Dr. Casey Means Reveals The Science of Eating for Health, Fat Loss, & Longevity

how long it takes you to come down after a meal so if you if you're dealing with someone who's pretty insulin sensitive even if they eat a big high carb meal like for me it would be like a huge handful of grapes those are just like they crush me it's just wild it might go up really far but it should come down really fast because that's a sign that your cells are hearing that insulin signal pulling it out of the bloodstream and that's all working properly but you can imagine if someone's kind of moving down that spectrum of metabolic problems and they're a little bit resistant they're not going to clear that glucose is fast all right hello everyone and welcome uh I'm Dr Anthony chaffy a host of the plant-free MD thank you for coming uh for another episode today I have a very special guest Dr Casey means who is a Stanford trained doctor and who has recently made a switch or or not maybe not so recently from a surgical career into uh the realm of metabolic health and started the uh company levels and um if you head over to levels. l/ plantree MD giveaway you can enter to win a levels annual membership plus a one- Monon CGM kit the giveaway will be open for one week from the date of this episode release and that's uh around a $400 value so uh do check that out I've got mine and looking forward to trying that out Dr means thank you so much for coming on so thrilled to be here thank you you're welcome uh so for people who haven't come across you in your work can you tell us about you and and what you do yeah absolutely so uh my name is Casey means I am a medical doctor I trained as a your nose and throat had an NE surgeon before making a big pivot into the world of metabolic Health um and you know I had done done four years of medical school at Stanford five years of almost completed five years of my surgical training and I was just about to finish my residency and and sort of take a faculty position as a as a surgeon and I really had um I would say like a a pretty profound wakeup call um kind of looking around me and and the American population and what's happening in healthcare today and and just realizing that you know the the real elephant in the room of American Healthcare today really Global Health Care today is that we're dealing with a metabolic disease epidemic and you know right around this time um there was research coming out at that time that 88% of American adults had metabolic dysfunction now it's up to 93 2% of American adults have at least one biomarker of metabolic dysfunction and so being a surgical Super Subs specialist focusing on a very focused uh part of the body it really just felt like um you know even though there a lot of there's a lot of value to that that specialty into the surgeries that these amazing Physicians are doing but there's a much bigger problem at play right now that our system is not doing a great job of approaching or fixing in fact it's getting worse every single year and that's the metabolic disease epidemic and as you know that's almost entirely preventable it's cropped up really in the last 50 to 75 years it's rooted in our diet and lifestyle and the exposures that our bodies are facing uh in this modern industrialized World which is crushing our metabolic Machinery our mitochondrial function our cellular function and what's showing up is just a huge spectrum of metabolic Associated diseases in all parts of the body that all look very different uh because they're they're happening in different organ systems and different cell types but when you zoom in and actually look at what's happening on the inside of the cell what's really happening across all those different cells is the same it's a problem with how our cells make energy how they uh metabolize food to Cellular energy and what you end up having when you have metabolic dysfunction is cells that are underpowered and underpowered cells are going to uh result in symptoms and disease and so that's in the brain it can look like all Alzheimer's dementia if it's in the vascular system it can look like hypertension or heart blockages erectile dysfunction retinopathy chronic kidney disease if it's in the ovaries it can look like polycystic ovarian syndrome if it's in the liver it can look like fatty liver disease if it's in the joint joints it can look like arthritis and so I stepped away from the surgical field and really devoted um my time my energy my brain power to how are we going to solve the metabolic SE epep epidemic in America which is which is underlying nine out of 10 leading causes of death that are torturing American lives and so that's what I've been doing about the past four to five years and part of that mission was starting a consumer health company co-founding it with my amazing co-founders um which is called levels um like you mentioned in the intro and the purpose of levels is to empower people to understand their own metabolic health and you know you're walking around with this Monumental issue in our country and yet the average person has no idea what their metabolic health is even though it's metabolic dysfunction is the thing that's probably going to kill them and so we are really um we exist to to change that Paradigm to empower people with their own personal Health Data uh so they really know and are owners of this critical part of health and there's a lot of different ways to understand your metabolic Health but one really important way is tracking your blood sugar levels it's uh one of many key metabolic biomarkers but it's actually the only one we can measure in real time right now so you can actually put a sensor on your body a continuous glucose monitor and see 24 hours a day seven days a week what's happening with your blood sugar and how every bite you take and and exercise workout you do um and other various lifestyle choices you make how that's actually affecting this key metabolic biomarker and we know that when blood sugar levels get out of control and start being disregulated and erratic and having sharp Peaks and valleys we know that's associated with metabolic dysfunction it's a sign that our cells are not doing a good job of converting food energy properly so that glucose is building up in the system and you can see that on a continuous glucose monitor so levels enables access to this technology to anyone who wants to optimize their diet and lifestyle understand their metabolic Health we pair it with software that helps people interpret the data um we give access to metabolic blood work that people can actually get in a lab to see a a more broad array of um of of biomarkers and then a huge educational ecosystem to educate the average person on the science of metabolism which I think every every person now in the western world really needs to know um in order to live the healthiest life so that's a little bit about about my journey yeah oh well that's great hey guys just want to take a second to thank our sponsor at carnivore bar I don't promote many products because honestly all you need to be healthy is to just eat meat for those times that you're out hiking road tripping or stuck at work and you want nutritious snack that is just meat fat and salt if you want it the carnivore bar is a great option so I like this product not because it's just pure meat but also because I want the carnivore Market to thrive as well and the more we support meat only products the more meat only products there will be available in the mainstream so if this sounds like something you'd like to get behind check it out using my discount code Anthony to get 10% off which also applies to subscriptions giving you 25% off total all right thanks guys and I I completely agree the vast majority of diseases we treat now are these so-called chronic diseases and they they are just getting worse so this isn't really a disease it's not like there's this a plague or a rash of infection that's that's getting out of hand something we're doing in our environment is damaging us and and we're we're neglecting that and we're seeing the results of that people are getting uh less and less well and having rely having to rely on more and more medications which are just Band-Aids they're not actually addressing the underlying cause and so I I really like that idea of empowering people and giving giving them back the control in their lives to be healthy and not have to be reliant on the medical system as well I mean I'm sure you know you were I was quite disillusioned by the fact that you you can go into like a sub specialty and do some really amazing really interesting things but you realizing that that what you're doing is just sort of damage control and you're sort of picking up the pieces and there's traumas and there's different sorts of things that they're like well this is just an acute emergency and and that's what we're here for but a lot of these things you're just sort of picking up the pieces of of lifestyle and environmental hazards that have just sort of built up over time and um and I mean I had a professor once um who decided not to go into vascular because he just said all I'm doing is I'm spending 16 hours fixing this vure and then people just going smoking and drinking and just destroying all the work that I did what the hell is the point of that and so you know yeah so that's that's it's just it's a sort of almost feels quite defeating you know when you when you run up against that absolutely and I think um ENT was such an interesting field because I didn't realize this until the very end but um I was essentially just an inflammation doctor and I didn't really realize it you know as you know but maybe some of the listeners don't like this suffix in medicine itis it's the suffix that means inflammation and I was looking at sort of what I was doing day in and day out and it was Len sinusitis otitis mastoiditis partis cellulitis Uvis I mean it's literally it's so much tracheitis I could just go literally on and on and and so really what was in our Arsenal in terms of impacting those conditions was just a whole bucket of steroids it was the oral steroids the inhaled steroids the nasal steroids the topical steroids and steroids of course are a medication that suppresses the immune response and so much of the surgeries that we do if those medications don't work is we essentially go in and bust holes in things to suck out inflammatory like pus so if you think about what are ear tubes which is one of the surgeries we did all the time you're cutting a hole in the eardrum and sucking pus out of the middle ear sinusitis surgery blow a hole in the sinus literally drill a hole in the sinus bone sometimes and let pus strain and you know if you've got uh you know if you've got a big abscess in the neck you make a hole in the cellulitis skin and you the pus strains and so it was like oh my gosh I'm really just treating chronic inflammation and then you look around you at all these other conditions like heart disease and diabetes and obesity and even depression and you start