Encore: The Worst And Best Foods For Your Blood Sugar with Dr. Casey Means

Summary

Summary of "Encore: The Worst And Best Foods For Your Blood Sugar with Dr. Casey Means"

Featured on The Dr. Hyman Show with Dr. Mark Hyman

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Introduction: The Metabolic Health Crisis

In the latest encore episode of The Dr. Hyman Show, Dr. Mark Hyman engages in a profound discussion with Dr. Casey Means, the founder of Levels, about the intricate relationship between diet and blood sugar management. The conversation underscores the alarming rates of chronic diseases in America, attributing much of this epidemic to poor metabolic health characterized by imbalances in blood sugar, high blood pressure, and abnormal cholesterol levels.

The Stark Reality of Metabolic Diseases

Dr. Hyman emphasizes the severity of the issue:

“More than any other country, probably three or four times the death rates per capita, is because we are so freaking unhealthy.” ([03:00])

Dr. Means echoes this sentiment, highlighting that nearly 90% of Americans are affected by metabolic dysfunction, leading to increasing rates of obesity, heart disease, cancer, and dementia.

Identifying the Worst Foods for Blood Sugar

One of the episode's focal points is the identification of foods that wreak havoc on blood sugar levels. Dr. Means presents compelling data from Levels' extensive dataset of 51 million glucose readings, categorizing the worst offenders:

1. Skittles and Similar Candies

   • Skittles top the list as the worst single food item, causing an average glucose spike of 83 mg/dL ([24:12]).
   • Other detrimental candies include Sour Patch Kids, Caramel Corn, Twizzlers, and jelly beans, all characterized by their "naked carbs"—refined sugars without accompanying fat, protein, or fiber.

2. Breakfast Cereals

   • Surprisingly, popular cereals like Cinnamon Toast Crunch, Honey Nut Cheerios, and Lucky Charms are identified as major glucose spike contributors, each causing spikes exceeding 60 mg/dL ([30:22]).
   • Dr. Hyman remarks on the deceptive marketing of these cereals, comparing them to having soda for breakfast due to their high sugar content.

3. Sugary Beverages and Sweetened Foods

   • Soda remains a primary culprit, but Dr. Means also highlights certain non-traditional worst foods like specific breakfast pastries (e.g., Pop Tarts) and certain takeout items that appear healthy but are laden with refined sugars and starches.

Best Foods for Managing Blood Sugar

Conversely, the conversation also delves into foods that promote stable blood sugar levels:

1. Balanced Breakfast Options

   • Frittatas, avocado and egg, chia pudding, and Greek yogurt with berries emerge as excellent choices, each maintaining glucose spikes below 20 mg/dL ([34:22]).
   • The Fab Four Smoothie, popularized by Kelly Levesque, is praised for its balanced mix of protein, fiber, fat, and greens, resulting in minimal glucose responses.

2. Smart Food Combinations

   • Dr. Means explains the importance of pairing carbohydrates with fats, proteins, and fibers to blunt glucose spikes. For instance, combining an apple with peanut butter and yogurt adds essential macronutrients that stabilize blood sugar.

3. Healthy Alternatives in Restaurants

   • At establishments like Chipotle, choosing options such as the keto bowl—a salad with protein, fajita veggies, guacamole, and salsa—results in minimal glucose spikes compared to high-carb choices like burritos.

Insights from Continuous Glucose Monitoring (CGM) Data

Dr. Means shares fascinating discoveries from Levels’ CGM data:

• Individual Variability: No two people respond identically to the same food. Factors like the microbiome, genetics, and overall metabolic health significantly influence glucose responses.

  “We know, for example, that no two people respond the same to exactly the same food.” ([11:50])

• Impact of Lifestyle Factors: Beyond diet, elements such as exercise, sleep, stress management, and avoidance of environmental toxins play crucial roles in maintaining stable blood sugar levels.

• Population Trends: Highly processed foods with ultra-refined ingredients, such as processed sugars and seed oils, are prevalent in the American diet and are major disruptors of metabolic health.

The Role of Fructose and Insulin Resistance

A critical segment of the discussion centers on fructose, a sugar that doesn’t spike blood sugar directly but contributes to insulin resistance through the production of uric acid, leading to oxidative stress and mitochondrial dysfunction.

“Fructose alone will not spike blood sugar or insulin, but it directly contributes to insulin resistance through a really interesting pathway.” ([44:08])

Dr. Hyman adds that consuming fructose in the form of whole fruits is less harmful due to the presence of fiber and slower digestion, unlike refined sources like high fructose corn syrup found in processed foods.

Timing and Sequencing of Food Intake

The timing and order of food consumption can significantly affect blood sugar responses:

1. Sequencing Meals

   • Eating proteins and fats before carbohydrates can lead to lower glucose spikes. For example, starting a meal with a salad, followed by protein and vegetables, and reserving starchy foods for last helps stabilize blood sugar.

2. Post-Meal Activity

   • Simple activities like walking for 15-20 minutes after eating can reduce glucose spikes by up to 33% ([21:48]).

   “Just take a walk right after you eat... can reduce your glucose rise by 33%.” ([21:48])

Achieving Metabolic Flexibility

Maintaining stable blood sugar levels fosters metabolic flexibility, enabling the body to efficiently switch between burning glucose and fat for energy. This flexibility reduces cravings and dependence on glucose, promoting overall health and weight management.

“By keeping glucose more stable, keeping our insulin levels under better control, we tap into fat burning much more effectively.” ([62:33])

Reevaluating "Normal" Blood Sugar Levels

Dr. Means challenges the traditional notions of normal blood sugar levels, advocating for stricter thresholds to detect and prevent insulin resistance early:

• Fasting Glucose: Ideally should be between 70 to 85 mg/dL, as opposed to the currently accepted upper limit of 100 mg/dL.
• Post-Meal Glucose: Should ideally not exceed 110 to 120 mg/dL, though official guidelines have yet to catch up with emerging research.

“The body is working so hard to overcompensate while our Fasting glucose remains at a seemingly normal level... we really want to keep our fasting glucose in that lower normal range more from 70 to 85.” ([67:07])

Practical Recommendations for Listeners

To empower listeners to take control of their metabolic health, Dr. Means offers actionable advice:

1. Utilize CGMs: Continuous Glucose Monitors provide real-time insights into how different foods affect individual blood sugar levels.
2. Choose Whole, Unprocessed Foods: Prioritize nutrient-dense foods that naturally contain fiber, protein, and healthy fats.
3. Incorporate Physical Activity: Engage in light exercise post-meals to mitigate glucose spikes.
4. Monitor and Adjust: Use data from CGMs to tailor dietary choices and identify personal glucose responses.

Conclusion: Empowering Personal Health Management

The episode concludes with a strong emphasis on personal empowerment in managing health. By leveraging technology like CGMs and adopting informed dietary practices, individuals can mitigate the risks of chronic diseases and achieve better metabolic health.

“We're not going to be able to actually break out of this horrible situation where it's kind of terrifying to me... by being in charge of our own health, being the CEO of our own health.” ([09:13])

Dr. Hyman and Dr. Means advocate for a shift from reactive healthcare to proactive personal health management, emphasizing the importance of understanding and monitoring one's own metabolic health to foster long-term well-being.

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Notable Quotes with Timestamps

• Dr. Mark Hyman ([03:00]): “More than any other country, probably three or four times the death rates per capita, is because we are so freaking unhealthy.”

• Dr. Casey Means ([24:12]): “Skittles, Skittles, Skittles. Not surprising because it's a refined carbohydrate... Skittles have naked carbs.”

• Dr. Mark Hyman ([09:13]): “It's all about empowering people, democratizing healthcare, democratizing medicine, giving people their own health data... being the CEO of our own health.”

• Dr. Casey Means ([44:08]): “Fructose alone will not spike blood sugar or insulin, but it directly contributes to insulin resistance through a really interesting pathway.”

• Dr. Mark Hyman ([67:24]): “By the time your blood sugar goes up, it's already way too late. Like a lot of it could be decades of metabolic poor health before your fasting blood sugar ever goes up.”

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Final Thoughts

This enlightening episode of The Dr. Hyman Show underscores the critical role of diet in managing blood sugar and preventing chronic diseases. By highlighting both the worst and best foods for blood sugar, along with practical strategies for personal health management, Dr. Hyman and Dr. Means provide listeners with valuable insights to take charge of their metabolic health.

