Everything You've Ever Wanted to Know About Blood Sugar & Glucose Monitoring, But Were Afraid To Ask Or Didn't Realize

My name is Ben Greenfield, and on this episode of the Ben Greenfield Life podcast.

So we're all in the sort of like 110 to 120 as your peak post meal glucose. I like to stay about between 70 and 90 in between meals, like resting during the day and not really go above 120 after meals. And I like to go up and come down within two hours, and that will pretty much make me feel my best.

Faith, family, fitness, health, performance, nutrition, longevity, ancestral living, biohacking, and a whole lot more. Welcome to the show. Unless you've been hiding under a rock or something, you probably have heard about this thing, this trend in health called cgm. CGM stands for continuous Glucose monitoring. Continuous glucose monitoring. Like, you might have seen me sometimes wearing a patch on my arm. Usually I put on the back of my arm, even though I'll ask today's guests if that's a decent place to put her if I'm totally messing up. But anyways, it tracks my blood glucose like 247 all the time. You may have been to the pharmacy and seen those little blood glucose pricks that you can get where you prick your finger and you bleed onto the little thing. This is just like doing that. But all the time. Even though there might be some subtle nuances or differences, which I will also ask my guest about today, they're super useful. Because even if you're not diabetic, I think it's no secret that paying attention to your blood sugar is one of the most important things you can do for your health. As a matter of fact, I'm convinced that paying attention to that, paying attention to your inflammation levels, and paying attention to what's called your heart rate variability are possibly three of the best things to track when it comes to keeping your finger on the pulse of your health. There's so many benefits to tracking blood sugar and so much I've learned over the past few years. But I haven't ever really done, like a big podcast on all of the nitty gritty questions that I have about continuous glucose monitors. Like, for example, like I mentioned earlier, where do you put them? Like your arm, your stomach? What are some surprising things that you might not know that might spike your blood sugar? Like, strangely enough, for me, one thing I found was, like, green beans. Then it turns out I did a food allergy test. I'm actually allergic to green beans, which is weird because that's like a slow carb, low carb food. Are there differences in accuracy between these different brands, like the Dexcom or the Freestyle. Are there other things these things could potentially track besides blood glucose? What are some reasons that people who are healthy might still have high glycemic variability? When is blood sugar going too high? I don't know. Maybe from a sauna or an exercise session. Not an issue. And what do you need to be concerned? Concerned about it? How soon should it come back down? Just like so many questions. So I decided I want to get somebody on the show who I could geek out on this stuff with. Fortunately, she's a doctor. I'm not a doctor. I just have the T shirt. Her name is Casey. Means you may have heard of her before. If you have looked into CGMs, because she's actually the chief medical officer of one of the top metabolic health tracking companies out there called Levels. Levels is kind of like this company that has an app that will allow you to go way beyond whatever the native plain Jane no frills app was that came with your continuous glucose monitor and allow you to do a ton of other stuff like run tests and get a lot more insight into glycemic variability and learn a lot more about your body. It's a pretty cool app. I have really, really enjoyed using it. Learned a ton from it. Casey is the person who's kind of like the mastermind behind this in terms of advising levels. She guest lectures at Stanford. She's the associate editor of the International Journal of Disease Reversal and Prevention, and she kind of lives her life through the lens of trying to reverse the epidemic of prevent chronic disease in many cases by helping people control their blood sugar. And she's well published, well respected, and very well known for being an expert in the whole continuous glucose monitoring space. So, Casey, welcome to the show.

Thank you so much, Ben. I am so excited to have this conversation with you.

Yeah, it should be pretty cool. And listen, I know because I've heard you on other podcasts and probably a lot of people are kind of sort of aware of this. I don't think that we have to spend an hour on this podcast telling people that controlling your blood sugar is a good idea or tracking your blood sugar might be handy for you to do. We could. But I want to dig into this stuff that selfishly enough, I want to know about that maybe isn't asked enough from a blood sugar standpoint. If you're game, is that cool?

Absolutely.

Okay. All right. So I guess my first question is, and this is alluding to something I already mentioned in the introduction, are you wearing one of these things right now?

Right this very second I don't have one on because it actually expired yesterday. So I have to put a new one on today.

If I could explain this to folks, it's like a sensor. You slap it on your body and it will stay active for a certain period of time. But I'll wear mine and then take it off, and after I've learned a whole bunch for a couple of weeks, put it back on a couple months later, or perhaps when I'm having weird energy levels or weird sleep, I'll put it on just to see what's going on with my blood sugar. But if you were wearing one kc, where would you stick it for ideal accuracy? The ideal combination of accuracy and ability to engage in your daily functions like workouts and things like that.

I personally love it on the back of my upper arm. So this is a very standard place that you'll see a lot of people wearing it, like when you're just walking down the street. And so the reason I like it on the back of my arm is for a few reasons, I think, just. Just in terms of where the options are. So for the Freestyle Libre, which is one of the main types of sensors, there's three main companies that make these sensors, which is Abbott, which is the Freestyle Libre, there's Dexcom, that makes the G6, and there's Medtronic. The two sensors that levels members use are the Freestyle Libre and the Dexcom G6. For the freestyle Libre, it's approved for the back of the upper arm, so that's really the place that they recommend wearing it. And for the Dexcom G6, they actually say that you can wear it on your upper arm, your abdomen or your upper butt, basically. So on your haunches, which I have not heard of very many people doing, but you can. And the upper arm, for me, I mean, frankly, one of the reasons is that I kind of like showing it off. Like, I think it looks cool.

Yeah, it is kind of a conversation starter, isn't it?

It's such a conversation starter, and I think it's becoming more and more a symbol of people, sort of similar to wearing other wearables like an Oura ring or an Apple watch. It's a symbol of caring about your health and showing to people that that is something that you value. And I think it's kind of becoming a little bit of a fashion symbol in a way. And of course, on top of the cgm, we have the Levels Performance cover, which is a great cover that makes it essentially waterproof and sweatproof. And you're not Going to catch it on a doorway as you're walking through and peel your sensor off, which can sometimes happen if you're not wearing the sticker.

Yeah.

Just in terms of the upper arm, There's a lot of ways, I think, to do it in a way that's most accurate and comfortable. I like to basically almost pull down on the area behind my triceps. So we're talking about, like, back of the arm about 2 inches below the armpit crease. I kind of pull down on the fleshy, you know, area behind the tricep and try and get it in as much sort of like fleshy or fatty tissue as possible. So not right into the muscle if I can avoid it. For people who are super ripped, there sometimes isn't a lot of that tissue, but as much as you can kind of get it in the. In the sort of like fleshier, fattier tissue and not right in the muscle belly. That's going to be better from both the perspective of pain, but also, I think, for consistency of your readings.

Okay, Yeah, I run into that. I don't have a ton of fat on the back of my arm, but that's where I tend to put it. I find that just seems to stick the best there and stay the longest there. When you slap the sensor on, you know, you kind of like, depress the button and this teeny, teeny, tiny, like smaller than a hair, like, needle kind of goes deep into the tissue. How's it measuring in terms of, like, the. The location of the sugar, if that makes sense, versus say, if I were just like, prick my finger and bleed onto one of those little strips. Is it measuring it from the blood, or is it measuring it, like, inside the muscle? Or. Can you explain in layperson's terms how exactly it's gathering that sugar data?

