Dr. Casey is a Stanford-trained head and neck surgeon who ditched a promising medical career to plunge into the world of functional medicine and healing disease by attacking the root cause of inflammation. You will love the story of her amazing journey of blending insights from genetic science to observe the shortcomings of western medicine as sick care rather than health care. Dr. Casey describes our current model as “reactionary medicine,” where we play “whack the mole” by attacking the symptoms of various diseases with drugs and surgery.
Casey describes the frustration of seeing many patients returning for the same invasive procedures that were caused by lifestyle-driven inflammation. After leaving surgery and getting additional training in functional medicine, Dr. Casey presents a unique, hands-on approach to patient care focused on optimizing lifestyle behaviors that will promote health and prevent disease. The centerpiece is the emerging technology of Continuous Glucose Monitoring (CGM) that she offers to clients as a co-founder of LevelsHealth.com operation.
In this show, you’ll learn why metabolic dysfunction is perhaps the most distressing disease condition of modern times. This is represented mainly by an inability to regulate glucose or burn fat efficiently. You’ll be inspired to take personal responsibility for your health, especially through the use of a now-affordable and accessible CGM device, and learn the importance of tight glucose regulation to feel and look your best. Dr. Casey is passionate about helping people on the “root-cause level” and loves to watch her clients’ health transform as they work on their metabolic fitness. She also stresses the importance of individualizing your lifestyle and diet, especially while you’re working towards metabolic optimization because knowing what works for your own body will empower you with knowledge that allows you to make the healthiest, most beneficial decisions for yourself. “What’s healthy for you, may not be healthy for me,” Dr. Casey reminds us.
Brad interviews a surgeon who discovered most of her patients needed to improve their lifestyle rather than be under the knife. [01:43]
Environmental factors change the expression of our biological blueprint. [05:20]
Newer medical ideas expand from “here are these symptoms; here is the treatment.” [07:59]
The majority of the diseases that are plaguing our country are diseases that are chronic illnesses based in lifestyle and dietary decisions. [10:23]
As an ENT surgeon, Dr. Means realized that most of the cases were inflammatory in nature. [12:41]
Is there a profit motive involved in the medical profession that keeps the “Whack-a-Mole” system going? [16:52]
Research suggests that more dietary and lifestyle interventions and health maintenance are the highest value. [21:07]
The insurance companies share the risk across a large population, some of which will be very ill and some very healthy. [23:35]
Symptoms arise from biologic dysfunction. Functional Medicine looks at all the variable functions. [25:24]
Every day we make hundreds, if not thousands of small decisions that affect our biological reality. Even how we respond to a stressful email, translates through our hormones to affect our cellular biology. [28:43]
There is an emerging technology of continuous glucose monitoring which is a powerful behavior modifier. [30:14]
The fluctuations in glucose levels may be potentially more harmful than sustained high glucose levels alone. [34:53]
Metabolic dysfunction is the root of infertility, erectile dysfunction, anxiety, and depression. [37:19]
Could one deliver normal fasting glucose but still be getting into trouble with poor glucose variability? [39:01]
What kind of particulars might influence our varied responses to white rice? [45:07]
After a sprint workout where the glycogen is depleted, what happens when I have an ice cream treat? [48:52]
Is the afternoon slump always associated with a blood glucose drop? Is it manageable? [50:46]
If two people eat the exact same number of calories per day, the exact same food, but they eat them at different times of the day, they will have a totally different metabolic outcome. [54:44]
In our culture, we are eating 150 pounds of refined sugar on average per person per year. [01:03:17]
Realize that when you are getting in stressful situations like traffic or at the workplace, you are spiking your glucose just like going down the street to get a Hostess Pie [01:05:16]
- “We have this really unique genetic blueprint, and environmental factors (what we expose ourselves to, what we eat, how we live) change the expression of this biological blueprint. But while we do have this set blueprint, we have agency in what we choose to expose ourselves to.”
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Get Over Yourself Podcast
Brad (1m 43s): DListeners. We have a live wire on the line. It’s dr. Casey means and get ready for a fast moving super exciting, incredibly informative show about metabolic health. And, Oh my gosh, what a story Casey has for you of her life journey through the traditional medical environment and intensive training to become a surgeon, and then having this awakening, this life change, where she realized that all the people she was operating on were coming to her with inflammatory conditions that could be possibly righted by healthy lifestyle practices. Brad (2m 23s): And that plunged her into a completely different career path. She’s at the forefront of technology and functional medicine. She’s going to talk to you about the amazing continuous glucose monitoring, new technology that you can access yourself and learn about all the different lifestyle practices that affect blood glucose. So we’re going to talk through all manner of topics relating to the traditional medical care environment, the traditional approach, that disease based approach and all the different options and alternatives you have, including this breakthrough of strapping a device onto your body and checking your glucose readings throughout the day. Brad (3m 4s): It’s been absolutely life changing for many people, and you’re going to get some good scientific insights from >r. Casey, but she does a wonderful job couching them in practical terminology and easy to understand approach. And also quick tips. One of them was when you have that glucose dip, you know, that afternoon blues, where you’re likely to reach for a snack to get a boost. She suggests instead waiting it out, profound advice. Your body will come back strong, but if you keep going on the roller coaster of the Jack in a box approach. Brad (3m 39s): So we got Jack in a box mentioned, we got, whack-a-mole mentioned. It’s a really fun and lively show. I’m going to have her on again because we teed up a part two at the very end of the show. When we talked about alternative approaches to healthy eating. Fascinating insights. Here we go with Dr. Casey Means of Dr. Casey’s kitchen.com. Dr. Casey Means we are so warmed up, like never before for a zoom episode. Brad (4m 12s): Why? Because we hung out in a beautiful park in Portland only a week ago, just random, you know, scheduling. And then here you’re on the podcast. It’s so it’s so great to connect with you and we’re going to, we’re going to hit it hard right now. Casey (4m 24s): I am so happy to be here. Thank you for having me, Brad. And it was definitely the highlight of my week to get to meet you last week in person. So what a, what a serendipitous event to have you driving through Portland the week before this podcast. So wonderful. Brad (4m 39s): Oh, thank you. And what was also amazing was to hear just a tidbit of your, your life journey. So I’d love to introduce you to the listeners with this amazing, I guess, transformation of going hardcore into the, the mainstream educational medical career. Here she is, she’s all set up. She did her hard eight years at Stanford, not four, people, but eight and wearing red every time I see you just because of that. Brad (5m 9s): And you have the right to, of course, but tell us about your educational background and then the, the changes that came about quickly into your career as a surgeon. Casey (5m 20s): Absolutely. Yeah, so I was, I started at Stanford as an undergrad around in 2005. So this was right after the human genome project had just wrapped up. And Silicon Valley was just a buzz with personalized genetics and, you know, direct to consumer personalized gene testing. And so 23 and Me was popping up and it was just a very exciting time to be interested in biology and, and at Stanford. And so that was really formative in terms of my medical education to be in that sort of ecosystem of personalized health. Casey (5m 53s): And so that’s what I majored in. I studied personalized genetics. I was a TA for Russ Altman’s, you know, first sort of personalized genomics class at Stanford. He’s head of the bioinformatics department there. And I worked at 23 and Me when I was an undergrad. So