For more information on managing blood sugar and optimizing metabolic health, consider exploring Dr. Hyman's resources and joining the conversation on personal health empowerment.

Transcript

[Dr. Mark Hyman]

Hey everyone, it's Dr. Mark Hyman. Thank you so much for being a loyal listener to the Doctor's Pharmacy for the holidays. I've decided to give my team a little break to rest up and prepare for more content and the new year ahead. So the Doctors Pharmacy will be replaying some older episodes for the next two weeks. But don't worry, we'll be back with more content and brand new episodes starting Tuesday, December 31st. So for now, here are some of my favorite past episodes of the Doctor's Pharmacy and see you next year. Coming up on this episode, the worst.

[Casey]

Food in our entire Data set of 51 million glucose data points is I.

[Dr. Mark Hyman]

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[Dr. Mark Hyman]

Jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand. Well, you if you're looking for data about your biology, check out Function Health for Real Time Lab Insights. If you're in need of deepening your knowledge around your health journey, check out my membership Community Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website Supplement Store for a summary of my favorite and tested products. Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to the Doctor's Pharmacy. Every week I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field, so let's just jump right in. The reason we are dying like flies in America, more than any other country, probably three or four times the death rates per capita, is because we are so freaking unhealthy. And that poor health is related to poor metabolic health. And essentially what that means when we say metabolic health is imbalances in your blood sugar, which causes high blood pressure, high cholesterol, and abnormal blood sugar. Those are the hallmarks of this poor metabolic health that now affect almost nine out of 10Americans. And and they're the things that are getting worse and worse and worse. So we're seeing obesity, heart disease, cancer go up. I mean, dementia rising. We're not winning the battle. We are seeing more and more chronic disease every day, more and more obesity. We're better and better at taking care of problems. We have better and better medication, better surgical techniques, better advances in our science. And we're failing so badly because we're barking up the wrong end of the tree. And that's because we're not looking upstream for the problem. So tell us about the foods that are driving all these problems, the places we should be looking at in terms of our diet and our lifestyle.

[Casey]

These are the foods that are highly processed, that have the ultra refined ingredients. These are the foods that make up the vast majority of the calories we consume in this country. They have the ultra refined wheat flour, the processed sugar, which of course has more than 50 names on the packages. So it's so hard to tell, you know, which of the foods actually have processed sugar, but the answer is most of the ones that are packaged in the store. These are the foods with fructose and high fructose corn syrup, the refined seed oils like sunflower corn, soybean oil. These are the foods that when we eat them in these super high concentrations that our bodies have never seen before in evolutionary history until about 50, the past 50 or 100 years. They completely wreak havoc on our core fundamental processes that allow ourselves to function properly, which is our metabolism, and they disrupt our homeostasis. So those are the types of foods that you certainly want to avoid in order to prevent these diseases. And the unfortunate thing is that these ingredients sneak into so many different foods, often foods that are marketed as healthy. And so we really are in a tough position right now. That summary was so phenomenal. We are dealing with two epidemics that are so interrelated right now. We're dealing with the metabolic disease epidemic, which is the leading driver of mortality in the Western world. Now, we like to call all these different metabolic diseases by different names, which, which may make them artificially seem like they have less impact. But really, like you said, the root cause is a problem with metabolism. When we talk about obesity, diabetes, heart disease, stroke, Alzheimer's, dementia, fatty liver disease, it's. We know that all of these are related to dysregulated blood sugar. And in fact, nine of the 10 leading causes of death in the United States are in some way either directly caused by or worsened and accelerated by dysregulated blood sugar. So to get to this question of what are the foods we need to avoid into in order to prevent these diseases? One of the biggest things we need to do is keep our blood sugar in a stable and healthy range throughout the entirety of our lifetimes. And we have the power to do that by making smart choices about our foods and of course, also pulling the other levelers that impact our blood sugar, which is of course, exercise, sleep, stress management, optimizing our microbiome, avoidance of environmental toxins, that hurt our metabolic pathways. I would say that the foods that drive these cardiometabolic diseases are foods that disrupt our cells from doing what they need to do to function optimally. And that then lead to insulin resistance, the physiologic process that ultimately creates the dysregulated blood sugar. The reality is that the average American wants to be healthy and is putting in work to try to be healthy. We see that 50% of American adults go on a diet every year trying to lose weight. You know, of course, 72% of Americans right now are overweight or obese, but half the country is making the commitment and reporting that, you know, in a survey saying that they're trying to lose weight. And yet every year we are getting sicker, we are getting fatter, we are getting more anxious. So there's clearly an effort, outcome, mismatch. And that's where I think the future of medicine.

[Dr. Mark Hyman]

Effort, outcome, mismatch. Yeah, that's a good way to talk about it.

[Casey]

Right? And that is where I think tools that can empower people with information to actually make choices that actually impact the physiology that leads to chronic disease and weight gain is really going to shape and change the future of healthcare and really create this patient empowered, more decentralized form of healthcare where we don't just outsource our judgment to other people, to the food companies, to health care systems that give very generic recommendations, you know, to anyone. We actually are able to have the judgment about our bodies for ourselves. And I think that's pretty cool.

[Dr. Mark Hyman]

It's huge. It's all about empowering people, democratizing healthcare, democratizing medicine, giving people their own health data, helping them learn about it, be their own autonomous health creating units. Because, you know, as we know, 80% of health doesn't happen in the doctor's office and maybe 20% does. And I think that's an exaggeration. Health happens where we live. It happens in our homes, in our kitchens, in our schools and our workplaces, in our grocery stores and our restaurants. That's where health happens. And if we don't focus on those factors and learning how to be not just waiting to go to the doctor to get fixed, but actually being in charge of our own health, being the CEO of our own health, we're not going to be able to actually break out of this horrible situation where it's kind of terrifying to me. I mean, just sitting on the front lines of it like you are, it just seems like one of those conversations is just not really happening. Like nobody's really Saying, hey, we're in like a crisis. Every upset about COVID But way more people die every year from bad food than die from COVID or get sick from COVID And it's causing so much more suffering, so much more health care costs, so much more crippling of our economy. You know, one of the things that's so exciting about the work you're doing, Casey, is that you're, you're not using sort of these large randomized controlled trials and large, you know, observational trials and things that are sort of the conventional way of looking at people. You're looking at what we call N of 1 Studies. In a sense, we're looking at how does each individual respond as their own control group. Because you basically slap on this glucose monitor that measures your blood sugar, continuously called levels. You put it on your arm, you leave it there, and your sugar is just being tracked. And so you get to actually witness what your body does in response to a particular food or sugar. And you've got data from 50 million glucose readings, which is insane when you think about that amount of data that you're collecting and that people are using this technology. And we're learning so many things that are so surprising. And I think, you know, we know, for example, that no two people respond the same to exactly the same food. For example, in Israel, they did a large study, they looked at the microbiome and they found that there, there were differences in people's blood sugar response depending on what bacteria were growing in their microbiome in their gut, which is like, what? That doesn't even make sense. It depends on your genetics, depends on your overall metabolic health. It depends on so many different factors, your toxin load. All these modify your individual responses. So when you've got these 50 million glucose readings from the levels app, the continuous glucose monitor, what are the sort of surprising things that you found? These are sort of non diabetics, right? So it's not like you're a diabetic, although probably I bet you're picking up people like 90% of people with prediabetes have never been diagnosed. I bet you're picking up a lot of that. What are you learning? What are you seeing? What is surprising?

