The Dr. Hyman Show - The Secret to Longevity, Reversing Disease and Optimizing Health: Fixing Metabolism with Dr. Casey Means

Starting point is 00:00:00 Coming up on this episode of The Doctor's Pharmacy. By optimizing our metabolic health and really stabilizing our blood sugar levels and keeping them stable and healthy throughout our lifetime, it is really the quickest way and the lowest hanging fruit way to achieve really almost any health goal that you have. Hey everyone, it's Dr. Mark. Whole body wellness is obviously a huge part of my life and I'm always looking for new ways to make feeling great easier. One of my non-negotiables is getting a daily dose of healthy light. For years now, I've been using Juve light therapy devices to easily do that all

Starting point is 00:00:39 year long and I especially love it during these shorter, cold winter days. You've probably heard me talk about Juve before. That's J-O-O-V-E. I use my Juve light therapy device every day, and I've experienced many benefits, from firmer, more radiant skin to improved sleep quality and faster recovery from my toughest workouts. It works on a cellular level, which is why it has so many benefits for the whole body.

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Starting point is 00:01:53 the perfect time. Just go to juve.com forward slash pharmacy, that's F-A-R-M-A-C-Y, and use the code pharmacy, F-A-R-M-A-C-Y. That's J-O-O-V-V dot com slash pharmacy. For a limited time, you'll get an exclusive discount on Juve's Generation 3.0 devices, and some exclusions do apply. This episode is sponsored by ButcherBox. You've probably heard me talk about ButcherBox before because they've revolutionized the process

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Starting point is 00:03:34 stipulation I always tell my patients when it comes to animal protein. Quality needs to be a priority. And with ButcherBox, you can feel good knowing you're getting the highest quality meat and seafood to optimize your diet. Right now, ButcherBox has a can feel good knowing you're getting the highest quality meat and seafood to optimize your diet. Right now, ButcherBox has a special offer for new members. If you sign up today, you'll get two ribeye steaks free in your first box, plus $10 off by going to butcherbox.com forward slash pharmacy, F-A-R-M-A-C-Y. That's 200% grass-fed ribeyes for free, plus $10 off your first box by going to butcherbox.com forward slash pharmacy. Now let's get back to this week's episode of The Doctor's Pharmacy. Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman and that's Pharmacy with an F,

Starting point is 00:04:18 a place for conversations that matter. And if you are one of the people in America who suffers from belly fat or any metabolic issues, you better listen up. And honestly, this is probably most of Americans. We're talking about almost 9 out of 10 Americans. So for the 1% who this doesn't relate to, I'm sure somebody in your family or who you care about it relates to, so you should listen up. We're going to talk about blood sugar, which is one of my favorite topics, with none other

Starting point is 00:04:45 than an extraordinary Stanford-trained physician, chief medical officer, and co-founder of a metabolic health company that I have invested in because I believe in it so much, and I'm an advisor for Dr. Casey Means. Welcome, Casey. Thank you so much, Dr. Hyman. It is a true pleasure and honor to be here with you today. Now, it's great, Casey, to have you too. And I think we were just chatting a little bit before about how you went from being an

Starting point is 00:05:11 ENT surgeon to being a functional medicine doctor. And now you're a lecturer at Stanford University. And your goal is really to maximize your potential and reverse this epidemic of preventable chronic disease, primarily caused by imbalances in blood sugar, by empowering people with the tools about their body that can help them understand what's going on and then help them make personalized decisions to optimize their diet and lifestyle. And your perspective is just so refreshing. And it's work that's been featured in the New York Times, Wall Street Journal, Men's Health, Forbes, Business Insider, and on and on and on. And I'm most excited about your goal, which is to empower individuals to understand

Starting point is 00:05:59 their bodies in a way to reclaim their health. You call it giving them agency over their health, as opposed to being victims. You go to the doctor and the doctor does healthcare to you. No, no, no. This is really about the decentralization of modern healthcare systems and the empowerment of individuals to take back their health and to understand what's going on in their bodies. So just quickly, tell me, how did you go from being a Stanford-trained ENT surgeon, which, by the way, is no small task to get there, requiring decades of study and a tough residency. How did you go, nah, I'm going to focus on functional medicine and blood sugar and start a company? Well, thank you so much for that introduction. And it was an interesting path. So I'm nine years into my postgraduate training. So four years of

Starting point is 00:06:52 medical school, five years of head and neck surgery residency. And I'm sort of looking around me and I'm taking stock of what I'm doing every day with my life. And I realized that most of the conditions that I'm treating are inflammatory in nature. It's sinusitis, laryngitis, thyroiditis. It's all the itises, which as you know, Mark, itis is the suffix in medicine that means inflammation. And I'm realizing, huh, I'm prescribing a lot of steroids every week. I'm prescribing oral steroids, IV steroids, topical steroids, nasal steroids. These all turn down the immune system. And it got me thinking, you know, I'm doing a lot to really tamp down on the immune system, but, you know, inflammation is the body's sign that there's a threat. It's perceiving a threat that it needs to fight. We were never

Starting point is 00:07:43 talking about what is that threat. No, right? That's so true. In medical school, we never learned how to be an inflamologist or how to be detectives to figure out what the heck's causing the inflammation in the first place. We got very good at suppressing the inflammation with aspirin and non-steroidals and steroids and immune suppressants and on and on. We get better and better drugs with more and more side effects, but we don't really ever ask the simple question is why? Well, you can't code for chronic inflammation, you know? And so it's not something that we really think about, you know? And so it got me saying, what is causing all this inflammation? What is the root cause? And what I

