The 3 KEY SIGNS You're Not Healthy & How To LIVE LONGER Today! | Casey Means & Mark Hyman

The key to losing weight is low insulin.

Right.

By optimizing our metabolic health, it is really the quickest way and the lowest hanging fruit way to achieve really almost any health goal.

Recently, a study was published that showed that 88% of Americans are in poor metabolic health. So how is that defined? What is that and why should we care?

Right. Yeah, that study was fascinating. UNC two years ago, 88% of American adults have at least one biomarker of metabolic dysfunction.

Because 75% of us are overweight, which means a lot of the skinny people are also poor metabolic health, right?

Exactly, exactly. And really my belief is that by optimizing our metabolic health and really stabilizing our blood sugar levels and keeping them stable and healthy throughout our lifetime, it is really the quickest way and the lowest hanging fruit way to achieve really almost any health goal that you have, whether it's to look good, feel good, to have longevity, to avoid chronic disease, to have athletic performance, to have your brain functioning properly. It's really the trunk of the tree of so many of these pain points we're dealing with today. So what is metabolism? Fundamentally, metabolism is the way that we produce energy in the body. So we have 30 trillion cells in the body and all of that.

Before you get in, I just want to come back a little bit because I think it's really important to define this poor metabolic health. There's really three biomarkers that are looked at, right? It was blood sugar, blood pressure, and cholesterol.

Right, exactly.

So 88% of Americans have a problem with one or more of those. And the cause of all of those poor metabolic health markers is, blood sugar.

Dysregulation and insulin resistance.

Yeah.

And so what happens is we have these 30 trillion cells and every single one, trillions, needs energy to function. We need to convert food to energy, an energy form that we can use in our cells, namely ATP, for our cells to function. And when that process isn't going properly, the metabolism, when that conversion is not working properly, We don't produce energy properly in cells. And what happens when you have energy, you get cellular dysfunction. When you have cellular dysfunction, you get tissue dysfunction. Tissue dysfunction leads to organ dysfunction, and organ dysfunction is symptoms. That's what it is. And so this is why metabolic dysfunction underlies so many of these seemingly disparate symptoms we're dealing with today, so many of which you've talked about in so much of your work, but metabolic dysfunction, this problem with producing energy in the body, is underlying some of the big heavy hitters, big killers in the US, obviously. heart disease, diabetes, Alzheimer's dementia, cancer, chronic liver disease, chronic kidney disease, depression. Depression. But all these other things that people don't even realize, depression, brain fog, infertility, erectile dysfunction, chronic pain, gout. There's so many of these that we don't really relate, when in fact, a lot of these are just this energy deficit, this problem creating energy and processing energy showing up in different cell types. but that core physiology is really the same.

So.

The main issue is that our lifestyle and what we're eating and what we're doing and how we're living is hijacking that process, that food to energy process by one of the big, big key players is the amount of sugar that we're eating in our diet. You know, the average American these days eats 152 pounds of refined sugar per year. 100, 200 years ago, we were probably eating around one pound of refined sugar per year. That's 152 times the amount of substrate that these poor little cells have to process. They break down. They just say no. And what that looks like is insulin resistance. As I'm sure many of you listeners know, when we eat carbohydrates and sugar, the body releases insulin, a hormone to help you take that sugar out of the bloodstream into the cells so that it can be used for these metabolic processes. But when that's happening in all the time, day after day, huge spikes in blood sugar, the cells become resistant to this insulin. There's so much insulin being poured out. The cells are like, we cannot process all of this. This is too much and the cells block it. So now you've got this issue where you've got tons of this glucose substrate, you've got all this insulin being poured out, trying to force more glucose into the cells, the whole machinery essentially gets gummed up. And that's really the root of metabolic dysfunction. You've got poor energy production in the cells. So by day after day, learning what is spiking our blood sugar and then learning how to optimize that, keep the blood sugar down, figure out what foods are affecting you, you essentially let the body rest a little bit. If you can keep the glucose down day after day by learning what's affecting you, you can keep the insulin down. And then the cells, start to perk up again to that signal and say, okay, we can do this. This factory can run a little bit better. So that's what Levels is helping people do, is really to learn how different foods and these products that we may be told are healthy are actually affecting our blood sugar. With that information, it's the first time ever we've had a closed-loop biofeedback system about what we're putting in our body and what it's actually doing to our health. I believe that people should know what food is doing to their bodies. Right now, it's kind of a black box and it's a mystery and we have to trust food marketing. We have to trust the different nutritional ideologies. And there's a lot of conflicting information out there. It's a hugely confusing landscape. And I really do feel that objective data, like through a wearable device that's giving you this real-time biofeedback, can just cut through a lot of that marketing a lot of those loud voices, a lot of the information from governing bodies that we know is not actually helping us achieve our goals. You can just see, this works for me, this doesn't, and then improve your metabolism with that information.