[Casey]

It has been so incredible to start to see some trends emerge from this huge anonymized, aggregated data set. Really the first of its kind in the world. Like you mentioned, we have 51 million glucose data points. And this is just amongst our closed beta program. 16,000 people who have gone through our closed beta program, you know, we have almost 200,000 people on our waitlist. So you can imagine that 51 million data points is going to get a lot larger when we start opening to more people. We have those 51 million glucose data points paired with 1.3 million food logs. So we can start to see for the first time ever how specific foods across a population are affecting glucose and creating this population data of a closed loop biofeedback. You mentioned the individualized aspect of this. That is so true. And that paper that you referenced, personalized nutrition by prediction of glycemic responses that was done about five years ago in Israel, showed how variable it is person to person. We could both, of course, eat the exact same cookie, and you and I could have a very different glucose response based on several factors like our microbiome, our underlying insulin resistance, et cetera. So that's a really important aspect, is for the individual what kind of data they can get to really, truly personalize their own data based on glucose response. Because, of course, and we talked about this a lot in our last episode, a more stable glucose level with more gentle rolling hills after meals, avoiding the huge spikes and valleys that we see after eating large amounts of carbohydrates and sugar. That's what we want. We want the gentle rolling hills, the low glucose response, so you can start to see that in yourself and shape your diet very quickly on the population level. Then we get to see something interesting as well that actually can benefit anyone, not just the people who have a sensor on, because this becomes a database that really informs the nutrition industry like we've never been able to before, where we start to see radical transparency about what food is actually doing to people's bodies. And I personally think in five years it's going to seem incredibly outdated, incredibly quaint, to walk into the grocery store and choose foods based on what the box says, you know, based on interests that are not aligned with your thriving and well being. They're aligned with taking you to your bliss point, making you dependent for it, making your dopaminergic reward systems want to keep coming back, but it's not aligned necessarily with your health. And so we're going to start to see this huge new way of choosing foods. I can imagine, you know, like a person with polycystic ovarian syndrome, for instance, a condition that we know is directly related to insulin resistance. And studies have shown that low carb diets, a healthy Mediterranean ketogenic diet for just 12 weeks, can actually reverse PCOS. This was a study done just a couple of years ago. So there's people and women are very savvy with their research and they're going out and they're reading the books, they're reading these papers and they know they need to keep their glucose and insulin under control. They know that just being prescribed a birth control pill and metformin is not the answer to their long term health. And so, you know, they're looking for tools. And you can imagine that woman, her doctor says to her, you know, oh, you don't have diabetes, you don't need to worry about blood sugar, you have pcos. It's very different. They know though, they've read, they do their research, we're not, you know, people are very smart, very informed. They know they're going to keep their, they're going to work to keep their blood sugar down because they know that in the research that shows that it will help. So they go to the grocery store now with this app with something that they can actually look up every food they're buying and see exactly across tens of thousands of people what it's doing to people's blood sugar. So you go into the non dairy milk aisle and you've got 15 different options. You've got oat milk, you've got almond milk, you've got cashew milk, blah, blah, blah. And it's like, what the heck are you supposed to get? And you think you're making a good choice because you're buying an unsweetened non dairy milk. But the reality is from our data set that there are some of those that give you a monumental spike, even if they're unsweetened oat milk, you know, and then there's others that actually have virtually no glucose response. So that person now can take their health into their own hand, make a consumer decision not based on marketing that's going to serve their goals. And I am so excited for that world because people are going to start, I think, demanding from food companies to actually create products that are not creating a huge amount of glycemic variability or these ups and down spikes and you can't hide from that data. And so I'm really thrilled that of what that's gonna do. So circling back to your main question of kind of like some of the themes that we've seen.

[Dr. Mark Hyman]

Yeah. What do we see?

[Casey]

I think one of the first things that's really interesting is our demographics actually. So aside from glucose data, actually 52% of our beta members are women. And this is so different than what you hear in the mainstream Media. You know, there's a New York Times article about levels that talks about how this is for the worried well, and the biohacker guys and the longevity crazy, you know, and it's like, that is not the reality. The reality is this is mostly women in their ages of 30 to 40. So very, very similar to the demographic I was talking about with people who are at high risk for things like pcos. And their primary reason for wanting to use a cgm. What they report to us is weight loss, followed by finding their optimal diet of men. In the 48% who are men, their number one goal is optimal diet as well. So people are clearly interested in finding what actually works for them. You know, if you go back to what you're talking about with COVID you know, the CDC just announced yesterday, finally admitted that 75% of the people dying of have four or more of these largely preventable cardiometabolic comorbidities. People know. They know now. And now it's finally coming out in the mainstream media that we've got to get the blood sugar under control. So that's one thing we're seeing is really interesting demographics. This is not the worried. Well, this is not the. For the celebrity, rich and famous. This is for people who want to just figure out their diet and lose weight, which is great. The second thing we've seen a lot of is that foods that are commonly touted as healthy or that we perceive to be healthy may actually be generating shockingly high glucose spikes. And I think we particularly see this around breakfast. Like breakfast foods, we certainly see snacks, common snacks, drinks, common takeout foods. And we can certainly dive into the details on those. But it's amazing how some of these things that we just think are totally normal to just eat on a Friday night or whatever they're actually. Or grab for breakfast or serve in school lunches at schools are actually causing these huge, huge glucose spikes. And then I think another thing that's been really interesting is showing people combinations and alternatives of foods that they can do that will do better. So, for instance, combinations. We see a lot of people log something like an apple, and then they'll log an apple with, like, peanut butter and yogurt. And that peanut butter and yogurt is adding, of course, fat and protein. Sometimes they'll put some chia seeds on that. That's some fiber. And we've definitely seen that when carbohydrates, sort of naked carbohydrates, like a fruit, are paired with fat, protein, and fiber, people do better in Terms of alternatives, we've seen some really interesting things. We just published an article on Chipotle. We see people logging all sorts of things at Chipotle. Some of them disaster for glucose, some of them virtually no glucose response, like an average of 7 milligrams per deciliter, very low. So that the really, you know, minimal glucose spiking things is the keto bowl. This is a salad that has protein, you know, fajita, veggies, guacamole, salsa, virtually no glucose spike, tons of nutrients. Burritos on the other hand with that gigantic tortilla send people on average through the roof. So people start learning, if I'm going to go to McDonald's, if I'm going to go to Chipotle, if I'm going to go to Sweetgreen, what should I order that's going to give me the best, you know, bang for my buck in terms of blood sugar. And then I think the last thing I would.

[Dr. Mark Hyman]

Everybody's different, right? Everybody's different, right? So you know, it doesn't mean that you know what works for you, like you say, oh, I found that this screwed up my blood sugar, doesn't mean it's going to screw up your friend's blood sugar. Right?

[Casey]

That's definitely true. So these are more the population based sort of things that we're seeing that can kind of give you, I think a general just stalled of where you should start. And then of course it's about actually trying it for yourself and seeing what actually works for you. There may be that person out there that doesn't spike to a huge flour tortilla. But for most people, you know, knowing that getting the keto bowl is going to have totally stable blood sugar on average for the population, they can at least go in there and get that and see what it does to them. So it kind of, I think nudges people in the right direction. And then the last big insight that I think we're seeing is around this is so simple, but it's profound is walking. We have seen that a simple walk after eating significantly reduces glucose responses. And we actually did an experiment where, with our members where we sent people a 12 ounce can of Coke and two of them and we said, hey, if you want to do this, drink this Coke on one day and then on the next day drink the Coke and take a walk right after you drink it.

[Dr. Mark Hyman]

Yeah, yeah, yeah.

[Casey]

And we actually saw across this population that of the people who completed both aspects of the exception experiment, the median delta of the glucose rise was 33% lower if you just took a walk. So that was going from an average of 162 milligram per deciliter peak to 132 over the course of your lifetime. If you're doing this every day, that's a huge difference.

[Dr. Mark Hyman]

So how soon do you have to walk after you eat?

[Casey]

Well, there's a lot of research that looks into this, and it really comes down to the sooner the better. If anytime you walk after a meal, even if it's an hour or two, do it, that's fantastic. But because our glucose tends to peak within an hour after a meal, I would say what I would recommend to people is after a meal, finish the conversation 15, 20 minutes, get up with the family, take a spin around the block, put the dishes in the sink, go take a nice stroll around the block, and then come back. And if you, if you don't want to walk outside because it's cold, put on some great music and have a dance party in the kitchen or, like, do a few squats. Like, it's really just about moving. But these are significant effects. So that's kind of the general layout of some of the things that have been so interesting to me just from looking at this huge, huge data set.

[Dr. Mark Hyman]

That'S just so fascinating. It's like we, you know, we just sort of have this one size fits all approach in traditional medicine, and it's just so far from that. Right. You know, you also learned about, for example, what would be things we should never eat? Like, what are those things we should just never eat?

[Casey]

Well, I'll go off of just what we're learning in our data set, like, because we could. Obviously you and I could talk about this forever about general principles, but.

[Dr. Mark Hyman]

Yeah, but I think getting the specific data is just so fascinating. That's why I want to get into it.

[Casey]

Absolutely. Of the categories of things that at this point, based on what we've learned, I would not really eat anymore would be certain candies, which I'll go into each of these in more detail. Cereals. Certain cereals. Soda, for sure. Fast food, and lots of common takeout. So when we look at candy, this is actually really interesting. The worst food in our entire Data set of 51 million glucose data points is.

[Dr. Mark Hyman]

I want to hear this. Drumroll, please.

