Few things are as impactful for my client's sleep, health, and mental health as balancing their blood sugar! That's why I encourage as many clients as possible to wear a continuous glucose monitor (even if only for 1 month) to get at the source of the 'WHAT' and the 'WHEN' about their diet that is throwing off their sleep and their health. Thankfully, Dr. Casey Means shares all of her wisdom around exactly what can help make a difference with stabilizing your blood sugar, even if you don't get the monitor (although, I highly suggest that you do!!). [If you do pull the trigger, use this link to skip the 40k person waitlist! levels.link/sleepisaskill ] Casey Means, MD is a Stanford-trained physician, Chief Medical Officer and Co-founder of metabolic health company Levels, and Associate Editor of the International Journal of Disease Reversal and Prevention. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tech-enabled tools to inform smart, personalized, and sustainable dietary and lifestyle choices. Dr. Means’s perspective has been recently featured in Forbes, Entrepreneur Magazine, The Hill, Metabolism, Endocrine Today, Endocrine Web, Well + Good, and Dr. Michael Greger’s (author of How to Not Die) video series. In 2020, she has been a guest on the podcasts Veggie Doctor Radio, Healthy Human Revolution, Work for Change, and others, speaking about metabolic health. She is an award-winning biomedical researcher with past research positions at the NIH, Stanford School of Medicine, and NYU. Use this link to skip the 40k person waitlist! levels.link/sleepisaskill
Glucose and Sleep
What is glucose, and how does it affect your weight, health, and sleep?
Glucose and sleep quality are related.
Find out how you can avoid diseases by learning about how glucose works.
In what ways can I find out my glucose levels?
What type of foods and eating time should I avoid to have a better sleep?
"We eat the same food at the same time, but...": Glucose works differently with each individual; you can take some steps to improve your health and sleep, which might not work on someone else.
Which foods are suitable to be consumed simultaneously, and which ones should you eat separately?
Controlling your glucose is quite easy; you can achieve a much healthier life and sleep quality by taking the steps mentioned.
Connect More With Levels Here:
***Use this link to skip the 40k person waitlist! levels.link/sleepisaskill
casey@levelshealth.com
@drcaseyskitchen
@drcaseyskitchen
https://www.linkedin.com/in/casey-means-md/
Unknown Speaker 0:04
Welcome to the sleep as a skilled podcast. My name is Mollie McGlocklin. And I own a company that optimizes sleep through technology accountability and behavioral change. Each week, I'll be interviewing world class experts ranging from doctors, innovators and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Let's jump into your dose of practical sleep
Unknown Speaker 0:27
training.
Unknown Speaker 0:35
Welcome, our
Unknown Speaker 0:36
guest today is Casey mean, she's the co founder of levels health, and out of just about all the gadgets and gizmos that we often have people testing out at sleep as a skill, a continuous glucose monitor tends to be one of the core things that I would recommend people at least test out for, if you were to try some of these for just a month, the understanding that you'll have will far surpass the average person of what food can do to impact so many aspects of your health, but also your sleep. So we're going to get into the details of that this company in particular is pretty exciting. They're actually still in beta right now. But they have now they're at I believe, a 40,000% waitlist. So if you do go to the website, you'll be added to that waitlist, that they have hooked us up with the sleep as a skill community with a link that will have you pass you know, bypass that waitlist. So if you do want to check that out a little bit sooner than the average population or public, then you can do that at levels dot link forward slash sleep as a skill again, levels dot link, forward slash sleep is a skill and you can use the promo code sleep as a skill as well. So all of that is going to give you the opportunity to see what your food is doing to your glucose levels, but around that how that can influence the quality of your sleep. So a little background on our guests. Casey means MD is a Stanford trained physician, Chief Medical Officer and co founder of metabolic health company levels, and associate editor of the International Journal of disease reversal and prevention. Her mission is to maximize human potential and reverse the epidemic of preventative chronic disease by empowering individuals with tech enabled tools that can inform smart, personalized and sustainable dietary and lifestyle choices. Dr. Means perspective has recently been featured in Forbes entrepreneurial magazine, the hill metabolism underpin today hendricken Webb well and good, you know, the list goes on and on. So I'm really want you to be excited to dive in and all the things that Casey has to share with us about glucose for not only your health, your mental health, but also your sleep. And welcome to the secrets of scale podcast. Casey, I'm so grateful that you're able to take the time to speak today. I know we've already been chatting it up, we got lots to dive into. So thank you, thank you for taking the time.
Unknown Speaker 3:04
So happy to be here, Molly, thanks for having me. Wow, well,
Unknown Speaker 3:07
so we've got a lot in common a lot that we can actually dive into around a shared passion around sleep. And I know you've been integral in doing a lot in that area. But particularly what we're going to be focusing in on is your work as co founder of levels. Very exciting company. And I've just really, really cannot wait to dive in more about this topic. But what you've created is this continuous glucose monitor to be available for the masses, even outside of people that might have been dealing with pre existing things around diabetes or what have you. So please share how it is that you came to co found this company, and just how you know how that passion is also relating to the world of sleep and how those things can be connected?