Starting point is 00:08:20 really started to, and why are we just turning to medication? And then when the medication doesn't work, going to surgery. And then it got me thinking, you can't operate on the immune system. So really, we're operating on these sort of downstream effects of these diseases, but we're not actually changing the physiology that's leading to these diseases. And you're seeing a lot of recurrent revision surgeries. And it really gets you thinking, are we actually getting at the root cause here? And so that really led me on a journey and a journey to looking at those root causes. And

Starting point is 00:08:53 what we know is that so much of the way we're living our lives these days in the Western world is what's triggering that inflammation. And one of the key root causes is metabolic dysfunction. It's blood sugar. It's insulin resistance. It's the way we're creating and processing energy in the body that can be a huge, when this is not going well, it can be a huge driver of inflammation in the body. And what I then sort of also realized was, okay, so ENT is kind of this niche part of the body, but all the other killers of Americans, the main killers of Americans, are also being caused by chronic inflammation, heart disease, diabetes, obesity, Alzheimer's, dementia, cancer. The same cytokines, the inflammatory molecules that are upregulated

Starting point is 00:09:35 in sinusitis, it's the same ones in all these diseases. So let's talk about that. And let's talk about how to mitigate some of these root causes and fundamentally that comes down to not a pill not a doctor's visit not a surgery it comes down to the choices that we're making every day about our exposures about what we're eating about how much sugar we're having about how much sleep we're getting the movement we're doing the toxins we're exposing ourselves to how we're supporting our microbiome our our micronutrient status. These are the hundreds of micro decisions we make every single day. And so it became really imperative to me to think about how do I, if I'm

Starting point is 00:10:16 a physician and my goal is to generate health, how do I actually empower people to make the decisions every day that are going to create conditions in the body that will ultimately lead to proper metabolic functioning, cellular biology, and ultimately health. And so that became a real shift for me from really being embedded into what is a highly reactive medical system that really benefits off people being sick and staying sick. That was another thing that really impacted me as a surgeon was realizing that I make money, I profit if people who are sick come to me. I actually don't make money really as a surgeon if people are all healthy. And I don't think that type of thought process really is

Starting point is 00:11:06 affecting the average doctor day to day, but it's built into our system. And those systems factors can be very troubling. And I guess, long story short, it came down to a real reckoning for me five years into my surgical training where I looked up and I said, we're spending $3.8 trillion a year on healthcare costs in the US. And the reality is that people are getting sicker, people are getting fatter, and people are getting more depressed. So this is how I make money. And we are increasing that spending year over year. And I am a steward of this system. I am a leader in the system. I'm a doctor. And if you're a doctor and you're looking at those realities, which are true, we're spending more and more every year and people are getting sicker, fatter, and more depressed. What are you doing?

Starting point is 00:11:57 If you're not stopping and saying, why? It's just amazing to me that we never ask that question is you know why is our ship filling up with water yeah let's just keep bailing the boat no let's figure out where the holes are fix them right and in medicine we don't do that what you're talking about you know your goal as a doctor is to you know create health for people i would disagree with you i don't i don't think that's what we're trained to do. We're trained to treat disease. We never took that course. I mean, maybe at Stanford they have a course in creating health 101. I surely didn't get that class in medical school.

Starting point is 00:12:33 And it's really a very subtle distinction. But if you go to the average doctor and say, how do I create optimal health? How do I create profound metabolic well-being and health? How do I optimize my brain? They're like, I don't know, eat better, exercise, sleep, I don't know, take a multivitamin. There's really no depth of understanding of the science of health. And your company Levels is really not looking at necessarily disease per se only, but it's actually helping people understand the subtle variations in their biology that determine the quality of their health, which determines the quality of your life.

Starting point is 00:13:08 Exactly. And that is what's so profound about the shift of this empowering the average patient in our medical culture. I mean, the average sort of traditional doctor was you go to the doctor, they tell you what to do, you just do it and there's no questioning. And the reverence for that is starting to slip for sure. But there's still this sort of understanding that, that you know you go to the doctor to get fixed it's just not how it works the doctor is sort of like an emergency room you just go there when

Starting point is 00:13:32 things are really bad to kind of you know help a little bit which is fine there's nothing wrong with that or you know sometimes you do need surgery or an intervention it's fine but for most of us we're not really dealing with the the fundamental issues that are causing us to not be well and um and i want i want to come back to metabolic health because this is really the focus of this conversation you know what is metabolic health and what is poor metabolic health because recently a study was published that showed that 88% of Americans are in poor metabolic health. So how is that defined? What is that?

Starting point is 00:14:11 And why should we care? Right. Yeah, that study was fascinating. UNC, two years ago, 88% of American adults have at least one biomarker of metabolic dysfunction. Because 75% of us are overweight, which means a lot of the skinny people are also poor metabolic health, right? Exactly, exactly. And really, my belief is that by optimizing our metabolic health and really stabilizing our blood sugar levels and keeping them stable and healthy throughout our lifetime, it is really the quickest way and the lowest hanging fruit way to achieve really almost any health goal that you have,

Starting point is 00:14:47 whether it's to look good, feel good, to have longevity, to avoid chronic disease, to have athletic performance, to have your brain functioning properly. It's really the trunk of the tree of so many of these pain points we're dealing with today. So what is metabolism? Fundamentally, metabolism is the way that we produce energy in the body. So we have 30 trillion cells in the body. And all of- Before you get into that, I just want to come back a little bit.

Starting point is 00:15:15 I think it's really important to define this poor metabolic health. There's really three biomarkers that are looked at, right? Yeah. And it was blood sugar, blood pressure, and cholesterol. Right, exactly. So 88% of Americans have a problem with one or more of those. Yes.