[Casey]

Skittles, Skittles, Skittles.

[Dr. Mark Hyman]

Wow.

[Casey]

Not surprising because it's a refined carbohydrate. You know, obviously there's refined sugar in there, but it's also kind of a naked carb. Right. It doesn't actually have fat, protein and fiber. Like a Snickers bar at least has some fat and some protein. The Skittles are just like naked carbs. So the skittles have an naked carbs.

[Dr. Mark Hyman]

I love that term. I never heard that.

[Casey]

I love that they're just on their own, you know, like, and you can think of like fat, protein and fiber is kind of clothing the carbs.

[Dr. Mark Hyman]

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[Casey]

So Skittles have an average glucose rise in our Data set of 83 milligrams per deciliter. So that's certainly going to take you up. It's way more than a Coca Cola. And you are going to almost inevitably crash after that type of spike. Because of course when you spike that high, you release all this insulin to soak up that glucose out of the bloodstream. And that huge surge of insulin can overshoot. You know you can. It just the body responds sort of in an exaggerated way. You take up all that glucose and then people often dip to below their baseline and have that reactive hypoglycemia after the spike, which is when they feel shaky, tired. Let's go lethargic. Yeah, exactly. You want to. The beauty of achieving more of the gentle rolling hills is that you don't end up having that reactive hypoglycemia that can make you feel really crappy. That post meal slump that people are often like, oh, I just need a cup of coffee or something. It's like, no, it's the Skittles. And so. So Skittles have a huge the other candies that are in the worst part of our data set are Sour Patch Kids, Caramel corn, Twizzlers, and jelly beans. So you notice they all are similar. They're all these kind of jelly beans. Not chocolatey, not no protein, no fat. Just like straight, you know, congealed sugar, basically. So those are the candies.

[Dr. Mark Hyman]

We used to have those things when I was a kid. It was like this powdered stuff, lickamate or something. Like, I forget what it's called. Lick them. You put a stick in your lickage. Pure sugar.

[Casey]

Yes. And the stick was made out of sugar, too, wasn't it? Like, Like a candy stick.

[Dr. Mark Hyman]

I never. I don't remember seeing that anymore. I mean, I don't really look for it, but I was like. That was my main go to thing. It's like when I was 6, 7 years old. Want the lick of mate sugar? It was like a fentanyl lollipop.

[Casey]

You know, I mean, we use sugar as a pain management tool in hospitals. You know, it's. This is abhorrent. But when children undergo circumcision in the hospital in their first days of life, what do they give them for pain medication? This little dropper called a sweetie's, which is just sugar water, that is the analgesic. So it's like exactly like you said. It literally is like a fentanyl lollipop. So that's candy. So. Yeah. So get rid of the Skittles. You know, a Snickers bar literally has half the glucose spike of Skittles. So it's pretty amazing. Then it's cereal. Oh, my gosh. Get the cereal out of the house.

[Dr. Mark Hyman]

So mentioned takeout and other things, too. Right.

[Casey]

Well, just to tell about the cereals. Cinnamon Toast Crunch, Honey Nut, Cheerios, lucky charms, about 60 or above on glucose responses.

[Dr. Mark Hyman]

Wait, wait, wait. Honey, not Cheerios. So we think honey is good, nut is good, and Cheerios are good. So it's like actually a. Just a wolf in sheep's clothing.

[Casey]

It sounds like after Cinnamon Toast Crunch, it's the worst. Yeah.

[Dr. Mark Hyman]

Oh, my God. Worse than Froot Loops or Pebbles or Cocoa Puffs or any of that.

[Casey]

Those. You know, I haven't checked those precisely in our data set, but when you look at just like the top 50 worst foods that people log, all three of those, these kids are going to school after having these spikes and crashes and, you know, Mark, like, a lot of them are probably eating a glass of OJ on the side, which. These are isolated food logs.

[Dr. Mark Hyman]

So, I mean, you know, Casey, I just break in for a minute. I remember when I was Filming the movie Fed Up. And one of the. One of the scenes was where the mother was, like, trying to get her kids to lose weight and her family lose weight, and she's like, well, what I really focused on is healthy breakfast cereals. And she pulls out these cereals that are marketed as, quote, health foods. I mean, Kellogg, who invented breakfast cereal as a breakfast food, which wasn't a thing, right? These are basically dessert for breakfast. It's 75% sugar. And it's. That is, you know, having a soda with breakfast. So I think. I think people need to get that. That cereal and starch for breakfast is a huge. No, no. If you can do one thing to change your biology quickly is get rid of any starch or sugar for breakfast.

[Casey]

Yes, yes. You said that. It's like eating sugar for breakfast. I will up the ante here. It's much worse than eating dessert for breakfast. Peach pie has an average glucose spike of 46 milligrams deciliter. Cinnamon Toast Crunch is 59. It's, you know, and they both have, of course, the refined seed oils and the flour, it's worse.

[Dr. Mark Hyman]

So give me the peach pie. I love.

[Casey]

I know, exactly, exactly. So you mentioned, you know, breath getting rid of the breakfast foods that have the refined starches. This has been one of the most fascinating things we've seen because all the common American breakfast foods are in the worst hundred foods that score. And these just to run through them really quick, we're talking about this is in our worst 50 foods. Egg McMuffin, bagel with cream cheese, French toast, Pop Tarts, cereal, English muffin, blueberry scones, cinnamon roll, Cheerios, croissant, toast with jam. Those are all above a 40 milligram per deciliter spike. So that's a big spike, which is a lot. It's a lot. If you look at then the best foods in our data set, like very little glucose spike, you also see a handful of breakfast foods. And so these are the ones we want to eat. Like what we see frittata, we see avocado and egg, avocado and greens, chia pudding, Greek yogurt and berries. And we actually see this. A lot of people log this, I think, because Kelly Levesque is sort of close in our network, but we get a lot of logs for the Fab four Smoothie, which is a smoothie that she has popularized, which is really balanced. It has very minimal fruit, a lot of protein, fiber, fat, and greens. And all of those that I just mentioned, all score below 20 milligrams per deciliter. So you want to get it. I mean it's basically Mark, it's the pegan diet. Like it's, it's, you know, people can read your book and like it's. But it's, it's, it's the, it's the beautiful sort of like nutrient dense foods that none of those have refined carbs. And I think people sometimes assume that oh, if I'm going to have a keto breakfast or a low carb breakfast, I need to eat the animal products. That's not true. Half of those things I just mentioned don't have animal products. The Fab 4 smoothie, the Chia pudding, you could do non dairy yogurt with some berries, some avocado with, you know and so that's just something important to remember that breakfast is. This one's straightforward. Don't eat those first things, eat those things.

[Dr. Mark Hyman]

So fat and protein for breakfast, get rid of the starch and sugar. Yes, very important. And I, you know, I think it's super important. I mean I used to, in my sugar detox book I create a smoothie which essentially nuts and seeds. So it's raw nuts, almonds, walnuts, pecans, whatever, hemp seeds, chia seeds, flax seeds, putting in like cranberries which is actually very low glycemic, the lemon, maybe some berries, unsweetened macadamia milk or whatever. And it's, it's basically and greens you can put in there and avocado and it's basically a protein and fat smoothie that tastes delicious.

[Casey]

Yeah.

[Dr. Mark Hyman]

And it's not all the typical, I mean, oh my God. Like things like ensure boost, all these sort of meal replacement things. Most you know, traditional smoothies are full of sugar, artificial sweeteners or processed, highly processed protein powders. I mean it's so good to get just real food. So I love that real food smoothie. I want to ask a couple more questions. So there are, there are a bunch of things you learn just because this is such a new area, we're just learning about in real time what happens to real people in a continuous glucose monitoring setting which people have to realize. This is not a technology that's been around for a long time. It's relatively recent and it's even more recent that it's being used at scale by non diabetics. So that's a huge thing. We're just learning stuff that we just never had insight into before and levels is capturing that data and making sense of it and has so many beautiful lessons and for you, for anybody, listening levels and relaunching. It's a great technology to actually see what's going on with your own biology. And I was super surprised too, and shocked. And I'll just give you a little anecdote of what happened to me, but the first night we got it, I used it and I was at my friends and we had this big dinner. We ordered all the healthiest food from this regenerative farm and lamb and all these veggies. And it was so healthy and non sugar, there was no starch. It was amazing. And we ate so much food. We just ate a huge volume of food, of healthy food. And we both were like going to bed, checking our sugar and texting each other like, what happened? Our sugar is like 160. This is freaking me out. What's happening? Any big meal also can cause a spike, but there's a few things you learn. One is what are the surprising things you learn? That we should really never eat. I mean, sorry, that we should that actually spike your blood sugar that are surprising to you. And what foods might not actually spike your blood sugar but you still should get kind of rid of.