Unknown Speaker 3:52
Yes, absolutely. So levels is the company that I am the co founder and chief medical officer of and we are the metabolic fitness company. So we are laser focused on helping people understand their current level of metabolic health and then learn how to optimize and improve it. And so the way you can think about this is it's a wearable. So it's a continuous glucose monitor, which is a little quarter sized device that you are on the back of your arm and it is measuring an internal biomarker glucose 24 hours a day, seven days a week and sending that information to your phone. And glucose goes up and down all the time throughout the day in response to what you eat and exercise and sleep and stress and many other things. And so this closes the loop really for the first time about what's happening in your body in response to things like lunch, you know, or a poor night's sleep or a stressful meeting. We've had many other fabulous wearables to track many things about our health in the past so namely, exercise and activity monitors heart rate monitors, stress monitors like HR Have you trackers and sleep monitors. And I'm of course, I love all these products. But we've actually never ever had one that monitors your response to nutrition with a buy it with a wearable. And so that's a really neat thing about continuous glucose monitors is you can finally do that and see immediately how a food affected you. So what levels does is it gives people access to these continuous glucose monitors and pairs it with software that helps you interpret the data stream, and helps you understand what to do differently to improve your glucose levels, which in turn improve your metabolic health. And just as a little background, these monitors, they were traditionally available only for diabetic individuals. So they're this game changing technology for the diabetic community because instead of having to prick your finger, you can wear this painless monitor that gives you so much more data, so much more granularity into this internal biomarker metabolism. And what we know more and more now in the biomedical sciences is that glucose is not just something that's just relevant to the diabetic population, this is a biomarker that all of us really should be thinking about, and making sure it's stable in our bloodstream, because it has a huge impact on our energy levels, our sleep quality, our athletic endurance, our propensity for gaining weight, and then of course, for a whole host of downstream diseases and conditions that are associated with glucose. So that's kind of you know, what we're all about is making this more mainstream getting access for people to really upload lives by managing glucose. And to kind of get back to the other part of the question, which is what got me here. It's a somewhat circuitous route. Because I started in surgery, I trained as a medical doctor, I was at Stanford for my undergrad and medical school training. And then I went into surgery, and I was practicing head and neck surgery for about four and a half years. And, you know, in that field, I sort of step back after, after almost five years of practicing and realize, Oh, my gosh, this is so interesting, almost all the conditions I'm treating in this field are inflammatory in nature, there. It's like all these irises, you know, sinusitis, thyroiditis, you know, all the itis is or the inflammatory disorders. And it was like vocal cord polyps or inflammatory masses, ear infections, it's just inflammation of the middle of your tissue. And I was just like, Oh, my gosh, why is everyone so inflamed? You know, and like, that just seems like we're inflamed at scale, you know. And we also know that so many of our chronic conditions that are plaguing our country, like diabetes, obesity, heart disease, all timers, these are also diseases characterized by upregulation, of the immune system. And so I really stepped back and I was like, Okay, I'm making some big cuts into people in the room. And I want to really understand a little bit more about Is there anything we could be doing up front, you know, on the front end, to help with this whole chronic inflammatory situation, before people get to the point where they have to be knocked out and go into the knife. And that was really a journey for me, that led me to so much, you know, reading so much literature, and really coming to the conclusion that there, you know, so much of what drives inflammation in the body is what we expose ourselves to every day. And what I mean by exposure is, is like, the types of things our bodies are registering, and the main categories of that is the food we eat. That's all molecular information that goes in the body, and either could be registered as a nurture thing, or a good thing or a threat. You know, obviously, we're exposed to a lot of processed, highly processed sort of frankenfoods. These days, a lot of chemicals in our food, these things can trigger our immune system. That of course, you know, stress, stress can be seen as an inflammatory trigger in the body toxins in our food, water and air can be triggered the immune system, even being sedentary can trigger the immune system, our bodies aren't meant to be sedentary. And so having just like a full day of not moving is not good for our pathways in the body and can get the immune system revved up. But a huge one is sleep. When we don't sleep, like our immune system revs up, we see an increase in the same inflammatory mediators that are related in so many chronic diseases. So that whole process of stepping back and thinking about some of these root causes of chronic inflammation, got me just really evangelized to think like, Okay, before I make more cuts in the operating room, I want to figure out how to help people on this front and take control of some of these triggers. And that led to a whole nother journey, which is like, how do I do that? How do I do that effectively, and as a doctor, ultimately, what that means doing that effectively is how you will change their behavior and make sustainable, positive, personalized decisions every day, to sort of really optimize those conditions, those behaviors that will generate health if they're done consistently. But as doctors we're actually not like great agents of behavior change, like a 15 minute conversation is not necessarily enough to get someone to change a huge entrenched habit in their life. And that's what got me really interested in digital health. How can we use tools That people do have with them every single day, like their phones and their wearables to motivate really personalized decision making. And you know, this was sort of years in the process. But ultimately, I felt like I wanted to, you know, take the training and the insights that I had generated throughout my, you know, early part of my career, and really focusing on building tools to empower people to make these choices that we know are associated with better health outcomes. So
Unknown Speaker 10:29
Oh, wow, well, how you put it up, yeah, being kind of evangelizing these topics, I feel very similar, and how important it can be and how valuable it can be to when we do have some of this information. While you know, often I'll speak about some of the problems around sleep being related to you know, increase in artificial lights and stimulus and gadgets and gizmos and all that at the very same time, it's my experience has been in order to help people make a difference with that often, having that technology and using it to our advantage with certain, you know, ways to measure what is really going on can help be the exact path out of some of the problems that we're experiencing with our sleep. And I think the same applies with glucose, and glucose, his relationship with all of those things, so holistic, I know you guys are fans of, or at least from Twitter, you guys had mentioned being fans of the why we get sick book, which I think is so helpful for just really all encompassing how huge this topic is, and how much it kind of splinters into so many areas of health. So I really get your passion and hear that. And I was wondering if we could help kind of parse out a bit more for people that still are kind of confused, or just a little bit of the ABCs of why it's so important for us to think about glucose and sleep. And you know, you mentioned the kind of bidirectional relationship that they have, so that people can for those of us that's maybe it's newer to us to understand why this is so important for both our sleep quality on one side of it, but also from a kind of preventative measure, and what that can do to help support our sleep. So glucose and sleep and how they are so closely connected.