Yeah, absolutely. So the way it works, like you said, there's this little filament that goes into the skin. You actually do apply this with a little device and applicator that does have a needle. And all that needle is doing is actually pushing this hair, like, kind of like dental floss type material under the skin. Then that needle immediately retracts. So there's no needle that actually stays in the body, nothing rigid, which I think is definitely reassuring to know that there's not some, like, rigid thing that's sticking in there, but that's sticking out of the bottom of the plastic sensor that's affixed to the outside of your skin. So it's almost like a big thumbtack. But the tack Part is actually flexible on that filament that goes under the skin, which for the, for the freestyle libre is actually only 4 millimeters long. So it is so, so, so, so tiny. The Dexcom G6 filament is a bit longer. I don't know the exact length, but probably about, I would say a centimeter and a half or so. So it's a deeper. That filament that's under the skin is. Is sitting in what's called the interstitial fluid. So not actually measuring blood, not in a blood vessel. It's in this sort of space between cells. And the filament is coated with an enzyme called glucose oxidase that's actually doing a chemical reaction, like an actual lab test in your arm automatically every 15 minutes or so and sending that information to your smartphone. And so what happens is that basically glucose reacts with this enzyme that's coating the filament and actually converts to hydrogen peroxide, which creates an electrical signal that's then basically registered as a glucose concentration. And I think one of the reasons I like to, you know, not get it right in the muscle, if I can avoid it, is that I do think that. And this is. I can't verify this, but this is just my hunch from wearing one for about three years that sometimes if you get it right in the muscle, there can maybe be some more, like, bleeding inside, very small amount, and then that can maybe interfere with some of the signals. So kind of just getting it into, like, anything that's a bit fleshier and really kind of getting into, like, skin, subcutaneous tissue. So things can be different. You know, if you're sensor to sensor, each sensor kind of can read a little bit differently and different placement, you can sometimes see differences. So I just try and keep it as consistent as possible in terms of my placement, sensor to sensor, you know, not kind of move it around my arm.

Okay, now, now, you know, some of these sensors, like, when you open up the app, it says you could calibrate, which means that you can take your blood glucose reading from. From your fingertip and match it up to what it has on the sensor, I suppose. But if your fingertip is measuring your blood glucose and the sensor is measuring more like the glucose in this interstitial fluid, are they going to be the same? The reason I ask this is that from what I understand, like, glucose goes from your blood vessels and your capillaries first and then into your interstitial fluid. So technically, if it was, like, high in the blood, it might still be low. In the interstitial fluid or vice versa. So why is it that you'd calibrate by using the blood? Does that make sense?

Totally, yeah. So prior to CGMs being these devices that so many people with diabetes are using, and now that people are using more for the general wellness market, people were pricking their fingers. And that is a actually using similar technology of glucose oxidase reactions, but using blood to do so. And like you said, once you digest, you know, carbohydrates, they go into your bloodstream and then from the bloodstream, they will then sort of seep into the interstitial fluid. So you can think of. And the concentrations between the interstitial fluid and the blood are very, very similar, but it takes time for it to get out of the blood. So you can think of the interstitial fluid readings, like on a CGM as just phase shifted somewhere between like, maybe five to 15 minutes into the future. Like, for instance, if you were, if you just ate a high carb meal and you have a quickly changing glucose in the bloodstream, that's where you might see, like quite a big difference between what's in your blood and what's in your interstitial fluid. Because it's going up, it's changing very, very quickly. If you're just fasting and your blood sugar has been the same for like an hour, then your interstitial fluid should be pretty similar to what's in the blood. So things that can make the difference between what's in the blood and what's in the interstitium different is if glucose is changing rapidly. So then you might see what's on your CGM essentially be maybe 15 minutes delayed from what's in your blood. So if you're just like actively pricking your finger and checking your sensor after a meal, the other things that can make it inaccurate is actually just the first day of the sensor. So both the Freestyle Libre and the Dexcom, the manufacturers mentioned that, like, day one can be a little bit off. So I don't actually put much stock in my readings in the first, like, 24 to 36 hours. I will take stock in the delta between, like the beginning of the meal and after the meal. But the actual raw number, I don't really take much stock into that until about 24 to 36 hours, when I know that it's going to be a bit more precise. And all the sensors are factory calibrated, so none of them actually require calibration, meaning that for them to be accurate, you don't actually have to prick your finger and put that into the app for the CGM to calibrate it. However, the Dexcom G6 has the functionality to allow you to do that, which means that you can take your little finger prick glucometer, prick your finger, put that into the Dexcom G6 app and it will actually essentially adjust what your CGM readings are. Again, that's not required for it to work properly, but it may make the accuracy a little bit better. But the companies have, they've both studied the like. Basically what is the level of inaccuracy in these compared to blood? And for both the Freestyle Libre and the Dexcom it's about 9% difference from blood on average. Which means that if you're doing gold standard, which is like a venous plasma glucose measurement compared to CGM readings, it's a 9% marred, which is mean absolute relative difference for both devices, which, you know, they were able to get FDA approval with that and that's pretty standard across wearables and that's good enough essentially for someone with diabetes to do things like manage insulin. So I think, you know, just knowing that there any tool is going to have some inaccuracy and 9% is pretty reasonable, I would say.

Okay, got, so do you, do you think that like out of the Dexcom versus the Freestyle versus the Medtronic one is the best? Obviously there's differences between all of them, but, but is one just considered like gold standard?

You know, there really isn't a reputation of one being the gold standard, I'd say in terms of market share. And you know what, what customers tend to really like, I would say the Freestyle Libre and the Dexcom G6 are the ones that I turn to the most. But to be honest, so I have access to both, of course, you know, being part of levels and I honestly flip flop back and forth between the two of them, I will say. So the Freestyle Libre, it is using what's called near field communication, which means that you take your phone and you actually hold it up to the sensor and scan it to transfer the data from the sensor to the phone. And then the Dexcom G6 is Bluetooth, so it actually just streams straight to your phone. So one thing for instance, like if I'm going on a wilderness trip or something like that, and I really don't want to look at my screen very often and I don't want to be kind of interfacing with a device, I'll actually wear the Dexcom G6 because I know it's just going to stream the data straight to my phone and that's awesome. I don't have to basically interact with the phone as much. I could just look at the end of the day and see all the data. On the flip side, if I'm in the real world and not backpacking or something like that, I actually get a lot of benefit from scanning the phone to my sensor because it actually keeps me almost more in touch with this process and it keeps me more thinking about glucose throughout the day. I actually like the process of scanning. You only have to do it once every eight hours. It really depends on the person and kind of what you're, what you're looking for. But both the Freestyle Libre and the Dexcom I find to be very, very accurate. Compared to my blood glucose on my finger pricks, I will say the Freestyle Libre tends to run low and the Dexcom tends to run high. And that's again not, it's kind of anecdotal, but we obviously have seen a lot of members and gotten a lot of support emails for members and that is the trend that we see. So like if I, let's say I prick my finger and it's 85 milligrams to deciliter, my Freestyle Libre will often be reading like 70 or 72 versus if I'm pricking my finger and it's 85 and I'm wearing a Dexcom G6, it'll often be reading like 95 or 100. And so I just know that I don't, you know, I, I think that you just have to kind of know that there is going to be this slight difference like from there is some baseline level of inaccuracy. And I think that what that gets to is knowing that the main purpose of these tools is to understand trends throughout the day and the delta pre meal and post meal, those things tend to be fairly accurate. You know, like if I go up 50 points after breakfast, whether I'm with the Freestyle Libre or the Dexcom, it's going to give me that same information.