[Casey]

This is such a great question you asked for some surprising foods that spike blood sugar. I want to preface this answer by saying that some of these foods, it's not necessarily that you should avoid them completely because they're actually nutrient dense whole foods. It's that it's good to be aware of how they're affecting you so that you can figure out how to eat the food in some different way. Maybe eat a smaller portion, maybe pair it more with fat, protein and fiber, maybe take a walk afterwards. But the intention is not to hear these foods and then say, oh, I can't eat that again, it's not a good food. So this is brings me to one of the first ones, which is certain fruits. There are certain fruits that spike people on average a lot more than others. The ones that we see in the data set are banana, which is maybe not that surprising. But grapes, Grapes have an average glucose spike of over 40 milligrams per deciliter. Whereas like a mandarin orange for instance is like 20. So it's a very big difference. We also see even within fruits, like different types of oranges. A mandarin orange has a low spike. A sumo orange is almost double that. And I mean, those sumo oranges are like so unbelievably delicious. And you know, it also could be kind of a size thing, but you know, chop up those oranges, put them in some Yogurt and have add some zen basil, you know, seeds or chia seeds or something with tons of fiber. It's going to potentially blunt that spike. So fruit, fruit juice is not a huge surprise, but like orange juice, huge spike, average of 40 milligrams or less liter. So I would say of course avoid liquid sugar, which I would consider juices to be liquid sugar. But certain fruits do have more of a spike than others for sure. The next one, corn on the cob, average glucose spike of 46 milligrams per deciliter which is the same.

[Dr. Mark Hyman]

What if you lather it in butter?

[Casey]

Well, maybe doing some grass fed. Yeah, I think it's a good point.

[Dr. Mark Hyman]

Grass fed beef with it as before.

[Casey]

Or grass fed butter, you know, some really nice butter, some ghee. I actually put corn now I only use corn really now within recipes because I know that if I eat corn alone it's going to spike me. So for instance, I make these really great hearts of palm crab cakes. So they're crab less crab cakes and they have some corn in there. They don't spike me. I eat it with an avocado relish. There's lots of other stuff going on. So I just have figured out how to balance it to not spike me. We also see big spike to some foods that are totally marketed as low carb. Like I hate to throw, you know, some, some certain brands under the bus, but smart sweets, you know, they market themselves as having significantly less sugar than other candy but they have a higher glucose spike on average than a cinnamon roll. So that's where marketing people are like oh crazy. Eat the low carb candy. You gotta test it on yourself. And then this one was interesting. So the fasting mimicking diet has become really popular.

[Dr. Mark Hyman]

And actually yes.

[Casey]

Oh this one in our top 10 worst scoring foods. So right next to Skittles is.

[Dr. Mark Hyman]

You mean the passing mimicking diet, the.

[Casey]

Prolon diet, the tomato soup has an average glucose spike of 53 milligrams per deciliter. I don't quite know.

[Dr. Mark Hyman]

So it wasn't the whole program? No, it wasn't the whole program.

[Casey]

This is an individual food.

[Dr. Mark Hyman]

Yeah, one of the soups. So then I need to talk to Valter Longo and tell him to swap out that soup. You should just send it to him.

[Casey]

I will, I'm going to, I'll send him the episode. You know, we, we have not met personally but the thing is their results of the data of that program are profound and it is clearly evidence based that it is extremely effective for Improving cardiometabolic biomarkers. What I would say, though, is that there's probably a way to even more tweak that program if the, if the ingredients were slightly modified. I don't think that glucose spike in the context of basically eating like 500 calories a day for five days is really going to hurt people. But we want to reduce glycemic variability and it's probably pretty simple to swap out some ingredients there. So that's good information to have. And the last thing I'd mentioned that has really blown me away is the energy bars. We probably have over 50 different types of energy bars logged in the data set ranging from quest bars, bulletproof bars, Clif bars, Luna bars, all of these. And the spectrum is profound.

[Dr. Mark Hyman]

We see that somebody's like, what bar should I eat? It's such a big question, what protein bar? What bar do I have? What's good? And people are eating stuff and I'm like, totally.

[Casey]

And they also wonder about it. They're walking to the Whole Foods and you know, you go into that aisle with all the bars and it's like, it's just colors galore. Beautiful packaging. All these claims on every box. Each one has a different thing. It's like, oh, this has no sugar alcohols, this has high protein, et cetera, et cetera. This one's organic. How the heck do you know what to choose? Well, in the future we can look it up like this and figure it out. So for instance, Clif bars have a spike around 42 milligrams per deciliter. That's almost 10 points higher than a Snickers bar. I used to eat those.

[Dr. Mark Hyman]

I used to live on those things.

[Casey]

Go macro bars have a spike of around 44mg L. And then you look at some of these others, like bulletproof bars are very low, perfect keto bars. And so I'm just. This is all just sort of, you're kind of anecdotal data. This is obviously not controlled trials. But what I get excited about is that that person in that aisle who has made the commitment to try to lose weight, to try to be healthier, is not at the mercy of the food marketing of what the box says. They actually have some agency now in the face of, unfortunately, industries that are, you know, not necessarily aligned with our, our long term health. So those are some of the surprising ones that we've seen.

[Dr. Mark Hyman]

Yeah, I bet. I mean, a lot of people are trying to design products are good, but they never had this tool before. So now they can reformulate, maybe think about it. And I think that's the key. We have to stay current with what's true. And I think your, your work and getting this data is going to be so important to helping us be empowered around making the right choices in general, but also for us. Right, so, so you, you also mentioned things that like, could spike your blood sugar. I mean, they don't spike your blood sugar, but actually we should still get rid of what. Why? Why is that?

[Casey]

Well, this is such an important question because I want to be very clear. Glucose is not the only biomarker that you need to orient your diet around. There are other. It's. Right now it's the only continuous biomarker that we have that can give us closed loop biofeedback on nutrition. We don't have anything else that we can put on our bodies and see exactly how food's affecting us. You know, I think, of course, both you and I would probably love to see an inflammatory monitor, an oxidative stress monitor, you know, these things that also affect our insulin. Insulin.

[Dr. Mark Hyman]

You told me you're going to have insulin.

[Casey]

Of course. And so that's what we, that's what kind of gets into the things that won't spike glucose, but you still should avoid for optimal metabolic health. The first and the biggest one is fructose. So fructose alone will not spike blood sugar or insulin. But we know from the mechanisms of how insulin resistance develops that it directly contributes to insulin resistance through a really interesting pathway. Fructose is broken down into a byproduct called uric acid, which goes into the mitochondria, you know, the seed of our metabolism in the cell, and generates oxidative stress, you know, this, this damaging free radical activity that actually causes the mitochondria to become dysfunctional and process glucose less effectively and shunt glucose to fat storage. So then you start getting fatty liver disease because of fructose, and that fatty liver disease causes liver insulin resistance, which then make, makes you less able to stabilize and regulate your blood sugar. So fructose has this really interesting side pathway that ultimately leads to more instability in glucose, but will not show up on a CGM if eaten in isolation. Now, of course, a really important thing.

[Dr. Mark Hyman]

I just want to stop there because you said something super important. You know, if you're, for example, eat a sugary soda with, you know, with high fructose corn syrup, you know, you'll get a mixture of glucose and sucrose. But if you have like pure fructose, which is like Agave, for example, that that's just pure fructose. And that actually turns out to be pretty bad for you. If you're eating fructose in the matrix of a fruit, it's probably not as bad, right? It's actually can be okay that you have it in a complex of a meal. We'll talk about food pairing in a minute. But the idea that you can be eating certain foods, fructose, which a lot of like for example, processed food is mostly fructose, like they use high fructose corn syrup. It could be 75% fructose. And that isn't going to spike your blood sugar like you said, but it's going to create a cascade of events that actually makes you more likely to get diabetic by increasing the uric acid in the liver. The insulin resistance. And the uric acid story is a very fascinating one. And David Perlmutter just wrote a book about it called Drop Acid, which isn't what you think it's about. Yes, it's about the uric acid in the blood that's causing some of these issues. And fructose is a huge culprit. So I just have a pause there.

