental process in the body, which is metabolism. Metabolism is fundamentally how we produce energy from our food and our environment, and we have like 30 trillion cells in the body. Every single one of them, to do anything, needs energy. So when we have a problem producing or managing energy, it can affect any cell type anywhere in the body and that’s why when these processes are screwed up, which our Western diet and lifestyle are screwing them up in a way that we’ve never been able to screw it up this much before, because we haven’t had access to all this crazy food and the chronic low grade stress and the chronic sleep deprivation and the sedentary behavior, and all these things are gumming up all these systems that basically break a core, core pathway in the body that lets every cell type function.
Dr. Casey Means: So that’s why glucose and metabolism being broken is related to so many seemingly different problems. I mean, infertility and Alzheimer’s disease, how are they related? But if your brain cell and your ovary cell are both not producing energy properly, you can have these different symptoms. So glucose and fat are the two main energy sources in the body that you can use to basically bring into the cell and then convert to a currency of energy that our cells can use. When we eat carbohydrates, they’re broken down into glucose. When that happens, our body releases this hormone insulin from the pancreas that basically allows the cells to take up that glucose from the bloodstream. So you eat something carbohydrate, your blood sugar will go up as you digest it, and then to get it back down to normal, it’s going to be shuttled into the cells via insulin to be used either to produce energy, or if there’s excess, which in our modern American lifestyle, there’s almost always access, to be stored as fuel and as fat.
Dr. Casey Means: Over time, as we eat so many refined carbohydrates, refined sugars, which are making up the vast majority of calories Americans eat these days, we spike that insulin over and over and over again. We give this signal to the body. We have so much blood sugar, we need to get it into the cells. That insulin, over time, it’s just pounding the cells saying, “Take up this glucose. Take up this glucose,” and the cells actually has a protective mechanism to say, “Stop, I can’t take any more glucose.” They become what’s called insulin resistant. Then the body has to produce more insulin to drive the glucose in there.
Dr. Casey Means: Over time, that process gets out of hand and you’ve got high insulin levels. Your glucose levels are rising. The cells, there’s too much energy substrate around in the body, but you’re actually not able to use it inside the cells, and you’re storing a lot of that glucose as fat because insulin, interestingly, not only is it the signal that take the blood sugar out of the bloodstream, there’s a lot of blood sugar around; it’s also the signal that says don’t burn fat for energy because we have enough glucose around for energy. So if your insulin is high, it’s going to be virtually impossible to burn fat. So, obviously, that’s relevant for any of the 72% of Americans who are overweight or obese in this country. So that’s the cycle of how continually spiking blood sugar, and then potentially spiking insulin, can lead to these downstream ramifications where we just have problems essentially taking up the glucose and processing of the body.
Dr. Casey Means: Then there are a lot of other things that can make ourselves less sensitive to insulin and become more insulin resistant aside from just that constant barrage of carbohydrates. That’s things like sleep deprivation. Sleep deprivation, one night of sleep deprivation makes us more insulin resistant. Things that cause oxidative stress and free radicals in the body like these refined, processed seed oils and vegetable oils that we’re eating that are easily oxidized, that can cause problems with our body’s ability to basically convert glucose to energy. Chronic stress and cortisol can also do that. So it’s not just the food, it’s this holistic life that we’re leading that tells the body, “There’s a problem. This is not normal,” and shuts down some of these really important systems.
Dr. Casey Means: So the nice thing is that once we know this and we know how our food is impacting our glucose levels, and we have visibility into that, which we’ve never had. The thing about the food industry and food marketing, it’s just a fairly unregulated industry. These boxes of food can say anything they want and so you walk into the store and it’s like almost everything is marketed as healthy. It’s like it’s either organic or it’s keto or paleo, or it’s low sugar. There’s just a claim on every box. How the heck do you really know like what is going to make me fundamentally healthy, which is synonymous with metabolically healthy. By having a continuous glucose monitor or other tracking that lets you see in your body how that food impacted you and your blood sugar in real-time, you can really cut through a lot of that marketing BS and really understand, “Okay, this food is affecting me in an extreme way in terms of my glucose and this one is not, so I’m going to choose the one that’s not, or I’m going to modify the one that is to try and have it have a lower impact.”
Dr. Casey Means: So that is really what Levels is all about is giving people that awareness and that visibility so they can make better choices because, at the end of the day, if you keep your blood sugar more stable and less frequent and less high spikes, you’re going to be better off in terms of maintaining your long-term metabolic fitness and keeping your cells insulin sensitive and reaping all the benefits of a functional metabolic system and producing energy properly in the body.
Krysta Huber: First, thank you for that explanation. It was fantastic. You really covered all of the key details without losing us in terms of the science, and I know some of this can get complex. We were talking before the episode and just something that I find among clients, among people that reach out to me on social media, there’s a lot of overwhelm over, like, “I could track this thing. I could track my sleep. I should track my stress levels. I could …” and all this amazing technology. Like the fact that we have this technology, as you pointed out, it’s amazing because now we can finally do something with it. I think to me, in my personal experience over the last two weeks, that was where I felt like Levels is helping me answer some questions. Because while I consider a lot of the food choices I make relatively healthy, like I’m not the type of coach out there who is eliminating things completely from my diet unless like there’s a sensitivity going on, and I’m not the type of person that has a list of foods deeming them as good and bad. I always put that in air quotes for people because it’s so specific to who you are.
Krysta Huber: Interestingly, you mentioned briefly sleep, you mentioned just chronic stress, those two have been very clear for me in tracking and looking at the Levels app. I’ve seen really specific changes and what’s interesting is like I’ll notice I might have eaten, but then I will track if I have an event like recording a podcast, going to workout. If I’m rushing to do something, that’s been one of the things that I’ve immediately seen spike. I knew that was going on just because of my own personal education around nutrition, but like I care about this stuff to a degree that it’s my profession, and same with you. So for the average person out there who’s just trying to get healthier, where do you recommend that they start if they feel like they think that they might have cues that this could be something they should dive into a little bit more, but how can they really unpack that so that it doesn’t feel so overwhelming, if that makes sense?
Dr. Casey Means: Yeah. So I think in terms of understanding, I guess, first of all, whether it is something you need to be focusing on. So is there a problem with my metabolic health? Like, that’s a really interesting question because, right now, the way that we, in the doctor’s office, diagnose metabolic problems really is just as simple as a fasting glucose check once a year. Like this one time point, out of 365 days, 24 hours a day of your blood sugar, and that’s being used to tell you whether the core fundamental pathway of your body that generates essentially as the foundation for all health is okay. It’s really a strange system, especially because we know how dynamic these numbers are. If I get a terrible night’s sleep and eat crappy and don’t exercise and I’m stressed, my fasting blood sugar is sometimes 10 or 15 points higher than it is on days when I’m really on point with all of my health behaviors.