I came into understanding the human body really, as we are this really unique individual genetic blueprint and environmental factors. So what we expose our to ourselves to, while we eat what we do, how we live, these are all environmental factors that change the expression of this biologic blueprint. Casey (6m 31s): And so in that sense, it’s an incredibly empowering view of health because we, while we do have this sort of set blueprint, we have agency in what we choose to expose ourselves to. And, and we can change that. We can have differential expression of that template by those choices. And so making smart choices is really the key to, you know, moving on the spectrum towards health or disease. And what’s also interesting what we’re learning even more. Casey (7m 2s): This wasn’t not even a term when I was in college, but now the whole epigenetics revolution is happening. And we’re actually understanding that while our blueprint is fixed, the folding of the blueprint is actually variable as well. So what genes are even able to be expressed at a given time is also modifiable by the choices that we’re making. So on every level there is room for intervention and action. So that was really foundational for my, my view of health and my view of the body. Casey (7m 32s): So flash forward, you know, I go to medical school and I’m also at Stanford for medical school. And there, it was a totally different ethos about health than what I’d been exposed to as an undergraduate, because Brad (7m 48s): Down the hall in one building over, people are talking about gene expression and epigenetics, and then you go to medical school and they’re like cut here with the scalpel to remove the, the tumor. Casey (7m 59s): Exactly. You know, it’s, it’s a little bit paint by numbers and it’s very, very cookbook and really modern medicine is all about pattern recognition. It’s here are a set of symptoms, which are subjective factors, and here are signs which are objective factors about a patient. And if these signs and these symptoms match up, then we’re going to label it with this diagnosis. And then once you have that diagnosis, ding, ding, ding, you’re set, because now you have this set of drugs or this set of invasive interventions to offer the patient. Casey (8m 31s): And that’s, that’s pretty much a to Z. And so that was somewhat disheartening to me because I was coming with a very different perspective of really thinking about biochemical individuality and the biochemistry of disease and really cellular biology. But a lot of those things, while we learn about them, in terms of actual clinical practice, kind of get brushed under the carpet in favor of this very high throughput pattern recognition and reactionary medicine. Casey (9m 3s): And so with that pattern recognition, you also get into this mindset of a very reactive nature of healthcare. So a healthy person’s not going to have a lot of signs and symptoms. So the doctor’s job really isn’t necessary there it’s only until you have those signs and symptoms that you come to the doctor and they do this labeling process. So what it does is it creates a culture where you’re really not thinking about or addressing the patient without disease. And you’re only really giving them attention and energy when they’ve, when they’ve started to have dysfunction and symptoms emerge. Brad (9m 38s): And I guess that’s okay because when my plumbing pipes are backed up, I want to call the guy with the tools to clear them up. But he’s not the same as the contractor that should have installed it the right way in the first place. And, you know, I’m, I’m coming from a medical family and they do such wonderful work, especially on the front lines. And it seems like anytime you hear like a, a criticism of mainstream medicine, it’s, it might be warranted, but it’s also taken out of context. And I think the patient has so much responsibility to, to, to make good choices and protect their health so that they’re not coming in, in a disease state or relying on medicine and pharmaceuticals to, you know, to, to write a course that could be easily write it in another way. Casey (10m 23s): Absolutely. And just like you said, with the plumber, there is always going to be this great role for someone who can come in and fix a problem. If you have a broken bone or get in a car accident and your skull is split open, you know, that’s not the time to probably talk about nutritional interventions or environmental exposures. That’s when our ultra advanced health healthcare system can really come in and be lifesaving. And that’s wonderful. But the reality is, is that the majority of the diseases that are plaguing our country and more and more our globe are diseases that are chronic illnesses based in lifestyle and dietary decisions. Casey (10m 60s): And these, these daily decisions that have stacked up day after day, year, over year, that have led people towards chronic disease. And so to approach those diseases with this reactionary mindset, as opposed to trying to unpack the factors that lead to disease, you know, starts to feel a little bit illogical. And so certainly for those acute cases, modern medicine react fix, that’s very important, but that’s a small fraction of what’s affecting people. These days, what’s impairing productivity, what’s causing pain and suffering, and what’s driving our astronomical, you know, $3.4 trillion healthcare costs. Casey (11m 36s): So, so this was kind of this balance I was trying to figure out as I was in medical school, you know, how do I feel about this? And ultimately I got bit by the surgery bug. And I think I got bit by the surgery bug for a couple reasons. One, because just feels so, you know, bad ass and it’s, it’s fun to be in the operating room, but really to me, it was like, okay, so this is the landscape of medicine. These are the realities of clinical practice. What I want to do is I want to help patients and I want to fix things. And so surgery looks really appealing because you can go in and you can fix something. Casey (12m 11s): And at the end of the day, you have this very tangible result. Like you said, if there’s a lump in the neck, take it out. If the sinus is filled with pus, punch a hole in the sinus, suck the puss out, boom you’ve won. And so that was very, very attractive to me. And so I, you know, go to residency, I do head and neck surgery, which is essentially your nose and throat surgeries. And, and the beginning of that does feel really good. You know, you’re really able to make these meaningful improvements very quickly in a short amount of time for a patient. Casey (12m 41s): But over time, I was in the operating room day in and day out. And I’m realizing interesting, pretty much all of the conditions that I’m treating in the operating room are inflammatory in nature. This is funny. So, so a lot of the things I was treating and ENT were chronic sinusitis, which is inflammation of the nasal tissue, which causes blockages. And then you get pus building up and then you punch a hole in it. You drain the pus out chronic ear disease. You know, kids who are getting lots of ear infections and pus in the middle ear. You, this is inflammation of the eustachian tube, which is the tube that drains the ear into the nose. Casey (13m 16s): And when that gets clogged, you get inflammation in the middle ear, you get pus. And so you put, you bust a little hole in the eardrum and you put a tube in there and the pus comes out, you’ve got Hashimoto’s thyroiditis, which is increasing in rates in the country, especially in women. And this is inflammation of the thyroid. And you’ve got all these vocal core conditions. You’ve got polyps, you got granulomas. And these are inflammatory masses, the vocal cords. So I’m, I’m sitting there thinking this doesn’t make a lot of sense to me that we’re treating inflammatory disorders with a physical intervention when inflammation is a process that’s dynamic and it’s happening in the body, usually because it’s being triggered by something, some sort of threat. Casey (13m 55s): And so it got me to step back and say, what is this threat? It’s it shouldn’t be normal that everyone seems to have these issues. And when we do the surgery, they come back a year later for their revision design, a surgery it’s painful, you know, and so, you know, I said, I got to think more deeply about this. And that led to a real journey of understanding inflammation and what are the root causes of these diseases. And that led to a real journey to network biology and systems biology, which are really sort of modern areas of, of the bio-sciences based on, you know, whole genome sequencing proteomics that are telling us what, when you look at all diseases, what are the common links between diseases that underlie these manifestations currently? Casey (14m 43s): Because we’re in a labeling medical system, we say these symptoms lead to this disease, but that’s not actually talking about what is the physiology