I totally get what you're saying. You're looking for a pattern. Either way, if it goes up, it goes up, it goes down, it goes down. It might not be the exact number that that's as accurate as you want to be, but as long as you're able to pay attention to trends, you pretty much know what's going on. You know that whatever this cold shower made it go down and that meal with a steak and potatoes or whatever made it go up. So Yeah, I totally get what you're saying. Now, regarding the difference between the sensors, one thing that I'm often asked about is because you're wearing this piece of electricity on your body all day long, whether people who are electro hypersensitive or concerned about dirty electricity or anything like that need to. Need to pay attention to. And there's very little data out there about this. I found one YouTube video where somebody was actually using one of those scanners to test the EMF levels of a Dexcom G6. Now, I'll link to it. If folks go to BenGreenfieldLife.com glucose, that's where I'm gonna pull the show notes and I'll show you that video. And what you're looking for, ideally from a health standpoint, is you want levels. If you're measuring milliwatts per meter squared, which is kind of like the gold standard, it'd be less than 1. And that video, it was like half that. Like, it was. It was really low. And then a lot of these things will use what's called a low radio frequency emission, meaning like a cell phone will put out like 100 milliwatts. And any of these glucose testers, at least the ones I could find, like the Dexcom and the Freestyle, they're like, on average, like 4,000 to 5,000 times weaker than that. So, I mean, like, doesn't even touch the equivalent of having a cell phone and even a cell phone in airplane mode in your pocket. So I don't think that's something people need to be concerned about. But have you ever thought about that or do you have any additional ideas in terms of the EMF dirty electricity piece?

Just like you said, it is very understudied. I have dug deep into this, like, you have, and have really mostly found, like, what you're talking about, which is like blog posts of people testing this thing on their own YouTube videos, things I came across. I think what was the same source that you were talking about, which is that the dex comment was 4,000 times less than a cell phone call or something like that. I have no idea if that is accurate, but I'm hoping that it is. And I think someone should do that study. I think it'd be fascinating. Anecdotally, I did go to my acupuncturist for some back pain a couple years ago, and it was on my left side where my sensor was. And he's like, you know, he said something about how I think you should think about the fact that you're Wearing the sensor on your arm, and it could be impacting your energy flow through this part of your body. And so that's always stuck with me of, like, okay, this is a device in your body. Your body responds to something that is obviously in it. But that type of study has not been done in a formal way.

Yeah, I'm not concerned at all. Like, with the values. Again, if you own a phone, even if your phone's in airplane mode, you're getting exposed to a lot more from that alone. So I wouldn't be as concerned about that. But it's kind of related to another question I wanted to ask you because, look, I won't beat around the bush here. I have a dexcom, and I've been using the dexcom for, like, six weeks. I switched from the Freestyle Libre to the dexcom. So far, I've had three transmitters fail. I've gotten no data over six weeks, aside from the very first day. I have the second one on because they keep having to send me replacements. And so I am just, like, racking my brain around what would cause, like, a sensor or a transmitter to repeatedly fail. Like, is it because I wear it in the sauna? Is it because, like, I've got, like, a pulsed electromagnetic field therapy thing that'll do therapy on sometimes? Is it something in the water in my house? Because the same thing has happened to another guy who works with me at my house. He's got a dexcom. His has failed twice in the past few weeks. So I'm curious, like, what will cause a transmitter or a sensor to fail so much? Is it something that they're getting exposed to, do you think?

I think it's possible. So one thing to know is that the operating temperature of these devices is 50 degrees Fahrenheit to 113 degrees Fahrenheit. And so if you're going far above that, which I'm, you know, of course you are in a sauna or a cold plunge, it's going to go outside the range of the operating temperature. And so that could very well be leading to ascension. Sensor issue. There's a lot of other things as well. I think that one thing I've noticed, again, this is my own personal experience, not something that's in their official documentation. But if I put the sensor in a place where it happens to bleed more. So every once in a while, I'll apply a sensor, and some blood will leak around the sensor. This is very rare and definitely don't want to put people off from these. They typically are totally Painless, you don't feel it going on and there's no blood. But every once in a while I've worn probably 100 of these at this point. There'll be a little bit of blood that comes out of the center of the freestyle Libre or around the sensor if it's the Dexcom. And I've noticed that when that happens, often the sensor fails. And I think it's because the blood is coating the filament inside and I can't do the reading. And so that is why I've become a bit more careful and precise about where I put the sensor and how I apply it. So one tiny tip with the dexcom is that the filament, when you take the sensor off, you can see that the filament goes at about a 45 degree angle out of the body. The freestyle librel, the filament comes out at 90 degrees from the sensor. The Dexcom G6 comes out at about 45 degrees from the sensor. So I make sure to apply the Dexcom G6 in a way that I know the filament is going to be going parallel to the long dimension of my arm and not like sideways because if it's sideways I'm assuming it's going to hit the muscle more like it's basically going to like. So that's one thing. And I think that when you hit the muscle it does bleed more. And so that's one thing I really try and avoid applying in a way that it's going to. And it's actually one thing you could try. Ben is trying the butt like where there may be a little bit more tissue.

Yeah, that's a good point. I haven't tried alternate locations yet.

One other thing to mention though is that a couple times my sensors has failed is when I was on an extended fast. So when I did a, I was doing a five day fast a couple years ago and I my blood glucose obviously went down during the fast and my freestyle libre was reading like in the 40s. Of course my finger prick glucose was still in like the mid-60s and I was asymptomatic so I wasn't too worried about it. But once it started hitting the 40s, like regularly on the freestyle libre and again the freestyle libre tends to skew low, especially if your blood sugar is actually low at the time. So if you look at the accuracy curve for the freestyle libre it's most accurate around like the 80 to 200 milligram per deciliter range. If your blood glucose is actually that when you get into the extremes of the low. Like, if your blood sugar is actually below 80, the sensor is going to start to get more inaccurate like that. That difference between blood and sensor is. Is greater. So if you're in a fast and your glucose actually is low in your blood, it could look even more inaccurate on the sensor. So the sensor was reading in the 40s, and then it just stopped, basically. And I think the sensor probably has some sort of algorithm built in that basically says if it's reading values that are essentially incompatible with life, it's probably broken and it just stops itself. So that's happened to me now on too fast, where my blood sugar actually did go low. The sensor read it even lower, and then it stopped.

Yeah. Well, for you, what would really low be? Just like, curiosity.

Like in my actual capillary glucose or in interstitial fluid.

I guess in the interstitial fluid that.

The sensor's reading, like, 60s.

Okay. That's not super low.