Dr. Casey Means: So it’s meaningless in a lot of ways. It has meaning in the sense that it can give a risk stratification of like, “You’re definitely in a bucket of pre-diabetes or you’re definitely in a bucket of having diabetes or you’re in a bucket of not having diabetes.” But other than that, it’s not very helpful for helping us optimize our health. So many physicians are moving towards other testing to basically better understand early signs of metabolic dysfunction and one of those is like a fasting insulin check, which you can ask your doctor for, but it’s not something that’s ordered in standard practice. Because, like we were talking about earlier, that insulin is going to become high and overcompensate for early insulin resistance for a long time.
Dr. Casey Means: So, for instance, you and I could both have a fasting blood sugar of 80, which is technically normal, but I could have a fasting insulin of 40 to be keeping it at 80, and yours could be two, and you’re going to be a lot more metabolically healthy than me if you’re able to keep your fasting blood sugar at 80 with an insulin of 2 versus my 40. Like that means my pancreas is like trying to overcome-
Krysta Huber: Working really hard.
Dr. Casey Means: … A bunch of insulin resistance and working really hard and I am on that spectrum. Research suggests that it’s about 13 years or so that your body can compensate before your fasting glucose really-
Krysta Huber: Wow.
Dr. Casey Means: … starts looking problematic. So that’s why it’s important to have earlier markers of these problems. I mean, once you walk into the doctor’s office and your blood sugar is above 100, which is in the pre-diabetic range, there have been problems probably going on for over a decade. So that’s what I think is important to know. So there’s physical clues that something could be going on and a problem with your insulin, like having difficulty losing weight, being overweight or obese, having issues we know are associated with metabolic dysfunction like infertility caused by polycystic ovarian syndrome or early erectile dysfunction, or potentially if your mood … if there’s issues with depression and anxiety that that treatment modalities aren’t working for, it could be that metabolic dysfunction is contributing to those things. Or, your doctor tells you that your liver numbers are up and you don’t really know why.
Dr. Casey Means: There’s all these subtle clues that should help people dig deeper, but often, in the medical system, we’re not going to pursue those things. They’re going to say, “Oh, your liver numbers are a little bit up, but like they’re not in a bad range so we’re fine, but they’re creeping up a little bit.” Or, “You’re a little bit overweight and your fasting glucose is a little bit high normal, but we’ll worry about this if it gets into the critical range”-
Krysta Huber: I’m sorry to interrupt you, but why is that the case? Like, why has that been the mentality in the medical field? Is it a lack of time with the patient and really being able to see it all the way through for them?
Dr. Casey Means: I think it has a lot to do with training, like medical training. We tend to be a very reactive medical system, meaning that we like wait for disease to emerge and then we treat it. It takes a long time to coach people about diet lifestyle and there’s also … It’s a lot quicker to do a lab test and then prescribe a pill. Also, we’re just not really trained to understand diet and lifestyle in a very nuanced way. Part of that is because the research on these topics is a lot harder to do. It’s a lot easier to take a group of people who all have a diagnosed problem via lab test and they definitely fit into a disease category bucket based on their lab work, and then give half the group of pill and half the group not a pill and see what happens. That’s like a relatively straightforward study to do.
Krysta Huber: Sure.
Dr. Casey Means: But when you’re doing a dietary intervention where people are free living and there’s a bunch of variables and it’s early disease, the biomarkers aren’t as clear, and it takes a longer time to see results, and it’s a lot more complex. So the research has really favored this cookie-cutter, reactive type of modality and has shied away from really more of the dietary and lifestyle interventions in what are considered our gold standard trials, which are our double blind, placebo-controlled, randomized controlled trials. It’s a lot harder.
Dr. Casey Means: So that’s something that a lot of people in the research and the medical space are trying to fix, like how do we do better nutrition and lifestyle research? Because we know that the chronic killers of Americans these days are related to diet and lifestyle and are largely preventable and are taking up the majority of our healthcare costs, chronic lifestyle diseases, and so we need to have better research, because once we have the research, once we have the evidence, it trickles down into medical education, and then trickles down into practice.
Dr. Casey Means: So there’s this just this bias based on a lot of factors for this more reactive name it, drug it, cut it out mindset. It’s a bit more efficient. But I think many of us know, as physicians, like that’s not the answer, because health is not generated from a pill. Health is not generated from surgery. Health is not generated in a doctor’s office. Health is generated from the hundreds of micro decisions we make every day out of the doctor’s office, in our homes, in what we choose to eat, when we choose to eat, how we exercise, how we sleep, how we manage stress, the toxins we’re exposed to, how our microbiomes are doing, what our micronutrients status is. That’s where health comes from. That’s where we build our body.
Dr. Casey Means: So that is very complex and hard to control, and that’s why I think this movement of home testing, things like direct to consumer lab, testing like Everlywell and others, and then, of course, biomarker tracking at home like the Whoop strap, you’ve got the Apple Watch on, we’ve got continuous glucose monitors on. People are measuring their heart rate variability. That’s this reflection of the micro decisions and gives us this ability to have this empowerment so we can understand our bodies in a way that we intuitively know is important and yet is not necessarily what is going on in the doctor’s office. So I think it’s really exciting time for medicine because doctors are starting to get involved. I know dozens and dozens of doctors who are so into wearables and home tracking and having their patients generate this data on a day-to-day basis so that you can have higher level conversations in the doctor’s office.
Dr. Casey Means: So long story short, I think there’s a lot of factors that go into it. None of it is like malignant and it’s not doctors trying to not help their patients. It’s just the culture and it’s also a lot in how it’s been financed. I mean, we get paid as physicians for doing and prescribing and reacting and cutting, and you can make a lot of money doing a surgery and you do not get paid, reimbursed, for having a 45-minute nutrition counseling conversation. So, unfortunately, those incentives are real and have subtly driven the practice of medicine to really be about reactivity, not on the individual doctor level, but on the systems level.
Dr. Casey Means: So a lot needs to change, I think, for us to truly create a population in the United States that is focused on health and healthcare rather than sick care and reactive disease management. A Lot of factors need to change: financing, incentives, medical education, the way we do research, all of these things. But we’re moving in that direction. I mean, you hear a lot more about this stuff now than you did 10 years ago, so
Krysta Huber: 100% and even in my own role that I play in my clients’ lives with encouraging them to be their own self-advocate, like going to the doctor’s office and giving them suggestions like, “Hey, when you’re getting your lab work done, specifically ask for these markers,” and people coming to me and looking for that information, I even talk about it with other coaches in the space, like, I think it’s a very exciting time in the sense that we are helping educate people to have more of an awareness around this and understand why it’s important to ask those different questions and talk to their doctors about these things.
Krysta Huber: Jumping off your point about this whole research piece, let’s tie that directly into Levels. Having the continuous glucose monitor on all day long, contextualize this with the whole process of Levels for us and how you get set up with a little telehealth appointment, and then it’s determined whether you can wear the monitor, and then you go through this 28-day period, what kind of information are you presenting to someone using it? Obviously, I know from having worn it, but let’s educate the listener on what they could expect from the experience and in using Levels and what’s inside of the app.