that lead to disease. And when you can understand the core root cause physiology amongst disparate diseases, instead of then playing constant medical, whack-a-mole where you’re just like one disease, isolated silo, whack-a-mole with a symptom-based drug, you know, whack-a-mole for arthritis, whack-a-mole for sinusitis, whack-a-mole for anxiety, whack-a-mole for cancer them over prostatitis. Casey (15m 14s): You look at all of them and you say, Oh, interesting. All of them have upregulation of TNF alpha and inflammatory cytokine. All of them have, you know, upregulation of NF Kappa B, a genetic pathway, that’s a master inflammatory pathway. And then you start to think, how do I impact that? How do I impact inflammation, NF Kappa B and, and potentially in one efficient fell swoop using sort of my modern biologic research help a patient in this multifarious way, as opposed to the whack-a-mole, which is extremely lucrative, you know, and, and read subspecialties a sentence essentially. Casey (15m 51s): And so long story short, that was a journey. I, I really came to understand that the root of chronic inflammation that underlies the majority of our chronic diseases is based in diet and lifestyle. I think the biggest or lowest hanging fruit there is the way that metabolic dysfunction, how we process energy in the body leads to inflammation. Metabolic dysfunction is a rampant in our country. And the same inflammatory mediators that are related to metabolic dysfunction are the ones that are upregulated in all of these other inflammatory diseases. Casey (16m 25s): So if we can impact that, what can we do for all these patients? And so, yeah, that led me out of the operating room. I, I left surgery and I decided I really wanted to devote my career, my brain power to people out of operating room, reducing inflammation and metabolic dysfunction at scale. And helping people feel empowered to make choices that change the physiology of disease. So that’s, that’s the triumphant. Brad (16m 52s): You said a few interesting things. One of them, the, the lucrative nature of playing Whack-A-Mole, and I’m wondering, I know this is not, the medical world is not filled with devious deceitful people looking to make money like a used car salesman that lie about the odometer. But I’m wondering if there is an element of laziness or lack of space in the brain to step back, like you said, quote, Dr. Brad (17m 25s): Casey said, quote, I stepped back out of the operating room and realized that all of these are inflammatory based conditions. And you know, when, when you have a full slate of surgery scheduled, you don’t have time to step back. You just have to get the pus out of the sinus to speak graphically to our listeners. But I’m just wondering why we haven’t come to these revelations as a, as a society. Is there, is there like influences like the, the profit motive that’s blinding us or something? Casey (17m 57s): I think it’s, that’s a great question. And I think, I do think a lot of where we’re at in terms of our medical culture is rooted in a history of healthcare economics. And I, I don’t think this is necessarily relevant at the individual practitioner level, but I think it’s very relevant at the systems level. So when we were setting up how we were going to finance healthcare, you know, 50, 60, 70 years ago, we, we decided that we were going to basically code things. And then we were going to bill for codes. And that honestly was I think the beginning of the end for thinking about prevention, because you can code diseases and you can code objective abnormalities, like objectively, you know, lab values that are problematic, but you can’t code just being healthy, your meme, you know, metabolically functional. Casey (18m 44s): So you code problems and then you bill for those problems. And so that was a way to organize the system tip for efficiency basically. And so we set up this, this fee for service healthcare system, where you get paid when you do something. So there’s really a bias towards action. And what’s interesting about a healthy patient is that you don’t really have to do anything to them. When you get a patient who is healthy, you have essentially lost a customer because you don’t have to do anything to help them, you know, at that point, sure. Casey (19m 15s): You could help them with continued preventative strategies, but someone who’s super dialed into stress management, sleep, diet and exercise is generally going to be someone that you’re not going to probably make a lot of money off or be able to bill or code for. So flash forward, you know, now we’ve got this gigantic healthcare industry that does profit off doing things to patients, without prescribing medication doing surgical interventions. So, so I think that is foundationally part of what has guided our research culture, our medical education culture, and our practice habits, even though we may not be cognizant of it on the individual physician level. Casey (19m 55s): And I think people are somewhat aware of this because you hear a lot of talk now of moving towards what’s called a value based care system, which is a move in the right direction so that the value equation is outcomes over cost. So you want good outcomes and low costs that would lead to a high value number. So you see in Obamacare and a lot of those discussions, they started talking about we’re going to pay for value. And so we’re going to objectively measure outcomes, and we’re going to object to them about your costs and try and make that better. Well, what’s great about that is that lifestyle interventions like improving diet or exercising are the highest value interventions you could possibly have. Casey (20m 32s): Exercising 150 minutes a week is going to slash your risk of chronic disease. And it’s essentially free. So that is a positive movement. And then you’ve got other systems separate from the fee versus service systems like capitated and HMO models. And these are systems where instead of paying fee for service, you are giving a lump sum of money to a healthcare system for a particular patient and saying, this isn’t the money that you get do with it, what you will, but what you make in terms of profit is what’s left over after your interventions. Casey (21m 4s): So that’s going to promote, again, high value. You, you are having to compete for customers. So you have to do a good job and you want the highest bottom line. So you’re essentially going to be the cheapest stuff that’s most effective. So in those systems like Kaiser, you see a lot more in the realm of health coaching, you see a lot more free, you know, primary care visits and things like that. And health promotion, because the research by and large suggests that those more dietary and lifestyle interventions and health maintenance are the highest value, highest ROI intervention. Casey (21m 38s): So… Brad (21m 39s): Yeah, the billboards by Kaiser, they must cost a lot of money where they’re saying thrive and pictures of people out there being healthy. So it seems like they have a vested interest in keeping people healthy. This might be an aside, but I’m curious, you know, healthcare premiums are not cheap, right? But even someone like me, who’s paid into the system, my whole life as healthy as can be. And I had a single incident in the last 40 years where I ruptured my appendix. I had to have emergency surgery. Brad (22m 10s): I had some complications and, and I wasn’t, you know, it was into the doctor’s office and having followup surgeries. And that pretty much busted all my premiums. And then some, and I’m, I would say one of the healthier people who consume healthcare. So how are these companies even making a profit when even the slightest trip to the surgical center is such astronomical costs Casey (22m 35s): In the companies, in terms of insurance companies? Brad (22m 37s): Yeah. Casey (22m 39s): It’s, it’s a good question. I think that, first of all, I’m sorry to hear about your appendix. That sounds like quite, quite the ordeal Brad (22m 50s): Little tidbit to the listeners. If you go into the emergency room and you report your pain is 10 out of 10, don’t go home. Cause they sent me home saying that I was fine. And then I went home and had a burst in bed and I laid there for 12 more hours and it turned into be a horrible situation. It could have been easily, you know, kind of alleviated, but I was trying to be such a tough guy because I don’t want to go and get extra care that I don’t need or take pain meds or any of that silly stuff. But I, I learned my lesson and totally recalibrated my approach to health and wellbeing, where there’s a time and a place to be self sufficient. Brad (23m 27s): And then when you got 10 out of 10 pain, you go in there and you stay there until they figure something out and back to the show with Dr.Casey’s Casey (23m 35s): So one benefit that insurance companies have is that they, they share risk across a large population, some of which are