Yeah, I mean, here's the thing, Casey, is that as doctors, we really don't learn about metabolics. We have nutritional biochemistry lessons when we study the Krebs cycle in first year medical school. And the joke among all the medical students is, this is just a grunt class, basically you're gonna forget it as soon as you're finished, just cram for the exam and don't worry about it. Turns out it's probably the most important class in medical school. And we don't understand metabolism as doctors, and we don't understand even blood sugar and insulin resistance. 90% of the cases of pre-diabetes, which affects about one out of every two Americans, are not diagnosed because doctors don't know how to diagnose them. And they'll say, oh, your blood sugar is normal on your test. what is normal, what is optimal? They'll say your A1C is great, you're fine, no problem. No problem. Levels is you're giving people the opportunity to measure in real time what happens when their body ingests food and how that affects their particular blood sugar. Because everybody drink a can of Coke and my blood sugar and insulin might go to X and Y, so it was perfect. I measured her blood sugar. I said, well, maybe we should do a glucose tolerance test. Her A1C, which is the average blood sugar result, was perfect. it wasn't like, it was 100. It was like 80, you know, fasting, which is really optimal. And I said, let's do a glucose tolerance test and measure your blood sugar. And we're gonna also measure insulin because most doctors, and this was, this was probably 25 years ago, most doctors just never measure insulin even today, 25 years later. But it probably, as we were discussing earlier, probably one of the most important tests. So her blood sugar, after she took, like, the equivalent of two Coca-Colas perfect, like never went over 110 even after drinking the equivalent of two Cokes. Her A1C was perfect. Her insulin, on the other hand, like normal should be about five or less. Hers was over 50 fasting, which should, which is super high. It's 10 times. And when she, she had the sugar drink, it went to 200 or 250, which you just almost never see. It should never go over 30. after a sugar drink. And I was like, wow, here's someone who, if she went to a regular doctor, would have a perfect test, even if they did a glucose tolerance test. And so, you know, the importance of really digging down to understand what's happening with your own body is so key. And that's what's so exciting to me about levels, is it gives people real-time access to data through a continuous glucose monitor. which is a really relatively non-invasive procedure where you track your, your blood sugar on your phone. Super easy and fun and gives you so much insight. And, and, like, I, I was sharing a story before. I was, I was using the levels app and I was putting, I had the device on my arm. And this friend of mine, we're having a meal in Martha's Vineyard last summer, and it was a farm to table meal, but we got it brought in. It was because it was Cove. We didn't go out. We had, like, delivered. It was a huge amount of extremely healthy food. And it was so delicious that we ate an enormous amount. But even the idea that you could eat healthy and it still causes a problem, if you overeat, it's nothing that most people really understand. So, you know, I can eat all this healthy stuff, but actually our sugars, both of our sugars really, really spiked, even though we're both really metabolically healthy. So it's kind of a fasting lesson and gee, you know, we don't really always know what's going on inside our.

Bodies until we start looking. I think that's absolutely right. And I think you bring up the great point about biochemical individuality when it comes to metabolic health and metabolism. What might affect you might affect me very, very differently. And I wonder, you know, with you and your friend at this dinner might have had actually eaten the same thing and had different responses, you know? And that is really an important piece. You know, there was a really fascinating paper that was published in the journal Cell about five years ago by the Weissman Institute, and it was called personalized nutrition by prediction of glycemic responses.

This was based on the microbiome.

Yes, yes. They took 800 healthy people, so non-diabetic individuals, and they put continuous glucose monitors on them, these little devices that measure your glucose 24 hours a day in real time, send that information to your smartphone, and they give them standardized meals. So they said, you all are going to eat an identical meal or identical cookie and see what happens. And based on what we know about the glycemic index, index, which is this idea that each food has sort of a inherent property of how much it will raise your blood sugar. They actually found something very different. Wait, wait, wait, hang on.

So people, what she's talking about, Casey's talking about, is that scientists have come up with this chart of if you eat a banana, it'll raise your blood sugar this much. If you eat an apple, it'll do this much. If you eat chicken, it's going to do this much. And what you're saying is that was.

All thrown out the window because it depended on what was going on in the microbiome. Right, exactly. They had some people who raised 10 points to a banana and others that 10 glucose points and others that went up 100 milligrams per deciliter. So what might be a really sort of okay metabolic choice for you might not actually be for me. And they actually found equal and opposite reactions between people. So person A could eat, have a huge spike to a banana and no spike to a cookie, and person B could actually have the exact opposite. So this is where I think testing can be really helpful because we sort of have this culture where there's loud voices in the nutrition space saying, there's a one-size-fits-all diet, but I do think there's probably some more nuance to that. So that gets into the kind of the nitty-gritty of the biochemical individuality. And like you said, in that study, the microbiome was a key determining factor of how people responded to those different foods differently, which was pretty fascinating.

So true. I had a patient once that taught me a lot also. I mean, most of the stuff I learned, I learned from my patients. You start looking at the biology and you start asking questions, start thinking, and Most of us as doctors honestly just are pretty arrogant. We got trained in this guild in which we were told that this is sacred knowledge that's true with a capital T, that anybody who questions it is a heretic and is not evidence-based, which is the way we crusade against people who have ideas different than us.

And.

We'Re basically often blind to the very things that are in front of us. When a patient gets better or changes something, pay attention. So this guy had this diabetic regulation problem where his sugars are really volatile and brittle and it was tough to control. And we did get dramatic improvements by changing his diet. and putting him on a super low glycemic diet. But it still wasn't great. And he kept complaining about his gut. So we started working on his gut. And at one time, I was saying, oh, I'm just having all this gas. And he said, why don't you just deal with your GI symptoms? Just take some charcoal as a sort of an emergent, you know, stopgap measure to help fix what was going on with him. And next time I talked to him, he's like, that was a miracle. I said, what do you mean? He says, my sugar dropped 100 points when I took charcoal.

Right?

And I'm like, how did that happen? Right? It's not like the charcoal is not absorbing the sugar. What's happening is that in the intestinal tract, he had a whole bunch of bad bugs that were producing endotoxins, which are these really nasty toxins that certain bacteria produce called lipopolysaccharides. They get absorbed over in the gut. They activate the immune system. The immune system, and this is just old technical stuff, but it activates these things called cytokines, which then bind to receptors on the cell that cause insulin resistance. So basically these toxic bugs in his gut was causing his blood sugar to be all off and fixing that fixed his blood sugar. So it's very complicated. I want to get into something with you that I think, you know, is really important for people to understand because we sort of touched on metabolic health and poor metabolic health. But I wonder if you could take us through a story of, like, what.

Actually are all the things that are.

Happening because you create a list of of conditions that are related to poor blood sugar. What is the biology of what's happening when your blood sugar is out of control? What happens to your microbiome, to your immune system, to your brain, to your hormones? Take us through what actually happens in the body when you are eating the average American diet.

Yeah.

So there's sort of four things that I think are kind of worth focusing on. There's the direct effects of high blood sugar. So you eat something and your blood sugar spikes and then there's biological effects of that. And then there is a fourth thing which is the long so in terms of those short-term things, like you drink a Coke and your blood sugar goes up from 75 milligrams per deciliter to 150 milligrams per deciliter, that blood sugar spike can cause glycation. It can cause oxidative stress.

What is glycation?