Yeah, yeah. I would say, because I don't do, like, full keto all the time. And so I would say that my baseline glucose. I know, Gosh. But I would say my glucose generally in my. If I'm finger pricking during the day, in between meals, would be around 72 to 85 or so. And then their sensor could be reading high 60s or, you know, it could be a sensor that's super accurate and actually reading within 1 or 2 milligrams per liter of the blood. But that's where I tend to sit during the day. And so the sensor could read if it's a freestyle libre between high 60s and 80s.

Do you think there's that much of a difference between sitting and standing, by the way? Like, have you noticed that?

I think so. I mean, I think when I'm. When I'm working at my standing desk and I'm always moving my feet around, I've always got music on on my headphones. I do think it keeps things just a bit more stable during the day when I'm, you know, when you're sitting all day, you're essentially. There's no real glucose sink. Like, muscle is the most incredible glucose sink. And if you're using it even marginally, like, even just gently walking or bouncing around on your feet a little bit at your standing desk, like, you're activating huge muscle groups and they all take up glucose. So I think any even marginal amount of movement makes a big difference.

I agree. Mine's always consistently lower when I'm standing. Of course, when I'm Walking on my desk, treadmill or I've got a little under the desk, little bicycle type of thing. Anytime I'm doing anything like that, it's lower, which seems intuitive, but even just something as simple as standing instead of sitting actually does make a big, pretty like a bigger difference than I would have thought. Like it's on average about 5 points lower if I'm standing versus sitting. So it's pretty significant. Okay, so the other quick thing that I wanted to mention is we were talking about sensors failing. Like if you don't know the answer to this, that's fine. But this whole idea of these biohacks that produce electricity, like infrared lights or pulsed electromagnetic field therapy, vibration platforms, things like that. Have you ever come across anything that would for sure cause a sensor to fail that you know of?

Not yet, have not come across that. But I bet we, we just launched a few months ago and so we're going to get a lot more, you know, people in the program and I, I would be so curious if this stuff starts coming up as the volume gets higher.

Yeah. What do you mean you just launched a couple of months ago?

We were in a closed beta for about two years. So we were, you know, basically refining the product, growing our operations and then this summer we, we've sort of more publicly launched and so, so anyone can kind of come and get the product and so we'll just start to see, pick up more of these things as more people use the product and try different biohacks and experiments out. But one thing we have seen and definitely have heard about is this idea of interfering substances with the sensors. And the manufacturers talk about this, but there are a few medicines and supplements that are known to actually interfere with the chemical reaction on the sensor. So the big ones are vitamin C and salicylic acid. So what's in aspirin? Okay, so with these, and it's dose dependent and when you look at the research, it really seems like you have to be taking very high doses of these things for it to be a problem.

Wait, I don't, I don't understand. What would they do exactly?

Well, with vitamin C, for instance, there's some thought that it actually interferes with the, with the actual chemical like the glucose oxidase enzyme.

Weird.

And so it, it actually will read much higher. So people have reported like being in three hundreds if they take like two grams of vitamin C if people are taking like normal. So, so this would be relevant to someone who's, and probably relevant to your audience, like people who are Doing an IV type vitamin C therapy or taking just a high oral dose, you might just see like a, if your glucose goes up to like 300 or 400, that might be why. And then similar to Sal. So salicylic acid is like aspirin. And some skincare products have it that above about 650 milligrams. And the average pill is usually a 325 milligram aspirin. So if you're taking like stacking these doses and taking a lot, it could affect the sensor. And then hydroxyurea is another one that is thought to potentially impact the readings. And then Tylenol used to have an issue with the sensors above about 1,000 milligrams. But now both manufacturers advertise that there is no more interference with Tylenol, but something to just keep in mind in case someone's on like, you know, post surgery or something and taking a lot of it and if they see the readings. But certainly salicylic acid and vitamin C at high doses may affect the sensor and actually dehydration, if someone is really dehydrated, it can, it can lead to falsely either elevated or low reading. So just want to make sure that you're, you're, you're hydrated.

Okay. And hydroxyurea, that's, that's like a pharmaceutical drug, right?

Hydroxyurea, you'd have to get through a prescription. Yeah, it's like it treats cancer.

Okay, got it. And by the way, you mentioned that you had been in closed beta and now you guys at Levels are letting other people in. But I should clarify because I think I understand the answer to this, but if you don't have diabetes or a chronic disease related to blood sugar, you can still get a Sensor and get the app, but it's just that it's out of pocket and insurance won't cover it. Is that correct?

That's right, yeah. And Levels right now is actually exclusively a wellness product. So it's not actually intended for any disease management or even disease prevention. It's meant for people who are, you know, trying to live their healthiest lives, trying to understand their bodies better, to basically have this incredible data stream that helps them understand really for the first time how food is affecting their health in real time and in a closed loop biofeedback way. And so, so what Levels has done is take this, what was traditionally exclusively a medical device only used in the clinical setting and brought this to a mainstream sort of consumer audience of people who are optimizers or are interested in general health and wellness. Because, of course, there's this huge, huge desire not only amongst people who are interested in like quantified self or wearables, but just generally people who have been struggling with trying to find the right diet for them, figure out how exercise affects their health, how sleep deprivation and stress affect their health, to really be able to have extra granularity into that. So, yes, the people who are using levels are people that actually do not have a clinical diagnosis and are using this for wellness purposes.

One other question regarding the logistics of this, then. I want to kind of ask you a question about numbers and stuff, but you talk about put it on the back of the arm. Or for me, I guess, now my butt. The package, when I get my levels package, it's got like these little black stickers. It's almost like Kinesio tape, but it's in the shape of the sensor. Like whether it's the Dexcom or the. Or the Freestyle. And you slap it over there, you think that's enough to keep it on? Or are there other tips that you have for keeping it stuck to the skin, whether it be like some kind of adhesive or glue or anything along those lines that you found that people really benefit from in terms of the stickiness?

Great question. So what you're talking about, these patches and these stickers, these are the levels performance covers. And so these are intended to go over the sensor to make them more waterproof, more sweatproof, and like, again, prevent them from being just dislodged when you're. The one that always happens is when you're walking through a doorway and you catch your arm and it just peels your sensor off. Oh, my God. Yes, yes. So the sticker basically prevents that from ever happening. But I do think there are some. Several things that you can do to actually improve the likelihood of the sticker staying on for the full 10 days of its Dexcom or two weeks if it's the Freestyle Libre. So some of the key things for. I always put it on after a shower when I've really gotten the oil off my arm. I think oil on the skin can just. Will totally prevent the adhesive from working properly. So I'll often use like a Dr. Bronner's Castile soap, which, like, I feel like really gets a squeaky clean and really gets oil off and use that. I'll use a little bit of an exfoliator, like a Luther or something on my arm, dry off the skin completely, and then use alcohol. And sometimes what I'll do again to get more oil off. There are alcohol swabs in the kit, but sometimes I'll actually just take a bottle of isopropyl alcohol and put it on a cotton ball and really, really get any oil off the skin. Skin. I have found that that makes a really big difference with having the adhesive stay on.

Okay.