going to be very ill and some of which are going to be healthy. And part of having this universal mandate for healthcare that was proposed with Obamacare is that if you can get more, especially the healthy population into the insurance pools, it’s essentially gonna lower, lower cost overall. Brad (23m 60s): Hey, for all them smokers. Oh right. Thank you. Casey (24m 3s): Yeah. So I think there’s, that’s part of the equation. There is that for one person like you, who is having, you know, an appendix rupture and maybe a 30, $40,000 surgery and treatment course, you’ve got a bunch of young people who are never seeing the doctor and not on any medications who are also paying into that system, quite high premiums and deductibles and sharing that load a little bit. And then another thing that factors into it is that the bill that you get is not necessarily the bill that the insurance company is paying to the hospital. Casey (24m 36s): There’s a lot of price fluctuation that goes on and there’s a lot of bargaining. And that goes into between insurance companies and hospitals about what’s going to be reimbursed. And when you get to be really, really large, you have a lot of bargaining power. And so the costs in healthcare are notoriously untransparent and notoriously unfixed. And so what you’re paying at one hospital for the same procedure versus another is going to be very, very different. So there’s a lot of complexity to it, but I think those are some of the factors that’s the plan. Brad (25m 8s): Okay, so you a once and for all walked out of the operating room, never to return most likely, and you had this vision to, to make a difference at the, at the symptom level. And where did that take you? Casey (25m 24s): Yeah, so that took me to getting additional training in functional medicine and functional medicine is essentially the clinical practice of everything I just described. So trying to understand health and illness on the biochemical level and understanding the physiology that leads to disease. So symptoms don’t just arise in a vacuum. It’s not just this magical thing that happens. Symptoms arise from biologic dysfunction. And if we can understand cellular and biologic dysfunction, we can then try and impact at that level to, and when you affect it, that level symptoms melt away. Casey (25m 59s): So this is not about treating symptoms like treating pain with a pain medication that blocks your perception of pain. It’s treating the pathway that leads to pain. And so that was much more compelling to me and much more interesting. And so I got initial training with the Institute for Functional Dedicine. Then I opened up my own functional medicine, private practice in Portland, Oregon. And so there, I was taking an extremely high touch approach to patient care. I was really trying to understand all of the different variables that go into leading to cellular dysfunction. Casey (26m 32s): So what people are eating, how people are managing stress, what are unresolved traumas from their life that are leading to deep seated, chronic stressful stress activation, the and autonomic system, or, you know, impairment, what is their exercise? What are their relationships like? What are their core beliefs about their purpose and value? What are the environmental toxins they’re being exposed to like digging in super deeply because that upfront investment with the patient, I’ve really doing a full landscape assessment of these environmental factors that change expression of health or disease. Casey (27m 6s): Once you get to the bottom of them and create, you know, a very personalized plan for these things, it’s often a very efficient process. They get better, they feel better and, and you’re sort of done. And so that is, that is really, was so heartening to me. But what I realized early on in my practice is that the big challenge is not necessarily figuring out what the dysfunction is. We have amazing lab tests and even taking a super thorough history and having an understanding of, you know, the cellular basis of disease. Casey (27m 38s): You can really put things together and understand how to potentially help people, but then they leave your office. And the next step is they actually have to do the things day in and day out that lead to different conditions in the cells that let those symptoms melt away. Brad (27m 54s): Great visit. Thank you, Dr. Casey. Great advice. I got so many tips. Thanks for the handout. Okay, bye. Where’s the salt and straw. Is that down the street? Okay. Casey (28m 5s): What’s funny is that there is a salt and straw. It’s true. So, so that became a real, really real intellectual interest for me of my goal is, is not to just have a one on one visit. It is to get people to change the behaviors that change their lives. And so behavior change really has to be a key component of this. And, and that’s not something that we’re really taught in medical school, how to be effective agents of behavior change. And so in my head, I was visualizing the situation where I could be on the shoulder of all of my patients every single day saying, Hey, Oh no, no, no, you shouldn’t do that. Casey (28m 43s): Oh, you should do that. Oh, good job. You’re doing a great job. Like when they walk towards the pelotons saying, yes, yes. Get on the peloton, you know, get on the treadmill when they walk towards the cookie saying, Oh, you probably don’t want to do the refined carbs, but I can’t be that. And for a little while, I kind of tried to be that, but it’s totally unsustainable. You know, you can’t be emailing with your patients every single day, all day evaluating all of their decisions. And every day we make hundreds, if not thousands of small decisions that affect what our biologic reality is going to be, even how we respond to a stressful email, translates through our hormones to affect our cellular biology. Casey (29m 15s): So it needs to be something that’s more in their hands and they need to feel empowered to make those lifestyle decisions. So very quickly in my functional medicine practice, I realized I really needed to understand behavior change better. And I wanted to support the development of tools that would help people make those decisions on their own. I also really liked the idea of people being empowered to make their own choices and not me telling people how to make their own choices. So that led me to start consulting to digital health companies that were helping people with biofeed bait back based behavior change tools that essentially empower individuals with their own data to make those good choices. Casey (29m 56s): So, so now that’s sort of how I split my time. I I’m a cofounder of a company that’s in the behavior change space to improve metabolic health at scale. And then I also still have my functional medicine, private practice, and I’m helping individuals, which really is as you know, a wonderful, still something I really enjoy doing. So, Brad (30m 14s): Yeah, it seems like this emerging technology of the continuous glucose monitor is one of the most powerful potential behavior modifiers because you have this real time information. Your company’s called them Levels. RightL And tell us a little about what they do. I know they have the CGM technology and I think you have ambitions to, to add more biofeedback and other tools for the, the self contained human to make good decisions. Casey (30m 44s): Yeah. So, so essentially this company that I co founded it’s called Level and it is leveraging this new tech, this technology called continuous glucose monitoring technology as a biofeedback tool to help people make decisions about diet and lifestyle in real time that are best for their personal biology. So you can kind of think of the level system as like Fitbit for glucose. And for while I’ve got my little sentence around my arms Brad (31m 10s): Viewers, she’s got a sensor on her arm, pretty cool. Casey (31m 13s): So this is a small quarter size shape, a device that attaches to your arm for 14 days. And it’s got a tiny little hair like thread that goes under the skin. That’s monitoring your glucose 24 hours a day. And glucose is a fabulous biomarker to track in the body. It’s the only biomarker you can track at home from, from the blood in real time. And what’s so great about it is that it is a core substrate of our metabolism. So glucose is sugar. And when you process carbohydrates, glucose goes into the bloodstream and your glucose levels go up and down, you know, all the time throughout the day. Casey (31m 48s): And so what’s really unique about glucose is it’s not only affected by food, but it’s also affected by exercise. It’s affected by sleep. It’s affected by stress. So it’s this mold, it’s this readout of all these multi-variate inputs that many of us are trying to optimize in our daily life already. And it closes the loop between how those different behaviors impact your health in real time. So for instance, like, you know, let’s say you’re