Starting point is 00:15:31 And the cause of all of those poor metabolic health markers is... Blood sugar dysregulation and insulin resistance. Yeah. And so what happens is, you know, we have these 30 trillion cells. And every single one, trillions, needs energy to function. We need to convert food to energy, an energy form that we can use in our cells, namely ATP, for our cells to function. And when that process isn't going properly, the metabolism, when that conversion is not

Starting point is 00:16:01 working properly, we don't produce energy properly in cells. And what happens when you don't produce energy properly in cells. And what happens when you don't have energy, you get cellular dysfunction. When you have cellular dysfunction, you get tissue dysfunction. Tissue dysfunction leads to organ dysfunction, and organ dysfunction is symptoms. That's what it is. And so this is why metabolic dysfunction underlies so many of these seemingly disparate symptoms we're dealing with today, so many of which you've talked about in so much of your work. But metabolic dysfunction, this problem with producing energy

Starting point is 00:16:30 in the body is underlying some of the big heavy hitters, big killers in the US, obviously heart disease, diabetes, Alzheimer's, dementia, cancer, chronic liver disease, chronic kidney disease. Depression. Depression. But all these other things that people don't even realize depression brain fog infertility erectile dysfunction chronic pain um gout there's there's so many of these that we don't really relate um when in fact a lot of these are just this energy deficit this problem creating energy and processing energy showing up in different cell types. But that core physiology is really the same. So the main issue is that our lifestyle and what we're eating and what we're

Starting point is 00:17:12 doing and how we're living is hijacking that process, that food to energy process. One of the big, big key players is the amount of sugar that we're eating in our diet. The average American these days eats 152 pounds of refined sugar per year. 100, 200 years ago, we were probably eating around one pound of refined sugar per year. That's 152 times the amount of substrate that these poor little cells have to process. They break down. They just say no. And what that looks like is insulin resistance. As I'm sure many of you listeners know, when we eat carbohydrates and sugar, the body releases insulin, a hormone, to help you take that sugar out of the bloodstream into the cells so that it can be used for these metabolic processes. But when that's happening

Starting point is 00:18:00 in all the time, day after day, huge spikes in blood sugar, the cells become resistant to this insulin. There's so much insulin being poured out. The cells are like, we cannot process all of this. This is too much. And the cells block it. So now you've got this issue where you've got tons of this glucose substrate. You've got all this insulin being poured out, trying to force more glucose into the cells. The whole machinery essentially gets gummed up. And that's really the root of metabolic dysfunction. You've got poor energy production in the cells. So by day after day, like learning what is spiking our blood sugar and then learning how to optimize that, keep the blood sugar down, figure out what foods are affecting you, you essentially let the body

Starting point is 00:18:45 rest a little bit. You know, if you can keep the glucose down day after day by learning what's affecting you, you can keep the insulin down. And then the cells start to perk up again to that signal and say, okay, we can do this. You know, this factory can run a little bit better. So that's what Levels is helping people do is really to learn how different foods and these products that we may be told are healthy are actually affecting our blood sugar. With that information, it's the first time ever we've had a closed loop biofeedback system about what we're putting in our body and what it's actually doing to our health. And I believe that people should know what food is doing to their bodies. Right now, it's kind of a black box, and it's a mystery.

Starting point is 00:19:29 And we have to trust food marketing. We have to trust the different nutritional ideologies. And there's a lot of conflicting information out there. It's a hugely confusing landscape. And I really do feel that objective data, like through a wearable device that's giving you this real-time biofeedback can just cut through a lot of that marketing a lot of those loud voices a lot of the

Starting point is 00:19:51 information from governing bodies that we know is not actually helping us achieve our goals you can just see this works for me this doesn't and then improve your metabolism with that information yeah i mean here's here's the thing casey is that as doctors we really don't learn about metabolism we have nutritional biochemistry lessons when we study the krebs cycle in first year medical school and the joke among all the medical students is you know this is just a grunt class basically you're going to forget it as soon as you're finished just cram for the exam and don't worry about it turns out it's probably the most important class in medical school. And we don't understand metabolism as doctors.

Starting point is 00:20:28 And we don't understand even blood sugar and insulin resistance. You know, 90% of the cases of prediabetes, which affects about one out of every two Americans, are not diagnosed because doctors don't know how to diagnose them. And they'll say, oh, your blood sugar is normal on your test. Well, what is normal? What is optimal? They'll say your A1C is great. You're fine. No problem. No problem. But after practicing this for decades, I have really learned that there are other ways to get the science of what's happening, which is sort of what you're really doing with levels is you're giving people the opportunity to measure in real time what happens when their body ingests food and how that affects their particular blood

Starting point is 00:21:10 sugar. Because everybody eating exactly the same food might have very profoundly different responses to that food. I can, you know, drink a can of Coke and my blood sugar and insulin might go to X and Y. Somebody else might go to, you know, A, B and A and B. And that's not something that you would inherently know. And the other thing that struck me was that the metrics that we have are just really poor. And I think, you know, I want to share a story of a patient which taught me so much about metabolic health. And this was a woman who had an enormous girth.

Starting point is 00:21:46 I mean, she looked like the sort of Pillsbury Doughboy. She was just round around the middle, skinny arms and legs, just big circle around the middle. And clearly she was in poor metabolic health. Blood sugar was perfect. I measured her blood sugar. I said, well, maybe we should do a glucose tolerance test. Her A1C, which is the average blood sugar resistance, was perfect.