[Casey]

It's so important. So going off of what else should we be thinking about? I would love to see a uric acid continuous monitor. Because then all of a sudden, if we could measure both those things, then we start to see a more holistic view of how food is affecting us. Because ultimately our mission at LEVELS is to help people know how food affects their bodies so we can reverse the metabolic disease epidemic. But right now there's still some blind spots. So like you mentioned, David Perlmutter is coming out with a book called Drop Acid about how fructose is affecting our health. We also in February are getting another book by Rick Johnson from University of Colorado that's called Nature Wants Us to be a Fat, which is also all about uric acid. And so I think we're going to be starting to talk a lot more about that come February, which is awesome because fructose is absolutely killing us. There's just absolutely, you know, really no two buts about about that. And like you said, it's not the fructose that comes in fruit, which is in a complex of fiber in a whole food slower to digest and smaller quantities. It's the refined liquid versions that go into our processed foods and that we find in juice that we should really avoid. Because what happens is we over the liver knows how to process fructose and it knows how to just produce small amounts of uric acid that our body knows how to handle. It's when we overwhelm those pathways in a short period of time that we get the uric acid skyrocketing and create that oxidative stress. So it's really a lot about pacing. And they've even done research showing that if you drink a Coca Cola slower, like over the course of an hour or two hours versus in five minutes, it actually has less of a damaging effect on liver because you have to think we're just, we're just made up of a ton of cells that are trying their hardest to process this stuff, right? And so if you can process and clear, process and clear, it's better than if you just jam it down your throat and overwhelm the enzymatic, you know, all these enzymes in the body that are trying so hard to get through it. And then you end up creating excess of these damaging byproducts that ultimately lead to organ dysfunction. So fructose is a big one. The second big one I would mention is the pro oxidative stress inducing foods that come from more like refined fats. So it's like the seed oils that we talked about. Again, the name of the game is in many ways oxidative stress, which is this process that damages our mitochondria. So you want to avoid those refined seed oils that are in everything that's packaged and you really be vigilant about looking at labels and, and trying to opt for things that only have oils like avocado oil, olive oil, coconut oil, ghee, butter that are less prone to oxidation.

[Dr. Mark Hyman]

So are you saying this based on your data from levels around the refined seed oils or just in a general way?

[Casey]

Not saying that based on our data set? None of these actually these ones for this question. Not talking about our data set. The thing is about the data set is that what we're seeing is the real time response to different foods. But the next layer of this onion, when we have lots and lots of people using this type of technology over long periods of time, is we think we'll start to see the longer term the lagging effects of how these other products like fructose and refined seed oils and excess alcohol over the longer term lead to glucose instability. A lot of that we just don't have much knowledge about because we haven't been looking at pre disease very much in our medical system. We don't really study healthy people and how they go from healthy to pre disease to disease, because that's not the way that our healthcare system works, we wait until disease and symptoms emerges and then we react and that's a problem. So I think we're going to see a shift here in starting to understand. But this is more based on what we just know from the mechanisms, the fructose and the seed oils.

[Dr. Mark Hyman]

Yeah. Amazing. So I have a question about another aspect which is not exactly what we're eating. It's dealing with more complex nuances around what we eat with what when we eat. Right. The timing of eating, you know, what we eat first, second, third. This is really interesting. And I remember talking to an endocrinologist at Harvard, I think a while back, he said, you know, we're finding like if you have a glass of wine at the beginning of meal, it messes up your metabolic health. But if you eat it like halfway through or drink it halfway through or have it after, it doesn't, or if you eat a piece of bread before dinner, it's a disaster. But if you have it like halfway through the meal, doesn't spike your blood sugar as much. So tell us about what you're learning about, you know, what you should eat with, what to kind of minimize the spikes in blood sugar. And two, what you should eat first, second, third and three, how does time restricted eating affect all this blood sugar stuff?

[Casey]

Yeah, well, I think the alcohol example is really interesting and it's an important one to mention, especially both in relation to your last question and this one. Alcohol is really interesting because straight alcohol, like spirits. No, mixers that have sugar actually often cause people to see a decrease in their blood sugar on their continuous glucose monitor.

[Dr. Mark Hyman]

Yeah, you mean, you mean like tequila?

[Casey]

Not like wine? Wine. Wine actually fits in there as well. So wine, tequila, other sort of like hard alcohol that's not mixed with anything, people often see that it blunts their glucose response. And this is a well known phenomenon. The way that alcohol acts on the liver is that it actually stops us from doing what's called gluconeogenesis, which is the process where, or it inhibits that process where. And that's where we make glucose in the liver from other substrates. So it's one of the pathways that our body uses to make sure our glucose never gets too low. But when you block that, it can make glucose just look artificially a little bit lower because that's one of the streams of glucose going to the body. Food is another one, but you're turning it off. And so that's an interesting thing where it will not spike your glucose. But, and I wouldn't say it should be avoided completely, but in excess it should be avoided because over time, you know, two or more drinks a day is associated epidemiologically with, with worse metabolic outcomes. Interestingly, if you look at the risk of alcohol and metabolic disease, it's actually a J shaped curve, meaning that if you drink no alcohol, people actually have, are in a slightly higher risk for developing metabolic disease, very minorly higher. But one drink seems to be associated with the lower, the lowest amount of future development of cardiometabolic disease. And then after one, it sort of goes up. So it's a J shaped curve. This is not to say you should drink for your metabolic health, but it is kind of an interesting thing that you do see in the literature. So that's sort of the case with alcohol. It won't spike your glucose, but an excess should be avoided. And another interesting thing about alcohol is that it of course disrupts the microbiome and can create some transient leaky gut. It also conventional wine is filled with pesticides and food additives that we know can impact the gut. And like we talked about earlier in the episode, Gut health and microbiome diversity is one of the predictors of your response to different foods in terms of glucose response. So it gets kind of complex. If we could also track our microbiome, this also might help us, help us understand our diets a little bit more. So we want to, you know, certainly be thinking about microbiome and about environmental toxins when we're eating. Even though some of those things are not necessarily going to spike your glucose in real time. Eating pesticides is not going to spike your glucose, but over time it can create the toxic damage to our cells that ultimately does lead to insulin resistance. And we know that certainly with, with several of these chemicals, like in our environment, like persistent organic pollutants that of course are not going to spike glucose immediately, but which over the long term create cellular dysfunction. So kind of getting back to your question about, you know, about how to pair foods and time them and sequence them. The key point is balance. You want to eat carbohydrates with fat, protein and fiber. That is generally going to blunt the glucose spike by slowing digestion. And fiber actually can sometimes block the amount of sugar you even absorb from the gut. They've looked at studies, I think with, with nuts, for instance, which have a good amount of fiber and the calories that are on the bag may not be the calories that you actually end up absorbing, because fiber blunts some of that absorption. So I Think of fiber as like a total magical life hack. And I end up adding, I end up adding chia seeds. And I love this other type of seed called Zen basil seeds, which actually have more fiber than chia. Just sprinkle it on stuff. It's like a little superpower, no?

[Dr. Mark Hyman]

You could even take a spoon of Metamucil in a glass of water and drink that. I mean, actually studied that. It helps pgx. Another one, polyglycoplex, which is from cognac root, a Japanese fiber. The Shirataki miracle noodles. That stuff is amazing. And that can be powerful. And you give it before meal. I've had people lose 40 pounds like that just adding that to their diet because it stops a spike in insulin, stops the spike in glucose. Pretty amazing.

[Casey]

It is amazing. I mean, the shirataki noodles that you mentioned, which I think generally have konjac root in them and some tofu. This root, konjac root has so much fiber, it's actually eating this food has been shown to improve metabolic outcomes and reverse obesity. And you think about like you could either eat like white pasta with refined white flour with very few nutrients, or you could eat some konjac root which has tons of fiber and nutrients. Like that's the type of swap that a lot of our members are like. It's kind of changing their lives. Like, yeah, totally. I still get to eat my pesto pasta, but they taste pretty good and.

[Dr. Mark Hyman]

They'Re actually called, they're actually called cognac. Cognac. It sounds like cognac. So it. And it's not the cognac you drink, but I was corrected by David Boulay, who was a friend of mine as a chef. I was like, oh, konjac is like, no, no, no, it's cognac.

