LEVELS – A Whole New Level

Sleep and diet don’t operate independently. Controlled studies suggest that when people sleep less, they tend to eat more, move less, and gradually gain weight. The relationship also appears to run in the other direction: what and when you eat can influence how well you sleep.

Mike Haney talks with Columbia sleep and nutrition researcher Dr. Marie-Pierre St-Onge about what the evidence actually shows at that intersection. Rather than chasing a perfect sleep score or a single “sleep food,” her work points toward a simpler idea: adequate, consistent sleep makes healthy eating easier, and a high-quality diet may help support better sleep in return.

Free course: Improve your metabolic health
Get our free email course on how glucose, nutrition, exercise, sleep, and measurement can help you build habits that support better energy and long-term health: ⁠⁠⁠https://levels.link/wnl

What We Cover:
Why even modest chronic sleep loss can accumulate into meaningful sleep debt
What controlled experiments show about short sleep, calorie intake, and weight gain
Why sleep deprivation tends to shift food choices toward less healthy options
How sleep loss affects appetite hormones differently in men and women
What the research says about eating close to bedtime
Whether tryptophan, melatonin-rich foods, and specific “sleep foods” actually help
Why fiber, fruits and vegetables, saturated fat, and refined carbohydrates may influence sleep quality
How much attention to pay to wearable sleep scores versus how you actually feel

🎙️ About the Guest:
Dr. Marie-Pierre St-Onge is Professor of Nutritional Medicine at Columbia University Irving Medical Center and Director of its Center of Excellence for Sleep & Circadian Research. Her research focuses on the relationships among sleep, diet, energy balance, body weight, and cardiometabolic health, with extensive work in controlled inpatient and outpatient sleep studies. Vagelos College

📍What Dr. Marie-Pierre St-Onge & Mike Haney discussed:
05:01 - What popular sleep talk still gets wrong
09:30 - A wearable score versus how you actually feel
10:37 - Sleep pressure and the body clock
13:00 - How a little lost sleep becomes real sleep debt
19:43 - Short sleep, and about 300 extra calories
27:11 - Six weeks short, and about a pound gained
29:05 - Why short sleep shifts you toward worse food
30:30 - Appetite hormones don’t respond the same in men and women
37:03 - What eating close to bedtime actually does
40:20 - Tryptophan, melatonin, and “sleep foods”
42:42 - Fruits and vegetables, and less broken sleep
46:10 - Saturated fat, refined carbs, and a better cycle

🔗 Helpful Links:
Marie-Pierre St-Onge — Columbia University: Columbia profile
Short sleep duration increases energy intake — American Journal of Clinical Nutrition (2011): PubMed
Prolonged short sleep and body weight — Annals of Internal Medicine (2026): PubMed
Sleep extension reduces calorie intake — JAMA Internal Medicine (2022): National Institutes of Health
Fruit and vegetable intake and sleep fragmentation — Sleep Health (2025): PubMed
Fiber, saturated fat, and sleep architecture — Journal of Clinical Sleep Medicine (2016): Vagelos College
Eat Better, Sleep Better: ihn.cuimc.columbia.edu

Watch the conversation: https://youtu.be/WxvbJu_GnSo
Find us on YouTube: ⁠⁠⁠https://youtube.com/levelshealth?sub_confirmation=1⁠

👋 Who we are:
Levels helps you understand your metabolic health with personalized data, expert guidance, and tools that connect your daily choices to measurable changes in your body. Our goal is to help you make better decisions about food, exercise, sleep, and long-term health.

Look for new shows every month on A Whole New Level, where we have in-depth conversations with thought leaders about metabolic health.

Medical AI is full of impressive models that work on retrospective datasets. The much harder problem is turning one into a tool that can operate continuously inside a hospital, earn clinicians’ trust, fit into an overloaded workflow, stay reliable across different health systems, and ultimately improve patient outcomes.
Mike Haney talks with Johns Hopkins researcher and Bayesian Health founder Dr. Suchi Saria about the decade-long journey from an academic sepsis-prediction algorithm to AI that clinicians are using in hospitals today. Her experience is a reality check on what it actually takes to make medical AI useful, and an argument for aiming higher than documentation and billing: toward systems that continuously watch patients, catch deterioration earlier, and help prevent avoidable harm.