Starting point is 00:22:07 That wasn't like it was 100. It was like 80 fasting, which is really optimal. And I said, let's do a glucose tolerance test and measure your blood sugar. And we're going to also measure insulin because most doctors, and this was probably 25 years ago, most doctors just never measure insulin, even today, 25 years later. But it probably, as we were discussing earlier, probably one of the most important tests. So her blood sugar, after she took the equivalent of two Coca-Colas,

Starting point is 00:22:34 perfect, like never went over 110, even after drinking the equivalent of two Cokes. Her A1C was perfect. Her insulin, on the other hand, like normal should be about five or less hers was over 50 fasting which should which is super high 10 times and when she she had the sugar drink it went to 200 or 250 which you just almost never see it should never go over 30 after a sugar drink and i was like wow here's someone who if she went to a regular doctor, would have a perfect test, even if they did a glucose tolerance test.

Starting point is 00:23:11 And so, you know, the importance of really digging down to understand what's happening with your own body is so key. And that's what's so exciting to me about levels, is it gives people real-time access to data through a continuous glucose monitor, which is a really relatively non-invasive procedure where you track your blood sugar on your phone. Super easy and fun and gives you so much insight. And like I was sharing this story before, I was using the Levels app and I had the device on my arm. And this friend of mine, we're having a meal in Martha's Vineyard last summer. And it was a farm-to-table meal.

Starting point is 00:23:48 But we got it brought in. It was COVID. We didn't go out. We had it delivered. And it was a huge amount of extremely healthy food. And it was so delicious that we ate an enormous amount. But even the idea that you could eat healthy and it still causes a problem if you overeat, it's not something that most people really understand.

Starting point is 00:24:06 So, I can eat all this healthy stuff, but actually our sugars, both of our sugars really, really spiked, even though we're both really metabolically healthy. So it was kind of a fascinating lesson and gee, we don't really always know what's going on inside our bodies until we start looking. I think that's absolutely right.

Starting point is 00:24:21 And I think you bring up the great point about biochemical individuality when it comes to metabolic health and metabolism. What might affect you might affect me very, very differently. And I'd wonder if you and your friend at this dinner might have had actually eaten the same thing and had different responses. And that is really an important piece. You know, there was a really fascinating paper that was published in the journal Cell about five years ago by the Weissman Institute, and it was called Personalized Nutrition by Prediction of Glycemic Responses. This was based on the microbiome.

Starting point is 00:24:54 Yes, yes. They took 800 healthy people, so non-diabetic individuals, and they put continuous glucose monitors on them, these little devices that measure your glucose 24 hours a day in real time, sends that information to your smartphone, and they give them standardized meals. So they said like, you all are gonna eat an identical meal or an identical cookie and see what happens. And based on what we know about the glycemic index,

Starting point is 00:25:21 which is this idea that each food has sort of an inherent property of how much it will raise your blood sugar. They actually found something very different. Wait, wait, wait. So people, what she's talking about, Casey's talking about is that, you know, scientists have come up with this chart of if you eat a banana, it'll raise your blood sugar this much. If you eat a apple, it'll do this much.

Starting point is 00:25:40 If you eat chicken, it's going to do this much. And what you're saying is that was all thrown out the window because it depended on what was going on in the microbiome. Right. Exactly. They had some people who raised 10 points to a banana and others that 10 glucose points and others that went up 100 milligrams per deciliter. So what might be a really sort of okay metabolic choice for you might not actually be for me.

Starting point is 00:26:03 And they actually found equal and opposite reactions between people. So person A could have a huge spike to a banana and no spike to a cookie, and person B could actually have the exact opposite. So this is where I think testing can be really helpful because we sort of have this culture where there's loud voices in the nutrition space saying there's a one-size-fits- all diet, but I do think there's probably some more nuance to that. So that gets into the kind of the nitty gritty of the biochemical individuality. And like you said, in that study,

Starting point is 00:26:32 the microbiome was a key determining factor of how people responded to those different foods differently, which was pretty fascinating. Yeah, so true. I had a patient once that taught me a lot also. I mean, most of the stuff I learned, I learned from my patients. You start looking at the biology and you start asking questions, start thinking.

Starting point is 00:26:49 And most of us as doctors, honestly, just are pretty arrogant. We got trained in this guild in which we were told that this is sacred knowledge that's true with a capital T, that anybody who questions it is a heretic and is not, quote, evidence-based, which is the sort of the way we crusade against people who have ideas different than us. And we're basically often blind to the very things that are in front of us you know when a patient gets better or changes something attention so this guy had his diabetic

Starting point is 00:27:32 no regulation problem where his sugars are really volatile and brittle and it was tough to control and we did get dramatic improvements by changing his diet and putting him on a super low glycemic diet but it still wasn't great and he kept complaining about his gut so we started working on his gut and at one time he's like oh i'm just having all this gas and so why don't you just just just to deal with your gi symptoms just take some charcoal as a sort of an emergent you know stopgap measure to help fix what was going on with him and And next time I talked to him, he's like, that was a miracle. I said, what do you mean?

Starting point is 00:28:07 He says, my sugar dropped 100 points when I took charcoal. Right, and I'm like, how did that happen, right? It's not like the charcoal's not absorbing the sugar. What's happening is that in the intestinal tract, he had a whole bunch of bad bugs that were producing endotoxins, which are these really nasty toxins that certain bacteria

Starting point is 00:28:25 produce called lipopolysaccharides. They get absorbed over the gut. They activate the immune system. The immune system, and this is just old technical stuff, but it activates these things called cytokines, which then bind to receptors on the cell that cause insulin resistance. So basically these toxic bugs in his gut was causing his blood sugar to be all up and fixing that fixed his blood sugar. So it's very complicated. Hey everyone, it's Dr. Hyman. I'm all about using food first when it comes to nutrition, but there are certain nutrients I recommend everyone supplement with because it's simply impossible to get adequate amounts from your diet alone. One example is magnesium, which our soils, well, they're not too healthy.