going about your day. Casey (32m 19s): And all of a sudden you get this, you know, total energy slump and it’s like afternoon. And you’re just like, Oh my God, I need to take a nap. It’s 2:00 PM. You don’t really know if that’s just your personality and your nature. If that’s from the poor, night’s sleep the night before. If that’s from the pressed juice you just had, or if it’s from the stressful email that you just got from your boss, and you’re kind of reacting to that. That’s really, it’s really difficult to know to close the loop on what led to that reaction. And so the really cool thing about wearing a continuous glucose monitor is you can say like, Oh, I had a pressed juice, which I thought was healthy, but it skyrocketed my blood sugar to 180 and then it crashed down to like 65 and you had reactive hypoglycemia. Casey (32m 58s): And then I immediately felt tired. That’s really interesting. And so all of a sudden you can link that action, the juice with some subjective experience and your glucose numbers and say, you know what, maybe that juice is not for me. Maybe if I had something that stabilize my glucose a little bit better during lunch, I wouldn’t have that crash. And over time doing that for all aspects of diet and lifestyle, you basically can generate a set of behaviors that lead to essentially flat and stable glucose, and really have a huge impact on, on subjective experience of day to day life, while also preventing some of that downstream metabolic dysfunction, that results from always having those swings in glucose day after day, year after year, that that marks you down that sort of spectrum of metabolic dysfunction. Casey (33m 49s): So, so it’s a really, really cool technology. And, and what our company does is we take this, this sensor and we basically facilitate access to it for health seeking individuals who are trying to optimize diet and lifestyle. And we pair it with our software, which takes this glucose data stream and parses it out and helps just basically hands people on a silver platter information and insights about how their choices are affecting their glucose response and how to, how to improve it. Brad (34m 19s): So, generally speaking, we want to have a tight regulation of our blood glucose levels. I’ve read that there’s only a teaspoon in your entire blood volume of a six or seven liters or something, which is such a mind blowing thing. So we’re, we’re really working hard in the liver with whatever we’re doing producing insulin to lower it, making glucose, if we’re starving, those kinds of things. And so we’re trying to keep this tight level, which I imagine would be our ancestral experience because we didn’t have regular meals and all that. Brad (34m 53s): And now today, like you described, but the fresh, fresh juice place we’re getting, or we’re prompting these, these spikes and these drops due to not just eating too much sugar, but all kinds of disturbing things that are related to stress management or glucose regulation, I guess. Casey (35m 13s): Exactly. So, so the, so most people associate essentially their year, if their yearly fasting glucose level is going up, that’s bad. That’s usually the only insight we have into glucose. Brad (35m 24s): All right. Once a year, once every six months, one, one snapshot. Casey (35m 28s): Exactly. And so one year you might have a fasting glucose of 99, which is the high high end of quote, unquote normal. And your doctor says, Oh, you’re fine. You’re 99. You’re not a hundred yet for fasting glucose. So you don’t need to worry about blood sugar the next year you come back and you’re 103., All of a sudden you’re quote unquote prediabetic. You know, and it’s this idea that there’s this light switch that goes off of all of a sudden you’re you’re you weren’t, you were fine. And now you’re not fine, but that’s not, that’s not what’s happening on the biologic level. Casey (35m 59s): On the biologic level. You’re marching along the spectrum from optimal metabolic and glucose and glucose function to dysfunction and glycemic variability, which is these up and down swings that you were speaking about are big contributor to longterm dysfunction in this regard. And we don’t have any insight into that because we don’t have any, you know, sensor or tools currently, other than this technology to see it. And so glycemic variability is these ups and downs, swings and glucose. It’s also called glycemic excursions. And it’s actually been shown in the literature that these excursions maybe potentially more harmful than sustained high glucose levels alone. Casey (36m 35s): So it’s thought that when your glucose swings and the hormonal response with insulin and other hormones, that results from that, it can lead to a lot of tissue damaging metabolic byproducts, such as free radicals and oxidative stress. It can damage blood vessels and cause what’s called endothelial dysfunction. It can cause damage to nerves. It can also significantly trigger inflammation and it can activate the stress hormone cascade. So the sympathetic nervous system, the fight or flight, the catecholomines and cortisol. So by going up and down, you’re uniquely contributing to some of this physiology that is problematic both for day to day experience of life, but also for these longterm risks for more chronic disease. Casey (37m 19s): And, you know, I think what, what people might not people, you know, don’t think of this because our system isn’t set up to make us think about this, especially before you’re diagnosed with an illness. But what’s interesting to me kind of going back to the whack-a-mole conversation is that metabolic dysfunction and glycemic variability has its finger in pretty much every pain point that you hear about, you know, in the media. So metabolic dysfunction and glucose irregularity, and the downstream effects of that, like oxidative stress inflammation, endothelial dysfunction, that is the root of the leading cause of infertility polycystic ovarian system. Casey (37m 58s): It’s the root of erectile dysfunction. It’s the root of a lot of acne it’s can be a root cause of anxiety and depression. It can be a root cause of bigger sort of the more overt things like weight gain and obesity and nonalcoholic fatty liver disease, stroke, Alzheimer’s , which is now being caused called type three diabetes, heart disease, heart attacks, and then obviously diabetes. But all of these things, you know, are, are intercalated with metabolic dysfunction. And so when you’re thinking about how each of those, you know, each of those conditions would be treated completely different in our conventional system, but what if we could just get our glucose and our metabolic function just totally dialed in with some personalized data that tells us exactly how to eat and how to live. Casey (38m 45s): And then all of a sudden, you know, these things kind of melt away. And so that’s, that’s really what interests me is helping people on this root cause level and just watch a really functional health full life emerge out of metabolic fitness. Brad (39m 1s): So just a couple things to understand could one deliver a normal fasting glucose at the right time, such as fast as eight hours or 12 hours, but still be baking a lot of trouble with poor glucose variability. Is it possible to go in there and, and deliver a 94 and then be that person at the juice bar going up to 180 and down to 64 and, and feeling burnt out at nighttime and chowing down the pint of ice cream. Brad (39m 32s): Cause you’re, you’re tired and craving sugar and all that. Casey (39m 36s): I think that’s, that’s such a great question. And the answer is yes. And so if you think of a graph that has huge ups and downs swings and amplitude, that’s going way up, way down, way up the average of that, which would be represented by a metric like hemoglobin A1C, which is average three month glucose levels, which is another test that is often done yearly. They would have, let’s say apps. And let’s say you have some with really tiny amplitude of their curve along the same, the same average, those two people on the hemoglobin UNC would look exactly the same, even though the person with the huge swings is going to have, that is an independent risk factor for a number of chronic diseases, separate from just A1C or fasting glucose. Casey (40m 20s): So not knowing that what’s happening in between those, those average tests is, is a real disadvantage. And it’s currently not something that we’re really thinking about in the average person that also that person with intense glycemic variability is going to be causing that oxidative stress, that endothelial dysfunction, that inflammation that may not show up necessarily on a glucose related tests. But those are other biomarkers that are probably going to be more off in that patient than the one who has the sort of, you know, more stable glucose level. Brad (40m 53s): Yeah. Maybe it was just the perfect timing of finishing your hot fudge sundae at 9:00 