[Casey]

I'm so happy to know this because I eat them constantly. I have a, I have a recurring subscription to, to New Pasta, which is the brand like that that makes these, these hundred. The only ingredient I think is cognac. So the last point I'll touch on is the sequencing that you talked about, which is how to order your foods in what order to eat them to get the best glucose response. And this has actually been studied in a lot of peer reviewed data as well. If you eat protein and fat before your carbs, people tend to have a statistically significantly lower glucose response to those subsequent carbs. So it's kind of the opposite of what we do in the restaurant where we get the tortilla chips and the bread rolls before Our salad and our main course, we should do it exactly the opposite. We should be eating, you know, the roughage of the salad, put something, some good fiber in our bellies, maybe have, you know, the chicken. You know, if you're looking at a plate that has chicken breast, a bunch of greens and asparagus and mashed potatoes, you know, the way to do it is eat your salad before the entree, then eat the chicken, then eat, you know, and eat the vegetables, wait two or three, four minutes, and then eat the mashed potatoes. That will likely have a better response than if you ate the potatoes first and then everything else. And so I think about that now when I'm kind of thinking about how to. How to approach my plate or how to serve food at a. At a dinner party. Just simple shifts in ordering can make a big difference. It also can be satiating, right? So you eat that protein and that fat, which is more satiating first. You may end up finding that you don't want as many of the rolls or the tortilla chips or the mashed potatoes after eating those things first.

[Dr. Mark Hyman]

So amazing. You know, I think. I think what you're saying is so important, and it speaks to something people really don't talk about enough, which is this idea of glycemic load. So the glycemic index I'm talking about, does a particular food spike your sugar? If you eat that food in isolation, this is what you'll see. But when you look at how we actually eat, we eat food in a food matrix. We eat protein, fat, fiber. In fact, there are very few foods that are just pure whatever. So protein, like meat is pretty much protein, and just olive oil is pure fat. And, you know, sugar is pure sugar. But often when we eat, like nuts or seeds or, you know, even vegetables, vegetables have fat. They have carbohydrate, they have protein. So it's interesting to kind of look at how do you design a way of eating that is actually creating a meal that can include foods you think are maybe forbidden, but actually you can add them in small amounts in ways that their effect is blunted because they're in this food matrix of protein, fat and fiber. And protein, fat and fiber are your friends for regulating your blood sugar. That's the bottom line here.

[Casey]

Absolutely, absolutely. And one of the things that I love to do is while I'm cooking, I'll have some of these foods that you just mentioned kind of out on the counter for people to graze on. So things like, things that I know don't spike Glucose, but which have those fat, protein and fiber. So some of my favorite things is having an assortment of nuts. We see that pili nuts and pistachios and walnuts and macadamia nuts are some of the best ones that we see. Then I'll have some olives, which very little glucose spike, lots of fat, delicious. And you know, some flax crackers or some seed crackers which have so much fiber. And maybe have some sort of like a sardine dip or something which has some fats, some protein, some omega 3s, so a little bit of like a really healthy charcuterie that is going to make people, when we get to the meal, not necessarily want to dive into whatever carb is on the plate. So really simple, delicious stuff. And another one I love to add is coconut chips, like the little dried coconut, they have virtually no glucose response and have a good amount of fat in them. So those are certainly some pre meal stuff you could try or even things you can pack in your bag to have snacks throughout the day that have a low glucose response.

[Dr. Mark Hyman]

That's great. I mean, there's a lot of tips. I created a video once called how to Never be in a Food Emergency. And it's kind of a goofy video you can find on my website. But essentially I kind of put all the snack foods that I choose to travel with so I don't get in a food emergency. And everything from olives, you can go in packages or nuts or seeds or canned fish, salmon jerkies, grass fed beef jerkies, for example. And I have all this stuff. So it's all stuff that is the opposite of people's typical snack foods. So snack foods aren't necessarily bad. I mean, I, I don't really snack. I don't think we should be snacking. I don't think we should be eating after dinner. I mean, I think snack culture is just ridiculous. And it's actually a driver driving force because how do we produce an extra 5 to 700 calories a day per person in America? What are we going to do? The food manufacturers want to sell that, the farmers want to sell that. So we're pumping in all this extra food in the marketplace mostly in the form of these roast snack foods. And it's a disaster. But if you're going to be on the road, you might need to eat. And I can tell you I carry a day or two of food in my bag all the time. So I never get in a food emergency. I'm never in an airport or somewhere where I'm like starving to death. And I have to make a bad choice because I'm just like everybody else. If I'm hungry, I'm like. And I'm going to die because I haven't eaten something. Which is what your body basically does. It's like a limbic response, the fight or flight mechanism. It's your reptile brain. You're not going to make a rational choice. So I make sure I keep all that stuff with me all the time. And it's great to learn from you. What are the things that are the most effective? So that's really great. I want to ask a couple more questions before we close, unless you have a comment to make about that.

[Casey]

Oh, I was just going to say one of the beautiful things about keeping your blood sugar more stable over time is that, and I'm sure I imagine you've noticed this in your own life. I certainly have. Is that when you keep that blood sugar down and you get on top of your insulin levels, you end up being more metabolically flexible. And actually that can really diminish that type of. That craving and hunger that we feel all throughout the day to have those snacks. Right. It's the spikes and the crashes that lead to this dependence on glucose, where our body is more biologically equipped to process glucose than fat. So by actually keeping glucose more stable, keeping our insulin levels under better control, we tap into fat burning much more effectively. And we all have several weeks worth of fat, even a lean person on their body, that can help us get, you know, stay satiated and not so, you know, viscerally hungry in between meals and not so dependent on glucose. So that's one of the other things that I really love about this technology, is that it trains people to kind of manage, like, anger and manage their cravings and become. That is really what one of the side benefits of metabolic flexibility is, is not, you know, having that desperate feeling of like, I have to snack. And I've definitely had times in my life when I've more. I know I've been less metabolically flexible because I'm always looking out for, where's the Hershey Kiss? Where's the snack? Where what if I don't have food with me? And that's not really a. That's not really a great place to be in, you know, and so it's very liberating to. To kind of be able to go longer between meals. And I was at a talk by Dr. Terry Walls at a conference just a few weeks ago, and she takes it to the extreme, which is that she's, she's so metabolically flexible that when she travels, because obviously air are just a disaster land for, for getting healthy food unless you bring your own. She just doesn't eat on travel days. Those are her extended fasting days. And she's trained her body to be so metabolically flexible over time that, you know, she can tap into her fat stores during those travel days and not have that kind of panic. And so, so that's definitely one of the things that motivates me as I keep my glucose more stable is I know I'm becoming more metabolically flexible and therefore I'm becoming a little bit more free from the dependency on always having a glucose hit.

[Dr. Mark Hyman]

That's amazing. Yeah, you know, I, I agree. I mean, I find that my, I'm never in a state of emergency with food. I know what to eat when, and I have my way of balancing my blood sugar and I just, I never get these crazy swings. Some, like a few days, you know, if I really like, kind of missed the boat or was with friends or, you know, we, we have some kind of, I don't know, my schedule gets disrupted. Yeah, I, I, I will get hungry or hangry like everybody else, but I really learned how to actually regulate this. And it's so, it, because you're not like, stuck in this vicious cycle of sort of looping on high and low sugars and insulin and ending up, you know, craving foods you shouldn't crave. I mean, it's really quite, quite amazing how if you just learn a little bit about your biology, you can fix this problem. So the thing I want to talk about was like, what do you find instead of this whole conversation about what's normal blood sugar? Because the, you know, what we learned in medical school is if your blood sugar is 100 or less, you're okay. Actually, when I was in medical school, it was like 110 or 115. Now they lowered it to 100, but it's actually, actually learning. We're actually learning that maybe that's even a hundred is not that great. So tell us about what we're learning about the spectrum of blood sugar, fasting and even after eating food. What's that tell us about what we should be having as our blood sugar as opposed to what we think of as normal.

[Casey]

Yeah, well, I have to admit, a lot of what I've learned about this comes from you. I mean, reading the blood sugar solution. I think when I was in medical school, one of my favorite books of all time, everyone should read it and But I mean, it's a wake up call because that book is based on the research and it was not what I was learning at Stanford Medical School, that, that if a patient walks into the office and their glucose is 99, that bill of health, it's under, it's under 100, you're totally fine. You don't need to think about this. That that is false nonsense.

[Dr. Mark Hyman]

Right?

[Casey]

We have learned. There was a paper in the Lancet from, I think two years ago that showed that fasting glucose is really a very lagging indicator of metabolic dysfunction and therefore probably not the best, the best screening tool for us to use to identify people who are on their way to big problems and this conversation.

[Dr. Mark Hyman]

So what is lagging? What does lagging indicator mean?