Starting point is 00:29:11 And because there's no organic matter, they can't extract the magnesium from the soil from industrial farming, which is a drag. And that leads to 50% less of these minerals in our food than there was 50 years ago. And then, of course, we're doing things that cause us to lose magnesium, like sugar, caffeine, fluoride, even stress, which none of us have, right? 80% of Americans are actually deficient in magnesium. And that may mean insufficient, not necessarily true deficiency, but just not enough for optimal functioning because magnesium is so important. And it's a huge problem for our health. Considering the pandemic of stress, along with the pandemic of COVID that we're facing, we should all really be conscious about our magnesium intake because it activates

Starting point is 00:29:53 the parasympathetic nervous system, which keeps us calmer and more relaxed. Magnesium is crucial for more than 300 other chemical reactions in the body and impacts everything from metabolism to sleep to neurologic health, energy, pain, muscle function, and lots more. My favorite new magnesium is from a company called BioOptimizers. Their magnesium breakthrough formula contains seven different forms, all of which have different functions in the body. There was truly nothing like it on the market. I really noticed a difference when I started taking it and I've tried a lot of different magnesium products out there. I also love that all their products are soy-free, gluten-free, lactose-free, non-GMO, free of chemicals, fillers, and made with natural ingredients. Plus they give back to their community. For every 10 bottles sold, they

Starting point is 00:30:35 donate one to someone in need and there's a lot of those. Right now you can try BioOptimizer's Magnesium Breakthrough for 10% off. Just go to magbreakthrough.com. That's M-A-G-B-R-E-A-K-T-H-R-O-U-G-H.com slash hymen and use the code hymen10 and you'll get 10% off this really great formula. I think you're going to like it as much as I do. And now let's get back to this week's episode of The Doctor's Pharmacy. I want to get into something with you that I think is really important for people to understand because we sort of touched on metabolic health and poor metabolic health. But I wonder if you can take us through a story of like, what actually are all the things that are happening? Because you create a list of

Starting point is 00:31:10 conditions that are related to poor blood sugar. What is the biology of what's happening when your blood sugar is out of control? What happens to your microbiome, to your immune system, to your brain, to your hormones? Take us through what actually happens in the body when you are eating the average American diet. Yeah. So there's sort of four things that I think are kind of worth focusing on. There's the direct effects of high blood sugar. So you eat something and your blood sugar spikes, and then there's biological effects of that. And then there is a fourth thing, which is the long-term stuff. So in terms of those short-term things, like you drink a Coke and your blood sugar goes up from 75 milligrams per

Starting point is 00:31:49 deciliter, 150 milligrams per deciliter, that blood sugar spike can cause glycation. It can cause oxidative stress. Wait, wait, wait. What is glycation? So glycation is the process where sugar just sticks to things in your body. It's actually just like sugar molecules sticking to things like fats and proteins and DNA, and that can cause dysfunction. It can cause those cellular parts to be dysfunctional. And so that's an issue. We don't want that.

Starting point is 00:32:16 It can generate inflammation immediately too. This huge surge of sugar is unusual for the body. It's like, what is going on? Why is this big change, this sort of homeostatic shift happening? We don't want that. And then it can cause oxidative stress, which is sort of this reaction where your body's producing metabolic byproducts that are reactive and can be damaging to the cells. So these unpaired electrons that go around and want to bind with things. It's rusting. Exactly. So these unpaired electrons that go around and want to bind with things.

Starting point is 00:32:45 It's rusting. Exactly. So big glucose spike, you can have immediate effects on oxyostress, glycation, and inflammation. And then the fourth thing is this thing that's happening both immediately, but also really has cumulative effects, which is the insulin surge.

Starting point is 00:32:59 So when you have that big glucose spike, your pancreas is releasing all this insulin to help you soak up the glucose out of the bloodcreas is releasing all this insulin to help you soak up the glucose out of the bloodstream into the cells so it can be processed and bring the glucose back down. And what can happen there in the short term is that if you've got a big spike, so that big up and down, the insulin can actually sometimes overshoot. It can actually do too good a job in soaking up all that glucose. And you can have what's called reactive hypoglycemia, which colloquially is known as the post-meal crash.

Starting point is 00:33:30 So if you've had lunch and then after lunch feel tired and you want to have that second cup of coffee at 1 p.m. and maybe you feel a little bit more anxious, that might just be the fact that your blood sugar has gone up. You've released all this insulin. The insulin's kind of overshot. You've crashed down. And now you're in this dip and the body's trying to get back into balance. And that roller coaster with insulin. It's a secondary cascade of hunger hormones and cravings. Exactly. And so that's happening in the short term. And then that insulin process, going back to what we were talking about before, can over time lead to that insulin resistance, where the cells see that huge surge in insulin

Starting point is 00:34:08 so frequently that they actually say, we can't keep doing this. This is too much insulin, and we get numb to it. And that's insulin resistance. And then what happens is your insulin levels, they start creeping up because your body's trying to overcompensate for that block by producing more. And then that leads to so many of the downstream conditions that we've been talking about. When you've got this high insulin, one of the secondary effects of that, let's just talk about obesity. Insulin is a signal to the body that glucose is around for energy. And it's also a signal to the body that because there's so much glucose around, we don't need to use fat for energy. Glucose and fat are the two