Dr. Casey Means: Yeah, absolutely. So what Levels does is breaks through the mystery of trying to guess what the perfect diet is. We do this by empowering individuals with this real-time continuous metabolic data to understand how all their different choices are affecting them. So what you get as a Levels member is threefold. So first is that because these devices are prescription only, you’re connected with a telehealth physician in an independent telehealth network that we work with, who evaluates you for this prescription. If a prescription is written by that telehealth physician, then our partner pharmacy ships you a box of continuous glucose monitoring sensors.
Dr. Casey Means: These sensors are worn on the back of the arm for two weeks. So you apply it to yourself at home, and it actually has this small four millimeter, like hair-like probe that goes under the skin, and it’s actually measuring an internal biomarker. It’s like a little lab test going on constantly on your arm. So in contrast, something like the Whoop or the Oura Ring or the Fitbit, or the Apple Watch, which are testing through the skin, this is actually measuring something in your body fluids. It’s really cool and it’s painless.
Krysta Huber: Super cool. And I can vouch that it’s painless. I did watch the video that you actually were the star of where you walk us through in the app and exactly how to put it on. I watched it a couple of times and I was like, “Okay, I got it.” Just go for it.
Dr. Casey Means: Yeah, it can be a little scary at first, but it’s so simple and easy. So you get the month’s worth of sensors, and since they do last on the arm for two weeks, you get two of them, to make up the 28-day program. Then you get access to the Levels app. So that’s really where we help people contextualize this continuous data stream. It’s generating in the background glucose values every 15 minutes and sending that to your smartphone, and the Levels app is meant to help you really understand that through education, through scores, through features that let you compare things and visualize things. One of my favorite features is the Compare feature. So you can say-
Krysta Huber: It’s real cool.
Dr. Casey Means: … “Okay, like I had sushi at a sushi restaurant, and then I made cauliflower rice sushi at home the next night. Like how were those two sushi variations different?” and that’s what I did recently. It’s like the white rice sushi was like a 60 point elevation and then the cauliflower rice was just like flat.
Krysta Huber: Wow.
Dr. Casey Means: So you can learn like, “Oh, this seems to be a better metabolic trace for me. White rice really affects me.” You can do like an apple and then maybe try an apple with peanut butter and then an apple with a walk and graph all of those things next to each other and start building this awareness and this metabolic toolbox. You can also log in there like how you’re feeling. Are you feeling stressed? Are you giving a talk? Or something like that and start to learn … really gain that body awareness of, “Okay, this happened and my glucose went up and I was feeling this way.” Putting those things all together, I think, is really one of the key goals, which is to have the sense of what’s going on inside your body.
Dr. Casey Means: I think, often, when we’re anxious or something, we can notice that our heart rate is beating faster and that is a signal to us like, “Oh, I am objectively feeling stressed right now and I need to do something to get that under control.” Like take a deep breath, do a two-minute meditation, whatever it is. Like, it’s a signal. It’s a little bit harder, I think, for most of us to understand what’s going on with our blood sugar. Like-
Krysta Huber: Totally.
Dr. Casey Means: … Can you feel it? I think after using continuous glucose monitor for two years, I definitely have a sense of what’s going on with my blood sugar. I know that if I have a big spike and then a big crash and I really spike, and then all that insulin is released, and then it soaks up all that glucose, you can sometimes overshoot and have this dip called reactive hypoglycemia. That is often when I feel tired, when I feel anxious, when I feel a little bit jittery.
Dr. Casey Means: So linking that, a choice I made, I had a huge bowl of oatmeal and then a huge spike and then a crash, and then I felt this way, linking all those things together is building essentially, just like with the heart rate, with anxiety, a sense of how I feel when my blood sugar is on a rollercoaster. That body awareness is so key to really, I think, moving in the right direction with health. When we can tap into how we’re feeling, we can start to make choices that help us feel better. So that’s a feature I love, the Compare feature.
Dr. Casey Means: There’s an activity catalog, which basically logs all the meals that you’ve logged and the scores that you got for them. So we have a metric called a Zone Score, which is from 1 to 10, which breaks down all the glucose metrics, which are in milligrams per deciliters and these numbers that are hard to contextualize and just says, like, “You got a 1 to a 10,” 10 being like flat, very little glucose response, and one being like a very, very high glucose response. So in your activity catalog, you can scroll through and be like, “Okay, I want to really focus, enrich my diet for meals that are in my like 7, 8, 9, 10 zone score range.” Or, say, “Okay, every time I got a 10-zone score, it’s because I was pairing my carbohydrate with fat, protein, or fiber, which I know blunt glucose spikes. So cool. Next time I eat fruit or rice or pasta or whatever, I’m going to make sure to do that. I’m going to pair it with extra fiber, fat or protein to blunt that spike.
Dr. Casey Means: So that’s the learnings that you’re trying to figure out is like build this metabolic toolbox so you know how to time food properly, pair food properly, whether walking after a meal is helpful for you, all those things. Then we can also integrate other data streams like steps and heart rate and sleep so you can also start to get those higher level insights about how this is not just about food; this is about our holistic lifestyle. That can sometimes be intimidating, like, “Oh my gosh, I’ve got to get my sleep perfect, and I’ve got to meditate every day, and I’ve got to exercise every day, and I need to do resistance and hit training, and I need to pair all my carbs that protein and fiber, and I need to eat my salads before my carbs.” It’s like, “Oh my gosh, there’s so much to do.”
Dr. Casey Means: But I don’t see it that way at all. I think it’s that there’s a lot of different opportunities to basically tweak and knobs to turn to up-level. So if today’s not the day that you can move a bunch or work out, then really try and focus on sleep that night. If this is a day that you are going to be at a family dinner and you’re going to be eating a ton of carbohydrates, then walk beforehand or bring some chia seeds and sprinkle them on top so you’ve got a little bit more fiber, I don’t know. It’s like about building that holistic lifestyle, but it doesn’t necessarily mean that, “Oh my gosh, I’ve got to eat perfect on everything.” It’s more that there’s a lot of levers to pull that we can use to be our healthiest.
Krysta Huber: 100%.
Dr. Casey Means: Yes, yeah.
Krysta Huber: Yeah, and I love what you just said. I tell my clients all the time, “Let’s look at levers,” and the other thing is low-hanging fruit is a term that we use often because I think people think that they have to make a really, really drastic flip and change overnight to see changes to their body. A lot of times, that comes from they’ve tried a million diets, they’ve tried a million workouts, they’re desperate to see changes. They feel like nothing’s working so we start to tell ourselves this narrative that, “Well, maybe if I just change it all at once, that’s the missing thing.” Like in the past, I just focused on working out and then I just focused on nutrition, that didn’t do anything. In the meantime, a lot of times we’ve also neglected sleep and recovery, which can tend to often be the problem from my personal experience and the people that I work with.