Unknown Speaker 12:08
Yes, absolutely. So first of all, major plug for the book, you recommended why we get sick by Dr. Ben Beckman, it's really, honestly is like a manifesto of why we're doing what we're doing at levels. And what Dr. Beckmann does, and I'll try and you know, describe briefly here about sort of this core physiology is explained why and how glucose and metabolic dysfunction are at the root of so many of the conditions we're seeing today. We in medicine today, and just in the general sort of health ecosystem, we like to think of sort of all these different diseases we see as like totally say, separate isolated silos. So it's like, acne is its own thing. And depression and anxiety are their own thing. And brain fog is another thing and cancers. And another thing, and obesity is another thing, and they're just, they're all separate. And we treat them as such, you know, we treat each of these diseases differently. And when you actually look at the molecular biology of these conditions, and when you look deeper at the root, cause all of them have an association with our metabolic health. And all of them can be improved by improving metabolic health. And really what that means, you know, you have to go back to what is metabolism. So metabolism is the way that we produce energy in the body from our food and environment. So we take in food, carbohydrates, fats, protein, and we have to convert these basic building blocks to energy that our body can actually use. This is fundamental, every single cell in our body, and we have trillions of them requires glucose, or some form of usable energy to actually just do its processes. And when metabolism this fundamental pathway of converting things like glucose and fat to usable energy, when that's not working properly, you can imagine how it could have so many different phases, it could look like so many different things, because it can affect every cell type and every organ system. And based on where that's sort of showing up most pronounced in a person, it's going to look like a different disease. So that's sort of step one. The second really is thinking about the process of how glucose works, which does set the stage as well for talking about why sleep is impacted by metabolic health. So when you eat carbohydrates, they generally converted to glucose in the bloodstream, and that glucose needs to get inside of cells in order to be converted into usable energy. For that to happen. Insulin has to be released from the pancreas, which binds to the cell and allows glucose to be taken up into the cell where it's converted into usable energy. But if you do that over and over again, where you're having, eating lots of carbohydrates, the glucose rises in the blood, you're getting this insulin release. What happens when you do that too much and that process glucose, insulin, glucose, insulin happens too frequently. too much of a magnitude, your body ends up having approved tons and tons of insulin, and your body actually gets a little bit numb to insulin. And it's like, it doesn't hear the signal as loudly because it's been hearing too much of it, you know, you can imagine kind of like losing your hearing, because you're exposed to too much sound, right. And so that's a process called insulin resistance. And so to get the same amount of glucose into the cells, you then have to produce more insulin. And this is this pathway of hyperinsulinemia. There's a couple of downstream effects of that, first of all insulin is because it's a signal saying your body has enough glucose, it also tells the body, we're good on glucose energy, we don't actually need fat energy, so it stops you from breaking down or burning any fat. So in the whole weight loss situation, that's a huge, huge implications. If glucose and insulin are high, you're not burning fat. And the second thing it does is that over time, you might not even be able to get enough glucose into your cells, your cells might get so numb to insulin, that it's actually very difficult to even officially get enough glucose into the cells. So then what happens glucose levels rise in the blood, you start to, you know, go into the doctor and they say, hey, you're pre diabetic, or you're diabetic, because your glucose is just at baseline rising, you can't get enough anymore. And you're not, you're not able to use that you're not able to make energy properly anymore. So imagine your brain not being able to convert glucose to energy well anymore, because the brain is insulin resistance. Well, that could look like Alzheimer's, other forms dementia, depression, anxiety, fatigue, brain fog, chronic pain, all conditions that are associated with metabolic dysfunction. If it happens in the ovary, it could look like polycystic ovarian syndrome, which is the leading cause of infertility in this country and is associated with metabolic dysfunction happens in the liver, non alcoholic, fatty liver disease, the kidney, chronic kidney disease, the heart cardiovascular disease, hypertension, atherosclerosis, so it's sort of like whatever cell type is insulin resistant and not able to get the energy it needs, you're going to see a symptom. So hopefully, that paints this picture of sort of the physiology and why, you know, you can imagine if we keep those glucose spikes and the amount of glucose, we're kind of dumping into the body from the diet lower, we keep the insulin lower, and the cells stay perky, they stay ready to hear insulin, you don't need so much insulin, they're really sensitive to it. And so just a little bit is gonna get the glucose and and you don't get all this downstream, you know, insulin resistant effect. So just I'll pause there because I want to show that, you know, clear and make sense. And
Unknown Speaker 17:36
yes, that was so all encompassing, and I've never heard anyone come perky cells, I like that. No, that was so well said. And it really paints the picture of how insidious this can be if we don't have this under control, and how it can kind of leak on into all these areas of our lives. And also, I think it's important, so I've had clients that have say, Oh, you know what, okay, this is a bit of an investment to get a continuous glucose monitor, all get one and then you know, my partner and I eat about the same thing. So we'll figure it out ourselves that way. And then but you kind of also pointing to how bio individual this can be, as well, if depending on the person, their baseline might be a little bit different than the other person, even if you're eating the exact same foods, which can be so fascinating. And I think, you know, for a lot of the people listening, very curious minds, you know, there's a spectrum of people that show up to sleep as a skill, they might either be having real troubles with their sleep, or looking to really fine tune the optimization element of things with their sleep. So they, you know, depending on where they're at, the through line often tends to be very curious, and how to improve their health, as well as sleep. So I think that I'm really excited that you're helping to show how this can not only help improve sleep, but so many other areas of your health and well being. And then, so I'm wondering if we can then so since you did such a great high level approach, so what would that look like? So say if people are like, okay, so you're saying that glucose can not only impact so much of my health, but also, I'm looking to really improve my sleep, this is my area, I'm going to take this on this year, or whatever. So they get the monitor. So once they do that, what are we starting to go after? what's possible in this area? Are you kind of, you know, screwed? If you have certain results? And you're stuck there? Is it something that we can really start to immediately make changes in? How do you kind of set up people powerfully for getting this and what to expect?