Starting point is 00:34:48 main ways that we produce energy in the body. And when that insulin's high, it blocks us from tapping in to fat burning. It says to the body, nope, you don't need to tap into fat burning. We've got a bunch of glucose around. And so this is relevant to anyone who is trying to lose weight or who has the excess belly fat because that insulin is a real block on helping us achieve those goals. And so for us to tap into our copious fats stores in our body, we need the insulin to be lower. So by getting off that glucose roller coaster, by eating foods that keep us more flat and stable throughout the day, which is what we want for optimal health, both in the short term and the long term, we give our body a break from producing

Starting point is 00:35:30 that insulin. And that can have a real significant impact on our ability to lose weight, to kind of get rid of that belly fat, to tap into this alternate metabolic fuel source, and to generate what we call metabolic flexibility, which is this ability of the body to flip between using glucose when it's around and using fat when it's not around. And that state of being able to do both is a really healthy state. It's adaptive. But the average American with the vast majority of our calories coming from ultra processed foods, and I believe more than 70% of processed foods in the U S have refined sugar in them. And we've been told of course, to eat six small meals a day,

Starting point is 00:36:11 you are on as an American, this up and down glucose rollercoaster all day. And so you're really never giving your body this time in a low insulin state. So you really do have to be quite aware and think differently. I mean, the reality is as an American adult, you're on a treadmill towards being overweight and chronic disease. And unless you are doing something different, you will end up sick. And that's, that's where having a little more awareness I think can be helpful. A hundred percent. And all the things you mentioned earlier, people don't relate to this. They don't relate to blood sugar. They get diabetes is related to blood sugar.

Starting point is 00:36:49 But what about cancer and Alzheimer's and depression and heart disease and so many other issues? Infertility, gout, you mentioned. Yeah. Sexual dysfunction. Yeah. Acne. I mean, just whatever.

Starting point is 00:37:01 It's just unbelievable how much of our modern ailments and how many of those ailments are driven by this single process right and you don't have to treat all these diseases separately if you dealt with that then these other things would get better and i i think it's a it's something that i don't know why but it's just such a dark black hole in medicine it's there's a lot of literature on there's no lack of science but in practice the average doctor doesn't know how to diagnose or treat insulin resistance you know one of my patients came to me and said you know my doctor's uh i saw his blood sugar was like 115 or something i'm like hey your fasting blood sugar is a little high you're heading towards diabetes like yeah i said has your doctor recommended anything he's like well yeah i said

Starting point is 00:37:50 what he said wait till it gets to be higher and they'll put me on medication and i'm like wow okay that is not a very enlightened understanding of how our bodies work and and you know the the biological processes are so central to every age. And, you know, the biological processes are so central to every age-related disease. I was at a longevity conference once, and I was walking with Leonard Guarte, who was from MIT, and discovered sirtuins, which are these incredible regulators of our mitochondrial function, our energy, which we were talking about earlier, and that are so important in longevity and aging. And I said, so what's the secret? Like, how do they work? And what's like, this was years ago.

Starting point is 00:38:25 And I was like, there's the data was just trying to come out. He says, sugar. I'm like, don't eat sugar. It's like, that's what's causing these systems to fail and for us to age and for all these chronic ailments. And most people listening are probably, well, you know, I'm like, I'm not diabetic.

Starting point is 00:38:42 I'm like, all right, why should I worry about it? Well, if you have high blood pressure, high cholesterol, if you have any belly fat, if you're even thin but eat a crappy diet, this is going on under the hood. And so tell me why you feel that continuous glucose monitoring, which is sort of part of this whole new movement of what we call biosensors or quantified self or portable metrics. People have scales that send their data up to the cloud or blood pressure cuffs or the aura ring or Fitbits or now there's continuous glucose monitors. Why are these important and why should the average person even care? Because if you're not diabetic or pre-diabetic, which most people don't know,

Starting point is 00:39:30 by the way, that they're pre-diabetic because doctors don't diagnose it, but why should people care? Yeah. So I think that we've touched a little bit on why probably more people should care than they maybe realize. With 88% of American adults having metabolic dysfunction, this is relevant to the vast, vast majority of us. But I really think it comes down to personal empowerment and really understanding our own bodies. You know, we're not going to fix healthcare without fixing health. And you can't fix health without fixing the decisions that we're making every day about what we're eating, how we're sleeping, how we're stressing, how we're moving, how we're supporting our microbiome, all these things. And so it really comes down to choices. And right now, we don't have a lot of help to understand what choices to make for our own body. And that's where wearables and especially bio-wearables, I think can be very, very helpful. I'm not the type of person who wants

Starting point is 00:40:27 to be strapped to technology for the rest of my life. That's not really like, it's not my goal to, you know, be a cyborg and be wearing a sensor, but, you know, I'd rather, I want to be unplugged in the back country, right? Like camping. However, the reality is that the system that we're living in right now is designed to hurt us. It's designed to keep us sick. It's designed to keep us dependent refined sugar and refined corn and wheat and disease causing foods. I think we need a little bit extra support. And I think that wearables can really help with that. And so, so that's where, you know, where I'm really passionate about this is the empowering people to understand their own bodies and to make decisions for themselves in the face of a healthcare system that isn't being really proactive about metabolic health. We, like you were mentioning with your patient, you know, those numbers, when we reach sort of the pre-diabetic

Starting point is 00:41:38 or diabetic threshold, it's likely that we've probably had issues going on with our insulin for 13 years, as one study from the Lancet showed that. 13 years before you get that diagnosis. So how can we as individuals have tools that can help us during this time? I mean, if you can keep your blood sugar in a stable and healthy range throughout your lifetime, I'm fairly confident that you're never gonna walk