looking at all the literature and it's like wait these all seem to have this element of chronic inflammation what is going on and there was this real wakeup call for me you know this is now 9 years into Medical school and training where I'm like I am learning so much about inflammation I am treating inflammation constantly but never once not once in all of this time has anyone stopped and said what is causing this inflammation you know why what what is inflammation it's an entire system of the body getting revved up to fight a threat it's it's there to fight something and we just I don't know if this was your experience as well Anthony but like we were not taught to step back and say like what is that threat you just sort of assume the inflammation just exists and we have to do something about it and so that really starting to ask why with that question was really interesting because a lot of people will Trace that conversation back to things like oh like our food is inflammatory and we've got toxins in our environments and environment and we're not sleeping enough and this is all inflammatory and that is true all of that is true but there's actually a deeper layer to to it which is what led me to being really a metabolic evangelist which is that you know then you have to ask like well why is the toxin inflammatory and a lot of the ways in which like food and toxins and sleep deoration and stress a lot of the ways they actually promote this chronic inflammation is that they are hurting our metabolic processes so they are either acting as direct mitochondrial disruptors or they're impacting the microbiome in a way that hurts our metabolic processes and what you end up with through a lot of these different Pathways is a cell that's not producing energy properly it's not producing cellular energy ATP properly and if you think about it what could be more stressful to a cell than not having enough power to do its job so a cell that's not able to produce ATP in the amount that it actually needs to do its work is going to send out profound alarm signals to recruit the immune system and then what happens is the immune system is at the ready it's like oh my gosh we've got all these sort of ailing cells that are not powered properly but they can't actually help because the problem is inside the cell it's being caused by environmental factors that are disturbing an intracellular process that's leading to an underpowered cell and the immune system can do nothing to help that if it was a bacteria causing the problem of course they could help then but it's not it's something much bigger than what the immune system can actually can actually help with you know they don't have arms to basically pull the doughnut out of your hand and you know throw it away they don't have the ability to go outside your body and throw away the laundry detergent that's filled with synthetic chemicals that are going to disrupt your mitochondrial function and so what happens is they keep working they keep releasing these chemical mediators these cyto kindes creating this complete war and fire inside your body that's really doing nothing to help you because it's not doing anything to actually stop the problem that's causing the metabolic dysfunction so it was a journey of figuring out okay chronic inflammation start asking why which we just don't do in medicine being led to a bunch of environmental factors and then asking why again it's not just those what are those doing to the cells and then realizing a lot of it has to do with how they're actually impacting our ability to make energy so now we've got these bodies that again they're underpowered and youve kind of got this like you know crisis going on in the average American Body which is revving up the whole immune system constantly until those conditions change and then of course when you change the conditions you improve the metabolic health and these symptoms as I'm sure you've seen in practice a lot of them just like melt away and it seems miraculous but the biology it all it all makes a lot of sense and I think um unfortunately the average doctor isn't thinking this way and so a big mission of mine is like this is not that comp complicated I think everyone can understand this and when you just understand some of these basic principles I think it really gets people motivated to make some of these long-term consistent Lifestyle Changes because if you're asking people to make all these changes and they don't understand why it's very hard but if you kind of get like what dominoes you're trying to get fall it's I think it's much much easier so um kind of making everyone well versed in the in the basic science of metabolism I think is a really a key step that um I'm for I'm grateful for like yours that are helping people gain some awareness oh thanks well yeah I I totally agree it's it's very interesting too you know just the idea that that the disruption in our in our energy mechanics in our cell can can precipitate an inflammatory response and uh I hadn't actually heard that before that's very interesting and it makes sense right and so you know what what is driving this inflammation what what is uh I mean obviously you we can get into you know why insulin is a problem having chronically elevated insulin and and and that is is an issue which is obviously why you want to you know cover your your or use a CGM and see exactly what your blood sugar is doing and what your insulin is doing as a response to that but you know that that is interesting um when you so at the moment are you you say you in a functional medicine practice now are you treating metabolic health or you mostly focused on uh the the levels company yeah so after I left the surgical World which was 2018 I did start a functional medicine Private Practice I went back and I got training with Institute for functional medicine and that was so invigorating because that was I you know it was like this light bulb went off of like oh this is the medicine I went to I went into to medical school to practice it put I was so disillusioned and I went back and got some of this additional training and it just was like yes this is how I want to help patients and I did that for for little less than a year opened up a practice up in Portland Oregon and um it was wonderful and of course the results were groundbreaking things I'd never seen in my ENT practice were happening routinely in my functional medicine practice like people actually like really really getting better with this High touch care but then I think just having a little bit of like an entrepreneurial mindset I I thought you know how can we take some of these principles and actually scale them you know how do we I can't spend two hours with every patient you know like and and have the impact I want to have I think with that even though each each individual interaction is so so so meaningful but like there were principles that were kind of applying to everyone that was interesting to think about like how do you do a one to many sort of version of that and that's what really kind of landed me towards more Health technology so how do we use maybe devices and software to get these principles out um and kind of let people um use Health technology to almost be a coach for themselves um um and and kind of be that a little bit of that functional medicine Spirit on their shoulder saying like yeah do this do that and kind of a lot of the things I was saying to my patients in the practice but through a through a more digital first uh technology yeah that's that's literally why I started the podcast was because I was having the same conversation with people and I was like I I just need to have a video for this so people can just I can just sayy just watch the video please and then you'll you'll understand what's going on here um yeah that that definitely makes sense and and and it is it is scalable and it's great that you can put that in people's hands so they don't need to come see me or you or another practitioner and and just sort of get that um that information face to face they can just do it at home and and just giving people the ability to to track their metabolic health I think is really really good so um could you go into some of the reasons and the benefits of track of using a CGM and tracking blood sugar uh for for people at home and and why that is uh well it's a major part of the levels program absolutely so I think the at the highest level the human body functions better when glucose is in a healthy and more stable range when there is high glycemic variability meaning that glucose in the bloodstream is swinging up down up down up down in big Peaks and valleys that is not good biology that is going to not only make us feel crummy dayto day but it's going to set us up for those longer term uh metabolic problems and the development of more dysfunctional cellular physiology so both in the short term and the long term keeping glucose in a healthy range and and less frequent erratic swings less glycemic variability is good for health so that's kind of a key a key premise um the simplest way to think about this is you know everyone's probably experienced like a postmeal crash where they eat a big meal um and then a couple hours later they like or even maybe an hour later they want to take a nap they might want want another snack you know they just kind of feel tired and that's often correlated with a big glucose Peak and then a crash afterwards of the glucose which is actually there's a term for that which is called reactive hypoglycemia so your body has a big influx sugar glucose which can be from refined carbohydrates or refined sugar which of course are making up the vast majority of American calories today and you know the glucose swings up the body releases a ton of the hormone insulin which helps the body take the blood sugar the sugar out of the bloodstream into the cells and the body kind of overshoots and swings really low and that reactive hypoglycemia is often when people feel that postmeal slump that period has been associated with anxiety uh with fatigue with brain fog and actually is when people often have carbohydrate cravings and the reason for that is because when the glucose goes low after a spike the body really wants to get it back up to its Baseline so it's there's going to be this sort of psychological Drive actually to eat carbohydrates when you have the dip so there was a p paper polish in in nature actually last year that was about how the magnitude of these post uh prandial like postmeal reactive hypoglycemia dips actually were predictive of how much people would eat in a 24-hour period and how much carbohydrates they would consume essentially at the next meal so you can imagine if you can level that out a little bit go from Peaks and valleys to more gentle Rolling Hills you're going to avoid that um that that uh reactive hypoglycemia that's quite unpleasant secondarily we know that glycemic Vari ability so big swings in glucose or persistently high glucose levels high blood sugar levels these are