PM. The previous evening heading to the doctor’s office at 9:00 AM. And you, you you’ve, you’ve hit that 94 when the blood pin goes in. And then you’re off to the Pancake House after your doctor’s appointment to go on living in disease lifestyle, but giving the thumbs up because of that, that snapshot moment Casey (41m 18s): Precisely. Yeah. And you know, what we’ve seen in our users or our customers is that this type of thing happens all the time, where there’s a lot of variability between fasting glucose day to day. We think of it as like, this is our, when we go to the, and our blood taken, we’re like, Oh, we’re a fasting glucose of 94, but that’s not actually the way it works. It changes every single day based on what we’re doing. And, you know, I like to think of that. We sort of have this toolbox of things that we can do to improve our metabolic health. Casey (41m 49s): There’s so many ways to affect metabolic health. You can, we’ve talked about these a little bit on this episode already, but really good sleep improves metabolic health. You know, the right diet and food combinations and food timing affects metabolic health. When you eat has a huge impact on your glucose levels, how you manage stress, your exercise, what type and frequency of exercise you’re doing. So let’s say one day you just do all the things, you know, that are, that are right. You could have a vastly lower fasting glucose. The next day we can see sometimes eight to 10 point swings in fasting glucose. Casey (42m 24s): So, so it’s really interesting how dynamic it is, but we don’t necessarily have a conception of that because of the way our healthcare system is set up and the way our standard testing is done. But once you start to realize how dynamic it is, it becomes very powerful and addictive and really empowering because you think, Oh, well, I’m just going to dig into my toolbox my bed of all toolbox and do everything I can to move that number in the right direction. Like there’s a lot of control and power over it, even in things as simple as how you pair your foods, you know, not eating carbohydrates alone and adding fat and protein to a carbohydrate, if you’re going to eat it to, to blunt the response. Casey (43m 2s): So, and then I think the other thing that’s important to mention is that, you know what we’re realizing actually also over the last five years with the emergence of continuous glucose monitoring in being worn by, by healthy individuals, is that two people like you and me will actually respond completely different to the same carbohydrate in terms of what happens to our glucose levels. So you and I could both eat it, let’s do it. Yeah. But we could both go in and have a cup of salt and straw ice cream. Casey (43m 36s): And I could go to a glucose level of 160 and you could go to a glucose level of 90. And this is work that the understanding of this is work. That’s come out of the Weizmann Institute in Israel. They published a really great paper in 2015, where they slapped continuous glucose monitors on a bunch of healthy individuals and then gave them all standardized meals and saw what happens. And basically what happens is people yeah. Full spectrum of how they respond. And then they found what were the predictive factors that determined how people would respond to a particular set of carbohydrates. Casey (44m 11s): And it came down to things like a microbiome was a huge statistically significant factor they’re anthropomorphic features. So like their body type, how much visceral fat versus subcutaneous fat they had. Things like sleep, exercise genetics. And so, so you can actually, based on, someone’s sort of overall biologic persona predict how they’re going to respond to a certain carbohydrate. But the key thing is that this idea that was sort of propagated with the idea of a glycemic index chart, that one carbohydrate is going to have a specific impact on your glucose level is essentially debunked at this point. Casey (44m 49s): That is, it is very, very individual to the person. And so what’s healthy for you for, you may not be healthy for me. And, and so you really have to know as you’re working towards metabolic optimization, what’s right for your own body, Brad (45m 7s): Right? So it’s been debunked now. So in about 17 to 20 years, it will be widely accepted by conventional society that the glycemic index is a bunch of nonsense, Casey (45m 18s): Right? Exactly. Brad (45m 21s): What kind of particulars might influence our varied response to white rice? Could it be that I have some, an allergic response or maybe a genetic predisposition to react to a certain food that works for you and are all these things in play? When you’re doing health consulting with someone where they, they love their wheat bread sandwich, every lunchtime, and there’s no adverse glucose response. So you, you give them a thumbs up or the next person should run screaming from a bread of any kind. Brad (45m 52s): l Casey (45m 53s): Hmm. Well, it definitely does come down to that where one person may do really well with a particular food and another person might not. And so I would, as a clinician say, this is probably something that is, I’m not going to be super harmful for you to including your diet. Whereas this might be very harmful for someone else. We never, we never want to have big glucose swings. There’s no purpose for a glucose. Brad (46m 20s): Never like what about at the CrossFit session from minute 30 to minute 40? Is that going to be a dumping of glucose in the bloodstream to finish the work? Casey (46m 30s): I should say a dietary induced glucose. I think you’re bringing up a great point though, which is about exercise induced glucose spikes, which is a sort of different physiologic pathway that isn’t necessarily going to have the same biologic effect. So Brad (46m 45s): Not as harmful, you mean, Casey (46m 47s): Well, it’s a totally different process. So basically what you’re referring to is this idea that when you work out, you’re going to, you’re, you’re basically telling your body, okay, I’m lifting a bunch. This is translated in the body. As stress you reduce, you starts to creating catecholamine hormones, which are stress hormones. Those go to the liver and they say, liver, our muscles need sugar to function and to produce ATP for muscle contractions. And so we’re going to dump out all of our stored glucose or some of our stored glucose into the bloodstream, so it can travel the muscles be taken up. Casey (47m 20s): And so what you end up seeing, especially with high intensity interval training workouts or power workouts with lifting is that you get this dumped into the bloodstream and you get a glucose spike. Actually that’s totally exercise induced, even if you’re fasting. And what we know about powerlifting and a high intensity interval training is that these are actually associated with metabolic health, even one high intensity interval training workout can cause improved insulin sensitivity the next day measurable. And so it’s not hurting you in the acute level. Casey (47m 53s): Also the muscle has unique sugar uptake mechanism where it doesn’t necessarily have to be insulin dependent sugar uptake. Like you do have to have it play when you’re taking in dietary glucose. So I sort of separate pathway. So I wouldn’t say that, yes, I should rescind what I said, glucose spikes of all types are not necessarily bad, but a huge swing in glucose from food is not necessarily advantageous. You, you know, with, with taking in glucose, we’re trying to take in an energetic substrate and we’re trying to replete our glycogen stores in the body, which is our stored glucose that later down the road, when we don’t have access to food, we have that stored for easy, quick access. Casey (48m 36s): Glycogen is our quick access energy that is more of our longterm, harder to access storage. So you don’t need, you know, to get up to a glucose level of 180 or 200 to replete those leakage in stores. It’s just, it’s kind of, I would say over overdoing it. So Brad (48m 52s): Sure. Now if we went to do our salt and straw contest and I showed up there after an hour long sprint workout where I totally depleted my glycogen, is that going to moderate a blood glucose spike? Because it’s going straight into the suitcases. As Dr. Cate Shanahan says, the suitcase says the glycogen suitcases are open. They’re going to take the, take the ice cream and store it away. Casey (49m 19s): Well, for people that are trying to gain muscle mass, it is thought that eating some sort of an ideally a complex carbohydrates and not necessarily like a refined sugar carbohydrate, like you’d find in sugar, in ice cream. In the first hour to two hours, right after a workout is the best time to replete that, that liver glycogen and the muscle also stores some glycogen. And so for you to get the maximum sort of build, that’s a good time probably to eat some complex carbohydrates. Casey (49m 50s): But what I think is valuable