And then there's other, there's other like little medical grade stickies that you like. Like fluids that you can put on your arm that make the skin more tacky before you put the patch on. I don't think those are necessarily fully necessary unless you're doing like extreme sweaty or sauna stuff. I was just traveling and was doing some sauna every day and my sensor did unfortunately just like kind of. I've had a sensor pop off in a sauna. I've had a sensor just like fly off in a Bikram yoga class. And so this, the heavy, heavy, heavy duty sweat and heat definitely can loosen that adhesive. So if I were to do that again, if I knew I was going to be doing hot yoga or going in a sauna, I might use that medical grade, like sticky stuff which you can get on Amazon. And I'm actually forgetting what the name of that stuff is called, but we could link it in the show notes.

It's like a skin adhesive. I've gotten it before. It's like tacky skin something. But I'll find it and put a link for people who want the extras who are super active or doing a, I don't know, a spartan race with your glucose monitor on all. I'll put it@BenGreenfieldLife.com glucose. Okay, I want to talk numbers a little bit. I want to talk numbers. So basically, if you're testing, do you think there's, for the lion's share of people, a really good average blood glucose level that you should be looking at during the day? And this might be a super simple answer. I don't know. And then on average, how much should it rise after your basic meal and then how soon should it drop back down to normal? I realize that might be kind of a basic question, but I just want to make sure we establish numbers here.

I hate to say it, but it's unfortunately not a basic question because the research on this has basically not been done. But I'll unpack what we do know about numbers.

Okay.

There's just, unfortunately it's not like, oh, this is the exact number because you know, you have to remember like, like the way that we have traditionally approached blood glucose values is all through the standpoint of essentially buckets of whether you're non diabetic, pre diabetic, or have type 2 diabetes. So those are the categories that the ADA has put forth. If you're less than 100 milligrams per deciliter for your fasting glucose, you're non diabetic. If you're between 100 and125, you're pre diabetic. If you're above 125, you have type 2 diabetes. And so it's, you're in these buckets. And that's, that's honestly not really helpful for the type of person who's trying to keep optimal levels to make sure that they're preventing chronic disease and hopefully not moving down the trajectory of metabolic dysfunction. Because you have to remember, and I'm sure many of your listeners know this, once your fasting blood sugar has gotten up to 100 or reaches the prediabetes threshold, there's evidence to suggest that actually metabolic dysfunction has been going on for a very, very long time as your glucose has slow, slowly risen throughout the years and probably decades from like, what would be probably optimal for fasting glucose, between about 70 and 80 up to 100. And there's evidence, there is a paper in the Lancet that showed that insulin resistance, you know, the process that leads to dysfunctional fasting glucose levels, really the root cause of these glucose levels being, you know, higher than they should be, is starting over a decade before our glucose numbers actually start rising. And we're really missing that early period of dysfunction, mostly because we don't actually check fasting insulin in our standard medical practice, which is a huge problem with the conventional medical system. And everyone should know what they're fasting. I'm sorry, fasting insulin levels, we don't check those. And so insulin is probably starting to rise many, many, many years before our fasting glucose starts to rise. So that's a very important biomarker to ask your doctor for. And we really want our fasting insulin to be below 10, ideally between about 2 and 6. And that's something we can track before our fasting glucose even starts to go off the rails. With all that said, your question was more about like, what is a, what is a good average glucose level and what is a good post meal glucose level? Again, the ADA doesn't tell us this because they're only concerned with whether we're below 100 for our fasting glucose. But there's been several scientific papers that have been published where they basically take in large groups of non diabetic, generally healthy individuals, put continuous glucose monitors on them for periods of a few days to a few weeks and just looked at what their glucose actually does. And so what these studies tell us, if you look at all the research together is that average 24 hour glucose levels in these healthy populations wearing CGMs are between about 84 and 104 milligrams per deciliter.

84 and 104, yeah.

And I'm summarizing about six to seven papers that basically have all the populations fall between that range of essentially mean 24 hour glucose levels for a healthy population wearing CGM. So does that mean that that's optimal? Still hard to know. Right, but this is a healthy population, so that's a good gauge. And then I think one other thing to think about with average glucose is that average glucose is of course going to factor in what your sort of baseline level is in between meals and overnight, but it also factors in those post meal elevations. So if we're talking about like okay, I'm in between meals, I haven't eaten for three hours, I'm not going to be eating for three hours, what do I want my glucose level to be? It might be even a little bit lower than that average glucose level because you know, that's obviously incorporating the 24 hour pattern. So I like to stay between about 70 and 90 for my resting glucose in between meals after I've come down from a meal and sort of what I like to see overnight and, and that actually there is some research to suggest that might be normal. There's one study that was looking at normal weight young non diabetic adults and they looked at premium glucose levels. So what was their glucose right before they ate? And on average it was between 72 and 90 milligrams per deciliter. So I think that that's a pretty fair like thing to shoot for, for premium. Then if you're talking about post meal glucose levels, which is obviously something that people care a lot about, if again we look at the ADA criteria for what should your glucose levels be after a meal, it's very hard to interpret. They're looking at, they basically say that two hours after a meal you want to be below 140 milligrams per deciliter. So you eat, you go up, you come down, and if you're below 140 milligrams per liter two hours after a meal, or an oral glucose tolerance test, which is like a drink of Glucose, then you're categorized as non diabetic. I personally think that's a ridiculously lenient number. Like if you're up in the 140s, two hours after a meal, that is very, very high. I like to first of all, not even go up to above 140 after a meal, but go up, up, and then come down with within those two hours and be back down to my like 70 to 90 resting glucose, you know, within two hours after a meal. So I think that's highly lenient and it's not really a great target. We've actually. So again, going back to the literature, if you look at those studies of people wearing CGMs, healthy non diabetic individuals, they basically say that peak glucose, so not at two hours, but actually their peak glucose, which generally happens between 45 minutes and an hour after meal, is typically on average between 99 and 137 milligrams per deciliter. So that's like they go up, they peak between 99 and 137 milligrams per deciliter, and then they come down within about two hours. We have actually surveyed our advisors. Our advisory board is just an incredibly credible group of thought leaders like Mark Hyman, Dom d', Agostino, Sarah Gottfried, Molly Maloof about what their optimal ranges after meals are. And we actually get an even tighter view. So Dr. Mark Hyman recommends that glucose should not rise above 120mg per deciliter after meals. Dr. Molly Maloof says that most healthy is less than 110 after meals. Dom says less than 120, and Dr. Sarah Gottfried says less than 115mg per deciliter. So we're all in the sort of like 110 to 120 as your peak post meal glucose. So just to summarize all that, I like to stay about between 70 and 90 in between meals, like resting during the day and not really go above 120 after meals. And I like to come, go up and come down within two hours. And that will pretty much make me feel my best.

Okay, got it. That's super helpful. Now, in people who eat a low carb diet or people who are keto, I think this flies under the radar and I'd love to hear your take on this. There's this phenomenon, and I guess what it's called is adaptive glucose sparing, meaning, like if you eat a low carb diet, you actually develop like this insulin resistance because essentially your muscles prefer to use fat as a fuel. Right. So they're resisting the action of insulin to bring sugar into the cells for energy because they don't necessarily need as much sugar, thus the sugar in the bloodstream stays elevated. So paradoxically, somebody could eat, be eating at like a low carb ketogenic diet and their average might be 90 to 100, whereas that same person, if they weren't eating a low carb or keto diet, they might be more like 80 to 90 simply because the muscles are using the fat. So it stays a little bit, the sugar stays a little bit higher in the bloodstream. And then furthermore, it might not be as much of an issue for chronic disease if that is the case, because that person who's following a low carb or ketogenic diet is so insulin sensitive that the high blood glucose is not necessarily associated with insulin resistance or very high levels of insulin or too much stress in the pancreas. Have you come across that phenomenon at all? Is there anything to it?