Krysta Huber: I can just tell that there’s not enough of an emphasis, and myself included, like I used to be a part of Team No Sleep, we’ll call it, for the sake of getting shit done. Over the past six months, that has been such a mission of mine and I only have focused on that. I tell people all the time only focusing on improving my sleep and just getting good quality food, like I’m literally just starting a fat loss phase as we’re recording this interview. For the past four months, I’ve definitely been eating in more of what I would call caloric maintenance and I’ve just prioritized, like, “I got to get at least eight hours of sleep.” It’s changed my weight and it’s changed my body fat percentage. I don’t think people can appreciate that until they actually collect that data and go through it themselves.
Krysta Huber: So I’m a huge advocate for biofeedback. My clients know that. They’ve got this big spreadsheet to fill out for me and even in times where they feel too busy and overwhelmed and they can’t fill that out, there’s another survey that they got to answer so I can get as much info from them, because I’m not with you looking at your plate on a day-to-day basis. But I also think it’s important through what you just shared, just in terms of like some of the tweaks we can make to our behaviors, so much of this stuff is just habitual and we don’t pay attention to it. Like, we just go throughout our day eating, accepting the fact that this chronic state of stress is “normal.” So from your perspective and really Levels as a whole, why do you think it’s important that we’re just collecting the information? Like why is biofeedback so essential?
Dr. Casey Means: Yeah. So I think that biofeedback can be really helpful when you are dealing with essentially systems that have historically been open loop, meaning that we really aren’t able to draw conclusions between a single behavior and a specific outcome, and nutrition has been notorious with this. Like we eat maybe, what, like 30 different things a day, ingredients and drinks and whatever, and then there’s this open loop of feedback. Like maybe our weight is up 0.8 pounds the next day. Maybe six months later, our fasting glucose is three points higher. Maybe our cholesterol is eight points down. It’s like, “Okay, was that because I’ve been adding chia or because I’ve been eating more omega-3s, or because I went more organic?” Like, it’s very hard to create behavior change with food with these complex variable system when you don’t have more of a relationship between a single choice and an actual immediate outcome.
Dr. Casey Means: So by closing that loop and by making it an open loop system to a closed loop system, we can move past what can be extremely frustrating trial and error. We can move past the frustration of, “Well, I’m trying all these things, I’m trying all this stuff and I’m not seeing results,” and it might be because you’re just getting totally bamboozled by a choice that you think is healthy, but it’s actually not having the outcome that you want and you’re doing that … With any nutritional intervention, you have to do it for a while.
Dr. Casey Means: So like you might say, for an example, is like one of our 10 worst scoring metabolic foods in our entire dataset is oatmeal. If you walk into the store and you look at the oatmeal box, it says heart healthy, great source of whole grains, high fiber. But the reality is that like rolled oats are ultra processed, they are ground down, you just have to add water for them to cook when, in reality, like if you’re cooking groats or steel cut oats, it takes like 45 minutes because they’re unprocessed. So these rolled oats that have all these claims on the box has been one of our highest glucose response foods of everything.
Krysta Huber: Interesting.
Dr. Casey Means: Like compare it next to like Chick-fil-A and like McDonald’s and Chinese food noodles and things like that, like things you would expect to be high spikers.
Krysta Huber: Sure.
Dr. Casey Means: So that’s interesting because a lot of people are doing this and they’re saying, “Oh, this is because I’m trying to get more fiber and whatever.” But the reality is if your blood sugar is spiking to 180 or 190 milligrams per deciliter every morning, it’s not supporting weight loss goals. It’s not supporting insulin sensitivity. No matter that like it’s a natural food, whatever. So degree of processing can really change that impact,, and so that’s helpful to know.
Dr. Casey Means: Our CEO, actually, Sam, he was eating like oatmeal every morning for his entire 20s and was always that type of person who, like mid-morning, needed an extra cup of coffee and had that post-meal mid-morning slump. When he put the CGM on, he realized, “Oh, that slump, that energy deficit when I need another coffee is exactly after I’ve spiked and crashed from the oatmeal.” So he switched to like greens, avocado and pasture raised eggs and his glucose is completely stable and he does not have that energy drop in the morning. So I’m plant-based, and so I don’t necessarily eat eggs, but I found breakfast for me that also don’t spike my glucose. So chia pudding for me is a winner. I’ll do chia seeds, coconut milk, some low-glycemic for me, fruit like blueberries, some almond butter, and it stays completely flat.
Dr. Casey Means: So that type of feedback just lifts that mystery of, is it a healthy choice? Is it not a healthy choice? With that said, it’s not like glucose is the answer for everything and if you just keep your glucose stable, then you’re in perfect health because there are so many other factors about food that you do have to factor in. Like, for instance, you could drink a quart of canola oil and your glucose is not going to spike, but that’s not going to be healthy for you.
Krysta Huber: We know that’s bad, yeah.
Dr. Casey Means: Right. You could drink a gallon of vodka and your blood glucose is not going to spike, and we know that’s going to be extremely damaging to your metabolic health. You can also drink straight fructose and that actually doesn’t stimulate glucose or insulin release, but we know it’s going to cause problems in your liver that’s going to ultimately lead to. So glucose is a great biomarker for understanding some really important aspects of our food. But the future, I think, is going to look like many more analytes in relation to food that can create a more holistic picture of what food is doing to our body, so that you can really say, “This food is healthy for me, for sure.” Right now, we can say, “This food doesn’t spike glucose,” and that is probably a good thing and maybe I can try a version of this food that I can get it to spike my glucose less. Like that’s positive, but I just want to be totally transparent, it’s not the panacea for everything, but there’s a lot of exciting work about thinking through what these other analytes could be and what the future of a more comprehensive picture of being able to answer that question: what is this food doing to my body?
Dr. Casey Means: But to answer your question, long story short, closing that biofeedback loop helps us make more efficient choices, helps reduce some of the trial and error, and can really in that regard be empowering and, for me, liberating. I’ve spent over 30 years thinking about food a lot. I’ve always been interested in food. I’ve always been interested in nutrition, but these experiments that you do for yourself can take weeks to understand if it’s working. This has shortened that so that I can just be like these are the foods that were great for me. This is how I modulate these foods for them to work better for me, and these are the foods that just are not right for my body, and now I just don’t really think about it. So that’s awesome.
Krysta Huber: I think overall, too, it just helps you bring a better sense of awareness of just because you’ve always done something some way doesn’t make that normal. Like we get so stuck inside of the fact that … I often talk to people about this with a more TMI subject about their digestion.
Dr. Casey Means: Yeah.