associated with all sorts of problems for our Biology one is that high blood sugar levels um is going to cause sugar to stick to things in the body like you just if you just imagine a bloodstream full of glucose it's almost like it will just bind to things all throughout the the the bloodstream um even in the cells and this is a process called glycation glycation is essentially glucose sticking to things of course when there's a higher concentration this is just going to happen more and when glucose sticks to things when glycation happens it's it creates dysfunctional um you know proteins fats um blood vessel Linings anything it sticks to generally creates dysfunction or an inflammatory response you don't want sugar sticking to things so glycation is one problem the second problem is that it does generate inflammation so high glucose levels creates a pro-inflammatory state and and we don't want that chronic inflammation because there's a lot of collateral damage when your immune systems are all revved up you know sort of seeping out all their inflammatory mediators revving up the sort of defense system of the body and the third thing is that it generates uh reactive oxygen species so these these molecules these metabolic molecules in the body that have unpaired electrons that basically go around trying to bind that electron that electron that's unpaired is quite reactive and so it tries to bind with things throughout the body to neutralize it and that generates oxidative stress and essentially um just sort of reactive um problematic uh biology and so you get glycation inflammation and uh reactive oxygen species oxidative stress plus you get this reactive hypoglycemia and all of this is why we want to keep our glucose more stable so that leads us to tracking glucose so if you have a little monitor on your body a continuous glucose monitor that's like basically showing you these glucose Trends 24 hours a day like a little movie and sending that to your smartphone you can start to see patterns of what you're eating how it's affecting that glycemic variability those spikes and crashes um how lifestyle factors like exercising or walking or meditating um or sleeping more or less uh how those things are mitig that glucose response because it's not just the food you eat that impacts the amount of um glucose in the bloodstream it's all these other things too like how much you're soaking up from the bloodstream into the muscles and if you're sleep deprived it's actually going to tell your body to keep more sugar in the bloodstream and if you're stressed the same thing happens and with certain workouts that are actually more intense like a like a powerlifting workout or a high intens intensity interval training class your body actually might release glucose from the liver to fuel the workout like a really intense workout so you might see glucose up go up when that happens and that's actually not necessarily a bad thing um it's a little bit of a different process but there's all these different things affecting what your blood sugar is at any given time and by wearing a monitor like this even for a short period of time two weeks four weeks you can start to really intu what patterns of eating and living are associated with that more stable gentle Rolling Hill physiology that we want to see in terms of glucose and um and start to make some smarter choices so we see a lot of people who have been kind of trying all these different dietary philosophies for years you know dealing with the reality of the situation as it's been forever which is that we have very little feed you know feedback in terms of how these choices we're making are affecting us like we might look at the scale the next day we might get cholesterol panel three months down the road but it's very hard to know how all these different micro choices we're making every day are affecting our health and our goals and the beauty of a sensor like this is it really tightens up that feedback loop it's instant bio feedback with this um with this biomarker that's quite important um so that you can really kind of cut through a lot of that mystery uh and kind of just cognitive load of thinking about what's working what's not and uh and and gets just get a little bit more clarity on on which choices having you know the best impact on on your metabolism yeah well that's great um and so leading into you know the problems of these metabolic issues and hyperinsulinemia and things like that I've heard you talk about how things like erectile dysfunction in PCOS are majorly driven by the these sort of metabolic dysfunction could you talk a bit about those and maybe some other choice metabolic issues that people can reverse uh focusing on on these sorts of tactics absolutely yeah so the so I think probably worth talking a little about insulin and how that relates to all of this glucose and Insulin of course go hand in hand uh when the body is trying to get glucose out of the bloodstream into the cells to convert it to energy the body releases insulin from the pancreas which essentially binds to the the cell membrane and brings those glucose channels to the cell membrane so that the glucose can flow from the bloodstream into the cell and ideally once in the cell that glucose would be taken out would be broken down taken up by the mitochondria and uh ATP would be the result of that and so that's when things are kind of working properly and theoretically you'd want to have a pretty good balance between the glucose that's coming into the body through food and the amount of ATP the body sort of needs and things would would run smoothly unfortunately with what's happening today we're eating some people say 50 to 100 times more sugar I mean there's so many different numbers being thrown around here um but a lot more sugar than our body really was ever um evolved to handle so youve got this huge uh excess of this substrate for metabolism coming in so from the standpoint of a cell the body's like okay I need to produce a lot more insulin to get all of this glucose into the cell and then the mitochondria is like oh my God I have to process all this glucose to energy but it actually can't and on top of that the mitochondria is being damaged by all these other lifestyle factors the chronic stress and cortisol the the the environment the 80,000 synthetic environmental toxins in our food water air um personal care products by the sleep deprivation which also leads to high stress hormones which hurt our mitochondria there's all these things kind of damaging this this machine that's converting glucose to energy and you've got way too much glucose coming in so the body is releasing all this insulin to get the glucose in the mitochondria can't really process it so what happens the mitochondria actually blocks that glucose from being converted to ATP because it can't handle all of it and a lot of that gets turned to toxic fats that sit inside the cell so you get these ceramides and diog glycerols bags and things like that and you get this cell that's basically filled with essentially toxic fat which actually blocks the insulin signal from being transmitted from the cell membrane into the cell and so you get this really dysfunctional biology where um too much glucose mitochondria is dysfunctional cell fills with fat blocks insulin signaling this is now insulin resistant so now the body is producing all this excess insulin to try to get the glucose into the cell but it's the cell's blocking it the cell's like nope can't do it so now you get more and more and more insulin being generated and that insulin essentially is going to um build up in the bloodstream just like the glucose is building up in the bloodstream and cause um lots lots of problems in its own right um including impairing the nitric oxide uh pathway in our body which is of course what dilates blood vessels and so one issue that you start to see here is issues with sort of vascular flow which leads back to what you're were talking about with the erectile dysfunction um you know because erectile dysfunction is essentially like the blood vessels in the penis can't dilate fully so you can't get an erection and so Viagra actually increases nitric oxide function in the penis but if you trace it all the way back to how this relates to metabolic dysfunction um we're really talking about an insulin issue uh and and coupling that with excess blood sugar in the blood stream which of course is causing glycation which further damages the lining of the blood vessels so it's just this like crazy perfect storm that is all linked back to just inundating our bodies with way too much of the substrate that the cell needs to process and damaging the mitochondria through all these other environmental factors that we've talked about so we want to keep insulin low and we want to keep glucose in a healthy range um when it comes to infertility the leading cause of female INF in the United States is polycystic ovarian syndrome and various different studies talk about different rates of this but somewhere in the like 12 to 25% of women globally of childbearing age are dealing with polycystic ovarian syndrome which is fundamentally a metabolic condition and what happens in this High insulin State like we we're just talking about is that insulin actually one of the other effects it has on the body is it it stimulates ovarian Thea cells to produce too much testosterone so now you've got women having their ovaries stimulated by insulin to make testosterone and that really perturbs the delicate balance of estrogen progesterone testosterone which have to basically be in like Perfect Harmony for normal ovulation menstration all these things and so um so insulin is essentially driving a different sex hormone milu um in the female body which lead to not only the infertility but also many of the other symptoms that women often see with PCOS like excess hair growth and acne and other things that are driven by excess male hormones in the female body so that's sort of just um some of the you know Sexual Health side of things and and there's a lot of other things actually going on in that in that realm as well like um we know now that actually aside from erectile function which is affecting a huge percentage of men over the age of 40 even younger than 40 but um the rates are very very high um sperm count is also down 50% since the 1970s I don't know if you've seen some of this data but it's wild you know if you just basically look at sperm under the microscope from the average average American man it's down 50% on average and a lot of this has to do with metabolic issues as well in part because it comes back to testosterone again you need the right balance of testosterone and other sex hormones to produce um sperm and in men the the visceral fat around the belly the fat that is associated with metabolic dysfunction um this is fat that actually interestingly acts as a hormone converter and it converts testosterone to estrogen so Dr Ben bman amazing metabolic researcher says that the fat around a man's belly is