Unknown Speaker 19:27
Yeah, so I think one of the most exciting things and one of the reasons why I was really compelled to focus on this as the company I wanted to start is because you're not screwed. wherever you are. There's still a Yeah, this is a spectrum where we can move, you know, in the right direction in the wrong direction. And I'm like, sort of the way we think about it. Normally, we're like, oh, we're healthy when we're young. And then one day we might get diabetes, and it's like an on off switch. That's not the way it works. Every day. We're actually moving back and forth on this spectrum of metabolic health and it's not like one You wake up and your glucose is in a range that you're not diabetic that's been happening for years or decades. And you know, even at that, that later stage, you can still move in the right direction. Because again, it's, it's like what I was mentioning, where if you can keep the glucose and the insulin spikes lower, your cells will start to hear it more again. And you can regain that insulin sensitivity and that metabolic function. And so what you need then is to know how to keep your glucose levels lower. And that's really what what we built at levels. And so the first step is testing out the foods that you're eating and seeing how you're responding to them. And this is the beautiful part about continuous biofeedback is that it's a closed loop, you can have a Clif Bar and in one hour know whether that's a good or bad choice for you. And it's just like black and white. And like you mentioned, it's different between each person. So you and I could both eat a Clif Bar, and you could go up just a tiny bit on your glucose, and I could go through the roof. And so it might be a better option for you than it is for me, because it's likely causing less of a glucose and insulin response in you and a big one in me. And there's been research studying this deeply. Why would two people respond differently to the exact same set of carbohydrates? Like I thought there was low glycemic foods and high glycemic foods? Like why would it be that two people are responding differently, but it's actually there's this biochemical individuality to it. And a big factor that's been studied is microbiome. So just the difference in composition in the gut, and how the bacteria processing these foods has an impact on how much the glucose rises in the blood after eating a specific carbohydrate. So there's a lot of variability between people and that also things like body type how much sleep people got the night before, those can have an impact on how a cent you know, carbohydrate in the mouth is converted into glucose in the blood. So with CGM, you know, you're testing those things, and seeing what what is impacting you the most and you can you know, so then people might say, Okay, great, so I'm going to find out that like a cookie spikes my glucose and I shouldn't eat the cookie like I knew that already. But it's actually so much more complicated than that. And that for software can make it really fun. Because there are lots of things that go into that how much the glucose rises after a meal. It is what you ate. It is how you paired the food. Were you eating a carb alone? Or were you eating it with protein and fat? what time of day did you eat it was it Morning or night eating carbs later at night for many people tend to spike glucose higher because of the impact of melatonin on the pancreas. How much exercise you did that day exercise has a profound impact on same day glucose metabolism, how much stress you're under, if your cortisol is high during the day, your glucose levels are going to be higher. And then a really key one is sleep, how much sleep you got the night before how much sleep you've gotten over the prior weeks. But even one night of sleep deprivation can make people more insulin resistant. And so the beauty of the CGM as you can start parsing out what context Am I building for my body to process carbohydrates? How do I leverage all these levers that have to do with glucose to my advantage, because ultimately, we want that line to be fairly thought and fairly low. And that's sort of a protective state. And every day that you keep it lower, and you keep it flatter, that's like a rep, it's like going to the gym, and that's like your reps to get stronger. Well, these are your reps to build ends on insulin sensitivity to build metabolic fitness. And so you're learning how to just turn all these knobs pull these levers to create the best conditions in your body for that flatline, which are going to be different for everyone. I will say, for most people, the sleep component is going to be pretty, that's pretty clear that low sleep is not good for anyone in terms of their overall glucose control and metabolic health. And the research is fairly overwhelming on that one.
Unknown Speaker 24:01
Absolutely. And I'm wondering too, you know, for women listening, that are administrating age, to the connection for them also to be aware of different parts of their cycle and how that can influence it too. And I think, you know, what's great about levels is there's a lot that you can kind of tag and you know, or like take notes basically about what you're doing and when, when I think that that's an exciting area for women to to start getting connected to of different parts of their cycle. Have you seen a lot for that too, for women when they change to be aware of?