Free course: Improve your metabolic health
Get our free email course on how glucose, nutrition, exercise, sleep, and measurement can help you build habits that support better energy and long-term health: ⁠⁠https://levels.link/wnl

What We Cover:
Why sepsis fits continuous AI monitoring
How causal reasoning separates signal from a noisy alert
Why real-time access to the full record matters
When a working algorithm still failed to get attention
How adoption and human-machine teaming became engineering problems
What happened when the system went live
How the same infrastructure extends beyond sepsis
Why healthcare is too conservative about medical AI

🎙️ About the Guest:
Dr. Suchi Saria is the John C. Malone Associate Professor at Johns Hopkins University, where she directs the Machine Learning and Healthcare Lab, and is the founder and CEO of Bayesian Health. Her work focuses on building and deploying machine-learning systems that use real-world clinical data to improve diagnosis, treatment, and patient safety.

📍What Dr. Suchi Saria & Mike Haney discussed:
04:30 - Why the real AI risk is what it is allowed to do
08:32 - Why sepsis is a race against organ failure
11:57 - From checklists to reading the full medical record
16:30 - How causal reasoning finds a patient’s baseline
18:50 - Using uncertainty to avoid another noisy alert
22:11 - Why an hour-late warning is already too late
25:06 - Reading Epic in real time without slowing it down
32:35 - A working algorithm still couldn’t get clinicians’ attention
35:53 - What happened when the system went live
45:32 - Human-machine teaming, and who still makes the call
54:17 - The same infrastructure, beyond sepsis
58:35 - Why billing and coding is too small a target

🔗 Helpful Links:
Suchi Saria — Johns Hopkins Research, publications, and academic background.
Bayesian Health: Saria’s company commercializing real-time clinical AI.
TREWScore — Science Translational Medicine (2015): The original real-time early warning model for septic shock.
TREWS patient outcomes — Nature Medicine (2022): Prospective multisite evaluation after deploying the sepsis warning system in clinical care.
TREWS clinician adoption — Nature Medicine (2022): Study of provider adoption and effects on sepsis treatment timing.
Human-machine teaming — npj Digital Medicine (2022): Clinician interviews on what made the deployed AI system trustworthy and usable.
Bayesian Health Sepsis Flagging Device — FDA (2026): FDA 510(k) clearance for the sepsis prediction software discussed in the episode.

Watch the conversation: https://youtu.be/uVEKgSvei4s
Find us on YouTube: ⁠⁠https://youtube.com/levelshealth?sub_confirmation=1⁠

👋 Who we are:
Levels helps you understand your metabolic health with personalized data, expert guidance, and tools that connect your daily choices to measurable changes in your body. Our goal is to help you make better decisions about food, exercise, sleep, and long-term health.

Look for new shows every month on A Whole New Level, where we have in-depth conversations with thought leaders about metabolic health.

Heart disease is the leading cause of death, but it’s also one of the most preventable. Decades of research have established a strong causal role for LDL and other ApoB-containing particles in atherosclerosis, and we now have multiple proven ways to lower them. The harder question is how to turn that evidence into a decision for an individual person.
Mike Haney talks with Johns Hopkins cardiologist Dr. Seth Martin, a co-author of the new 2026 dyslipidemia guidelines, about what the latest evidence says we should actually measure and act on. The throughline is pragmatic: lower exposure to atherogenic particles earlier and for longer, use additional tests when they can change a decision, and distinguish interesting new measurements from ones that have actually been shown to improve outcomes.

Free course: Improve your metabolic health
Get our free email course on how glucose, nutrition, exercise, sleep, and measurement can help you build habits that support better energy and long-term health: ⁠https://levels.link/wnl

What We Cover:
Why the evidence that LDL and ApoB-containing particles cause atherosclerosis is so strong
What “lower for longer” means and how the new LDL and ApoB goals change with cardiovascular risk
When ApoB adds useful information beyond a standard lipid panel
Why the guidelines recommend against routine LDL particle-size testing
How PREVENT risk scores and coronary calcium scans can help decide when treatment makes sense
What decades of statin research tell us about benefits, muscle symptoms, and diabetes risk
How much lifestyle changes typically move cholesterol, and when non-statin drugs enter the picture
Why common heart-health supplements don’t have the evidence behind proven lipid-lowering therapies

🎙️ About the Guest:
Dr. Seth Martin is a professor of medicine and preventive cardiologist at Johns Hopkins, where he directs the Advanced Lipid Disorders Program and Digital Health and AI Lab at the Ciccarone Center for the Prevention of Cardiovascular Disease. He is a co-developer of the widely used Martin-Hopkins LDL cholesterol equation and served on the writing committee for the 2026 ACC/AHA dyslipidemia guideline.