Krysta Huber: Because people are running around with … I think gut health is becoming a very hot topic these days, and when you start talking to people about their digestion and bloat, and then, “Are you constipated? Do you have the runs?” So frequently people are like, “Oh yeah, I haven’t pooped in a couple of days. That’s really normal.” It’s like, that’s actually not normal, but it’s normal to that person, right? So unless you’re taking the time to sit back, start looking at this information, mapping it out, and then in the case of, say, working with a nutrition coach, getting someone else’s perspective on like, “Wait a second, is everything working for you here and what is triggering that?” I think that’s the benefit of continuing to collect all of this information.
Dr. Casey Means: Yeah, I think that’s so true and I think there’s one other thing that you touched on there that was really important, which is that tracking can help raise earlier red flags before we consciously understand that something’s happening. So I’ve had friends tell me, kind of make fun of me for doing such intensive sleep tracking because they’re like, “Why don’t you just wake up and decide if you’re tired or not?” Like, “Why do you need a device to tell you if you’re tired or not?” and I’m like, “Because the body is amazing and compensates and we have all these like tools to help us compensate,” like coffee and like drugs literally, like caffeine.
Dr. Casey Means: So if I’m getting six hours of sleep a night for three weeks, it’s possible that I don’t register that I’m exhausted, because I’m like coffee and I’m working out and I’m fine. But there’s no question, based on what we know about the research and my own personal experience, that after about three or four weeks of chronic sleep loss, I will break down. My body’s going to start to break down.
Krysta Huber: 100%.
Dr. Casey Means: My skin is going to look bad. I am going to start getting digestive issues and like little IBS stuff is going to start creeping up, and my mood is going to be labile. Then all of a sudden, it’s like four weeks into this like chronic sleep loss, I’m like, “Why am I mopy and why am I anxious?” and like, “What’s going on?” Then I can look back at my sleep tracking and be like, “Oh, duh, I’ve been getting six hours of sleep a night and like that’s associated in essentially every research study with like all these problems.
Dr. Casey Means: So whereas I consciously didn’t register that I was like getting super exhausted, my body was falling apart, the same is true for glucose. You could go along for your whole 20s and even your 30s, like spiking crashing, spiking, crashing, and compensate, like take a nap, drink more coffee. You’re working out a ton and so maybe you’re not like gaining a ton of weight, but you’re having trouble with like a little bit of belly fat, and you just don’t put it together. But then 10 years passed and it’s like, “Wait, my glucose has been creeping up all those years.” So it’s like this early alarm, like early warning system so you don’t get caught up in being shocked down the road with a real overt manifestation when there’s just been these like subtle, barely perceptible symptoms that you’ve thought were just normal all along the road.
Dr. Casey Means: So that’s how I see it is it gives you awareness that sometimes we’re not necessarily picking up on. I do think, over time, you become more in touch as you’re tracking that data with those subtle cues so that after a few nights maybe of sleep loss, you’re like, “I’m feeling a little off. I’m not feeling great,” and you know what your best feels like so you can start to feel like, understand a little bit of what feeling off is earlier. So that’s where I think tracking can be helpful, and it’s not like I’m someone who like wants to be attached to technology for the rest of my life. Like I’m actually a total … I just want to be in like the back country camping and like totally unplugged. That’s who I am naturally, but I kind of say to this boomerang effect is like we’re facing intense challenges in our culture right now with what is normal and what normal lifestyle is and what normal food is.
Dr. Casey Means: So it’s like a boomerang of like we’re going to use tech to understand that landscape and understand how to be empowered within that world that we’re living in, build that body awareness, and then hopefully we just know and we learn. We can move past that and just really have a sense of what is healthy for us, and maybe be able to part with some of the technology, but I know I’m still learning and as long as I’m still learning, I’m going to use the technology. But, yeah, it’s just an interesting time we’re living in and I think these tools can help us have a little power in the face of some really big industries and cultural norms that can be damaging.
Krysta Huber: Absolutely. We’ve been talking a lot about our glucose spiking and dropping and what that means and why it happens, but I think it’s also important to share, I’ve heard in some other conversations that you’ve had on various podcasts, about what kind of the standard ranges are, and let’s tie it back into Levels and how a person’s score is created off of that. So tell us a little bit more about what that looks like, because from what I’ve heard you share in previous interviews there isn’t a lot on this in terms of it’s just either like, “It’s at this range, so we should be concerned; or, it’s not anywhere near there, so you’re fine.”
Dr. Casey Means: Right, right. Yeah, if you look at sort of standard criteria for like, “Okay, I’m a 33-year-old woman, what should my glucose be?” it’s really hard to know. The main things are essentially the governing bodies have put out these diagnostic criteria. So the ADA, American Diabetes Association, says if your fasting glucose, so first glucose in the morning, not having eaten any calories for eight hours, if it’s under 100 milligrams per deciliter, you’re non-diabetic, you’re normal. If it’s between 100 and 125, you’re pre-diabetic, and if it’s 126 or above, you have type two diabetes. Then another way we can do this is you can drink this glucose drink as a diagnostic test called an oral glucose tolerance test, which is 75 grams of straight glucose, and then check your glucose over the course of two to three hours in a lab setting. Basically, if your blood sugar comes down below 140 milligrams per deciliter after two hours, you’re considered normal. Like that’s a considered a normal glucose response and insulin response. Then there’s another test that we use called hemoglobin A1C, which is a three-month average of glucose.
Dr. Casey Means: So that’s the information we have. We’re like, “Okay, so if I drink a 75 gram glucose drink and I’m under 140 at two hours, I’m okay, and if I’m under 100 in the morning, I’m okay.” But that is really not … Like that does not give us a lot of guidance in terms of like day-to-day living. How much should I be spiking? How flat should I be? What’s the best fasting glucose I could get to basically improve my health longevity? That’s not the way our system is designed to coach. Because, again, we’ve never really focused on keeping healthy people super healthy. We’ve always focused on just like risk stratifying based on disease buckets.
Dr. Casey Means: So there is this huge opportunity now to understand what is really optimal and what do 24-hour patterns look like. Because continuous glucose monitoring is now available and it’s like a movie of your glucose, we just start understanding what our dynamic trends. So that’s a lot of the research that we’re working on with our research partners at Levels. We’re working with Yale, Thomas Jefferson University, University of South Florida, Brigham Young University, doing research to understand really early markers of metabolic health and metabolic dysfunction and how that relates to CGM patterns and what should we really be shooting for, for optimal health. But if we look at the research, there are some clues about where we might want to target.
Dr. Casey Means: So if you look at research on fasting glucose, it’s not like everyone who’s under 100 milligrams per deciliter for fasting glucose is exactly the same. You actually increase in health problems as you go from a low normal fasting glucose to a high normal fasting glucose. So someone who’s more around like 70 to 85 is going to have much better long-term health outcomes than someone who’s like 95 to 100. Those are different.
Krysta Huber: Sure.