Unknown Speaker 24:31
Yeah, well, there is research on this. And it is interesting that actually glucose levels will fluctuate and insulin sensitivity based on different parts of the cycle. So typically, and this is going to vary for each person in the follicular phase, which is pre ovulation there when there's a higher estrogen to progesterone ratio, tend to see better glucose levels slightly lower, more influence sensitivity and estrogen seems to be a bit protective in terms of metabolic health. And then post ovulation when both estrogen and progesterone are rising together. But that ratio is a little bit lower of an estrogen to progesterone ratio, you start to see a little bit more insulin resistance a little bit higher glucose levels. And so that's something that's can be interesting to track and, you know, may influence the choices we make, you know, during that days, if things are going up a little bit, and we're a little bit more variable on our glucose, that might be a time to sort of tighten up a little bit on the refined foods, we're eating in the refined grains and stick to sort of more the foods that are lower glycemic for us to kind of keep things stable. So there's some really, really interesting stuff there. And for the menopausal woman, when estrogen declines in menopause, it's an interesting time, because that's when we start to see women really increase their rates of both obesity and diabetes. So that's like this risk time where Yeah, estrogen, which seems to be protective for metabolic health is plummeting. And we see this inverse relationship with these metabolic conditions. And then, of course, downstream metabolic conditions like cancer or Alzheimer's, which are very much related to blood sugar. And you see all of that going up. And so so I think there's a really neat opportunity for in that phase of life to be tracking glucose, and just making sure you're not like, accidentally falling off a metabolic Cliff that you're just not aware of.
Unknown Speaker 26:19
Yes, that metabolic Cliff? Absolutely. You know, it's interesting, too, because there's two things that I hear people speaking about often as it relates to glucose. And as it relates to sleep, so to that, I'd love to get, you know, deeper with you on our one wakeups in glucose, management regulation and to anxiety in glucose, because I think so many people aren't quite aware of how glucose can impact both of those. And certainly anxiety plays a lot into the role, we tend to have a lot of an anxious bunch around sleep as a skill and you know, dealing with their sleep management. And so I'm wondering if you could speak to, you know, could start with wakeups, and glucose, and how those might be connected for people to be mindful of?
Unknown Speaker 27:02
Yeah, yeah. So you can kind of think about if glucose is going up, and then down, that is usually associated with other sort of lability, in our sort of general subjective state, whether that means mood, energy wake ups, like if there's fluctuations in our glucose, there's often going to be fluctuations and sort of our lived experience of the day or night. So stable on glucose is stable, sort of with everything. And certainly, it's not like the panacea for sleep or, or mood or energy, but it is widely studied in those realms. And so it is absolutely a factor, a modifiable factor that we can tap into, just like avoidance of artificial light before bed is one like this is one that is very much researched. And we should be thinking about and a lot of us aren't. So with anxiety, there's two things to sort of mention there. One is that people with diabetes, so like overt conditions of metabolism, where you know, I think we're talking about much more of the the non diabetic population in this podcast, people who have sort of tried to tighten up the fluctuations in glucose, but haven't reached sort of this clinical stage yet. But in that clinical stage of diabetes, we see much, much higher rates of anxiety and depression, to x rates of depression and people with diabetes. And I think it's 40%, higher rates of generalized anxiety disorder, but I have to double check that number, but it's quite quite a bit more. And it is thought that some of this is related to the chronic inflammation that happens in the body and the brain in states of metabolic dysfunction. Also the insulin resistance in the brain and how that's affecting our ability to get the glucose to the brain cells properly, and sort of feed the cells in the way that they're supposed to be fed. So that's sort of just to say epidemiologically, people with worse metabolic function have worse mental health outcomes, unfortunately. Now, let's talk more about maybe the people who are just non diabetic, but what would a big glucose spike or fluctuation How would that impact their anxiety and it seems like it may be doing just that. So the real it's so it's when you think about you eat some food, your glucose is going to go up, it's going to come back down. When that is a big, big spike, your body is releasing tons of insulin, and it can sometimes overshoot on the amount of glucose that gets soaked up in the cell and create a situation called reactive hypoglycemia. So you can imagine like mountain and then a valley that is like lower than the baseline. That moment of reactive hypoglycemia has been associated with anxiety like moments of anxiety, and I think I personally have felt this you know, if I have a really big high carb meal or just you know, an unhealthy breakfast or whatever, and you kind of like two or three hours later, like tired, maybe a little moody and grouchy and like want to take a nap kind of a post meal slump type of situation, something that has been powerful for me and I know a lot of customers is being able to now link that to a specific biologic event that's happening. Like I can say, this is how I feel. This is what happened to my glucose. And this is what I ate to make it happen. And that trifecta, that feedback loop is so empowering, because you can say, Oh, well, this is something I can modify it I'm not just, I'm just anxious. This is just not my my personality assembly. This is something that was a choice. And this happened, and I can change it. So that's very empowering. Yeah. So that reactive hypoglycemia moment tends to be what's associated with anxiety. And in our culture, with the food that is out there marketed as healthy you can imagine, this could be happening many, many times a day, like, you know, with things like pop tarts and cereal for breakfast. And, you know, pasta as like a normal dinner and bread at every meal, like we're talking people are often on an absolute glucose roller coaster, and getting reactive hypoglycemia multiple times a day. And it's just we just don't know. So
Unknown Speaker 31:01
absolutely, no, I think it's such an important element for overall mental health to be really tightly aware of this, because I'm pretty convinced that you know, certainly didn't have continuous glucose monitor years back. But part of the reason I created some business skills, because for so many years, I was like going to bed crazy late living in the middle of Manhattan, stressed out and then until I went through my own period of insomnia, and it was just such a trying time. But coming out on the other side of that made me so you know, couldn't get off the soapbox about sleep. So you know with that, but I really believe that so much of the anxiety that I was experiencing for so many years was just a disconnect of realization of how much of a roller coaster I was really on. And for so many of my clients will discuss their food, and they're truly trying to make great, you know, choices. And they'll say, No, no, that's not me. I have a smoothie. I have this, I've done that. And then you put the continuous glucose monitor on. And it's just spike city, you know, and you get to see Oh, my God, okay, Wow, well, once we see it in black and white, we can really make a difference. So yes, I think that's really, really important. And the other thing that we've found to with these wakeups is just occasionally for people that are eating later on in the night, and I love how you spoke to glucose being on a circadian rhythm and the the difference that it might have, during you know, the morning versus the night, that people that are eating right before bed, and might not even be right before bed, but still, like you know, even within those couple hour threshold before bed, having those more fragmented sleep patterns and waking up throughout the night. Have you been able to see that too in your data? Because it's exciting because it is so hard to find data on glucose for healthy individuals, or quote unquote, healthy individuals that are not pre diabetic or diabetic? Is that something that you see a lot for people.