📍What Dr. Seth Martin & Mike Haney discussed:
00:04 - LDL and ApoB are causal. Lower for longer
07:10 - Guidelines set the standard. Not your doctor
11:40 - 2026 shift: earlier treatment, PREVENT, lower goals
17:01 - LDL near zero does not eliminate cholesterol
19:59 - Hard numbers are back, and lower
23:05 - ApoB if a high result changes treatment
27:42 - No trial says treat particle size instead of LDL
34:51 - PREVENT is for people not already high risk
38:52 - Calcium 300 can push the goals. Zero can mean lifestyle first
44:29 - The 3% statin line, and the choice just under it
51:22 - Muscle symptoms uncommon. Statin can move prediabetes diagnosis earlier
56:21 - Lifestyle often lowers LDL about 10%, not the whole benefit
59:05 - Other proven drugs when a statin is not enough
1:05:31 - Statin beat the supplements. Fish oil can raise AFib risk

🔗 Helpful Links:
2026 Guideline on the Management of Dyslipidemia: ⁠Read the guideline and supporting materials⁠
The New Cholesterol Guideline: What to Know — Johns Hopkins: Read the Johns Hopkins summary
PREVENT-ASCVD Calculator.: ⁠Use the PREVENT calculator⁠
Martin-Hopkins LDL Equation: Learn about the Martin-Hopkins method
SPORT Trial — JACC (2022): Read the SPORT trial

Watch the conversation: https://youtu.be/vRfhof5dOZw
Find us on YouTube: ⁠https://youtube.com/levelshealth?sub_confirmation=1⁠

👋 Who we are:
Levels helps you understand your metabolic health with personalized data, expert guidance, and tools that connect your daily choices to measurable changes in your body. Our goal is to help you make better decisions about food, exercise, sleep, and long-term health.

Look for new shows every month on A Whole New Level, where we have in-depth conversations with thought leaders about metabolic health.

Most of NextLevel starts with a measurement problem: we can see more biology than ever, but we still have to figure out what to do with it. Bioelectronic medicine flips that sequence. We already know how to send electrical signals into the nervous system to change biology, including an FDA-approved vagus nerve treatment for rheumatoid arthritis, even though we still can’t map or read most of the individual nerve fibers carrying those signals.

Mike Haney talks with Dr. Kevin Tracey, a pioneer of neuroimmunology and bioelectronic medicine, about what becomes possible when nerves become a therapeutic target. The opportunity is not simply vagus nerve stimulation, but learning which signals control specific organs, then building systems that can read and write them. That is still some distance away, and Tracey separates it from looser claims about vagal tone and vagus nerve hacks.

Free course: Improve your metabolic health
Get our free email course on how glucose, nutrition, exercise, sleep, and measurement can help you build habits that support better energy and long-term health: https://levels.link/wnl

What We Cover:
Why the vagus nerve is not one wire
How one minute a day became an FDA-approved rheumatoid arthritis treatment
Why a nerve target can be more precise than a drug
Why mapping the vagus fiber by fiber is only beginning
Why CRP and cytokines are not a true inflammation readout
What HRV, breathing, humming, and cold plunges can and cannot show

🎙️ About the Guest:
Dr. Kevin Tracey is a neurosurgeon, scientist, and President and CEO of the Feinstein Institutes for Medical Research. His work helped establish how the vagus nerve regulates inflammation and helped launch bioelectronic medicine. He is also co-founder of SetPoint Medical and author of The Great Nerve.

📍What Dr. Kevin Tracey & Mike Haney discussed:
00:00 - A nerve can treat one organ. A pill cannot
04:43 - The vagus nerve is 160,000 fibers, not one wire
07:53 - Why the first fiber-by-fiber map of the human vagus is only months old
10:29 - FDA-approved vagus nerve stimulation for rheumatoid arthritis
14:33 - Why one minute a day can quiet inflammation for 12 to 24 hours
17:39 - Why it took 30 years to get from the mouse finding to patients
31:53 - How one minute of current reaches millions of immune cells
41:19 - Why arthritis has a known mechanism and epilepsy and depression do not
49:16 - What single fibers could change in diabetes, the liver, the gut, and stroke recovery
52:59 - Why CRP and cytokine levels still fall short of a true readout
1:04:18 - Resting heart rate, not HRV, is the cleaner vagus signal
1:09:55 - Why deep breathing and humming are not vagus nerve stimulation
1:16:35 - A cold plunge is fight-or-flight first, vagus second
1:20:23 - The spleen signal he would measure if he could