Yeah, this is a fascinating, fascinating topic, this paradoxical rise in blood glucose on a low carb diet. And I'd say the person who's really the expert on this is one of our advisors, Dr. Ben Bickman, and he actually has a name for this which is called reverse metabolic inflexibility.

Reverse metabolic inflexibility, yeah.

Okay, so, and we can link to a blog post on this that he's written for the Levels blog. But it's really fascinating and it's mostly what you would see in like a long term keto diet and not in everyone. And it may, I think it's in part due to what you're saying is that you, you know, the average American is stuck in a glucose burning mode. And when you shift the body to being almost exclusively in a fat burning mode as a result of low insulin levels, which is a healthy state, your body is less responsive to insulin because it's not using it much. And so it may take longer for a glucose load with a meal to clear. And this, this may also have to do with the hormone glucagon. So glucagon is a, is a hormone that antagonizes the actions of insulin. So insulin is a glucose lowering hormone and glucagon is a glucose raising hormone through gluconeogenesis in the liver and then glycogenolysis. So breaking down glycogen into glucose and then making glucose from other substrates in the liver. And basically, if you are on a long term, low carbohydrate D diet, you may end up driving up Glucagon levels because your body's essentially being stimulated to make glucose because you're not consuming glucose. And also dietary protein stimulates glucagon. And since a low carb diet is going to have probably higher ratio of protein, you may be stimulating more glucagon. So there may be an element of the body actually just responding to the fact that you're consuming low exogenous carbohydrates by, by stimulating hormone that's gonna bring glucose back up a little bit. And that's of course in the context of super low insulin levels because you're on a super low carb diet. So then the question is, in the context of low insulin levels, is this slightly higher glucose a problem? The answer to that is not known. However, I will say that Ben Bickman, I don't wanna speak for him, but I think feels that the physiology is very different than normal hyperglycemia. And it's, and it's probably not something that people should worry too much about if their glucose is just slightly bumped up. 10 milligrams per S liter, for instance, on average, in the context of very, very low insulin levels.

Yeah, I mean my for sure tend to trend a little bit high if I'm being super strict on carbohydrates. But again, I think it's a non issue. Obviously these are glucose levels that aren't necessarily caused by face feeding with sugar and, and high starches all the time. So I personally don't think it's as much of an issue and would probably tend to agree with Ben Bickman on his whole take on that. So maybe I'll include a link to a helpful article about that and kind of an explanation of it in the show notes@bengreenfieldlife.com glucose all right, let's talk about some fun stuff. Obviously built into the levels app is the ability for people to run experiments like what happens if I eat oatmeal versus eggs for breakfast or cold shower versus hot tub. All sorts of things. So obviously you guys have collected some data and what I'm curious about is like most people know, oh, if you walk after a meal, your blood sugar is going to be low, or if you lift weights, maybe before a meal, your blood sugar is going to be low. But is there anything that's popped up that's been super interesting as far as surprising or unexpected results from people experimenting with what might cause their blood sugar to be low or high? And if so, what are some of the more interesting takeaways that you found.

Oh my gosh, people are doing so many fascinating experience. It might be one of the most fun parts of this job is to see what people are posting on social media, you know, tagging levels of what they're trying, you know, Wim HOF breathing and cold plunging and all sorts of stuff. I'll mention a few of the ones that are sort of my favorite. I will say some of the really basic experiments are some of the ones that are most life changing. You mentioned walking after meals. That's one that we've actually studied in our community at a more at a bigger scale and it's, it's pretty profound. I'll just mention briefly, we did this study where we sent people cans of 12 ounce cans of Coke. So they basically drank a Coke one morning and then the next morning under hopefully very similar conditions, similar sleep, similar stress levels, et cetera, they drank a Coke and then walked after the Coke just like a gentle walk. And we actually found that the median glucose rise between a walk and no walk was actually 33%. So the peak went from one 62 milligrams just liter to an average of one 32 milligrams deciliter. So that's, that's like a huge difference. You can imagine over the course of your lifetime if, like, if you're always 30% lower on your glucose spikes, that's pretty monumental. So that was really cool to see. We also, we just had a member post an amazing reel that she did with levels basically showing she tried two different breakfasts that were isocaloric, so exact same calories. And one breakfast was eggs, sauteed, brussels sprouts and onion, half an avocado and blueberries. And the next was two pieces of whole grain gluten free toast, one tablespoon of peanut butter and three quarters cup of oj. So a very like what some people would say is like, oh, that sounds like a sort of healthy breakfast. The eggs, avocado, blueberries, brussels sprouts. She had a 20 milligram per deciliter rise and was above target for only 45 minutes. And with the bread, peanut butter and just a small cup of OJ, she went up 79 points and was above target for 98 minutes. And so, you know, it just goes to show that like if you looked at both those breakfasts, there's a lot of people who would say that, that, that seems like a reasonable, you know, whole grain toast, peanut butter, a little bit of oj. But it absolutely threw her glucose like through the roof. So just having like Obviously a more whole foods based protein and fat rich, healthy, healthy protein and fat rich breakfast.

She probably could add like scrambled eggs on a glass of orange juice and the orange juice still would have done that. I mean like, like any fruit based sugar absent of fiber, even some fruits like grapes and raisins, those massively spike blood glucose sometimes higher than just pure sugar. It's crazy because they're just a very sweet fruit without a lot of fiber to slow down that release of blood glucose. Yeah, even grapes can be an issue. Or a glass of wine. It is kind of interesting. Now, what about dairy? Because dairy is very insulinogenic. It's one of those things that seems to be associated in many people with weight gain. Does, does dairy seem to spike blood glucose in a lot of people?

You know, it's funny, it actually doesn't and it depends on the dairy source. But like, for instance, a lot of people end up posting on Twitter that they eat ice cream and they don't have a glucose spike and they're so excited. And I think, you know, unfortunately this is one where it's very, very nuanced because in a sense ice cream is sort of like this, this balanced meal. It's got protein, fat, no fiber obviously, but like it's got, it's got carbohydrates, protein and fat. And so like it's probably likely that that protein and fat are the high sugar. That doesn't necessarily mean it's healthy to eat that sugar. But the thing about dairy, like you said, it's highly insulinogenic. And so that the dairy proteins are known to potentially spike glucose like six times higher than other protein sources. And so that does actually cause me a little bit of concern about eating too much dairy because obviously we don't want our insulin to be high. And so it's something that you may see glucose not rising with a dairy based product, but it might be at end the expense of very high insulin levels after that meal.

What if somebody does a dairy substitute like rice milk or oat milk or almond milk or something like that?

Oh my gosh. We actually did an amazing community experiment with oat milk and unfortunately the results were not favorable for oat milk. But basically we'd heard reports from members that oat milk was causing really bad, big spikes for them. So we did an experiment with it. We basically had people either have their coffee with oat milk or have their coffee with unsweetened nut milk of any other kind. So like macadamia, almond milk, cashew milk.