about wearing a continuous glucose monitor is that some people may just totally overdo it, you know, pound tons of gels and tons of, you know, protein shakes filled with, you know, different refined sugars and then eat some sweet potatoes and this and that to try and get as much as they can in. And I’m not confident that that’s necessary to get the same effect you’d get from a more balanced, slower carb eaten right after a workout. And you may be able to mitigate this huge insulin surge, this big hyperglycemic sort of potentially inflammation response, you know, keeping it a little bit and more balanced may allow you to have the exact same glycogen storage glucose update to the liver and muscle without some of the collateral damage of a big, big insulin surge, you know, an energetic crash afterwards. Casey (50m 41s): And some of that inflammation and oxidative stress that may impair recovery Brad (50m 46s): Back to those afternoon blues that you mentioned a while back where you just feel like, heck, and you, you need to take a nap. You can’t concentrate. Is this always associated with a blood glucose drop to below normal below manageable? Or are there other outside factors like this happens to me, let’s say, you know, now, and then where I just have an afternoon bomb out. Sometimes I link it to extremely difficult workout, you know, eight hours prior or something, but I haven’t tracked my glucose on those occasions, but I’m just curious..Are there other factors that might come into play? Brad (51m 21s): Like just when your, your brain feels fried and you, you need to go down for a break? Casey (51m 29s): Absolutely. Yeah. There’s, there’s so many different pathways that can lead to the same symptom. And I think that, I think that glycaemic dysregulation and metabolic dysfunction is a, is a big one that we have the ability to be aware of. Now, we now have the ability to close the loop on that one. And since it is so prevalent in our culture and our society, I think it’s a really valuable one to track. So if you think about like a condition like depression, for instance. Casey (51m 59s): Depression by definition is a collection of signs and symptoms that if you meet them, you get this label of disease. But from a biochemical level, there’s a number of different things that can contribute to depression. Vitamin D deficiency, hypothyroidism, metabolic dysfunction, people with diabetes have twice the rate of dying of depression. And so, and there’s a thought that insulin resistance in the brain like it is in the body with diabetes has an impact on mood. And so there’s lots of different causes that can lead to a symptom, but having the ability to sort of rule out one of these major ones and the link that I think is very high yield. Casey (52m 37s): But certainly yeah, the, the post meal or, sorry, the afternoon slump or, or fatigue or whatnot could have lots of different causes, but, but this is certainly one that’s in that mix of possibilities. Brad (52m 51s): Just a quick one. I suppose, if you were noticing a blood glucose drop, for whatever reason, maybe too stressful of a morning, traffic altercation, crappy breakfast at the Pancake House, what’s a, what’s a good strategy to try to rebuild your energy for productive afternoon. That’s a good point. Casey (53m 11s): Yeah. So if you’re finding yourself in that sort of reactive dip, which we call reactive hypoglycemia in the very short term, Brad (53m 16s): An excursion, you called it? Cause I’ve taken an excursion to the shithole cause I can’t anymore. And how do I get into a different type of excursion? Casey (53m 31s): Amazing. Yeah. Brad (53m 32s): I’m here for you. We’re keeping it, you know, we’re keeping it fresh. The next interview might not be as fun for Dr. Casey is trying to get up there on the scoreboard. Okay. How do we do a positive excursion? Casey (53m 47s): Yeah. So my honest recommendation would be to kind of wait it out. So you’re going to bounce back. I mean, the body is beautiful and its ability to self regulate. And so the inclination might be to just like pound a bar, you know, something with some sugar, you know, eat some food, try and get it back up there. But then you’re kind of playing this like hormonal, you know, Jack in the box, like, you know, insulin went up your glucose plummeted, so you eat some sugar. So insulin went up again and you might end up just kind of getting this like bouncing around. Casey (54m 19s): So Brad (54m 20s): You’ve just described the, the weight loss diet book industry of the past 50 years. That’s all. That’s what all the books, 80% of the books out there are trying to do? What, what was the term you just used the Jack in the box. We have Jack in a box. We have whack-a-mole I’m getting a good podcast title. Now, if you keep him third one, then we’re Casey (54m 44s): Ooh, Ooh. I will. I will think of I’m going to dig deep, but yeah, I mean, I think that so much of the past 20 years of dietary advice has been so misguided in the sense that it has not factored in the hormonal basis of, of metabolism and of, of weight. And it’s all been about, you know, a calorie’s a calorie calories in calories out, you know, if you’re in a calorie deficit, you’ll, you’ll lose weight. But what we know is that two people can eat the exact same number of calories per day, same macros, exact same food. Casey (55m 18s): And if they eat them at different times, they will have a totally different metabolic outcomes. So there was an interesting study that showed that people who ate the exact same food between 8:00 AM and 2:00 PM versus 8:00 AM and 8:00 PM. So just spacing the calories out more versus less had totally different insulin sensitivity and a 24 hour glucose and insulin levels. So the people in the shorter feeding window 8:00 AM to 2:00 PM had much better metabolic parameters. And when you think about things on the hormonal level, it makes a lot of sense. Casey (55m 49s): Every time you take carbohydrates in you’re going to have an insulin surge. And as you have an insulin surge, what insulin does is it’s the, the anabolic hormone in the body. It tells your body, we just got energy and we need to store it. And so we’re going to either store it in the liver as glycogen. And if there’s extra, which in our culture, there’s always extra. Cause we’re eating to at least 10 times more sugar than we should be. We’re going to store that extra as fat. So insulin actually tells the body to store excess glucose as fat in our adipose cells. Casey (56m 21s): And what it also does is it tells the don’t burn fat. We don’t need to burn fat. We just got tons of energy. So if you’re spacing out your food and eating little carbs all the time throughout the day, you’re constantly getting these insulin spikes and you’re literally telling your body it very clear language do not burn fat. You don’t need to versus if you eat your calories in a much more condensed period, yes, you’re going to get that glucose surge, but you’re only going to get it for a very short period of time. It’s going to come up, it’s going to come down. And then for all those other hours during the day, when you’re not eating your insulin low, you’re going to burn through your stored glucose. Casey (56m 58s): And your body’s going to say, Oh, there’s no insulin and no foods coming in. We better start burning fat. And so this is really just this I think is such a powerful aspect to this. So this continuous glucose monitoring technology, because if I can look at my phone and look at my glucose curve and my app and say, my glucose is basically been low and steady throughout the entire day, I can safely assume my insulin has also been fairly low and stable throughout the day. And that I am probably getting into fat mode and our, and I can confirm that because I checked my ketones as well. Casey (57m 30s): And I know that the days that I don’t have my glucose spikes and I keep my glucose low and stable by doing the things I know for me personally, keep my glucose low. I get into ketosis. That’s what happens. It’s not a mystery. And so all of a sudden you’ve just totally pulled the rug out under from this idea that, you know, weight loss is impossible. It’s, it’s really about managing your hormones and letting your body giving your body the language and the signals to say, you can burn fat now. Casey (57m 60s): So unfortunately in our culture, because we eat all the time, we snack all the time. We’ve been told that we need to snack to rev our metabolism. You know, we never get into this low insulin state. And so now we have 2 billion people in the world who were overweight or obese. We have 74% of Americans who are overweight or obese. We have 128, a million million Americans with prediabetes and diabetes. And you know, I think it’s not a mystery why we’ve gotten here. So, Brad (58m 27s): Wow. I mean, that’s the heaviest insight around that we’ve heard, you know, in decades really that this meal timing, thankfully, it’s a centerpiece