Dr. Casey Means: You have moved farther on that spectrum. You’ve gone from that compensatory high insulin, keeping the glucose down to like that ship has sailed and you’re starting to increase your glucose levels, meaning that your insulin compensatory mechanism is starting to break down a little bit. We don’t want to get to that. So really shooting for more like 70 to 85 in your fasting glucose is probably associated with better health outcomes. In those studies, some of them are in really big journals, like the New England Journal of Medicine, which showed that basically they took from 70 to 100 of fasting glucose, split them into quintiles, like five different groups, and each group, as it went up within the normal range, had higher risk of developing type two diabetes in the future. Other studies have shown higher risk of heart disease and cardiovascular outcomes and stroke as well.
Dr. Casey Means: So, yeah, so basically lower is probably better, but our guidelines don’t tell us this right now. So really defining what’s optimal is important. Then in terms of post-meal levels, the International Diabetes Federation has put out slightly more stringent guidelines for post-meal levels. So from the ADA criteria, we only know what to shoot for after an oral glucose tolerance test. IDF has said, “After a meal, if you’re non-diabetic, you probably never want to go above 140.” So you want to keep it below 140, not two hours after a meal, but at any time point after a meal.
Krysta Huber: Okay.
Dr. Casey Means: Yeah. So that’s a little bit more stringent. I would say when you look at some of the research that’s been done of just taking a healthy population of young people and putting continuous glucose monitors on them, there are some studies that show that the average healthy young person actually stays between a range of like 70 to 120 for over 90% of the day.
Dr. Casey Means: So taking all of this together, I think it’s safe to assume that it’s probably a good idea to stick between about 70 and 120 for the vast majority of the day, shoot for like a fasting glucose between about 70 and 85, and really try to shape diet around not going above 140. Like, if you do a few times, like that’s fine, your body can compensate for it. It’s about not going there or above like five times a day for like 10, 15 years. Like it’s not going to hurt you once. It’s patterns, it’s adaptations that we’re worried about. So that’s how I would sum it up, but so much more research really needs to be done to understand how, if you can keep your glucose in these narrower ranges, does that predict that you are going to essentially be much healthier for the long-term? That’s intuitively, I think, we know the answer is going to be yes, but we have to really show that outcomes data.
Krysta Huber: Now, I know that Levels’ purpose is to really bring awareness to the information and empower the individual to make changes versus giving like an RX in terms of like, “Here’s what you should do. Here’s what you should change.” It’s more of just like, “Try this. Here’s a suggestion here and there.” So I don’t know necessarily how much you want to go into the details on this question, but I’d love to know whether it’s from personal experience from other people on your team, from people you’ve spoken with who have used Levels for some period of time now, what are some behavioral changes that have consistently now shown up in their day because, like we said, this is individual, to help them have a better glucose response and not seeing spikes if they were initially, when they first started tracking this information? You touched on like walking after meals, but maybe tell us a little bit more of examples like that or why that is so important and why our body ultimately responds that way from movement.
Dr. Casey Means: Yeah. Yeah, so I think one thing just that you touched on that’s important to note is that this is very individual. Like what’s going to work for you might be very different for me. It’s possible that you’re one of the people who oatmeal doesn’t really spike your glucose and for me it does.
Krysta Huber: Yeah, I actually love oatmeal, and I haven’t eaten it in a few weeks since wearing my Levels monitor and the LibreLink. So I actually am going to eat it in the next couple of days because I’m curious now.
Dr. Casey Means: Totally, and I mean, it absolutely depends on the type of oatmeal. Like I mentioned, steel cut and groats, like a completely different experience than like an instant rolled oats because they’re totally different processing. So it’s really that instant that is the one that we’re seeing the biggest spikes with.
Krysta Huber: Interesting.
Dr. Casey Means: But some people who eat groats, which is essentially like the whole oatmeal like kernel, like virtually no response because it’s filled with fiber and all this stuff.
Krysta Huber: Sure.
Dr. Casey Means: The other thing is we’ve seen people really try and hack the oatmeal like adding almond butter, adding flaxseeds, adding chia seeds, egg whites-
Krysta Huber: I add egg whites to mine all the time.
Dr. Casey Means: Yeah.
Krysta Huber: So I’m curious. I’m going to do it for the sake of like, “I think this is important to share in how you can use the information in the app. I’m going to do it just eating the oatmeal plain, and then I also want to do it with my usual recipe that I follow by adding some of those other ingredients like your nut butters, my egg whites, because I recommend that to clients all the time, but I think it’s a great way to just potentially demonstrate like, “This is why there is an importance around food combining and why we’re telling people like, ‘Hey, make sure you’re getting your protein and the movement of all …’” I’m sure, I don’t know if you’ve heard this before, but a lot of coaches preach like no naked carbs. A lot of that has to do with some of the information that we can glean through the Levels app.
Dr. Casey Means: That’s exactly right. Yeah, so that’s going to be fascinating to see and, yeah. So essentially that really gets down to, answering your question, some of the things that people have learned. I think the one about pairing foods is a huge, huge one. People, I think, are much more like focused on balanced meals after using Levels and, in particular, the impact of protein and fiber and fat as well on just like really curbing a glucose spike.
Dr. Casey Means: I think another thing is food sequencing. When we eat our carbohydrates like first in the meal, they can often have a higher spike than if you put some stuff in the stomach first and then eat the carbohydrates. That might mean that like eating a salad with tofu or chicken in the beginning of the meal and then having bread or pasta or whatever later in the meal. You have all this food in your stomach that is blunting that spike and that’s supported by research, but we do see it in our members as well.
Dr. Casey Means: I think another big one is like we talked about walking after a meal, just a little bit of movement. I mean, muscles are a huge percentage of our body mass and they are glucose sync. They just take up glucose and use it. So even if you’re walking two minutes around the house, it’s like a ton of muscles, that every single one of those, like hundreds of millions of cells has to use glucose to just walk for two minutes. Like that’s amazing and that’s an easy way to like soak it up and not store it, but use it. So I love just like that framework of like, it doesn’t need to be a half marathon; like, just move your body, you move those muscles. The other really cool thing about muscle is that it can take up glucose in an insulin independent way, meaning that just the muscle contractions in their own right can take up glucose. You don’t need that. So that’s amazing. You can basically get this usage without spiking the insulin.
Dr. Casey Means: We’ve seen some really interesting … I mean, certainly people are, like you’re talking about, are understanding the impact of sleep loss or stress on their glucose. I am always more erratic glucose if I’m getting like less than six hours of sleep, which happens very, very rarely. But if I do, like usually my glucose will just be like a step change higher at all time points the next day and more variability after a meal.
Krysta Huber: Interesting, okay. So, like, once it’s up, it’s staying there.
Dr. Casey Means: I find that for me.
Krysta Huber: Okay.