Unknown Speaker 32:47
So in our personal data set, this isn't something that I have seen yet, because we've just brought in sleeve tracking as part of our product. So I'm so excited to see, you know, great what we find all right, in the in the research literature, you do see this so like you mentioned the circadian rhythm of glucose. I think the key point to note is that at night, we we secrete melatonin, ideally from the pineal gland, which helps us get sleepy and go to go to bed kind of tells our whole body to go to bed including our pancreas and actually, is thought that melatonin stops the pancreas are producing as much insulin. So you can imagine if you're eating like pasta, or bread products, and you know carbs or big dessert late at night, when your Melatonin is active, you are dumping all this glucose into your body that and with not a lot of insulin to have it be taken up. So that's just like sitting in your bloodstream and slowly getting absorbed into the cells and likely just kind of bouncing around throughout the night. And so that is just if there's one you know, practical tip to definitely give people it's like do not eat your carbs late at night. You know, try to ideally not eat that close to bedtime in general, like winding down eating around five 6pm give your body time to digest. But if you are eating later really focus on more the protein and the fat and the green leafy vegetables and not the higher carb meals because you're essentially getting like a double punch from that because of the way your hormonal system is working at night. And just like with the anxiety with you know wake ups and sleep, if your glucose is bouncing around throughout the night, that's going to have a big impact on your sleep potentially, as the glucose dips and maybe you know bumps back up. You may see wakeups at those times because your body is like you know dealing with this lability this label glucose and the other thing is that elevated glucose at night can cause the blood it can can change basically our thermo regulation at night it can change the way the blood vessels function, and it can make you hotter. So acute blood glucose spikes late at night can make you sleep hotter and we know that elevated body temperature at night is associated with sleep quality. So for so many reasons, it's just, you know, it's not ideal. And unfortunately, it's a vicious cycle. Because if your sleep quality is poor, that's gonna set you up the next day to make worse choices metabolically. And what I mean by that is that it has, you know, our sleep quality has an impact on our hunger and satiety hormones, ghrelin and leptin. And, you know, even one bad night of sleep can affect these hormones and make us you know, be more likely to be reaching for the high carb, sugary calorically dense foods The next day, so it can just be so perpetuating. So yeah, I would say wrap up the carbs way earlier in the day. And if you're going to eat later in the evening, focus on sort of that more like keto like meal of, you know, low carb, higher fat, higher protein, green leafy vegetables, avoid the starchy stuff.
Unknown Speaker 35:48
I'm so glad you're saying that because I think that's been a bit of a misnomer for quite some time for people. And a real strategy of OI, he, you know, I purposely eat higher carbs in the evenings, because it makes me tired and almost like Thanksgiving dinner or something. So you'll hear people really have that as they think that they're doing something that's serving their sleep, and I'm so glad you're kind of helping to shed light. And certainly, if you put on the continuous glucose monitor, people can see that for themselves, you know, the real difference that makes and I love that you're pointing to that earlier, meal timing. So that last meal, ideally being between that like five to six range, or, you know, plus or minus, depending on people's schedule. I think that's really, really huge. And if we could start to make that trendy to have you know, the early bird dinner, then that would be fantastic.
Unknown Speaker 36:36
Right? Yeah. When all the New York restaurants start having the five to seven window be to get well, no, we're moving in.
Unknown Speaker 36:45
Love that, please. And the other thing I wanted to just touch on to is, you know, these seem more kind of like a given as it relates to sleep, but I think they are interesting is both, you know, alcohol and caffeine and how those can show up differently for different people on with the continuous glucose monitor. And some people have been kind of surprising effects for you know, some people maybe not noticing it with the caffeine or coffee, some people noticing it more with alcohol, depending on the type of alcohol might even see it drop lower on their continuous glucose monitor and how they can make sense of all of that as it relates to you know, certainly that can impact our sleep quality, too.