[Casey]

Meaning that it's not going to change until there are. Until the train is really off the rails. You.

[Dr. Mark Hyman]

So by the time your blood sugar goes up, it's already way too late. Like a lot of it could be decades of metabolic poor health before your fasting blood sugar ever goes up.

[Casey]

And this paper was conservative, I would say, based on the methods, and showed that it was about 13 years before your fasting blood glucose starts showing problems that you probably had underlying insulin resistance. So the body is so amazing. We put all these stresses on it, like repeated glucose spikes. Each one of those glucose spikes is telling your pancreas, it's stressing your pancreas and telling it to, you know, create that insulin surge that takes the glucose out of the bloodstream. And as that happens repeatedly, over and over again. And as your liver insulin resistance develops because you're eating so much fructose, these things are working together to basically make you less sensitive to insulin, to, to create insulin resistance, which is the body's protective way of saying, whoa, too much insulin, too much glucose coming around. We can't get this all into the cell, we can't process it fast enough. Block. But the body is smart and adaptive, and the pancreas says, well, we gotta get that blood sugar out of the bloodstream. So I'm just gonna produce more insulin to keep driving that glucose into the cells. So you're having this rising insulin, keeping that glute, that fasting glucose at a seemingly normal level while you march down this trajectory of worsening insulin resistance. Of course, we do not check fasting insulin in conventional medical practice. The ADA guidelines do not recommend checking it in virtually any patients, even if you have diabetes. And so we miss this window where the body is working so hard to overcompensate while our Fasting glucose remains low, but one of the, and only when that process really starts breaking down do we start to see that fasting glucose creeping up, where those compensatory mechanisms have essentially kind of gone off course. So, so we really want to keep our fasting glucose in that lower normal range more from 70 to 85. And there's large studies, New England Journal of Medicine has shown that people in the, the lowest quartile or quintile, I forget the exact data, but in the lowest range of normal blood sugar. So more in that like 70s have a much lower risk of future diabetes development than someone who's in the high normal range. And yet for many of these people, their doctor is telling all of those people in that category that they're normal. So the cool thing about continuous glucose monitoring is that as you become more insulin resistance, you tend to have a more unstable post meal level of glucose, like you spike higher to the same food. And so seeing sort of where you are in terms of your responses to foods can be a little bit of an early indicator of whether you're moving down the spectrum of insulin resistance. And Michael Schneider at Stanford has done amazing work showing that basically that we get more 24 hour continuous glucose variability as we march down that spectrum of insulin resistance, even in the face of a normal fasting glucose. The second thing, of course, and I'm just obviously preaching to the choir here, is ask your doctor to order a fasting insulin test. You want to make sure that fasting insulin is in a low and healthy range, which is a sign to you that your body is not having to do all this extra work and overcompensation in the face of silent insulin resistance that's developing.

[Dr. Mark Hyman]

So do you want to know my secret for living a long and happy and healthy life? Well, all I have to do is check out my weekly newsletter, Mark's Picks, where I share my favorite tips for health, longevity, wellbeing and lots more. Check it out and link below. I think this is so important. I remember a case of a patient who was, I think I might have mentioned on this podcast before because it was so striking to me. She was, she was, you know, classic shape of apple, which is big belly, skinny arms and legs, classic pre diabetic insulin resistant. You know, I thought, I'm gonna look at her blood sugar, she's gonna be diabetic and she had perfectly normal blood sugar. We even did a glucose tolerance test and her blood sugar never went over 110 and it was like 80 fasting, maybe 100105 after a sugar load, like drinking two Coca Colas. And she, her sugar was like perfect. And we also checked her insulin, which most doctors never do. And her fasting insulin was like 50 and it should be less than 5, ideally 2 or less. And anything over 10 is like, yikes, right? And she was 50. And then her post glucose challenge insulin was like 200, 300. It was just off the chart. And, you know, I've rarely seen these spikes that high. And honestly, I think we probably would see it in the culture much more because my patients already come in, they're pretty health conscious, they're health focused, they're not eating fast food, they're not drinking tons of soda. So I see a lot of problems. But when I have these kind of virginal patients who are just eating the typical American diet, it's shocking to see the levels. And you often will miss things. If you check the hemoglobin A1C, you check fasting blood sugar, which is what typically doctors do, you're going to miss a lot of cases of people who are really in the metabolic health crisis. So I think what your point is really, really important.

[Casey]

Well, and that example we've seen several times in our, in our members so far. We actually just recently launched a new offering for our members, which is a metabolic health lab panel that tests insulin. Because so many people were telling us, my doctor won't order this for me. So we have a way now where we send a phlebotomist to the patient's house and they order a cholesterol, they get a cholesterol panel, a fasting glucose, a fasting insulin, inflammation markers, et cetera, so that you can start to see that type of thing. But we, we had an amazing member. She's actually, I will mention her by name because we actually recorded a podcast with her for the levels podcast, a whole new level. Her name is Betsy McLaughlin. She's actually an incredible businesswoman. She was a CEO of Hot Topic, which is a huge clothing company. She's on the board of Good American and Bark and all these companies. She's a huge powerhouse. But she struggled with weight for like 40 years. And she had some great functional medicine doctors and they ordered fasting insulin. And her fasting insulin was like 35 fasting. They didn't do the two hour insulin test like you were talking about, but it was way too high. Like we want it somewhere between like 2 and 6 or so for our fasting insulin. So she couldn't get the weight off. So she put levels, she put a CGM on and basically what she did was she tested all the food she was eating and saw anything that spiked her glucose above 120 and then just stopped eating it. So she totally. Yeah.

[Dr. Mark Hyman]

That's amazing. That's so amazing. But so you're saying basically we should never have our sugar over 120 after we, we eat. Right. So we check our levels monitor. We should never go for 120. Is that right?

[Casey]

I mean, or what's your cutoff? There is not, this is not yet agreed upon by the medical or scientific bodies that be. Again, because we have not done longitudinal studies that show that certain post meal levels ultimately lead to disease. We are actually doing a lot of that research right now. We're working closely with Sarah Gottfried at Thomas Sheffield University, Gerald Shulman at Yale, several people to actually look at what it, what should our glucose be after meals. But from everything I've seen in the literature, it really shouldn't go above 110 to 120.

[Dr. Mark Hyman]

Yeah. Wow. Amazing. Amazing.

[Casey]

I'd be curious to hear your threshold.

[Dr. Mark Hyman]

Yeah, I think we don't know yet. I mean I think it's really up in the air and I agree, I don't think probably should go over 110.

[Casey]

I agree.

[Dr. Mark Hyman]

I think a lot of people do. But that's interesting. This has been such an incredible conversation. Casey. Your work is so important. Important. I, I really love having you on the podcast and I, I actually you, you are offering to people who are listening in the audience a beta program to get over the wait list, which is kind of cool. There's 120000 people on the wait list so if you want to skip the line, go in, try it early, go to levels links forward slash, hymen. It's going to be in the show notes levels link, hymen and you can get into the beta test. It's super fun. I've done it. It's really interesting. Learn about your biology, Casey. Your work is so important. We're probably gonna have you back on when you learn more and more about this and everybody should check it out. And if you love this podcast, please share with your friends and family on social media. Leave a comment what have you learned about your managing your own blood sugar? Maybe you try these CGMs. Subscribe wherever you get your podcast and we'll see you next week. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you up upgrade your health and subscribe wherever you get your podcasts and follow me on all social media channels at Dr. Mark Hyman and we'll see you next time on the Doctor's Pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free Mark's picks [e-mail] MarkSpix I promise I'll only email you once a week on Fridays, and I'll never share your email address or send you anything else besides my recommendations. These are the things that have helped me on my health journey and I hope they'll help you too. Again, that's drhiman.commarkspicks thank you again and we'll see you next time on the Doctor's Pharmacy. This podcast is separate from my clinical practice at the Ultra Wellness center and my work at Cleveland Clinic and Function Health, where I'm the Chief Medical Officer. This podcast represents my opinions and my guest opinions, and neither myself nor the podcast endorsed the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. Now, if you're looking for your help in your journey, seek out a qualified medical practitioner. You can come see us at the Ultra Wellness center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com if you're looking for a functional medicine practitioner near you, you can visit ifm.org and search find a Practitioner Database. It's important that you have someone in your corner who is trained, who is a licensed healthcare practitioner and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public. In keeping with that theme, I'd like to express gratitude to the sponsors that made today's podcast possible.