Dr. Casey Means: Yeah. I think I just am generally insulin resistant that day until I really catch up, and then it can settle back down. We’ve seen a lot with athletes and fueling, a lot of these foods that are marketed towards athletes are big glucose spikers. So sports bars, Gatorade, sports drinks, these goos and gels and things that are eating. The purpose is to give you quick energy and that’s why that they’re out there, but I think that some of them are causing such an exaggerated glucose response that it’s actually like really overcompensating and potentially causing problems. So, for instance, like some sports drinks that are filled with literally like 40 grams of sugar, high fructose corn syrup marketed as a sports drink, I mean, you don’t need to have an 80 point glucose rise to replete your glycogen in your muscles. You probably need like a much smaller amount and so why not get the glucose and get the carbohydrates to fuel you without having this huge magnitude spike that’s going to cause a crash? So a lot of athletes I think, are tweaking how to get more complex carbohydrates in a way that they can tolerate during training without such a huge spike so that they just feel more stable and feel better throughout their training.
Dr. Casey Means: So that’s been some interesting stuff. It’s been really fascinating to watch these experiences. I mean, on our social media, we’re re-posting all the time people’s screenshots of these experiments, and that’s really inspiring for me because I learn all these things. Also, I mean, some of my favorite things are seeing swaps that people have figured out. So like, they love pasta so they try, but the pasta is spiking them, so they’re like, “Okay, I’m going to try konjac root pasta, like shirataki noodles or NuPasta, or like these alternative pastas that are made from like high fiber tubers that tastes really good, but might have a hugely like lower glucose response. Or, they might try zucchini noodles, which have potentially like virtually no glucose response. Other swaps like that, using from tortillas to maybe using charred wraps or butter lettuce, or almond flour tortillas or flax tortillas or something like that. It’s always fun to get tips from what people are trying and learning.
Krysta Huber: Yeah, it’s really fascinating, and I think even just being able to piece it all together too, so you can take those food swaps for example. But then some of these perfect storm situations where like maybe we’re pushing ourselves to work out, we didn’t get a ton of sleep the night before, then our food choices may change up a little bit because a lot of times when we’re sleep-deprived, we might not make the best food choices in those scenarios, and then you go do this workout that’s like super intense on the body. I mean, that’s something that I’ve seen, like I’ve really done more of a personal deep dive into looking at my cortisol levels, just knowing that I’ve experienced a lot of stress. Like I’ve done the Dutch test and have a really like much more detailed understanding, and so I’ve been a lot more thoughtful personally in the type of workout that I’m doing.
Krysta Huber: So having had a few months of paying attention to that, and honestly eliminating the intense cardio that I used to have as such a part of my routine, like a lot of circuit style training and that sort of thing, I, about maybe it was one of the first few days that I was wearing the CGM. But I was like rushing to make this workout class, I decided to switch the time, hadn’t eaten anything in a few hours so I had all these factors stacking up against me, and then I switched to the time of the workout and had to move some meetings around. It was really fascinating because looking at the Levels app, my glucose started to spike well before I began the workout, and then it was like pouring a little gasoline on the fire, so to speak, by going into this intense cardio class, because it went up and it stayed there for the entire time and it took a little while after the fact to come back down.
Krysta Huber: So I think, for me, I got an appreciation of like, “Okay, it’s really important that you think about your training and your recovery in tandem, because if one of those things is off, it could have a bigger impact on you than you realize until you’re looking at any of this stuff.” Sometimes we just take it for granted because we’re like, “Oh, well I always operate this way. I’m going to be fine.”
Dr. Casey Means: Totally. This is one of the things I love about the Whoop strap that I’ve been wearing for a while, which is that it basically reinforces that message every day. You can handle certain amounts of strain, which is how much you’re putting your body under, but you have to balance that with recovery. When you don’t balance recovery and strain, your body breaks down. It’s pretty simple math. Yes, you can do it one day. Like some days I have really low recovery score, but I feel like running eight miles, like, great.
Krysta Huber: So you go for it, yeah.
Dr. Casey Means: I do it. But if I do that every day for five years, it is likely that I’m going to, I think, breakdown my tissues. So just having that awareness, it’s just so, so, so helpful. So I love that, that message of it. Also, I think in this culture where we’re like, we got to go hard all the time, all the time, all the time, that’s really respected, and I’m with you with like the circuit training stuff. If I’m on the Peloton, like if I don’t get my heart rate up to like my max heart rate, I’m like, “This wasn’t even a workout.” But I think these tools helped me create this mental model for like, “I’m not doing myself any favors if I do that today.” Like, no, like it gives me a reward for not doing it in a way.
Krysta Huber: Exactly.
Dr. Casey Means: And I’m still getting my workout. I’m still … probably a more effective workout by keeping my heart rate maybe more in my like zone two or three for that day probably going to have bigger wins. So I think it’s honestly, it’s like this cultural way of thinking about things. If it’s like, if it’s not hard, it doesn’t count, and we’re learning more and more that that’s not necessarily the case. So, yeah, I’m a big fan of some of these technologies that help us tap into that and feel really good about being a bit more sustainable about [crosstalk 01:14:00].
Krysta Huber: A 100%. I mean, stress management has become huge in my personal life, and then it has trickled into my coaching with a lot of the clients I work with because they’re coming to me and they’re working out like six days a week, and then you couple that with not necessarily eating in a way that supports that level of intensity, forget about other factors like sleep. But then it’s the first thing, if we look for those low hanging fruit opportunities or different levers to pull on, it’s, “Hey, why don’t we try to switch new training three days a week? Let’s see what happens.” It’s always initially met with this resistance of like, “Well, but I’m trying to lose weight, so I should be doing more.”
Krysta Huber: So I think it’s breeding that healthy conversation around giving yourself permission to do less and ultimately see that that can be very effective. To your point, it’s really a cultural change that we’re moving towards.
Dr. Casey Means: Yeah, exactly.
Krysta Huber: I want to be respectful of your time becCause I know you’re a very busy person. I like to wrap up the FYX episodes with a little lightning round, but before we get into that, I would love just, as Levels is still in its beta testing, where do you see all of this going? Like, what are some of the big goals of the company over the course of the next 12, 18 months and even beyond?
Dr. Casey Means: Yeah. So our mission is to reverse the metabolic disease epidemic through personal empowerment, with data and by helping people understand their bodies. So that’s the long-term mission. I mean, that’s what we’re striving for. I think one of the things I’m most excited about in terms of our company and where this is going is building community around this. I think right now the experience with Levels is a bit more isolated and personal and people definitely share on social, but how could we learn from each other? Your experience, I’m sure if you shared some of your data, I could learn so much from it and vice-versa. So giving people the opportunity to share and create community around that and learn from each other is awesome. Especially with food, it’s like infinite options, and how cool would it be if someone who responds really similarly to me in terms of glucose and has similar lifestyle and age, potentially, if I can learn from what’s working for them so I don’t have to reinvent the wheel myself.
Krysta Huber: Yeah, I love that.