So glycation is the process where sugar just sticks to things in your body. It's actually just like sugar molecules sticking to things like fats and proteins and, and DNA, and that can cause dysfunction. It can cause those cellular parts to be dysfunctional. And so that's an issue, we don't want that. It can generate inflammation immediately too. This huge surge of sugar is unusual for the body. It's like, what is going on? Why is this big change, this sort of homeostatic shift happening? We don't want that. And then it can cause oxidative stress, which is sort of this reaction where your body is producing metabolic byproducts that are reactive and can be damaging to the cells so these unpaired electrons that go around and want to bind with things, it's resting exactly. So big glucose spike, you can have immediate effects on oxidative stress, glycation, and inflammation. And then the fourth thing is this thing that's happening both immediately but also really has cumulative effects, which is the insulin surge. So when you have that big glucose spike, your pancreas is releasing all this insulin to help you soak up the glucose out of the bloodstream into the cells so it can be processed and bring the glucose back down. And what can happen there in in the short term is that if you've got a big spike, so that big up and down, the insulin can actually sometimes overshoot. It can actually do too good a job in soaking up all that glucose and you can have what's called reactive hypoglycemia, which colloquially is known as the post-meal crash. So if you've had lunch and then after lunch feel tired and you want to have that second cup of coffee at 1:00 PM and maybe you feel a little bit more anxious, that might just be the fact that your blood sugar has gone up, you've released all this insulin, the insulin's kind of overshot, you've crashed down, and now you're in this dip and the body's trying to get back into balance.

And that roller coaster- that creates a.

Secondary cascade of hunger hormones and cravings. Exactly. And so that's happening in the short term. And then that insulin process, going back to what we were talking about before, can over time lead to that insulin resistance where the cells see that huge surge in insulin so frequently that they actually say, we can't keep doing this. This is too much insulin and we get numb to it. And that's insulin resistance. And then what happens is your insulin levels, they start creeping up because your body's trying to overcompensate for that block by producing more. And then that leads to so many of the downstream conditions that we've been talking about. When you've got this high insulin, one of the secondary effects of that Let's just, we can talk about obesity. You know, insulin is a signal to the body that glucose is around for energy. And it's also a signal to the body that because there's so much glucose around, we don't need to use fat for energy. Glucose and fat are the two main ways that we produce energy in the body. And when that insulin's high, it blocks us from tapping in to fat burning. It says to the body, nope, you don't need to tap into fat burning. We've got a bunch of glucose around. And so this is relevant to to anyone who is trying to lose weight or who has the excess belly fat because that insulin is a real block on helping us achieve those goals. And so for us to tap into our copious fat stores in our body, we need the insulin to be lower. So by getting off that glucose roller coaster, by eating foods that keep us more flat and stable throughout the day, which is what we want for optimal health both in the short term and the long term, we give our body a break from producing that insulin. And that can have a real significant impact on our ability to lose weight, to get rid of that belly fat, to tap into this alternate metabolic fuel source, and to generate what we call metabolic flexibility, which is this ability of the body to flip between using glucose when it's around and using fat when it's not around. And that state of being able to do both is a really healthy state. It's adaptive. But the average American, with the vast majority of our calories coming from ultra-processed foods, and I believe more than 70% of processed foods in the US have refined sugar in them, and we've been told, of course, to eat six small meals a day, you are on, as an American, this up and down glucose roller coaster all day. And so you're really never giving your body this time in a low insulin state. You really do have to be quite aware and think differently. I mean, the reality is, as an American adult, you're on a treadmill towards being overweight and chronic disease. And unless you are doing something different, you will end up sick. And that's where having a little more awareness, I think, can be helpful.

100%.

And all the things you mentioned earlier.

People don't relate to this. They don't relate to blood sugar. They get diabetes is related to blood sugar, but what about cancer and Alzheimer's? and depression and heart disease and so many other issues. Infertility, Gal, you mentioned, sexual dysfunction, acne, I mean, whatever. It's just unbelievable how much of our modern ailments and how many of those ailments are driven by this single process. And you don't have to treat all these diseases separately. If you dealt with that, then these other things would get better. And I think it's something that I don't know why, but it's just such a dark black hole in medicine. There's a lot of literature on it. There's no lack of science, but in practice, the average doctor doesn't know how to diagnose or treat insulin resistance. You know, one of my patients came to me and said, you know, my doctor, I saw his blood sugar was like 115 or something. I'm like, hey, you're fasting blood sugar, a little high, you're heading towards diabetes. Like, yeah. I said, has your doctor recommended any thing. He's like, well, yeah. I said, what? He said, well, he said, wait till it gets to be higher and then he'll put me on medication.

And I'm like, oh, okay.

That is not a very enlightened understanding of how our bodies work. And, you know, the, the biological processes are so Central to every age related disease. Yeah. I was at a longevity conference once, and I was walking with Leonard Guarte, who was from MIT and discovered sirtuins, which are these incredible regulators of our mitochondrial function, our energy, which we were talking about earlier, and that are so important in longevity and aging. And I said, so what's the secret? Like, how do they work? And what's like, this was years ago. And I was like, there's the data we just tried to come out. He says, sugar.

Yeah.

I'm like, don't eat sugar. It's like, that's what's causing these systems to fail and for us to age and for all these chronic elements. And, and most people listening are probably, well, you know, I'm like, I'm not diabetic. I'm like, all right, what do I, why should I worry about it? Well, if you have high blood pressure, high cholesterol, if have any belly fat. If you're even thin but eat a crappy diet, this is going on under the hood. And so tell me why you feel that continuous glucose monitoring, which is sort of part of this whole new movement of what we call biosensors or quantified self or portable metrics. People have the scales that send their data up to the cloud or blood pressure cuffs or the OraRing or Fitbits or now there's continuous glucose monitors. why are these important and why should the average person even care? Because if you're not diabetic or pre-diabetic, which most people don't know, by the way, that they're pre-diabetic because doctors don't diagnose it. But why should people care?