basically acting like an ovary like it's basically creating estrogen and this then um is decreasing the ability of of men to create healthy sperm and so that's just kind of focusing on the sexual health side of things but um it's just it's all intermingled with the metabolic conversation and um and has not yet quite permeated the subs Specialties um in a way that we're actually practicing uh in a in a metabolically focused way so we still hit men with viagara we're hitting women with um you know birth control pills to manage their hormones um you know we're now focusing on things like semaglutide and OIC for the fat but but none of it's really getting to that root cause yeah absolutely that was um in the in my functional medicine practice the well the practice that I joined that was one of the first things that he talks to his patients about when he counsels them is that the he sort of plays a quiz you know what is the largest endocrine organ and it then no one gets it but he says it's the fat your fat is your largest endocrine organ especially when we're quite overweight and have a lot of excess fat tissue that you know as you say you know creates U you know generates estrogen it's basically our largest endocine organ so he he really focuses on that say hey we need to we need to correct this and that will also correct your hormones as well and that's something that I didn't get taught in medical school I don't know if they they they mentioned that to you but that was news to me yeah definitely yeah it's not definitely not mentioned in medical school and you know it's interesting you talked to some I have a lot of friends who are OBGYN and um one of the key medications that's used in women with polyic ovarian syndrome is metformin which is a diabetes medication and yet when you talk to doctors about hey have you ever thought about prescribing like a continuous glucose monitor to your patient with PCOS it's like no of course not like that would be and it's it's so it's interesting it's just even though CGM is a tool for managing diabetes there's some Missing Link because you're in the specialty of okay well this is this medication is standard of care for our patients because they are dealing with insulin resistance but going a step further and prescribing a tool to you know Empower them to sort of change their diet um is is still not not common practice for sure um so yeah but but Trends are the trends are definitely I think favorable I think there's a lot more doctors who are aware of of metabolic Health than there were a few years ago so that's definitely hardening but it's it's still it's still it's still more the functional medicine Community for sure yeah well it it seems like fertile ground though right because they're saying that that this is well we understand this is insulin resistance and we prescribe metform and like very easy short step to say well maybe this is a consequence of metabolic dysfun function and pre-diabetes or diabetes that we're just not really diagnosing as such and uh and then so treating it in the same fashion would probably make sense yeah and also 50% of women with PCOS will develop type two diabetes before they're 40 so it's like it's just the opportunity for prevention is so so high because so many of these women it's basically like a big warning sign of you know it might be their first sign of metabolic dysfunction in a way it's like a gift it's like okay you are heading down this road so before you move into full-blown type two diabetes like get on top of this but just prescribing that woman you know oral hormones maybe a lowd do metformin that's not going to be enough to Stave off you know a metabolic issue down the road so I think people really learning um okay this is the moment to put in some really intensive dietary and lifestyle strategies and there's been amazing research that's come out in the PCOS World about how even shortterm dietary interventions can be incredibly effective um in reversing PCS there was a study um I'm just making sure I get the details here but um yeah they put uh it was 2020 and they put a group of women with PCOS on a ketogenic Mediterranean diet so it was basically like healthy protein unlimited leafy greens um and that was pretty much it it was like protein and like like unlimited vegetables essentially low glycemic vegetables and they did it for just 12 weeks and they also gave them a polyphenol supplement so like some plant you know healthful plant chemicals and the women lost on average 20 pounds in 12 weeks Beyond this low glycemic Mediterranean diet and they had sign statistically significantly lower levels of insulin insulin resistance triglycerides total cholesterol LDL and their reproductive hormone levels normalized in 12 week week so you know it's just it's so hopeful it's like dietary interventions that's going to not only set that woman up for better chances of fertility but also like just longevity um so so really some great hopeful data in that area um about the impact of of diet yeah absolutely um and i' I've certainly noticed that the the reactive hypoglycemia that you you mention Ian I don't eat anything really except just me but even just just milk right like I'll have I'll have a glass of milk and I feel fine and then an hour later I'm like passing out on the couch in the middle of the day so I I mean I tend to avoid milk just for that reason and uh I actually did an experiment where I drank quite a lot I drank like a gallon of milk a day for three days and um just then I checked my my Bloods and I checked my my insulin My fasting insulin had was elevated um the next day you know so it actually had a had a big impact on me already and it normalized uh subsequently within a few days but it um it was interesting that just milk could do that as well and um so even people in like you know just sort of an animal-based meat only diet they they still have to watch out for those sorts of things that these carbohydrates you know they If they raise your blood sugar enough they they will raise your insulin and doing that long term can can damage you that's amazing are are you just going into a lab and getting like a a blood draw insulin when you do an experiment like this is it it's probably easier to ACC in Australia it's it's still there's a barrier to doing it in the US unfortunately which is you know like and I don't know if it's the same in Australia but you need the physician prescription for the test and all of this stuff but um but you know it' be we're certainly hoping for uh improved access to insulin monitoring over time because like you said it's it's it's I would say you know in addition to glucose it's one of the most important tests we can know about our own bodies and I I would just say for anyone listening like that is not a standard ordered test it's not something that in the US doctors are going to order on a yearly physical but it probably is the most important um blood test that I think people can get um is a fasting insulin because um you know even if your blood sugar is falling in if the fasting blood sugar is falling in a fairly normal range um without knowing the fasting insulin you actually don't really know how hard the body is working to keep the blood sugar in that range you can imagine someone who early insulin resistance and their body is pumping out more insulin to drive blood sugar into the cells they might have a quote unquote normal fasting glucose level like 85 milligrams to L liter but one person might have a fasting glucose of 85 milligrams to D liter and their insulin is like two or three very low the body's not working very hard to keep that blood sugar at that level and they're clearly very insulin sensitive but the person with the same fasting glucose glucose and an insulin of 20 that's a sign that person might be early insulin or or developing pretty significant insulin resistance and their body is actually pumping out so much more insulin to keep the blood sugar at that level so um yeah I I think that um certainly for anyone listening that's a that's a test to really push your doctor to order for you at the same time as a fasting glucose so you can really understand um level level of insulin resistance which you know my hope is that in a few years every American is going to be well versed in understanding whether they are insulin resistant or not because that is information that is truly like can be life-saving um and these tests are not very expensive they just you know there it needs there needs to be willingness of a doctor to order them and one of the things we're actually doing at levels to solve that issue is we're now offering in addition to the continuous glucose monitor we're also offering a five biomarker blood panel that you can order through levels very seamlessly and basically walk into a lab get these five blood biomarkers done for $149 anytime you want and be able to keep track of things like fasting insulin um just because there's there's still quite a bit of push back in the US for primary care care doctors ordering that um perplexingly and so we're trying to make that much much easier to access for people at a at a at a affordable price with you know easy Logistics yeah that that is one of the easier things about Australia I can just prescribe myself um medications or blood tests I can just I just walk in and be like yep I want these and like okay and so so I just decided one day like yeah I'm just gonna I'm just going to get my Bloods run and so I I just you know filled out my own my own portions and and uh yeah and and that's the thing too is that I see people exact I'm I'm sure you see a lot of this is that people have completely normal blood sugar they'll have normal hba1c or even low hba1c but you check their fasting insulin and it's elevated it's markedly elevated and so and and from what I understand you can have insulin resistance or elevated insulin but normal blood sugar for a decade or more before you start having um uh disfunction of your pre-diabetes and your blood sugar starts going up but I would sort of think you know if we're depending on how we Define our terms if type two diabetes the Hallmark is insulin resistance um that's really the start of diabetes is when when you start having to overly compensate with this insulin resistance and your in insulin levels are very up your body's compensating you're able to handle it so your body is it's not fulminant diabetes not fulminant um insulin resistance however it's there and and as you say you know if we're if we're if if we're only chasing our tails and going to when it's is completely off the rails and someone has full-blown diabetes like you've missed you've missed the boat you know you've missed the opportunity to address this and stop this from being a problem in the first place right this is like you know it's the difference between telling someone to wear a helmet and you know doing a a craniectomy to to remove you know a subdural after they smash their their head in right I mean so like you can stop this before it starts right yeah