of our new book that Mark Sisson and I are putting out called Two Meals a Day, but really to put this all together and to realize that just the timing of what you eat. And you said the two groups in the study, and I know there’s been many studies, Jason Fung mentioned numerous ones where they ate the same stuff, but one ate it from 8:00 AM to 2:00 PM and the other one on their, on their snacking mode and had a third of a power bar here and a third of the power bar there, sorry, this show is not sponsored by PowerBar the ultimate snacking tool to keep your insulin and glucose high. Brad (59m 8s): But that’s pretty huge because I don’t know. I talked to real people all the time. I’m sure you do too Casey, that aren’t highly motivated and living and breathing this stuff. And people are looking to enjoy their liv There’s habit patterns and cultural forces. And so if we could at least urge people to get a, get a unit on their, on their arm, because that’ll, you know, be hugely impactful. But if you can just kind of, you know, strategize to have a feast or famine mode in your life, you’re going to have an explosion in health predictably. Casey (59m 43s): Absolutely. I think that that is totally true. And, and one thing I really like about where the research is going these days and are just like increasing understanding of the roots of metabolic dysfunction is that this is not necessarily just about eating low carb. That is not necessarily the answer to getting stable glucose levels, because what we know is that a carb affects one person differently than it’s going to affect another person. Casey (1h 0m 14s): So it’s about creating this entire context for your body to process carbohydrates in a healthy and efficient way. And so that might be optimizing, you know, micronutrient status, getting a lot of sleep, exercising, managing stress, well, timing your meals properly pairing foods properly, but it doesn’t necessarily mean deprivation of any one thing. It means being really thoughtful about the metabolic context through which you’re processing food. It means optimizing the microbiome, optimizing digestion, these things all are related. Casey (1h 0m 47s): So one thing I’m, I’m just sort of heartened by is that it’s not necessarily about restriction. It’s about thoughtful management of a whole system that is extremely complex, Brad (1h 0m 59s): Right. And that’s not just your opinion because you’re gathering the data from real humans. And I know we have to wrap up, but I’m, I’m teeing you up for an entire repeat show and we have all these notes to talk about because of your strategies and your personal dietary habits and the, and the data that you’ve gathered. But, you know, you, you talked, you gave me a few soundbites that, you know, this Keto or a low carb diet, that’s poorly formulated and poorly contemplated where you’re snacking on fat bombs all day long, you’re still inhibiting fat burning and you’re inviting adverse consequences such as failure to drop excess body fat, even though you’re following the rules that are written in the bestselling books, including ones of my own that are being misinterpreted and taking out of context. Brad (1h 1m 45s): So I love the, the practical insights there and also the, the, the variability between individuals. Casey (1h 1m 55s): Yeah, it’d be fun to talk more about all that, that stuff. And, you know, I think I certainly am very, I am, I am a plant based metabolic health person. So, you know, I’m vegan and I eat probably a hundred to 150 carbs a day grams of carbs a day or more, and try and get 50 to 75 grams of fiber a day. And that would, a lot of Ket individuals would, would say, Oh my God is crazy. Like what, what are you doing? This is not the way to do it. And, but I think, I think there are multiple different ways to get to, to metabolic health and, you know, just going with low glucose input, you know, clearly not taking in a lot of glucose is going to cause you to not have a good, big glucose response in the blood. Casey (1h 2m 40s): That is one way to not elevate blood glucose levels, but there are other ways to do that as well. Like building an entire system of, you know, cells, digestion, microbiome, hormones, mitochondrial, co-factors that all processed carbohydrates really efficiently and don’t give you a big glucose spike so that you can eat, you know, lots of carbohydrates and not necessarily see it in your bloodstream. And so, you know, something that I think that the low card movement is doing a really great job of is spreading awareness that we are dealing with just absolute carbohydrate toxicity. Casey (1h 3m 17s): In our culture, we are eating 150 pounds of refined sugar on average per person per year. Now when a hundred years ago, we were eating like two pounds of refined sugar per year, if any, you know, it’s it’s orders of magnitude and the carbohydrate toxicity, the substrate toxicity that we’re dealing with is our poor little bodies and our mitochondria, that process glucose. They have absolutely no idea what to do. And we’re just seeing bodies break, which is why we’re seeing astronomical rates of chronic lifestyle related diseases that are just absolutely being interrupting the human capital and the economic capital of our country. Casey (1h 3m 55s): And so that is, I am so happy that we are talking about carbohydrates and understanding that we need to move away from refined carbohydrates, but, but that’s a very different, I think conversation then looking at like a whole foods plant based diet that has quite a, quite a bit of carbohydrates filled with micronutrients and mitochondrial cofactors and whatnot that can support really efficient, both cellular biology, but also a microbiome that’s diversified to really process carbohydrates well. So the right bacteroides and Firmicutes ratios and all of those things that we know are associated with metabolic health. Casey (1h 4m 30s): So, you know, so I, I think there’s, there’s just, it’s a really interesting time for these conversations and I, I’m certainly happy. We’re spreading awareness about the importance of being more thoughtful about carbohydrates. Brad (1h 4m 45s): Dr. Casey Means you killed it. It was fascinating. And we’re totally teed up for show number two, with these varied approaches to healthy eating and metabolic health. And this I’m excited because I feel like when we talk personally about this in Portland, we got a little further down the road. We’re going to bring that to the listener next time, but it kind of helps to reconcile some of the controversy dispute argumenting back and forth among health experts. Brad (1h 5m 16s): And now we kind of try to pursue some common ground and realize that if we get the bad behaviors out of the way, and we only touched on this briefly, but you know, when you’re getting in those traffic altercations and stressful workplace environment, you’re spiking your glucose. Just like if you go down the street and get a Hostess Pie. So we’re going to do some big picture reconciling and boy, what a, what a pleasure it was to have you on the show and give people a little tidbit about this new technology. Where can we learn more about you and the level’s operation and all that? Casey (1h 5m 51s): Yeah. Thank you so much for having me on Brad and people can find out more by going to www dot level’s health.com. And I would highly recommend doing levels of health.com/blog, where I, and many other metabolic health clinicians have written a lot of content digging into this a lot more. So it’s a great, a great educational resource. And if you do want to get access to the technology, which right now continuous glucose monitoring technology is only FDA approved for type one and type two diabetics. Casey (1h 6m 24s): And we have set up a telemedicine network of physicians who will evaluate Level’s customers through a telemedicine consultation to get access to people who are non-diabetic, who are health seeking to use this technology for health optimization. And we set you up with that consultation chip sensors, and then you get access to the levels software, and that’s, you can sign up for our wait list for thatUlevelshealth.com. Casey (1h 6m 54s): You can find us on Twitter and Instagram at Unlock Levels, and you can find me on Instagram and lots of plant based metabolic health tips at Dr. Casey’s kitchen. So that’s sort of find us Brad (1h 7m 7s): Awesome. Thank you, Dr. Casey means thank you, listeners. Thank you for listening to the show. We would love your feedback at firstname.lastname@example.org. And we would also love if you could leave a rating and a review on iTunes or wherever you listen to podcasts, I know it’s a hassle. You have to go to desktop iTunes, click on the tab that says ratings and reviews, and then click to rate the show anywhere from five to five stars. And it really helps spread the word so more people can find the show and get over themselves because they need to thanks for doing it.