Unknown Speaker 37:22
Yeah, absolutely. So so the alcohol thing is really, really interesting. its impact on on blood glucose. So a couple things with that. So first is that alcohol, one of the effects it's going to have is going to block our liver from making glucose. And so what does that mean? So we essentially, we don't want our glucose to get too low, we want it to be in like this perfect golden range that's like good for optimal metabolic health. And we want it to be in this narrow sort of space. But if it gets below that, it can be very, very bad for the body, we don't want our glucose to go too low. And one of the protective mechanisms our body has to make sure that we don't ever go to too low is that our liver can actually just make glucose from other substrates in the body like, like lactate. And that's a process called gluconeogenesis. And alcohol blocks that process in the liver. And so one of these feeders of glucose into the blood that's kind of always consistently active to sort of just give us this low grade baseline of glucose will be blocked by alcohol. So you can imagine if you are eating, if you're fasting, or if you're on a keto diet, and your glucose is already super, super, like low and stable and flat, if you add alcohol to that, and you block one of the ways of getting glucose, that can be a huge problem, you might actually see glucose, like go down in a dangerous way. And for the more average person who's eating like regular food, and what they might see is that if they're eating a meal, that normally would cause a pretty big glucose spike, they might actually see a lower glucose spike, if it's in the context of alcohol, because of the way that you're kind of blocking this one faucet of glucose into the bloodstream. And that's not necessarily to say that this is a good thing to do. It's just a physiologic thing that we see. And I would should caveat, and this is for, like, sort of pure spirit. So like, yeah, wine, hard alcohol, things like that. Obviously, if you're having like a sugary cocktail, like that's, this is a moot point, like no sugar is gonna affect you. But we see that a lot where the red wine or something like that with like a fairly high carb meal sort of tend to blunt the spike a little bit. So zooming out. So that's sort of the physiology of that and it's definitely dangerous to I would say to drink on if you are fasted, or on a really heavy duty ketogenic diet. So just something to think about. Another interesting thing, just epidemiologically looking at like large population studies, that actually seems that people have the best metabolic health outcomes or people who drink one drink per day, essentially. So more than that risk of metabolic disease goes up and less than that risk of metabolic disease goes up. So people it's a j shaped curve with the app. lowest rates at one serving of alcohol a day, to mention our servings are very skewed in our world these days, like the types of glasses of wine we get poured in a restaurant are sometimes like two or three times the size. And so it could be putting us at actual risk. But I think that it's sort of an interesting factoid, that it's a Yes, yeah,
Unknown Speaker 40:19
absolutely, no, and I've heard of some of those studies, too, which are very interesting, kind of that same, maybe a little bit of that stressor might make us actually stronger the same way, you know, sitting in a sauna, or cold therapy, or certain things are working out. Could be so the lots of possible theories around all that, but very interesting stuff. So with this, so maybe, hopefully, we pique some interest for people because there it can be just so eye opening. And I really advocate for people, even if you were just to do this for you know, most of your packages being around like a month time, just to begin to get that insight, it can just be so long lasting and then maybe use it as a tune up or however you might want to look at it, I think can be fantastic for people to just forever kind of have burned into their brain, oh, I've got to think twice about having whatever that sandwich or something, you know, and what that will look like for them. So people are interested. Now how does this process look? I've had a lot of people just kind of feel like, Oh, this is very invasive, or this is going to be very complicated, or it's going to hurt to put in, could you just help demystify that a little bit, if you could help just share that it doesn't have to be such a scary thing.
Unknown Speaker 41:32
Totally. Yeah. So it is a device that has a sensor that goes under the skin. So that can be a little bit scary, but it is actually it's so simple. And it is, in my opinion, painless, you know, really does not hurt at all. And I think most of us who put on the sensor are like shocked by how you don't even know that it actually went. And I think a lot of people have thought that their applicator of the sensor didn't work because it they didn't even know that it went in. So we're talking about a four millimeter hair like filament that is something glucose just under the skin. And it's really almost like dental floss. It's totally flexible. So you get this box, it's this prescription device, and it's got a little applicator and you just put it on the back of the arm and you press down and it it sends this little hair like filament just under the skin to test the glucose. And yeah, I don't know how your experience was Molly, I have never felt anything
Unknown Speaker 42:25
saying Yeah, and I'm pointing this out not to be you know, just like crazy with the details. But I've had clients that will receive the box, but the box sits there for like ages because they're like, intimidated. How do I do this, or will be intimidated, even just to order because it just seems like a big thing. But once they do it, it's like oh my god, that was so easy. So just helping to share that it's not, it's no longer like for the weird biohackers it can be very easy to do. I've got clients that in their, you know, late 60s doing it or actually in their 70s to, you know, different, whatever doesn't it's very user friendly.
Unknown Speaker 43:02
Yeah, and I think a testament to how simple it is to like put on is that there's now been this trend we're seeing on social where people are posting their application videos. So they like are making tic tocs and making cool little videos where they show them applying their continuous glucose monitor. So you know that's obviously a testament to it not being too too scary. I will I will say though I am like super detail phobic, which is ironic since like, you know, well yes. Formerly in the surgical world, but very, I was so nervous the first time I put one on and I was like, is this gonna hurt? What's it gonna feel like that it uh, and I had to like blast music on my head felt my Bose headphones before I put it on. I had to like amp myself up like pregame. This like, you know, before basketball game like yes, like the music. And you know, it literally took me an hour and then I put it on. And I just was like laughing so hard. I was like, I cannot believe I got myself so worked up about that it was nothing. And then of course the next time I'm like, I want to show this off on Instagram. I want to show everyone like this is so fun and cool. And I'm becoming a cyborg and it's amazing. So it's a journey, but we try and make it as accessible as possible. Like on our Instagram, we have a whole set of people's user customers CGM application videos that we're we've reshared I've got a sensor application video that walks you through every step of it. And the whole process of getting the sensor we try and make really easy to so it's just a very quick form on the internet that's sent to a physician in your state, the physician reviews your answers. And if you're approved for a CGM prescription, we ship them to you in a nice box. And then, of course, there's all these resources for putting on your sensor. So it's not
Unknown Speaker 44:40
that exactly oh my goodness, yeah, I found it to be a very seamless process, both the ordering process receiving it putting it in, and that's a great idea to record the actual application process to do that the next one, okay. So I hope that this is you know, keep some interest for people to hopefully take that step and and connect how this could Be a real strategy. Even I know we only touch on a sliver of what's what's possible with it. But I like to speak to people often about both those, the anxiety element really from a mental health strategy to be mindful of this and what you know, kind of putting ourselves back in the driver's seat around, you know, just experiences throughout the day, our energy levels, our productivity, and how this can play a big role. And then, of course, anxiety is so related for sleep. And people finally, you know, if they're riding that roller coaster all day long, and then they lay in bed, and no surprise, having difficulty falling asleep, or staying asleep. So I think that's super important. And of course, as wakeups that we spoke to. So I really appreciate you, you know, really taking this time to share all this information with us. And I really encourage people to follow you guys on social to on all the platforms, but to share as far as where can people go to find out more about you? And also the waitlist? How is this all working? Phyllis Ellen?