🔗 Helpful Links:
The Great Nerve - Kevin J. Tracey (2025)
RESET-RA - Nature Medicine
SetPoint System - FDA
The inflammatory reflex - Nature (2002)
Vagus nerve stimulation in rheumatoid arthritis - PNAS (2016), early human study
Vagus nerve stimulation after stroke, paired with rehab - The Lancet (2021)

Watch the conversation: https://youtu.be/x_h6Dd_Ap_o
Find us on YouTube: https://youtube.com/levelshealth?sub_confirmation=1

📲 Connect:
Connect with Dr. Kevin Tracey at Feinstein Institutes for Medical Research

👋 Who we are:
Levels helps you understand your metabolic health with personalized data, expert guidance, and tools that connect your daily choices to measurable changes in your body. Our goal is to help you make better decisions about food, exercise, sleep, and long-term health.

Look for new shows every month on A Whole New Level, where we have in-depth conversations with thought leaders about metabolic health.

Most health decisions happen before the science is settled. A study points one way, another points somewhere else, experts disagree about what matters, and even strong population-level evidence may not tell you what will happen to you.

In this episode, Mike Haney talks with physician and economist Dr. Anupam Jena about how to make decisions under that kind of uncertainty. The goal isn’t to find a single hierarchy of evidence or a perfect source to trust. It’s to understand how much weight to put on any one piece of information, when personal experimentation can actually teach you something, and how the potential downside of an intervention should change the amount of evidence you demand before trying it.

Free course: Improve your metabolic health
Get our free email course on how glucose, nutrition, exercise, sleep, and measurement can help you build habits that support better energy and long-term health: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://levels.link/wnl⁠

What We Cover:
Why even a high-quality study should rarely change your mind by itself
Why a meta-analysis is only as useful as the studies that go into it
What randomized trials can establish, and where they can still fail to apply to real life
How to judge whether a study’s outcome is actually meaningful, not merely statistically significant
When N-of-1 experiments can help, and how they can fool you
A practical framework for deciding whether an intervention is worth trying: potential harm, quality of evidence, biological plausibility, and cost

🎙️ About the Guest:
Dr. Anupam Jena is the Joseph P. Newhouse Professor of Health Care Policy at Harvard Medical School, a physician at Massachusetts General Hospital, and an economist whose research uses natural experiments to uncover unexpected influences on health and medical care. He is also the host of Freakonomics, M.D. and co-author of Random Acts of Medicine.

📍What Dr. Anupam Jena & Mike Haney discussed:
04:04 - Why taxi and ambulance drivers die least often of Alzheimer's
09:20 - Why half of people still skip a free heart medication
13:02 - Why the headlines on coffee keep reversing
14:55 - Judge the study on its merits, not on who funded it
17:43 - Why even a high-quality study should rarely change your mind
23:04 - Why a cold plunge trial cannot separate the bath from the belief
26:19 - Why a meta-analysis is only as useful as the studies inside it
27:15 - What a randomized trial can establish, and where it still fails in real life
33:53 - The coin-flip test for whether a study shows cause and effect
36:25 - Absolute risk, relative risk, and what "significant" leaves out
43:06 - When an N-of-1 experiment can teach you what a trial cannot
46:02 - Getting better does not mean the experiment worked
53:55 - Harm, evidence, plausibility, cost: is it worth trying?

🔗 Helpful Links:
Dr. Anupam Jena — Harvard Medical School profile
Random Acts of Medicine — Anupam B. Jena & Christopher Worsham
Freakonomics, M.D. https://freakonomics.com/series/bapu
Alzheimer’s mortality among taxi and ambulance drivers (BMJ, 2024). Hypothesis-generating, not evidence that driving prevents Alzheimer’s: Read the BMJ study
Marathon road closures and cardiac mortality (NEJM, 2017): New England Journal of Medicine

Watch the conversation: https://youtu.be/k9XI7ym7iP8
Find us on YouTube: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://youtube.com/levelshealth?sub_confirmation=1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

📲 Connect:
Connect with Dr. Anupam Jena on https://x.com/AnupamBJena

👋 Who we are:
Levels helps you understand your metabolic health with personalized data, expert guidance, and tools that connect your daily choices to measurable changes in your body. Our goal is to help you make better decisions about food, exercise, sleep, and long-term health.

Look for new shows every month on A Whole New Level, where we have in-depth conversations with thought leaders about metabolic health.