Yeah, so I think that we've touched a little bit on why probably more people should care than, you know, they maybe realize with 88% of American adults having metabolic dysfunction, this is relevant to the vast vast majority of us. But I really think it comes down to personal empowerment and really understanding our own bodies. You know, we're not gonna fix healthcare without fixing health. And you can't fix health without fixing the decisions that we're making every day about what we're eating, how we're sleeping, how we're stressing, how we're moving, how we're supporting our microbiome or, you know, all these things. And So, it really comes down to choices. And right now, we don't have a lot of help to understand what choices to make for our own body. And that's where wearables and especially biowearables, I think can be very, very helpful. I'm not the type of person who wants to be strapped to technology for the rest of my life. That's not really, like, it's not my goal to, you know, be a cyborg and be wearing a sensor. you know, I'd rather, I want to be unplugged in the, in the backcountry, right? Like camping. However, the reality is that the system that we're living in right now is designed to hurt us. It's designed to keep us sick. It's designed to keep us dependent and, you know, coming back, you know, for medications and surgeries and whatnot. So in the world we're living in where our taxpayer money is going towards subsidizing refined sugar and refined corn and wheat and disease-causing foods, I think we need a little bit extra support. And I think that wearables can really help with that. And so that's where I'm really passionate about this is the empowering people to understand their own bodies and to make decisions for themselves in the face of a healthcare system that isn't being really proactive about metabolic health. We, like you were mentioning with your patient, you know, those numbers when we reach sort of the pre-diabetic or diabetic threshold, it's likely that we've probably had issues going on with our insulin for 13 years is one study from the Lancet showed that 13 years before we get that diagnosis. So how can we as individuals have tools that can help us during this time. I mean, if you can keep your blood sugar in a stable and healthy range throughout your lifetime, I'm fairly confident that you're never going to walk into a doctor's office one year and get a huge bomb dropped on you that you have a metabolic condition. If you're looking day after day, year after year, and knowing that what you're putting in your body is not causing these huge spikes, you have unlocked the door to essentially minimizing your risk drastically of all of the conditions that are killing Americans and eight of the ten leading causes of death in the US are directly related to blood sugar.

Absolutely.

And so that's- and then the cost.

And the suffering and on and on and on.

Right.

And so I think having a tool in the face of the modern world that we're living in can be great. And I also think that from what I've seen with my patients, when you really understand your body and understand how the environment is affecting your body, it's very motivating. Nutrition has kind of been a black box. It's always been an open loop system where you make a choice and you actually don't really understand what the result is often for a long time. Maybe you eat healthy one day and then the next day you step on the scale. That's kind of the lagging indicator. How do you create a relationship between what specific food led to that result? Maybe it's six months from now, you get a blood sugar test or a cholesterol test, but that one-to-one relationship has been missing. And now what's not with these bio wearables? So for me, for instance, you know, I was eating oatmeal for breakfast.

Oh, yeah. I wish I had read my ultra metabolism book then.

Exactly. Yeah. And I, you know, the box literally says heart healthy on it and good source of whole grains and fiber. I ate it with a continuous glucose monitor on and my blood sugar and I'm talking plain oatmeal, zero sugar, zero fruit, zero juice, plain plain, boring oatmeal, my glucose went up about 85 points. For me, there is no chance that that food is heart healthy for me because glycemic variability, these ups and down swings like that, I mean, I never really want my glucose to go above 20 to 30 points above my pre-meal levels. This was like 80. So, for me, it is not a heart healthy food. And anecdotally, for most of our members at Levels, it's also not a heart healthy food. We've seen very few people. if you look at the advertisements for this food, almost universally, it's the oatmeal with brown sugar, with fruit, with OJ, maybe with a piece of toast. I can't even imagine. So I think that's where some of this technology can really help. And I think it honestly can also improve the relationship between the doctor and the patient. I think this is not like people going to Dr. Google and coming in with a bunch of theories and questions. This is real information. It's real objective data. And I think it kind of can equalize that playing field and that power dynamic between the doctor and the patient. I think sometimes doctors will recommend things and patients will try them and it doesn't work. Their labs don't get better, they don't lose weight, and there can be a lot of frustration. There can be some mistrust. But if you can use a wearable to help personalize and almost be like a coach to help you achieve your goals. That can be great. And the reality is that 49% of Americans every year try to lose weight. So people are trying.

And probably 75% should be.

Right.

But that's a huge, that's hundreds of millions of people who are trying, who are making the mental commitment to, I want to do the work. I want to do better. I want to try and we don't have much to grasp onto to help us. And so I'm very passionate about how we can, for all these people who want to do better, give some tools sort of a lifeline.

Here's a secret that most people don't understand, especially around weight, is that the key to losing weight is low insulin. Not necessarily low blood sugar, but low insulin, because insulin locks the calories and the fat in your fat cells.

Yeah.

It's like a one-way turnstile. So once the glucose gets into your fat cells in your belly, it can't get out if the insulin's high, which people don't realize. And so the key, really, to weight loss is, is in addition to addressing all these chronic diseases, is to really get the insulin low. And, and, and the tool of levels, which is just an amazing technology that helped people in real time, track their blood sugar, correlate with what they're eating, with their activity, with their stress, with their exercise. It gives them a sort of a window into their biology that we really haven't had before. And we're just going to get better and better, better at it. Can I ask you, Casey, tell me from the people who use it, because now it's in beta, right? It's not quite out and it will be soon. By the way, for people listening, there's a closed beta happening now, but There's a waitlist of over 120,000 people who want to sign up. If you want to skip the line, you came to the right place because all you have to do, because you listen to this podcast, is get early access through going to levels.link/hyman. That's levels.link/hyman to get to be part of the waitlist, top of the line. So you get to cut the line. So In all the people who've used it, tell me what are some of the cases that just were the most instructive, the things that you learned from people's experience? You mentioned a few things, I've mentioned a few things, but give us some real patient stories.

It has been so exciting to see what our members are learning by putting these continuous glucose monitors on and using levels. Some of the most fascinating things, I mean, there's a lot of low-hanging fruit, right? It's like if you drink a soda, your blood sugar often goes through the roof. so that's that these are sort of the obvious ones. But then there is sort of the not.

You know, it's really interesting is that, sorry to interrupt you, but I just remember the study in the New England Journal years ago where they looked at first degree relatives of type 2 diabetics who were actually healthy. And when they did a challenge with them, they found that they had higher spikes of sugar and insulin than people who didn't have first degree relatives.

So.

Even if you look thin and great, you still might not be headed there, if you're not careful. If you're a Pima Indian, even if you were living 100 years ago, if you had a can of Coke, you're going to be in trouble.

Definitely.

And that's how they got to be.

The second most obese population in the world after Samoans. Absolutely, yeah. But I think even those simple learnings can be really helpful because we kind of know we shouldn't drink soda, although most Americans do. But you walk into the grocery store and it's everywhere and it's subsidized by our government.