Dr. Casey Means: I think that’s really, really exciting. It also, more broadly speaking, I think the way that we can leverage really population data to understand for the first time what’s normal, what’s optimal, what is good for, what should we strive for, all of that, contributing that to the body of knowledge will be really exciting. But I envision a world in which like, as opposed to going to the internet to find a recipe based on Googling keywords and seeing that it has like a four fork rating or whatever, five stars, that you do that. But then there’s also the ability to see like how it objectively impacted people on a larger scale. So that, again, we move past loud voices in the nutrition space, the nutrition wars, just like it’s getting crazy. Like it’s really hard to know what’s healthy.
Krysta Huber: Yeah.
Dr. Casey Means: And just all the marketing language, and really move into a database system where we’re choosing things that are likely going to have a positive impact on our unique bodies, and glucose is the start of that, but I think there’s other biomarkers that can complete that picture and, in 10 years, we’ll be able to say like, “I’m cooking this for dinner and I have like really good certainty that this is going to be like a really healthy choice for my body.” Like no different than the way we look at food ratings based on personal preference, so yeah.
Krysta Huber: I love that. I’m with you there. I think that can help a ton of people. Even I think with the decision process too, because I think there’s such a decision fatigue in our lives in general, that a lot of times people, when it then comes down to their food choices, they just don’t want to think about it and make yet another choice, but that’s coming at the expense of their health and their longevity, and that’s something that we need to take very seriously.
Dr. Casey Means: Yeah, totally.
Krysta Huber: So I’m excited for everything that you guys are working towards and to have the opportunity to be a part of it. So thank you for joining me today and need like 90 more seconds of your time. Finish it up on a fun note. Just quick lightning round questions.
Dr. Casey Means: Perfect.
Krysta Huber: You ready?
Dr. Casey Means: Yes.
Krysta Huber: All right, so what is your favorite food? Like something you just cannot live without?
Dr. Casey Means: Oh God, there’s so many. There’s so many. I love food more than anything. There’s probably some recency bias here, but I can’t live without like really dark chocolate. So I would say like 88% or 90% dark chocolate-
Krysta Huber: Nice.
Dr. Casey Means: … With some almond butter on top and some flake salt. Like that is my go-to, no glucose spiking treat, so.
Krysta Huber: You got your salty and your sweet in there. It sounds good.
Dr. Casey Means: Exactly.
Krysta Huber: How long have you been plant-based? We didn’t get into that.
Dr. Casey Means: Yeah, about three years or so. So, yeah, I’ve just love plants and vegetables and just really have found for me in my personal health journey that to be a really healing system for me, whole foods, plant-based. When I was dealing with some gut issues several years ago, when I was actually in my surgical training and like life was very out of … A lot of things in life weren’t in control: sleep, lots of stress, cafeteria food, plants and a whole foods plant based diet really helped me heal all of that stuff. So I think it’s really interesting because it’s very variable for different people. Some people, a ton of plants will trigger their gut stuff if they’re, in a baseline, have gut issues, but for other people it can be really helpful. So it’s something that worked well for me.
Krysta Huber: You mentioned running, you mentioned your Peloton, what’s your favorite kind of workout?
Dr. Casey Means: Oh my gosh. Really, just moving of any kind. I love the Peloton. I love outdoor cycling. I love running. I love anything with a ball. So like basketball, tennis, like just any games that involve, like throwing a football, like any of that. I could entertain myself for hours if I have any type of ball or sport or something like that. Yeah, but my day-to-day is mostly like cycling, running, and then I really love hot yoga. Don’t love … not hot yoga because I’m not the most flexible person, but hot yoga gives you that little boost, so-
Krysta Huber: Helps you get opened up, yeah.
Dr. Casey Means: Yeah. Bikram and Modo yoga are my favorites.
Krysta Huber: I’m not sure if most of your reading consists a lot of the research that you’re doing and more of the medically focused information, but do you have a favorite book that’s more of a guilty pleasure or even like a TV show or something like that? Like what do you like to do to unwind?
Dr. Casey Means: Well, I’d say like probably lifetime favorite book would be Atlas Shrugged by Ayn Rand, and certainly love all the health books and those are constantly up-to-date on those. I think in terms of health books, my favorites have got to be … I love Why We Get Sick by Ben Bikman. I love Metabolical by Rob Lustig. I love Sara Gottfried, all her books are amazing; The Hormone Cure, The Hormone Reset Diet. I love Mark Hyman’s book Food Fix, which talks about the systems issues that have led to our chronic disease epidemic. David Perlmutter’s Brain Wash, like all these health books, just I love them so much and learned so much from these amazing forward-thinking physicians. Then guilty pleasure TV show, I actually just watched a show on HBO called Hacks, which is about a female comedian and it was so, so good and under the radar.
Krysta Huber: Nice, okay.
Dr. Casey Means: So love anything about female comedians and female comedy. It’s great.
Krysta Huber: Yeah. It’s nice that Netflix has been putting a lot more like comedy series and episodes that I would say over the past like year and a half, two years, I’ve gotten more into that myself. Like I wouldn’t normally watch stand-up comedy and since they’ve added it, I have a few favorites and there’s a lot of cool female powerhouses out there, which we 100% support.
Dr. Casey Means: Yeah.
Krysta Huber: Well, thank you again for your time today, dr. Casey, really appreciate it. Last but not least, what’s your shameless plug? I know you’re not a huge … you mentioned not being like totally connected all the time. So maybe social media is not totally your thing, but if people want to stay in touch with you, where can they find you?
Dr. Casey Means: Yes. So we are at @levels on Instagram and Twitter, and again, really fun to follow the Instagram because people are doing so many cool experiments that I think are great to learn from even if you don’t have a continuous glucose monitor, just for tips and whatnot. We’re at levelshealth.com, and there, you can sign up for our waitlist for our beta program and our newsletter; and levelshealth.com/blog is our blog, which is just absolutely amazing, incredible information about metabolic health written by the key thought leaders and academics in the space. It’s just really a wealth of information. Then I’m at @DrCaseysKitchen, D-R Caseys Kitchen on Instagram and, yeah, I post a lot about my experience with glucose monitoring and food and all sorts of things, but also to serve from that plant-based perspective. So, yeah, we’d love to connect with anyone on those platforms.
Krysta Huber: Amazing, and we’ll be sure to link all of that down in the show notes to everybody who tuned in to today’s episode. We appreciate you guys for being here. This was packed with so much science, a lot of different information, and we would appreciate, if you benefited from it in any way, to share it with other people. I think that’s something that really shined through in Dr. Casey’s messages, the more information we have and that community building piece, the more we can do with this stuff. So we can start that now by sharing it and talking more about these things and becoming our best advocates for our own selves in terms of our health.
Krysta Huber: This has been another awesome episode of the FYX. Appreciate you, guys. Connect with me on Instagram at @thekrystahuber, if you want to get in touch. I’ll definitely be sharing more over the next few weeks about my own experience with Levels and app and wearing the CGM, so I’m excited to share that. Hope you guys have an awesome rest of your day. Thank you.