And the oat milk was unsweetened too?

Well, most oat milk technically says unsweetened, but it's, I think it can be a little bit tricky because the way the oats are processed, even if they're not adding refined sugar, the way they're processing the oats. Oats does lead to a lot of highly accessible, essentially refined sugar. It may not be added, but the way the oats are processed can, can essentially make it very glucose spiking. And what we saw in this, in this study was that for people who had their coffee with oat milk, they had an average glucose spike of 29 milligrams just liter. And if they used any other type of unsweetened night milk nut milk, it was 9 milligrams per deciliter. And the people who use the oat milk milk were their average time above range. And our, our top of our range is 110 milligrams. For L Cedar, they were above range for 42 minutes. And if you used any other type of unsweetened nut milk, it was 11 minutes above range. And so there was, that was one of our experiments that really I think had the biggest difference. And this was again to just test some, some anecdotal reports that we'd gotten amongst our team and amongst our members and then studying it in a larger group of people. We did see that. So, so I definitely avoid oat milk, knowing what I know now from our data set. And another interesting one we did was on resistant starches. So essentially this concept of if you take a starchy food like a potato or rice and you eat it fresh out of the stove or oven versus if you take that food and then you cool it and eat it cooled or reheat it. The idea is that some of the carbohydrates in the cooling process actually transform into a form that's indigestible, a resistant starch. And so we had people do this with rice and it was actually quite interesting as well. The people who just ate fresh hot rice had an average glucose response of about 38 milligrams liter. And if they cooled it, it was 26 milligrams just liter. So it was pretty, it was a fairly significant. And these are of course these are not super controlled scientific studies, but these are. We love to do group experiments with our, our members and one that you might actually. One other that you might be really like interested in just being an athlete. We're doing a study right now with our members or an sort of a group community Experiment where people are essentially trying to figure out their exercise threshold that does not spike their glucose. So you may have noticed on your CGM that with high intensity interval training or powerlifting or things that are sort of above all out efforts or generally above a VO2 max of about 80%.

Yeah. Well, to interrupt you quickly, anything stressful sauna session, anything that your body gets the message that it needs to run from a lion, you get that transient rise in blood glucose that I've said many times before on a podcast isn't something to be that concerned about because that results in long term insulin sensitivity and long term lower blood glucose. It's kind of like your heart rate right when you exercise, your heart rate goes up, but the long term effect of that is a lower heart rate.

That's exactly right. And that's the key point. When you do these high intensity exercises or any. Well, when you do the high intensity exercise, you're often going to see your glucose spiking. And that's the body feeling like, okay, I'm running really hard. This must be some sort of threat. I need to mobilize glucose to feed the muscles. The liver actually dumps out glucose for the muscles to use. And you often see a glucose spike with high intensity exercise. And with lower intensity exercise like zone two, walking, light jogging, we'll often see a decrease in glucose because you're just utilizing, you're not putting your body into a stress response, you're not mobilizing that glucose from the liver and you're just using circulating glucose and so it's going to dip a little bit. So we're having members essentially see at what point do they flip from that, more picking up circulating glucose and it dropping. So a low intensity exercise, which is we'd associate more with a fat burning state as well because the body's going to be more favoring fat oxidation and that lower intensity exercise versus when do you flip into high intensity sort of glucose rising. So for each member it's going to be a different strenuousness level. And so that's something that we're trying to study and like figure out whether we can kind of figure out what is sort of like the flip from fat burning threshold to more glucose utilization threshold for an individual member.

Yeah. What about gum?

In what sense?

Like let's say you're chewing gum. Let's even say it's not gum that has sugar in it, which might cause blood sugar up a little bit, I guess. But has anybody done any tests on gum? Because I chew a Lot of gum.

I have not seen any experiments on that. Have you noticed anything with your cgm with gum?

Not really. I mean, obviously it causes a little bit of a rise in creatine hormones because it's the taste of something in your mouth and your body prepares to digest food. So it's possible that in the similar way that having bitters before a meal or apple cider vinegar or cinnamon might lower blood glucose if they're technically is a hormonal response that results in the body's ability to be able to process fuel or calories a little bit more effectively, you could expect it to lower blood glucose. But then again, if the gum is caffeinated or has nicotine, et cetera, and sympathetically stimulating, then raise blood glucose. Yeah, tough to say. I don't have any data. I was just curious.

I gotta try it now.

I know I might have to too. As soon as I can get my freaking sensor to start working. Okay, so. So that covers a few of the surprising things. Now what about the things that most people probably don't know about? Like we talked about exercise, we talked about cold, I mentioned some of these blood glucose disposal agents like Ceylon cinnamon, apple cider vinegar, bitter melon extract. We know a lot of those can lower blood glucose. Anything surprising that controls blood sugar that you think more people should know about?

Yeah. So you hit a lot of them. I think some of the surprising things that will raise glucose is like you said, high intensity exercise, stress and heat. Of those three, I don't worry too much about heat or exercise because as you said, the long term those are going to actually improve insulin sensitivity. However, with stress raising blood sugar, that actually I do think that's probably maladaptive.

Yeah, but that's not that surprising for people. I think everybody knows the stress is going to raise it. What about the microbiome? I was kind of hoping you might mention something about that because obviously now people are selling probiotics that they say will lower blood glucose. I have some in my pantry. I haven't tested them yet, but apparently if you have levels of a certain bacteria in your gut, you're better able to manage carbohydrates. And furthermore, and this is super interesting, I did a podcast about this a while ago that if you're accustomed to eating a high carbohydrate diet, you tend to build up a bacterial profile in the gut that results in your body actually experiencing low blood glucose and energy destabilization unless you feed it carbohydrates, which might factor into this whole Idea that a lot of people will have to be on a low carb diet for eight to 12 months before they really notice that shift in the gut biome and the shift in the ability to feel good and have adequate energy levels. So what, what's the link between the gut and the blood sugar?

Yeah, I mean, massive link between gut and blood sugar, really. More and more research literally every day is coming out showing that what's happening in our gut has a direct impact on our mitochondrial function and our insulin sensitivity and glucose homeostasis. I think on the probiotic front, the strain that is coming out with the most compelling research, I think, for improving metabolic health as, like, a supplement is Akkermansia. That might be the one that you have. But Akkermansia, there's hundreds and hundreds of papers about it basically showing that it has impact on metabolism and general health. And it's been shown in mice to basically improve metabolic disease and improve glucose homeostasis. And the mechanisms for it are thought to be a few things. One is increased thermogenesis. So it actually induces uncoupling proteins in brown fat and may actually make your essentially just like, make you hotter, make your basal metabolic rate higher. It also helps secrete GLP1. So one of our gut hormones intimately involved in metabolic health, it's a bacteria that lives in the mucin layer of the gut. And we know this mucin layer is so important for gut integrity. And with the diets we're eating today, we're depleting our mucin layer. And so it's a mucinophilic gut microbe that really protects that mucin layer layer. And it's been shown to help with maintenance of tight junctions between our colon cells and produces antimicrobial peptides in the gut and really, like, restores mucin thickness. And so all of that is, of course, so important for the concept of gut integrity and leaky gut and general inflammation in the body that's related to gut dysfunction. And so that's a really promising one that's now being commercialized. There's a company, Pendulum Therapeutics, that's selling Akkermansia.