And.

You might get the impression like, oh, well, if it's subsidized by the government and it's covering Safeway, it's probably okay. But then you see the data and you're like, oh, wait, it's definitely not okay. This is going way out of range. But then it gets into some of the more nuanced and exciting stuff. So one big learning is people realizing the importance of balancing their meals. And what I mean by that is adding fat, protein, and fiber to their carbohydrates. So, people will eat, let's say, an apple all by itself and have a pretty significant glucose spike. But they take that apple and they put some almond butter and some chia seeds on it, and they might have a very different response because we know that that additional fat, protein, and fiber from the chia seeds and the nut butter can actually slow the amount of time to absorb the glucose. and it can really change the dynamics. It also impacts the microbiome and so may even make us absorb less of the glucose because we are putting fiber in there. So that's been a major thing that we've seen is fat, protein and fiber.

Another- We call that the glycemic load.

Right.

Which is what is the total effect of the meal?

Yeah.

And even the timing, right? Have you learned about what happens when people eat what?

Yeah, exactly. The timing has been a huge thing. We've seen that people often find that if they eat something very late at night versus the exact same meal meal earlier in the day, they'll often have a larger response at night and it can impact their sleep quite a bit. You have it the same meal. Exactly, same meal. And part of this is because we're a little bit more insulin resistant at night naturally and this has to do with melatonin secretion. You have dessert earlier in the day? Basically, I mean, I would say that if people are eating dessert for breakfast. You know, eat your, I do tend to now front load my carbs because of what I, in the day, because of what I've learned from continuous glucose monitoring and I also know that those ups and down swings called glycemic variability at night can really impact sleep. And we integrate our glucose data stream with sleep and activity tracking so you can start to make some of those higher level insights about how sleep and glucose are related. We've seen a lot of people comment on how when they get less sleep, their glucose is quite a bit more erratic the next day. It's a huge impact. Massive sleep and then of course exercise. So one of the biggest takeaways is people realize that just getting up and walking for 15 minutes after a meal can have a significant effect on your post meal spikes. It can bring your glucose down faster. And if you look at a lot of traditional cultures, getting up and taking a stroll, it's super common. And now we have the biometric data to back up why it makes a big difference. and the last one I think that's been really interesting and again supported by the research is that stress definitely causes people's glucose spikes to be higher. We've had people who are fasting, you know, it's first thing in the morning and they have to give a talk to their company or they're on a podcast or something like that and they might get a glucose spike just from the stress alone. And the mechanism of that is really interesting. The cortisol and the the catecholamine hormones that are released when we have stress, they tell our liver to actually dump glucose into the bloodstream. And evolutionarily, the purpose for this was because when we had a stress signal like a threat, we thought, oh, we're probably gonna have to run from something. We're gonna have to run from the lion or whatnot. And so the body was like, okay, cool. You need to use your muscles. So we're gonna help you mobilize some glucose from the liver to feed the muscles. But now, what we're dealing with are mostly these psychological stressors, an email, a honking horn, a stressful phone call, whatnot. And so that glucose from the liver is not actually helping us. It's just sitting in the bloodstream causing problems. So what I'm loving seeing in our members is that this is not just about, okay, put on a glucose monitor and eat low carb and get a flat glucose line. It's about having a holistic picture of your health and all these different lifestyle behaviors that feed into building a body that processes food effectively. And that includes the amount we sleep, how we're responding to stress, how we're moving throughout the day, of course, how we're pairing and timing foods, and altogether those things can sort of work to let us have a better glucose response. Yeah, I mean, people don't know, like.

They have a glass of wine when they go to a restaurant at the beginning of the meal. It's very different than adding it in the middle of the meal. Same glass, very different effect on your body. So those kinds of things or having bread, which they put at the table, obviously, is to spike your hunger, which it does because it spikes your blood sugar. So if you have the bread middle of the meal, I mean, we shouldn't eat that much bread anyway, but it's like basically there's a very different thing. So how have you found that levels has helped people change behavior? Because at the end of the day, people want to change behavior so they can change the outcomes of their health, weight loss, reversing diabetes, improving the way they feel, right?

Yeah, absolutely. So I think it's twofold. I mean, one is that it's really helping people understand that this is, again, not just about eating the low-carb bar that has no sugar. This is about really building a comprehensive lifestyle that supports our metabolic health and how to pull those different levers to do that, whether it's moving more, Exercise, for instance, the beautiful thing about muscle that I don't think most people or doctors know is that it can actually take up glucose without insulin. It's this glucose sink that soaks up glucose from your bloodstream without the insulin signal. So the more we can just get up and move around the day, even for two minutes walking here and there, it contracts those muscle groups and helps you soak up that glucose that's out of your bloodstream. so we've really seen people learn about foods that are very surprising to them. A lot of people who have been on diets and haven't had success and then realized that there are foods they thought that were healthy that are actually not working for their body. And some of the key ones, I'll use me as an example. I learned, I've been using this for now for about 18 months, but in the first month I realized corn, rice, grapes, sweet potatoes, oatmeal, and most grains all sent me above 150. We're all told to eat whole grains.

Right.

And sweet potatoes and grapes. I mean, it's fruit. And it's not to say those are unhealthy foods, but if I were trying to lose weight or if I were... That would be good for you. They wouldn't have been right for me. So that's the type of behavior change we're really seeing. And I think athletes have been a fascinating one as well. A lot of athletes are eating the standard sort of recovery foods, whether it's a shake, a Gatorade or a sports bar, and seeing that they're just going to the moon, you know, and that that's actually not supporting their goal with recovery. So, so that closed loop biofeedback, the ability to have, you know, awareness, control, sort of some agency, I think that's where we're really just seeing people feeling great. It's not just about the food, it's about feeling like we finally have something to hold on to, some form of control in what is a very complex food ecosystem. Well, this is such a tremendous advance.