Starting point is 00:42:03 into a doctor's office one year and get a huge bomb dropped on you, that you have a metabolic condition. If you're looking day after day, year after year, and knowing that what you're putting in your body is not causing these huge spikes, you have unlocked the door to essentially minimizing your risk drastically of all of the conditions that

Starting point is 00:42:23 are killing Americans. And eight of the 10 leading causes of death in the US are directly related to blood sugar. Absolutely. And then the cost and the suffering and on and on and on. Right. And so I think having a tool in the face of the modern world that we're living in can be great. And I also think that from what I've seen with my patients, when you really understand your body and understand how the environment is affecting your body, it's very motivating. Nutrition has kind of been a black box. It's always been an open loop system where you make a choice and you actually don't

Starting point is 00:42:57 really understand what the result is. Often for a long time, maybe you eat healthy one day and then the next day you step on the scale. That's kind of a lagging indicator. How do you create a relationship between what specific food led to that result? Maybe it's six months from now you get a blood sugar test or a cholesterol test, but that one-to-one relationship has been missing. And now it's not with these bio-wearables. So for me, for instance, you you know i was eating oatmeal for breakfast you just read my ultra metabolism book then exactly yeah and i you know the box literally says heart healthy on it and good source of whole grains and fiber um i ate it with a continuous

Starting point is 00:43:39 glucose monitor on and my blood sugar and i I'm talking plain oatmeal, zero sugar, zero fruit, zero juice, plain, plain, boring oatmeal. My glucose went up about 85 points. For me, there is no chance that that food is heart healthy for me because glycemic variability, these ups and downs swings like that. I mean, I never really want my glucose to go above 20 to 30 points above my pre little meal levels this was like 80 so for me it is not a heart healthy food and anecdotally for most of our members at levels it's also not a heart healthy food we've seen very few people and you know if you look at the advertisements for this food almost universally it's the oatmeal with brown sugar with fruit with OJ maybe

Starting point is 00:44:26 with a piece of toast I can't even imagine so I think that's where some of this technology can can really help and I think it honestly can also improve the relationship between the doctor and the patient I think this is not like people going to dr. Google and coming in with a bunch of theories and questions. This is real information. It's real objective data. And I think it kind of can equalize that playing field and that power dynamic between the doctor

Starting point is 00:44:52 and the patient. I think sometimes doctors will recommend things and patients will try them and it doesn't work. Their labs don't get better. They don't lose weight. And there can be a lot of frustration. There can be some mistrust. But if you can use a wearable to help

Starting point is 00:45:08 personalize and almost be like a coach to help you achieve your goals, that can be great. And the reality is that 49% of Americans every year try to lose weight. So people are trying. And probably 75% should be. Right. Right. But that's a huge, that's hundreds of millions of people who are trying, who are making the mental commitment to, I want to do the work. I want to do better. I want to try. And we don't have much to grasp onto to help us. And so I'm very passionate about how we can,

Starting point is 00:45:46 for all these people who want to do better, give some tools, sort of a lifeline. Here's the secret that most people don't understand, especially around weight, is that the key to losing weight is low insulin. Right. Not necessarily low blood sugar, but low insulin. Right. Because insulin locks the calories and the fat in your fat cells. It's like a one-way turnstile. So once the glucose gets into your fat cells in your belly, it can't get out if the insulin is high, which people don't realize.

Starting point is 00:46:14 And so the key really to weight loss is, in addition to addressing all these chronic diseases, is to really get the insulin low. And the tool of levels which is just an amazing technology that help people in real time track their blood sugar correlated with what they're eating with their activity with their stress with their exercise it gives them a sort of a window into their biology that we really haven't had before and we're just going to get better and better better at it can i can i shoot case you

Starting point is 00:46:45 tell me from the people who use it because now it's in beta right it's not quite out and it will be soon by the way for people listening uh there's a closed beta happening now but there's a wait list of over 120 000 people who want to sign up if you want to skip the line you came to the right place because all you have to do because you listen to this podcast is get early access through going to levels.link forward slash hyman. That's levels.link forward slash hyman to get to be part of the waitlist top of the line. So you get to cut the line. So in all the people who've used it, tell me, what are some of the cases that just were the most instructive? The things you learned from people's experience? You mentioned a few things. I've mentioned a few things, but like,

Starting point is 00:47:33 give us some real patient stories. It has been so exciting to see what our members are learning by putting these continuous glucose monitors on and using levels. Some of the most, you know, fascinating things. I mean, there's a lot of low hanging fruit, right? It's like, if you drink a soda, your blood sugar often goes to the roof. So that's, they're sort of the obvious ones. But then there's sort of the nuts. You know, what's really interesting is that, sorry to interrupt you, but I just remember the study in New England Journal years ago where they looked at first degree relatives of type 2 diabetics who were actually healthy and when they did a challenge with them they found that they had higher spikes of sugar and insulin than people who didn't have first degree relatives so even if you look thin and great you still might not be you might be headed there right if you're not careful if you're a Pima Indian you know even if you look thin and great, you still might not be, you might be headed there, right? If you're not careful. If you're a Pima Indian, you know, even if you were living

Starting point is 00:48:28 a hundred years ago, if you had a can of Coke, you're going to be in trouble. Definitely. And that's how they got to be the second most obese population in the world after Samoans. Absolutely. Yeah. And, but I think, I think even those simple like learnings can be really helpful because we kind of know we shouldn't drink soda, although most Americans do. But you walk into the grocery store and it's everywhere and it's subsidized by our government. And you might get the impression like, oh, well, if it's subsidized by the government and it's covering Safeway, it's probably OK. But then you see the data and you're like, oh, wait, it's definitely not OK. This is going way out of range. But then you see the data and you're like, oh, wait, it's definitely not okay. This is going way out of range. But then it gets into some of the more nuanced and exciting stuff.