I think that's such a good point I mean this is why it just drives us crazy that that pre-diabetes is called pre anything right because pre-diabetes is essentially Advanced insulin resistance once your blood sugar is starting to creep up into the non quote unquote normal range that insulin resistance may have been there like you said for 10 years or more and there was this paper from the Lancet a few years ago that that showed this that basically showed that if you actually are checking markers of insulin resistance which is that early sign that the cells are blocking the entry of glucose into the cell likely because there's toxic fat inside the cell because of Downstream or Upstream mitochondrial dysfunction and this problem converting glucose to energy the cell then is protecting itself basically by becoming insulin resistant and then that's triggering the pancreas to release more insulin so once that insulin number starts going up just keep that visual in mind it's like there's a lot of crap happening in our cells for that response to happen in the pancreas and that is happening in I would guess there's not research on this but I would guess that is in the vast majority of American bodies at this point because there's just you know so so many people with metabolic dysfunction and and if 50% of Americans which is the statistic now are pre-diabetic or have type two diabetes and that is happening 10 years down the road after insulin resistance starts you know how big is that number if you actually had all comers with insulin resistance so absolutely you know there's not an optimal range right now for what optimal insulin levels are um that has been defined by any governing body like the international diabetes Federation or the Ada they don't even talk about what normal ranges are for that um we have surveyed our group of medical advisers for levels who are some of the you know leading metabolic Health researchers in the world people like Dr Robert lustic Dr Mark Heyman Dr David pearlmutter Dom dagostino Ben bman Terry walls Sarah gotfried um David uh Sinclair from Harvard so we routinely like ask them you know based on your expert opinion and your review of the literature what do you think is optimal and when we talked to our advisers about insulin really the range that we kind of like came back with with the synthesized expert opinion is 2 to six millius per milliliter so pretty tight pretty low some advisers said less than 10 less than eight but two to six seemed to be probably where optimal is if you look at the lab sheet that you get back from a lab in the US they will typically say less than 25 is normal and so you really have to think about first of all what's optimal and what's normal and then what's just like you know a lab basically saying oh this is two standard deviations from the mean of everyone who comes in here well you don't want to be the mean or within a couple standard deviations of that from the average American so so two to six is is certainly where I try and land I don't know if the units are the same in Australia but I'd be curious if if you've if there's a particular range that you've kind of landed on in your clinical experience so the the ranges that that we tend to use are um remember off hand other I think it's four to seven four to seven or four to nine any in that very very close and those are ones we used mine mine like 3.5 yeah mine's 3.8 yeah yeah at least last time time yeah and I think every I think everyone in the ideally everyone in the world you know should know should be able to Rattle off like what is your fasting insulin what is your most recent fasting glucose what is your most recent F fasting triglycerides um probably also their CRP an inflammatory marker like if you can do that and they're all pretty optimal like you are so far ahead in terms of the whole like longevity reverse you know prevention of chronic disease realm but but we need to if I think if you went to a dinner party and went around the table and asked everyone to do that I think probably 0.1% of people could do that right now maybe they're fasting glucose but um but certainly not not the others so if you're listening to this get those tests and make sure you know them because it's uh it's gonna it's gonna help you live a much happier healthier life if you can get those in range yeah I mean I would I would be surprised if anyone who was non-diabetic you know even knew they fasting gluc I mean there be a few people in this realm that would check that sort of thing but I think from the normal person it's really like you don't Che track that unless you have a dysfunction and you're sort forced to track it yeah yeah so um that brings us to well okay we have this sort of marker of metabolic dysfunction people cont trct and say okay my insulin is a bit up blood sugar is fine now or maybe I'm sort of pre-diabetic or you know in in advanced diabetes is really what it is um what do people do at home what are some of the interventions that people can do to improve uh their functionality at home it's a great question and actually just one other thing that you just said that that I reminded me of something else that might be worth mentioning is that um you know we were talking about this like window between when people might have normal gluc normal-ish fasting glucose but High insulin levels and there's this window before they might know they have a problem one interesting thing about wearing a continuous glucose monitor is that there can be some signals of insulin resistance or like Brewing metabolic problems that you might see on a glucose curve that you would not necessarily see just by having your fasting glucose and a couple of those like one is General glycemic variability like how spiky are you there was an interesting paper out of Stanford Michael Schneider's lab a few years ago that was all about glucotype and he basically put continuous gluc monitors on lots of healthy and pre-diabetic people and looked at their patterns and and showed that there's sort of low intermediate and high spikiness of a 24-hour glucose curve and the more spiky someone gets more glycemic variability that gluco type of more severe variability was associated with those higher fasting insulin levels higher triglycerides that's that's basically a sign that they're you're kind of moving in that bad metabolic Direction so spikiness is one the second is actually like how how long it takes you to come down after a meal so if you if you're dealing with someone who's pretty insulin sensitive even if they eat a big high carb meal like for me it would be like a huge handful of grapes those are just like they crush me I might go up a 100 milligrams for D lader with a big a big handful of grapes just wild you want it to it might go up really far but it should come down really fast because that's a sign that your cells are hearing that insulin signal pulling it out of bloodstream and that's all working properly but you can imagine if someone's kind of moving down that spectrum of metabolic problems and they're a little bit insulin resistant they're not going to clear that glucose as fast so so they might actually have a wider Spike and it looks more like instead of like a sharp up and down more of like a wide Mountain you know and maybe it would take two three hours to come down all the way so that's kind of another clue is like how wide are the spikes um so you know so that's kind of an interesting one and um just sort of other little things you can look at from that 24-hour curve that you'd never be able to get from a one time um a onetime measurement um but in terms of things that that people can do um you know I I mean I have to say the basic one and the one that I would say is like foundational to above all others is to focus on food first and to move away from all Ultra process foods like that if there's of all the things I know and have learned over the years it's like if people could move away from the ultra processed foods so essentially the refined processed sugars the refined processed grains and the refined industrial seed oils and just eliminated those from the diet and move towards more real food that's minimally or unprocessed I mean that's number one and you know it doesn't even really matter in my mind what the pattern is whether it's carnivore or vegan or whatever if you move in that direction towards eliminating the ultra processed foods you're going to be doing better and the reason for that is in part because unprocessed foods are going to give your body a lot more of the good stuff that they need for the cells to work properly the micronutrients the poly you know the antioxidants the polyphenols um the the protein just the the basic building blocks that the body needs to function properly the second piece is actually has to do with the sort of monumental overloading of the body that we're doing right now with substrates essentially through alra processed diets with real food you cue the body's really Exquisite satiety mechanisms to basically uh help you not want to overeat when you eat real food of almost any kind the body is fairly incapable of overeating because it is so welld designed to essentially cue these hormonal satiety signals it's when you start Ultra processing food and just changing it and turning into this different thing that you just basically override the the body's ability to Signal when it's full or not this is why you don't see any obese animals really you virtually don't see any obese animals in the wild because no matter what they're eating there's plant-based animals there's carnivore animals there's omnivorous animals they don't get obese generally because the body knows how to self-regulate but only if it's eating minimally or processed food so that I mean that to me is number one and and when people start moving towards a more um Whole Foods diet um they tend to you know see their glucose numbers do a lot better but then there's a lot of refining um that can be really really interesting and one that a lot of people notice is that um it's just like the impact of balancing their meals properly so people really learn quickly wearing a continuous glucose monitor how making sure that there's adequate Protein healthy fat and fiber in meals and I we might feel differ about fiber and that's totally fine but uh but just in terms of if someone's spiking on a food that they love if they can add in more protein fat or Fiber they will often see a big diminishment of that Spike because of the way it's slowing digestion the fiber may even be blocking glucose absorption from ever even getting into the bloodstream um and it also cues increased satiety so they might actually eat less of the carbohydrates people also find that food sequencing um sequencing the meals a little bit differently can help so actually if you're going to be having sort of like a meal with all different macronutrients eat the fat and protein earlier in the meal eat the carbohydrates last and that seems to also change the glucose response so let's say you had a dinner