Unknown Speaker 45:56
Yes. So to learn more about levels and sign up for the waitlist, you can go to levels health.com. We also have a blog that I contribute a lot to and a lot of our guest experts, including the author of why you get sick, Ben bickman. He's written some amazing articles on our blog. And really, it's just to flush out a lot of these topics we've been talking about why does this relate to the average person? How can stabilizing glucose help really uplevel your life, so check out the blog, you can follow levels on Twitter and Instagram at levels. And then me personally, you can follow at Dr. Casey's kitchen. So Dr. Casey's kitchen on Instagram and Twitter and I write a lot about metabolic health from the standpoint of a plant based person. So I'm, I'm vegan. And I'm, you know, really into plant based nutrition. And I think a lot of people think that that may lead to glucose spikes, because it's generally thought of higher carb, but that you know, is not necessarily true. So I love writing about that and giving some really practical tips on how to incorporate plants in a glycemic friendly way. And yeah, and so right now we do like Molly mentioned, we do have a waitlist. And we are in a beta program we haven't fully launched yet. But for people who are interested in joining the beta, Molly has a code and that will help that will get you in front of the waitlist, so it'll skip the waitlist and you can get access now. So
Unknown Speaker 47:12
yeah, absolutely. What did you say the waitlist is that now? It's crazy. 40,000 people already? That's what it was? Yes, it is. Because it's kept growing over the time that I've been speaking with you guys. It was like 20,000. Now it's 30. Then it was 30,000. Now it's 40,000 people, it's incredible. I'm so excited for what this could do for the planet. Really just, you know what, what awareness this could bring about for people? And yes, absolutely we have what I'm excited with working with you guys is that your team has been awesome. And just really thinking outside the box and has created a dashboard for us to be able to start to really begin to overlay with sleep results. So I happen to be pulling in the aura rings data. But there's, you know, lots of other sleep trackers, too, that we can start to play with. But certainly the aura ring data and the dashboard at levels. So I've been able to really work with different clients to see how this impacts their sleep results. And it's fascinating. So definitely, if you're interested in that check out you know, levels, and you can use the sleep as a skill code in order to kind of skip that waitlist so that you're not waiting quite so long. And we can start experimenting. And I really encourage people to check out your social media to your blogs are incredible that you guys have from all different contributors, as well as what I think is super interesting is all the user information. So we'll see I love following you guys on you know, Twitter, Instagram all over, because people will share what they're experiencing, you know, day to day, oh my god, this yogurt, when I have it at 8am acts totally different than when I have a 8pm or whatever, you know, just really interesting data. And I love that you also mentioned to being you know, plant based because maybe it's just the bubble that I'm in I'm often hearing you know, whether it's paleo or keto people really excited about continuous glucose monitors, I'm so happy that you're representing no it's not just exclusive for that team or crew or category. It's no no no, this is a whole really important area for also, you know, people that are having a plant based lifestyle and a lot of friends and clients that are doing that and you know, could really get into this conversation or actually really great.
Unknown Speaker 49:19
Thank you. And you know, I do think that there there is risk with any diet for having this metabolic collateral damage that we're not aware of. And it's certainly true of plant based veganism You know, there are so many plant based products out there that are going to be horrible for blood glucose and yet even within the healthy foods, there are things that may not be right for your body and isolation for me it's been corn grapes, sweet potatoes, you know very healthy foods but by themselves they just send me to the moon in terms of glucose so learning how to modify those like adding a ton of you know, tahini and you know, coconut cream on top of some of these carbs to really help I'm blunt that glucose spike or add chia seeds and fiber, like, it's amazing how you can just modify the foods to not get that collateral damage. And so that's really what I'm all about, you know, sharing with people. And you can by doing that, you know, you might be able to really block some of this absorption of glucose into the bloodstream or the quickness of how it gets into the bloodstream, and I'm able to actually be in have ketones, so I'm able to keep ketones up even on a fairly high carb diet, because and really an interesting point is that, you know, high carb doesn't mean high glucose are two different things. And so the in between there is where CGM can really fit in. So yeah, wow, I could go on about I
Unknown Speaker 50:42
control myself on these topics, because there's just so much Well, I really appreciate you taking the time and sharing all your information you mean you're have such you know, a student training or in wisdom and background and to bring to this topic, it's really, really exciting what you guys are up to. So thanks again for your time. And I'm very excited to continue to learn more about what you guys have going on the platform is gorgeous, and lots of exciting things in the works. I know.
Unknown Speaker 51:08
Thank you so much for having me on Molly and thanks for the amazing message that you're spreading on your on your podcast. It's so so important.
Unknown Speaker 51:15
Thank you.
Unknown Speaker 51:18
You've been listening to the sleep is a skill podcast, the number one podcast for people who want to take their sleep skills to the next level. Every Monday I send out something that I call Molly's Monday obsessions containing everything that I'm obsessing over in the world of sleep, head on over to sleep as a skill calm to sign up.