That now we have the technology at a relatively low cost to measure our blood sugar continuously. And it's just the beginning. I mean, Levels is going to be working on lots of other biomarkers that we need to measure insulin, for example. And then we're going to be seeing this technology of biosensors, quantified self, wearables becoming just part of the standard of care as a way of helping to understand what's happening in our bodies. and giving us the ability to be proactive about it and to be in charge. And, you know, my friend Chris Carr got cancer, and she. She decided she was gonna, you know, take ownership of her own health because it was an incurable cancer. So she's jokingly says she was the CEO of save my ass Technologies, you know, Inc. You know, and I think that's sort of where we all need to be thinking, because. sadly, our healthcare system is not a healthcare system, it's a sick care system. And if you want to create health, you have to learn how to do it outside of that system most of the time. And these companies like levels and others that are helping people get the data that they don't traditionally get from their doctor is going to just revolutionize healthcare. Just quickly, tell me how did you go from being a Stanford trained ENT surgeon, which by the way is no small task to get there requiring Decades of study and a tough residency, how did you go, Nah, I'm going to focus on functional medicine and blood sugar and start a company?

It was an interesting path. I'm nine years into my postgraduate training, so four years of medical school, five years of head and neck surgery residency. I'm sort of looking around me and I'm taking stock of what I'm doing every day with my life. I realize that most of the conditions that I'm treating are inflammatory in nature. It's sinusitis, laryngitis, thyroiditis, it's all the itises, which, as you know, Mark, itis is the suffix in medicine that means inflammation. And I'm realizing, huh, I'm prescribing a lot of steroids every week. I'm prescribing oral steroids, IV steroids, topical steroids, nasal steroids, these all turn down the immune system. And it got me thinking, you know, I'm doing a lot to really tamp down on the immune system, but inflammation is the body's sign that there's a threat. It's perceiving a threat.

What's wrong here?

It needs to fight. We were never talking about what is that threat.

No, right. It's so true in medical school. We never learn how to be an immunologist or how to be detectives to figure out what the heck's causing the inflammation in the first place. We got very good at suppressing the inflammation with aspirin and non-steroidals and steroids and immune suppressants and on and on. We get better and better drugs with more and more side effects. But we don't really ever ask the.

Simple question is why? Well, you can't code for chronic inflammation.

You know, and so it's not something.

That we really think about.

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You got me saying, what is causing all this inflammation? What is the root cause? And what I really started to, and why are we just turning to medication? And then when the medication doesn't work, going to surgery. And then it got me thinking, you know, you can't operate on the immune system. So really, we're operating on these sort of downstream effects of these diseases, but we're not actually changing the physiology that's leading to these diseases. And you're seeing a lot of recurrent revision surgeries. It really gets you thinking, are we actually getting at the root cause here? And so that really led me on a journey and a journey to looking at those root causes. And what we know is that so much of the way we're living our lives these days in the Western world is what's triggering that inflammation. And one of the key root causes is metabolic dysfunction. It's blood sugar, it's insulin resistance, it's the way we're creating and processing energy in the body that can be a huge, this is not going well. It can be a huge driver of inflammation in the body. And what I then sort of also realized was, okay, so ENT is kind of this niche part of the body, but all the other killers of Americans, the main killers of the Americans, are also being caused by chronic inflammation, heart disease, diabetes, obesity, Alzheimer's dementia, cancer. The same cytokines, the inflammatory molecules that are upregulated in sinusitis, it's the same ones in all these diseases. so let's talk about that and let's talk about how to mitigate some of these root causes. And fundamentally, that comes down to not a pill, not a doctor's visit, not a surgery. It comes down to the choices that we're making every day about our exposures, about what we're eating, about how much sugar we're having, about how much sleep we're getting, the movement we're doing, the toxins we're exposing ourselves to, how we're supporting our microbiome, our micronutrient status, these are the hundreds of micro decisions we make every single day. And so it became really imperative to me to think about how do I, if I'm a physician and my goal is to generate health, how do I actually empower people to make the decisions every day that are going to create conditions in the body that will ultimately lead to proper metabolic functioning, cellular biology, and ultimately health. And so that became a real shift for me from really being embedded into what is a highly reactive medical system that really benefits off people being sick and staying sick. That was another thing that really impacted me as a surgeon was realizing that I make money, I profit if people who are sick come to me. I actually don't make money really as a surgeon if people are all healthy. And I don't think that type of thought process really is affecting the average doctor day to day, but it's built into our system. And those systems factors can be very troubling. And I guess, you know, long story short, it came down to a real reckoning for me five years into my surgical training where I looked up and I said, we're spending 3.8 $8 trillion a year on healthcare costs in the US. And the reality is that people are getting sicker, people are getting fatter, and people are getting more depressed.

This is sounding much fun.

And we are increasing that spending year over year. And I am a steward of this system. I am a leader in this system. I'm a doctor. And if you're a doctor and you're looking at those realities, which are true, we're spending more and more every year and people are getting sicker, fatter, and more depressed. what are you doing if you're not stopping and saying why?

It's just amazing to me that we never ask that question is, you know, why is our ship filling up with water?

Yeah.

Let's just keep bailing the boat. No, let's figure out what the holes are and fix them.

Right.

And in medicine, we don't do that. You were talking about, you know, your goal as a doctor is to, you know, create health for people. I would disagree with you. I don't think that's what we're trained to do. We're trained to treat disease. we never took that course. I mean, maybe at Stanford, they have a course in creating Health 101. I surely didn't get that class in medical school. And it's, it's really a very subtle distinction. But if you go to the average doctor and say, how do I create optimal health? How do I create profound metabolic well-being and health? How do I optimize my brain? They're like, I don't know. Eat better, exercise, sleep. I don't know. Like, take a multivitamin. There's really no depth of understanding of the science of health. and your company levels is really not looking at necessarily disease per se only, but it's actually helping people understand the subtle variations in their biology that determine the quality of their health, which determines the quality of your life.

Exactly.

And that is what's so profound about the shift of disempowering the average patient in our medical culture. I mean, the average sort of traditional doctor was you go to the doctor, they tell you what to do, you just do it, and there's no questioning. and the reverence for that is starting to slip for sure. But there's still this sort of understanding that, you know, you go to the doctor to get fixed. It's just not how it works.