a plate that was like a salad and then steak and then potatoes what the research shows and what we also seen in our data set is that if you start with um like the steak and eat that first and actually give it a second to sort of digest and then maybe eat the salad so starting to get a little more carbs and then eat the potatoes at the end it would be a much different glucose response than if you ate the steak I'm sorry the potatoes and then the salad and steak so that's kind of like a freebie you know just like eat the eat the meal in a different sequence um and then another like really simple tactic that I would say most people wearing a CGM end up employing pretty regularly is taking just a brief walk after a meal we see an almost 30% on average decrease decrease in Peak glucose response if people just take a simple gentle walk after a meal and the reason for this is because the muscle is a massive glucose snc it's just it's you know when you activate the big muscle groups which you're doing by taking a simple you know gentle walk um that is just pulling in tons of glucose from the bloodstream so there's almost nothing more exciting when you put on a continuous glucose monitor than after a meal where you start to see your glucose going up just immediately throw your tennis shoes on and take a 20 minute walk and just see it come right down uh so that's really really motivating and I would say speaks to a broader point which is that um one of the things that I think the the glucose monitors really in gender is the value of actually moving more throughout the day in a lowgrade way like it's not like you need to be exercising all day but kind of moving away from this Paradigm of like oh I'm just going to exercise for 45 minutes and that's my physical activity for the day versus can you maybe walk a little bit you know every hour throughout the day even if it's one to two minutes just get up walk around move around a little bit keep the muscles active cuz then you're kind of creating a situation in the body where you're keeping your glucose channels at the cell membrane like all day you're keeping those glute four channels at the cell membrane all throughout the day kind of keeping the muscles taking up glucose and that can have a really big impact on 24-hour kind of average glucose levels so get up do a few air squats take a one to two minute walk um it it it just sort of constitutively keeps the glucose moving out of the bloodstream in contrast if you're someone who's sitting most of the day and then has their 45 minute an hour workout in the evening that's great or in the morning that's great because you're getting some some exercise but it's a totally different physiology from that person moving a little bit every hour throughout the day because you know the times that you're sitting for three or four hour periods you're basically not activating your glucose channels to come to the cell membrane and so you're keeping more of that that that glucose in the bloodstream so um big takeaway for sure from our population and from the research is try to do like a little bit of low grade movement every half hour hour throughout the waking day and you'll see generally much lower glucose uh patterns okay that's that's interesting actually I remember hearing about a a start when looking at indigenous populations um you sort of H gather sort of things um and they were thinking like okay are they more active or are they standing walking moving they found that they were fairly sedentary they were sitting on average similar amounts of time as people in in the westw except that they were getting up about every 15 minutes so they weren't just sitting down for five hours in a row they were sitting down for 15 20 minutes they were getting up they doing something they were sitting down again and uh at least that researcher I I forget his name but he's at he's at Harvard and he he thought that that was a major um driver for their good health or at least one of them anyway just that that getting up and moving throughout the day it's so interesting it is that I I do think that probably is it um because there's been research that's sort of repeated this in the in the US literature and there was one that was super super interesting it was a study where they basically took three groups of people and um what they did was they had people um they okay so people were either doing a discreet 30 minute exercise period once per day um or walking 1 minute and 40 seconds every 30 minutes during waking hours and so basically both groups walked for 30 minutes total per day but one was split up into like just like you're saying with this indigenous tribe like a minute or two like up and down you know every 30 minutes and vastly lower 24-hour glucose levels in the group that did the every 30 minutes and so you know theoretically they could have been and in that study they were sitting the whole rest of the time but just that like popping up and getting those muscles to essentially be metabolically active and keeping that engine running throughout the whole day created a totally different situation in the body for for metabolism so that's an easy one to implement free easy not hard you know and I would say um definitely a big takeaway from what we've seen in our data set yeah great um yeah would say you know with the with the fiber I totally um think that that fiber is a good idea depending on what you're eating too because you know like exactly as you say and as I've seen Dr lustig say uh when you're eating whole fiber it makes a lattice and it blocks out about 30% of your absorption so if you're eating a lot of carbs you're just blocking out 30% of the carbs you're eating so that makes perfect sense why studies would say that this helps with blood sugar control like I I don't doubt it it's like you're not eating 30% of the carbs that you're eating grey yeah exactly freebies yeah so if you're eating things that that you don't actually want to absorb eat it with fiber great idea um I mean I don't think I need it from me because I don't I don't think I'm eating anything that that I don't want and um and so I want to absorb all that sort of stuff but I do think in those in those circumstances it would be a good idea um and so well we talked about exercise and we talked about diet what about um things like sleep and stress how do they affect metabolic health yeah I mean I think I think sleep is one of the most underrecognized factors of our Chron epidemic um of any of them I I think we're starting to talk about it more I mean thank God for Matt Walker Andrew hubman and you know the eight sleep people a lot of cool sleep technology coming out you've got Aura and whoop like people are starting to get it but um I think one one key takeaway I I I just um finished a book on metabolic Health that's coming out next year but I think one of the things that was so struck by by sort of like reviewing all the literature was that it's not just sleep quantity that is that is really impactful for metabolic Health it's actually sleep quantity it's Sleep Quality and it's sleep consistency so quantity is basically the total number of hours that you're sleeping and the literature shows that actually it's seven to eight hours time of sleep that appears to be best for overall metabolic health and it's actually a j-shaped curve so meaning that below s to eight hours the risk of metabolic diseases go up sharply but actually over eight hours and it also goes up which is sort of hard to totally understand but but basically there's a sweet spot and when when the body is deprived of sleep uh quantity um it's it's certainly a stress signal on the body and those those catac colomine hormones and the cortisol and the inflammatory mediators get released and that's all a problem for metabolic Health um so I I'm am a big fan of the sleep wearables and The Trackers because I think it's really easy to think that you're getting enough sleep and actually you're Pro somewhere between you know 30 minutes or an hour less than what you think you got getting into bed at midnight and getting up at 7 is not seven hours of sleep right there's time that we're awake during the night there's time to fall asleep there's there's all these different things and so we really want to see 78 hours time asleep on a Tracker and make sure you're you're logging that day after day week after week um for optimal metabolic Health the quality has to do with you know how much of the different sleep stages you're getting are you getting enough REM and deep sleep and restorative sleep and all these different patterns of sleep and that has a lot to do with the Sleep environment and um what you're doing before bed so eating late at night um drinking alcohol anytime close to bedtime or really anytime at all and having any light on in the bedroom can all have impacts on quality of sleep in in huge ways even having the light from like an alarm clock um can have an impact on our sleep so you really want the room to be pitch dark you want it to be silent uh you ideally you know don't want to have any alcohol on board and and try to space out food a couple hours at least a couple hours from Bedtime that can all have a positive impact on Sleep Quality and then consistency also has an impact on metabolic health and that is basically are your bed times and awake times pretty consistent day to day and this so so it's like are you going to bed at 11:00 p.m. sometime between 11 and 12:00 p.m. every night and getting up between 7 and 8 am every morning if that's sort of like your schedule that's fine and it actually matter it seems to matter more that you're consistent than exactly what those bed times are like it's not necessarily that 10 to 6 is better than 12 to 8 it's it's it's it's actually probably just as important or more that that you're being consistent dayto day and getting that good good quantity and quality so that's certainly the I would say of my Wellness Journey personally that's the one that's hardest for me I mean you're you're in the medical field too but you know how it is like during training and I don't know how it is in Australia but like that was actually impossible during a lot of training because of on call nights and I mean I felt the toll like I my metabolic Health went off the rails and when you when you when you screw up something as you know as primordial as sleep the body does not like it um and that comes down to a lot of our circadian Pathways um the Sleep consistency we have these genes in our bodies that are like the clock genes and genes that are controlled by our Central clock um in in the brain and um and they're on these 24-hour schedules but but they're not perfect and one of the ways that we entrain the clock in the body reinforce its 24-hour signal um is by when we go to bed and when we wake up when we eat our meals during the day and when we see light during the day those are three of the main ways that we reinforce the circadian clock and so eating regular meal times getting sunlight first thing in the morning and