Yeah, I heard about Pendulum. Yeah, somebody mentioned that. Dr. William Davis, when I interviewed him, we talked a lot about yogurt and specific strains of yogurt, like El Rooteri, that seemed to stabilize blood glucose. And he mentioned the Pendulum company as one that's relevant. I haven't started taking it for two reasons. One, I just haven't gotten my hands on it, even though I do have A bottle from a different company up in my pantrip. I forget the name of it. There's a few now that are making it and then two like full disclosure. I developed a blood glucose stabilizing supplement that works pretty well for me that Kion sells with the bitter melon extract and chromium and vanadium and astragalus and a few other decently researched blood glucose stabilizing agents. So I kind of just go with that because I know a guy and I get a good deal on it. So there are other things. Dihydroberine is one that my friend Sean Wells swears by as a form of berberine that works, works really well. And then I've mentioned this so many times, I won't dwell on this, but I have found nothing, nothing to control blood glucose more effectively than a bout of morning cold thermogenesis. And that is why every day, even throughout the winter, cold shower, cold soak, cold body water, something cold, even a brisk cold walk, wearing limited clothing. I'm not walking around the neighborhood in my G string, but shorts on and sandals in the winter. Oh my gosh, like your blood glucose. I've been like in the 40s to 50s until like 3 or 4pm If I do a morning cold swim or something like that. It's crazy.

It is wild. And you mentioned your supplement. I think that those like chromium and others like, I think that a key thing, we talk a lot about some of like the more esoteric things that we could use for metabolic health, like you know, berberine and things like that, like cinnamon. But I think one key thing that I think about a lot is like just our basic micronutrients, like we actually need those to be in a good place in our body for like our electron transport chain, our mitochondria to work properly. Like a lot of these enzymes that are super related to glucose processing and energy ATP production in the body, like in the mitochondria, are dependent on micronutrient co factors which many Americans are actually depleted in because of our, you know, poor standard American diet. And like some of the key. So, so aside from some of the fancier stuff like Akkermansia and I take some other mitochondrial support supplements like duralithin A, but even just basic stuff like vitamin D, magnesium, selenium, zinc, B vitamins, manganese, vitamin C, omega 3s, chromium, these things are critical just for baseline cellular metabolic functioning. And so just making sure people are knowing what micronutrients are key to these processes and then making sure they're getting them in their diet and if they can't, supplementing with them. So I certainly supplement with magnesium and vitamin D and omega 3s and things like that, because I think, think especially with what's going on with our conventional farming and our poor soil health in the country. So much of our food is actually more micronutrient deplete than it was 50 or 100 years ago. So even if you're kind of eating like a perfect whole food diet, you still might be getting fewer of these key micronutrients, your metabolic health, than you would if you were eating food that was grown on better soil. And that goes for both plants, but also for meat, meat grown meat that has eaten plants that were grown on good soil have much higher levels of omega 3s and micronutrients and even phytonutrients, which we often think of being only in plants, but actually animals can be a source of phytonutrients, but really only if they're raised on plants that were grown in good soil. So just the basics, I think, are also a big part of the conversation too, as much as I also do try some of these other more advanced things like, like vital pure with urolithin A or Akkermansia or berberine or things like this. And then one last thing I think I would mention is just uric acid is another big piece of this whole metabolic puzzle. Like, we know that fructose and high fructose corn syrup raise uric acid levels, which creates mitochondrial oxidative stress and can really create problems with insulin resistance. And Rick Johnson and David Perlmutter both wrote books this year on uric acid. Nature wants us to be fat and drop acids acid. And there's several supplements that actually specifically improve uric acid levels, which are quercetin.

Luteolin, tart, cherry, quercetin. I know two off the top of my head.

Yeah, those are that. Yeah, quercetin, tart, cherry, luteolin, dha, vitamin C and chlorella are the big ones. And so there's just a lot of different tools in the toolbox. And frankly, I take a lot of them and I find benefit from a lot of it. But I think food is medicine and getting the basics of those key micronutrients through food that's grown in good organic or regenerative soil is pretty foundational for just the basic cellular physiology.

Yeah. Last question. Do you think that there's a possibility that in the future, based on what's in the interstitial fluid you could slap a CGM on and it could also be measuring, I don't know, cortisol or inflammatory markers or lactic acid or something like that. Or is that just not even something on the radar? Radar.

It's definitely on the radar. And the exciting thing is that Abbott is actually coming out with three new sensors, which is lactate, alcohol and ketones.

Oh wow.

They're all going to be on separate sensors. So the dream would be right, they're all in one sensor, but it's not, we're not there yet. But I think this is massive progress for the field because, I mean I, I am so excited to have a ketone monitor on one arm, a CGM on the other arm, a lactate monitor on my butt. You know, just like, like just knowing all this.

One sensor could it all though, huh?

I know, I know. But that's called the Abbott lingo is the new series that's coming out. My absolute dream would be continuous cytokine monitors, something that measures oxative stress, ketones, glucose, some sort of byproduct of the microbiome, like short chain fatty acids. Just something that can really tell you about what is the actual, how is your actual physiology doing under the hood. But we really are believers that, that this, this whole concept of continuous biosensors and really having like a movie of what's going on inside your body is the future of health care and of patient empowered healthcare. Especially because if you understand more about your body and how your choices are impacting your health in real time, which we call biologic observability, you know, you can't control a system that you can't observe. And the more we're being able to observe our own bodies inside, the better it's going to be, I think for reversing our chronic disease epidemics. So there's definitely strides being made with these new sensors and I think we're going to see vastly more over the next 10 years and levels. Goal is really to help create the software layer that integrates all these data streams to empower individual human health.

It's pretty sweet. I dig the app. I'll put our link to it and everything in the show notes. So if people want to sign up and use it. And it's super fun, it's super fun to test this stuff. I had all sorts of questions about this. You asked them. I keep going, but we're out of time and maybe we'll have to do a round two. But in the meantime I'm going to link to as many resources as possible. If people go to BenGreenfieldLife.com glucose I'll put our special link to levels. I don't know what we have for a link or a code or whatever, but I have something where you save money or get moved to the front of the line or whatever benefits that link we worked out. Oh, there we go. Levels link Ben. And so check all that out and you too can join the club of strange freaks who look like robots walking around as modern day cyborgs tracking our blood glucose 24 7. You can be part of that cool club too. So BenGreenfieldLife.com glucose Casey, thanks so much for coming on and sharing all this stuff with us. I don't know who else would have been able to answer all my questions other than you, so thank you.

Oh, it's an honor. I love your content. I so appreciate what you're doing for the world and I'm so grateful to get to have this convo.

Awesome. All right folks. Well, I'm Ben Greenfield. I'm with Kasey Means signing out from BenGreenfieldLife.com have an amazing week. More than ever these days, people like you and me need a fresh, entertaining, well informed, and often outside the box approach to discovering the health and happiness and hope that we all crave. So I hope I've been able to do that for you on this episode today. If you liked it, or if you love what I'm up to, then please leave me a review on your preferred podcast listening channel, wherever that might be, and just find the Ben Greenfield life episode. Say something nice. Thanks so much. Means a lot.