The thing that I really wanted to, to, to Usher in and bring to the Forefront, because it sounds the most, like, ghostly. It sounds like cast with the ghost. Like, it's not even a real thing is inflammation and how inflammation has an impact on your body composition. And the data exists. It's just that a lot of folks don't know about it. And the way that it really manifests when we're talking about inflammation is that it has this very detrimental impact on our organs that are related to our body's production and utilization of our fat, kind of fat loss related hormones. So, namely, let's take our liver, for example. Your liver is incredibly important in regulating your metabolism. You know, we're talking about a relationship with how it manages insulin, even the production of fat. takes place in your liver too. The storing of glycogen can take place in your liver. You know, if your liver is if your body's overburdened by glucose, your liver can literally convert that into fat right there on the spot. And so if something is damaging your liver, it's going to inherently damage your your endocrine system and your process of metabolism. So inflammation, and I've just kind of shared some of the data in the book, damaging your liver and what this is one of the most fast growing issues in our country is non-alcoholic fatty liver disease.

Yeah.

This is really a kind of chronically inflame in inflamed situation taking place in our liver. And also, how do we, how do.

We get fatty livers?

Because I think people should know we go to fancy restaurants and they give you foie gras, which is French for fatty liver. And, and it's, it's how do they get the ducks to be like that? And how do they get us humans to have 90 million Americans with fatty liver?

Everybody should know by now. Very simple. The fastest way to, to damage your liver and to create that fatty liver. When, by the way, it's called non-alcoholic fatty liver disease because we associate it with alcohol. But sugar.

Sugar. Absolutely.

Sugar, starch, flour. It's, it's so bad. It's so bad, particularly liver has corn syrup.

Your liver has to take on the brunt of it because your liver is really, even the name, live, it's responsible for so much. Like every minute, it's filtering your entire blood supply. You know, it's so important.

That's right.

But to take this one step further, and I'll just drop this little nugget so we can move on to the other topics, but also the master regulator often referred to, of course, you know, I've even taught this in my conventional University setting. But your hypothalamus, all right? Your hypothalamus is one of the major regulators and communicators with your thyroid, with your liver, with your adrenals. All the organs related to fat loss and fat storage, the governing kind of master gland, it's called the master gland is your hypothalamus.

That's in your brain.

You hate it.

Right. And now we've got data that this new term, neuroinflammation, inflammation specifically regarding the function of your hypothalamus can damage what's happening with your metabolism. But nobody's talking about that in these cookie cutter diets that you need to address the inflammation in your brain in order for you to lose weight.

Right.

So these are all. And the beautiful part is it's possible. It's not just possible. It's probable when you have the right information, and we avoid the things that create the inflammation. And namely, you just mentioned. sugar, but we go through a whole subset of the different things. Yeah, in functional medicine, we also look.

At, you know, food sensitivities and environmental toxins and the microbiome and all, there's so many things that drive inflammation. And if you're overweight, you're inflamed. And for those listening, you know, think, oh, you know, I'm a few pounds overweight, a little extra belly fat, you know, maybe I need to lose 10, 20 pounds, or maybe you're over more overweight or obese. you should really pay attention to what Sean's saying because right now during this COVID pandemic, what we're finding is those people who are overweight or obese or have even a little bit of extra fat are much more likely to get sick, much more likely to end up in the hospital, the ICU, and to die from COVID-19 because of poor metabolic health. And what's so beautiful about the body is that you think, oh my God, I've taken years and years to get here. Within a couple of weeks, you can change all of that. You might not lose all the weight in a couple of weeks, but you can change your inflammation markers, your hormones, your brain chemistry, literally in a couple of weeks of changing your diet and following the principles that are in Eat Smarter, which is Shawn's new book, which.

You should all get a copy of. Thank you, Mark. And just to reiterate, reiterate what you just said, it's so important. You know, the CDC's recent report found that about 90 folks, 94% of the folks who lost their lives had an average of 2.6 chronic diseases or comorbidities, you know, and we've got to get our citizens healthier. And the big thing in the beginning of this was, well, we can't get people healthier overnight.

When?

When are we going to start? And truly, it's up to us in conversations like this. So I just wanted to share that. But also leaning into this topic and just, you mentioned environmental toxins, but I'm going to share something that's a little bit controversial. And this has to do with supplements because there's been a big shift taking place that it went from about seven percent to 20 of hospitalizations related to liver damage are related to supplements because this is because, like, Mark, when I was trying to turn my health around, I became a natural pill popper first. I didn't get it with the food. And so I'm taking, I've got, like, my grandma's, like, pill full of, like, 20, 30 different things.

Yeah.

I'm trying to take to get these nutrients. And so, yeah, not to say that the right supplements aren't helpful, but it's a largely unregulated field on top of that.

Yeah.

But also we need to Target and understand that your liver is responsible. for metabolism of all these supplements. And it's also responsible for drug metabolism. And now we've got about 70% of the United States population on pharmaceutical drugs right now. And your liver is responsible for that drug metabolism. So just want to throw those things out there. But to shift gears to go from inflammation, that's one of the major causative factors behind an inability to lose weight. And the other one is hormone dysfunction.

Yeah.

And your hormone response. This is where the real magic happens. This is where the show is going on. Your hormones are like the little chemical Messengers that are communicating with all the cells in your body and really create communicating a message on what they need to do. And so there are hormones that are specifically related to fat storage, and there are hormones specifically related to fat utilization.

Yeah.

And just to give a super overarching look at this insulin. Insulin is our body's major kind of energy storing hormone. It's a beautiful thing. Insulin's not a bad guy that is storing energy slash fat.

It's.

It's helpful. We need it. It's part of our Evolution to have it now. It's getting. It's being hyper utilized and hype and put to work chronically, and it can get overworked and it can just be like, I quit, you know? So we've got insulin, but on the other side, insulin has a brother. glucagon. Glucagon really does the opposite. And they're both produced at, you know, from their loving mother, Miss pancreas. And so they each have opposing roles, but glucagon can't do its job unless insulin sits down. You know, that these two things is a binary process, but insulin literally triggers the cell to open up to use that energy. And there are specific nutrients involved in these Communications, in these Pathways. and nutrients that make these pathways kind of suppressed and create hormonal clogs. So a big mission with the book is taking folks through and teaching them about all of these fat loss and fat storage related hormones to give them really good education, but in a way that's fun and it makes sense. You know, we get a conversation about thyroid hormone, your adrenals, all those things. So hormone dysfunction, regardless of what diet you're on, we have to find ways to optimize what's happening with your hormones.