not too much late light late light late at night and having consistent bed times are three of the key factors we can do to reinforce our circadian rhythms and that is Monumental because so many of our genetic Pathways that are related to metabolism like literally when genes are turned on and off are Downstream of the Circadian sort of central clock and so you want to do what you can to entrain it and of course in our modern lives where we're like erratic sleep light 24 hours a day light all the TVs on in the background we're sleeping you know and then eating meals just kind of whenever can you imagine how confusing that is for our circadian genes and our our Central clock like it's just absolutely I can't imagine how confused it is and so of course we're getting this whole you know metabolic um disaster because our bodies are just so confused so a lot of what I think about is like how do you actually create this environment through our choices for the body to just actually make it understand what time it is like it doesn't have a clock inside like it doesn't it doesn't have a watch to check you need to give it signals to let it know what time what time it is and one of those things you can do is go to bed at a set bedtime which I struggle with still but um it's what it's one that I'm working on so that's kind of the Sleep picture and happy to talk a little about stress as well but um if there's any follow-ups on the sleep stuff I'd be happy to to talk more about that well no I I mean I think it's it's it's really important you know it's interesting about the j-shaped curve where you know it can be a problem afterwards I wonder if that's a product of of physically sleeping too long or because you're so metabolically unwell and your body's requiring you to sleep more and that is is a consequence of just being unwell something like that is there is there any evidence to One Direction or another it's a great question I don't know the answer to that but that is a really interesting hypothesis of like yeah if the body is sort of in a um almost like a state of needing increased recovery because it's sort of got problems um for whatever reason maybe that's why people are sleeping longer and that could have to do with the j-shape Curve that's very interesting yeah or dealing with something like depression or other conditions that kind of lead to hypersomnolence or whatnot so very very interesting yeah I don't think that's known yeah yeah it's um well it's interesting that it happens at all you know you you would think more sleep you know better um and I do remember remember one study that was very interesting with mice and they and they just looked at the the impacts of losing RM sleep and so they they tracked them and as soon as they went to sleep and went into the RM pattern they just sort of woke them up you know gently just woke them up and they get sort of agitated and they go back to sleep but they would never let them stay in RM uh pattern for very long and just wake them up immediately and so after a few days they were just like you know a bit more tired and agitated and they were getting a bit more erratic and they did this for a couple weeks and and and they got more and more erratic and then after two weeks they all died and so and that was just and but they were getting the same length of sleep overall they just weren't getting RM sleep and so yeah it was very interesting how how much of an impact that has on our brain and metabolic Health yeah yeah that's wild I mean they just dropped it yeah um that reminds me we have one other study that I I is fascinating that's I think was worth sharing which is that um you can actually take a group of humans and they I don't think they could do a study like this anymore but they did it back in the day and they took 11 young healthy men and they basically took them and gave them six nights of sleep deprivation and it was not all it was not all nighter sleep deprivation they basically just limited them to four hours of sleep which honestly like probably some college kids are doing that you know like young healthy person six nights of sleep where they only slept for four hours I probably did this during exams or finals what what happens when you do that you basically turn them all into pre-diabetics like in like over the course of six days and so you end up inducing impaired glucose tolerance and they actually were 40% slower after day six of clearing glucose out of their bloodstreams they'd give them like a glucose load like an oral glucose tolerance test and it would take it was 40% slow are getting out of their bloodstream which is essentially a sign of pretty severe insulin resistance because the body's not able to clear uh the the the blood sugar into the cells so then they followed up with seven nights of 12 hours of sleep so basically as much as they they had 12 hours they could sleep I don't think they probably all slept 12 hours but they could sleep as long as they wanted essentially and things normalized but it's profound and for me it's very motivating that like if you can induce in slim resistance in your body just by not sleeping even if you're eating the perfect diet um and doing all the other things if you're not sleeping you're inducing insulin resistance and so it's very motivating to me personally um that you know you it's it's you know these are lovers that we can all pull um for our metabolic health and if you skimp you maybe it's not four hours a night but skimp to five and a half or six hours for over the course of days weeks years like that's going to have a huge impact and the average American on average is sleeping 6.8 hours per day now and this has decreased from over like a little bit over 8 hours a century ago so sleep is going down and I think there's no question this is absolutely going hand inand with our our konic disease epidemic so yeah yeah absolutely who who is the gentleman from from Berkeley the Sleep specialist um God mention him but he said that um in his book he said that if you average less than six hours of sleep at night you're six times more likely to develop Alzheimer's so I mean that that's clear clearly showing metabolic dysfunction from lack of sleep unbelievable yeah is this Matt Walker maybe it yeah yeah why we sleep is such an incredible book I recommend that to everyone um really the science of sleep and yeah um definitely makes you think that the healthare system needs to reform because a lot of the studies where they're showing the the negative detriment the detrimental impact of sleep deprivation is in residents like like medical trainees who are basically you know end up having micro sleeps as they're working because they fall asleep for little momentary periods because they're so tired and they get into more car accidents and create medical errors and all these things are happening so aside from the metabolic issues of course there's just a huge cognitive you know load and not to mention when you are sleep deprived you're body is so much more motivated to eat carbohydrates that's a very well-known phenomenon um and so we we see a lot on the continuous glucose monitor data we hear this a lot from our members of like if they you know took a took a flight that caused them to be up all night or whatever like often the glucose the Baseline glucose will just like jump up 10 points like the It frame shifts up basically um and that's one thing that's really interesting to see on the CGM is like we think think that kind of like we have some set level of metabolic health or like insulin sensitivity that's sort of like where we are right now at this point in our lives but the reality is it's bouncing around like all the time and so that's actually helpful to see is like you can make yourself pre-diabetic either of us could in a week if we wanted to and then get back on track and this has actually happened to me before like I like my fasting glucose to sit between like 75 and 80 most of the time but like if I am totally off the wagon like I'm traveling I'm eating a little bit of airport food I mean things that I don't try and do often but like not exercising not lifting weights not sleeping well I'm stressed whatever I can easily get up to a 100 fasting glucose I can get back down very quickly but if you can see how that's happening you can just imagine how if you weren't aware you could slide down that slope and just kind of keep moving into that territory until it's sort of more firmly SL ified in your body so and that's another really interesting thing about monitoring and you can even do this with a a finger prick glucometer if you don't have a CGM is like realizing how Dynamic the body is in in both the wrong direction but also in the right direction if you kind of dial in the habits I think it's it's very motivating um so sleep is definitely a factor in that though for sure yeah I just that that reminds me back when I was doing um one of my suby at Duke I was in in plastic reconstructive surgeon I was getting maybe 3 4 hours of sleep at night you know we were we were you know in the door at at 4:30 in the morning and we'd be operating till 9:10 at night easily every night and and sometimes you know 2 in the morning and then back in at 4:30 sort of thing and so that was that was a lot and then I just I just sleep for 16 hours on the weekend like as soon as I get I just I'd just be in a coma and I remember that phenomenon of just like I need carbs you know I wasn't doing carnivore at the time but I was always very meat-based and so I every every morning when I went in I'm like okay I need to get you know go to the commissary and I would just get you a bunch of carbs and like a big soda with a bunch of sugar and caffeine like this is I need this to survive and I absolutely felt that then my intern year was the first year I ever started drinking coffee because I was like doing 100 105 to 120 hours a week and um and you know not not fun not pleasant work and I was just not happy and I was just felt miserable and just tired all the time and just uh you know if I was home I was sleeping that's that's what it was I didn't have a life that year and you know contrast that with now where I'm I'm arguably doing more hours because I I can do just as much just as as much at at work um but then I have my functional medicine clinic on the weekends that I'm not working at the hospital and I'm doing podcast stuff on the evenings and weekends that I that I have free time so basically every waking hour of every day I'm doing this you know it's much more I mean it's not fun not sleeping it's not fun working all night and then all the next day and then late until the evening um or 48 hours over the weekend and then having to do a 4 a 14 hour shift on Monday that's not fun but I can handle it now and I'm not completely stressed out freaking out just going like I'm just going to kill myself that my in year was the longest year of my life that that just like that that took forever to get through and now it's just it's been like four and a half years I'm like really is it really that's crazy it's just flown by so I don't think I'd be able to do that I would not have been able to do that if it wasn't for my diet and being more healthy overall but if I had if I had other pieces of puzzle out of place it it would all fall apart for me totally totally yeah I I that man bringing back memories um but yeah no my health went just totally off the perfect health in medical school just like thriving you know everything was great and then residen surgical residency started I got you know IBS and I was you know low energy acne chronic pain in my neck I was getting anxious all this stuff and it was like you know the second I am I don't know if you had this in your residency but it's like uh the I had like a research block for six months where it was like out of the hospital and just like a ninet to-5 in a lab and I was eating normally again and seeing sunlight and sleeping regularly and like everything went away in like six weeks you know it was just back back to normal everything and that was a real that really was definitely laid the groundwork for me pursuing the functional medicine path after I left surgery because I realized it's all the conditions you know this is not you could easily imagine if you if you didn't see such a stark like onoff switch of Health like that like where it was like I'm healthy and then I'm not and then I'm healthy again you could think like oh this is just who I am I'm just someone with acne I'm just someone with moodiness I'm just someone with gut problems but it's like no like this was an onoff switch because of these five or six things that were happening in my environment you know chronic stress not sleeping being on call all the time you just like um the cafeteria food all that stuff and then the carbs of course because you know I was you're just ravenous um and yeah and so that it's just when you experience that much of a stark contrast it's like oh this is this is conditional this is the this is the environment this is not me um and so but I think when some patients have been living this way for so long and they've never seen the other side of it like oh this is not my Baseline this is the conditions and then if you can pull them out of it so they can start to see how good you can feel it's hard to go back you know so you you so I think yeah a big part of um I think putting people sometimes on like a really strict couple of weeks of a diet like a whole 30 or something like that or probably for you putting people on a carnivore diet or something like that it's like you can so rapidly get people to start to feel a little bit better maybe for the first time and then it's kind of like a glimmer of hope that you can then work towards growing that yeah definitely and so well you mentioned it as well you know stress being a major driving Factor obviously has hormonal components as well and can derange our metabolism can you can you touch on the importance of stress and Stress Management yeah absolutely um so there's been a lot of different research that's kind of touched at this um ranging from you know chronic low-grade stressors like work stress being associated with development of type two diabetes or metabolic dysfunction also childhood trauma so there's the aces score which is adverse childhood events and an ace an adverse childhood event would be something like um losing a parent early or a divorce or being abused or a number of other different things and basically the more of these experiences that a child has had the more likely they are to develop a metabolic issue down the road um and so there's certain certainly this epidemiologic data that shows that an adult being under stress a person who do with stress in their childhood this all pushes people towards more of a chronic disease profile and then the reason it's probably happening on a biologic level is um it's a couple things I mean stress impacts our microbiome it changes it changes our gut function and our our diversity of microbiome which of course the gut brain AIS is so so so linked um it impacts our HPA axis so sort of like this master stress system in our body from the hypothalamus pituitary to adrenals that that produce this whole series of hormones that control our stress response um Early Childhood trauma can just kind of impact that in a in a profound way over the long term and sort of change our stress threshold um and make our bodies kind of a hypervigilant State and um keep us in a bit more of like a chronic hormonal stress State through cortisol and other cacom hormones and these hormones have an impact on both our liver and our liver's production of glucose and also our our mitochondrial function and our inflammatory system so in the way that it affects the liver um cortisol and other stress hormones actually tell the liver to break down stored glucose and release into the bloodstream and so we store glucose of course in Chains called glycogen in the liver and that's basically like this debbit account of energy in the body where like if your body thinks that you need energy really quickly it'll dump some glucose in the liver into the bloodstream to sort of fuel the rest of the body and in a real stress situation like you need to run from a threat this would be useful because if you're fasted and you really need some quick energy for your muscle sure if your liver dumps a little bit of glucose and it can fuel the muscles and the Brain that's great but in our current life we don't need to really run from anything we're just sort of stressed because of these more tional issues that we're dealing with and sort of like more psychological stressors the emails and the honking and the text messages and the News cycle and all these things and so what's happening is the body's still responding by dumping glucose into the bloodstream but our body's not actually using it it's not it's not fueling the muscles because we're not going anywhere we're sitting at our computers so you end up basically just like chronically dumping glucose into the bloodstream and it's it's essentially sitting there that's a problem so so that's one way the second piece is that the body is that stress is going to rev up our immune system and our our chronic inflammation and that's like we talked about earlier sort of just basically intermingled with the whole metabolic dysfunction sort of pathway they're kind of the yingyang of metabolic disease is sort of the mitochondrial function and metabolic side and the chronic inflammation side and together they just create the perfect storm of dysfunction in the body um and so yeah so a big thing that we see on our in our population of people wearing continuous glucose monitors is actually that they find that wearing the glucose monitor is almost like a mindfulness bio feedback tool in some ways because they'll find that things that they didn't totally realize maybe we're stressing them out like maybe they have to talk in front of their company or go on a podcast or something like that they might find that their glucose Rises during that and that is probably a sign that something things happening where stress hormones triggered the liver to release glucose into the bloodstream and that's a great signal basically showing you okay my body was feeling stress in some way um people sometimes find when they fight with a spouse like have an argument their glucose will go up or something like that and so what that then could cue is that people need to develop the toolbox of stress mitigation strategies to hopefully just essentially create situation in the body where it feels safe so that might be you know working on the diaphragmatic breathing or the Box breathing or you know keeping a gratitude Journal whatever modality is helpful for like acutely creating a sense of safety in the body in the moment that would be a good sort of tool to employ in that moment because day after day if this is happening over and over and over again it's of course going to com create compounding problems so um yeah so stress has a really interesting relationship with blood sugar and um and I think the modern world we're living in we're dealing with a lot of these chronic lowgrade stressors that are probably different from what our ancestors dealt with which was more like intense acute stressers that resolved and went away but day-to-day they weren't happening kind of all the time in this little sort of like nagging way that has a uniquely problematic uh impact on our our metabolic pathways yeah well that's great well I well that's all excellent and I think that that's given a lot of people a lot of tools to improve their metabolic Health whether they go on a cornivore diet or anything else and it's not like as you say it's not just diet it's a major major factor but there's so many other things that go in so thank you very much for for sharing all that and and sharing your time with us I really appreciate it oh it's my pleasure it's so great to connect thank you so much absolutely so where can people find you and and follow you so the best place I would say to find more information about like anything that we talked about today is levels health.com blog um we have an amazing editorial operation at the company that really strives to be the best resource for comprehensive metabolic health information on the web and so that's levels health.com blog we put a lot of sort of derivative education from that on social media so at levels on Instagram and Twitter and you shared the giveaway Link in the beginning so that's a great opportunity for people to try continuous goost monitoring if they want which I believe was levels. linkthe plant freemd MD giveaway um and our newsletter is amazing tons and tons of Education a lot of practical stuff about food what to buy it when you're at Costco or Trader Joe's or Whole Foods that's going to be metabolically healthy so I'm personally at Dr Casey's Kitchen on Instagram and Twitter and um but most of my articles come out through through the levels uh content so yeah those are the best places to find me perfect well I'll put those all up in the description and people can can find you there so Dr me it's been absolutely it's an absolute pleasure thank you so much for coming on thank you hey guys thank you very much for taking the time out to listen to what I had to say if you like it then please like And subscribe to my YouTube channel and podcast and if you're on YouTube then please hit that little bell and subscribe and that'll let you know anytime I have a new video out which should be every week if not more and if you could share this with your friends that would help me get the word out and let me know that you like what I'm doing thanks again guys to show is that that meat is bad you shouldn't eat meat you should eat fruits and you say when you eat more fruits and vegetables people automatically think you're eating that instead of meat right that's not the case you're eating it instead of processed garbage and if you're eating it instead of meat you will have poor health outcomes just like the akiu