And then they play a huge role in regulating your metabolism, as you said. And they're driven in large part by what you eat. People don't understand their testosterone levels and your sex drive is controlled by what you eat. If you're a guy, if you're a woman, your level of estrogen and fat is determined by what you're eating. Certain foods increase estrogen like sugar and alcohol. That's why they give estrogen to male steers to fatten them up, marble their fat before they take them to market, right? There's no lack of science about this. We just don't understand it. And then of course, there's the appetite issue, which is such a big thing for people.

Yeah.

Oh, Mark, and this is so important. This goes back to when I mentioned Dr. Lulu Hunt Peters impressing upon society that hunger is related to weight loss. And unfortunately, millions of people still believe this. and hunger is a biolot, like biofeedback, it's biological feedback that something is awry here, all right? And this could be a nutrient deficiency. This could be related to some form of like habitual, you know, addictions, things like that. But our hunger isn't the issue. We want to make sure that we're not hungry because that hunger is associated with overeating, of course. And we could try to battle our biology. But eventually it's going to win out against our willpower, which is finite. And so with that said, let's get folks educated on how our appetite works. And now these terms that we've been talking about, you and I probably for over a decade at least, but now a lot of folks know about the power of leptin and the power of ghrelin. These are kind of the major players, but we go deeper than that. And now we know that leptin, for example, leptin is your body's major satiety hormone. and it's actually produced by your fat cells. Now, here's the catch. Folks, and this is one of the studies that I put into Eat Smarter as well, and this was published in the New England Journal of Medicine, found that folks who are overweight and obese.

Actually have plenty of leptin that should make them satisfied.

Dr. Yeah.

Well, they have leptin resistance. Dr.

Exactly. Dr. and inflammation causes leptin resistance. Dr. Exactly. It all starts to go together.

They're still getting the DM.

The leptin DM is being sent. but it's going to spam. You know, it's just like been throwing spam.

So.

And so that's what creates that leptin resistance.

Yeah.

And that's just one aspect. And then, guerlin is this glorified hunger hormone. There are specific things we can do with our nutrition, obviously, that encourages leptin sensitivity and really helps to get ghrelin in check. But there's so many other players. Adiponectin is one that you're going to be hearing a lot more about related to satiety. And adiponectin has been found to help. move more of the kind of troublesome body fat in the visceral fat area and actually transfer that to the subcutaneous fat area, which makes it a little bit more protective. We still want to address both of these kind of white adipose tissues, but the visceral belly fat is what's really dangerous, the most dangerous from the.

What's fascinating about adiponectin is that when you have high levels of adiponectin, you can't actually mobilize fat. And what causes high levels of adiponectin is insulin resistance, which is pre-diabetes, which is eating too much sugar. So it all comes down to the starch and sugar. So your book is just filled with wisdom and information about these key mechanisms about how different foods and nutrients affect your brain function, about the microbiome, how it affects relationships, how it impacts our communities and stress levels.

I mean, it's just, it's so full.

Of beautiful things that are far beyond just what to eat. You talk about love languages in the book. It's such a fantastic book. And I just want to sort of close by talking about the research around sitting down for a meal with people you love and what that does to your health, your food choices, to your body composition, because we've kind of lost that. I think the idea of a family dinner, the idea of cooking together, eating together, being together, it's like I think the average family has dinner together a couple of nights a week, usually all while eating different foods made from different factories, heated up in a microwave that are eaten while watching TV or being on their phone. not exactly conducive to health. So tell us about this, this research about eating together.

Yeah.

And this is incredibly powerful because it's not just what we're eating, but it's also how we're eating and who we're eating with has a major impact on our overall health. And I share this story in each smarter that I grew up. It might sound a little far-fetched for some folks. It's like people aren't sitting down to eat together. I can count on my hands how many times I sat down and ate a meal with my family growing up. Wow.

All right.

Wow.

This was an incredibly rare occasion. This is usually, if it wasn't a holiday, by the way, holidays are a little bit different, but it's usually just a free-for-all. We might eat at the same time, but we're not eating together and/or we're eating in front of the television or playing a video game or something like that. And so this is not abnormal, by the way. This is really shifting to be the norm. and here's some of the healing factors of this. Researchers at Harvard University uncovered that folks who consistently eat dinner with their families frequently consume more fruits and vegetables and less processed foods and sodas. And one of the most, I think this can get overlooked in the study. They found that folks who consistently eat dinner with their families also had higher intakes of some of the most important nutrients that regulate our fat storing hormones and your fat burning hormones as well. So things like calcium, folate, B vitamins. Also they found they had a generally higher lower intake of dangerous compounds, you know, like trans fats and yeah, yeah, and toxicants in our food. So this is really powerful. But one other study, and this is the most important for myself personally in this mission, and this was published in the Journal of Nutrition, Education and Behavior. and they found very similar results. And now it gets into numbers. They found that folks who eat with their family, and this could be any meal of the day, breakfast, lunch or dinner, just four times a week, dramatically increased consumption of fruits and vegetables and reduced consumption of soda and chips. And what was so beautiful about this study is that this was done on folks who would be considered higher risk. which was minority children, minority families. So this isn't just about fixing the environment around the thing, it's the personal responsibility as well knowing you have leverage because the simple act of eating together as a family helps to increase, improve the health outcomes for the children and the adults as well.

It's so true.

My friend Laurie David who was involved with the movie Fed Up that I was in years ago, I wrote a book called the Family Dinner and she talks about the research on if you have family dinners where you're eating food together and you're making it together and you're enjoying real food, that the kids have less likely to have obesity, eating disorders, violence, do better in school, have less drug use. I mean, just so many benefits that you wouldn't even think, I mean, better grades. I mean, just by eating dinner together. So, I think that's really important. And, I think it's beautiful how you combine the understanding of the deep science around food and how optimize your metabolism with the science around relationships and love and connection. And that's really what food's about. It's about joy and pleasure and connection, but it's also about having us live our best lives because the tagline in the book title, Transform youm Life, actually is true. And food has the power to do that. And eating smarter will teach you how to do that.

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This is a central driver of almost all chronic Western diseases.

Heart disease, cancer, diabetes, Alzheimer's, high blood pressure are caused by this phenomena of insulin resistance or too much insulin, which.