Starting point is 00:49:11 So one big learning is people realizing the importance of balancing their meals. And what I mean by that is adding fat, protein, and fiber to their carbohydrates. So people will eat, let's say, an apple all by itself and have like a pretty significant glucose spike, but they take that apple and they put some almond butter and some chia seeds on it. And they might have a very different response because we know that that additional fat protein and fiber from the chia seeds and the nut butter can actually, you know, slow, you know, the amount slow at the time to absorb the glucose. And it can really change the dynamics. It also impacts the microbiome. And so may even make us absorb less of the glucose

Starting point is 00:49:53 because we are putting fiber in there. So that's been a major thing that we've seen is fat, protein, and fiber. We call that the glycemic load, which is what is the total effect of the meal. Yeah. And even the timing, right? You learn about what happens when people eat what. Yeah, exactly. The timing has been a huge thing. We've seen that people often find that if they eat something very late at night versus the exact same meal earlier in the day, they'll often have a larger response at night and

Starting point is 00:50:20 it can impact their sleep quite a bit. Even if it's the same meal. Exactly. Same meal. And part of this is because we're a little bit more insulin resistant at night and it can impact their sleep quite a bit. You have the same meal. Exactly. Same meal. And part of this is because we're a little bit more insulin resistant at night naturally. And this has to do with melatonin secretion. So we have dessert earlier in the day? Basically.

Starting point is 00:50:33 I mean, I would say that if people are going to eat dessert, you know, I do tend to now front load my carbs because of what I, in the day, because of what I've learned from continuous glucose monitoring. And I also know that those ups and down, up and down swings called glycemic variability at night can really impact sleep. And we integrate our glucose data stream with sleep and activity tracking. So you can start to make some of those higher level insights about how sleep and glucose are related. We've seen a lot of people comment on how when they get less sleep, their glucose is quite a bit more erratic the next day. It's a huge impact. Massive. Exercise. Sleep and then,

Starting point is 00:51:13 of course, exercise. So one of the biggest takeaways is people realize that just getting up and walking for 15 minutes after a meal can have a significant effect on your post-meal spikes. It can bring your glucose down faster. And if you look at a lot of traditional cultures, getting up and taking a stroll, it's super common. And now we have the biometric data to back up why. It makes a big difference. And the last one I think that's been really interesting

Starting point is 00:51:40 and again, supported by the research is that stress definitely causes people's glucose spikes to be higher. We've had people who are fasting, you know, it's first thing in the morning and they have to give a talk to their company or they're on a podcast or something like that. And they might get a glucose spike just from the stress alone. And the mechanism of that is really interesting. The cortisol and the, you know, the, the, the catecholamine hormones that are released when we have stress, they tell our liver to actually dump glucose into the bloodstream. And evolutionarily the purpose for this was because

Starting point is 00:52:15 when we had a stress signal, like a threat, we thought, Oh, we're probably gonna have to run from something. We're gonna have to run from the lion or whatnot. And so the body was like, okay, cool. You need to use your muscles. So we're going to help you mobilize some glucose from the liver to feed the muscles. But now what we're dealing with are mostly these psychological stressors, an email, a honking horn, you know, a stressful phone call, whatnot. And so that glucose from the liver is not actually helping us. It's just sitting in the bloodstream causing problems. So what I'm loving seeing in our members is that this is not just about, okay, put on a glucose monitor and eat low carb and get a flat glucose line. It's about having a holistic picture of your health and all these different lifestyle behaviors that feed into building a body that processes food effectively. And that includes

Starting point is 00:53:06 the amount we sleep, how we're responding to stress, how we're moving throughout the day, of course, how we're pairing and timing foods. And all together, those things can sort of work to let us have a better glucose response. Yeah. I mean, people don't even know, like they have a glass of wine when they go to a restaurant, the beginning of the meal is very different than adding it in the middle of the meal. Yeah. Same glass, very different effect on your body. So those kinds of things, or having bread, which they put at the table, obviously, is

Starting point is 00:53:32 to spike your hunger, which it does because it spikes your blood sugar. So if you have the bread in the middle of the meal, maybe we shouldn't eat that much bread anyway, but it's like basically it is a very different thing. So how have you found that levels has helped people change behavior? Because at the end of the day, people want to change behavior so they can change the outcomes of their health. Weight loss, reversing diabetes,

Starting point is 00:53:52 improving the way they feel, right? Yeah, absolutely. So I think it's twofold. I mean, one is that it's really helping people understand that this is, again, not just about eating the low-carb bar that has no sugar. This is about really building a comprehensive lifestyle that supports our metabolic health and how to pull those different levers to do that, whether it's moving more.

Starting point is 00:54:17 Exercise, for instance, the beautiful thing about muscle that I don't think most people or doctors know is that it can actually take up glucose without insulin. It's this glucose sink that soaks up glucose from your bloodstream without the insulin signal. So the more we can just like get up and move around the day, you know, even for two minutes walking here and there, it contracts those muscle groups and helps you soak up that glucose, get out of your bloodstream. So we've really seen people learn about foods that are very surprising to them. A lot of people who have sort of been on diets and haven't had success and then realize that there are foods they thought that were healthy

Starting point is 00:54:59 that are actually not working for their body. And some of the key ones, I'll use me as an example. I learned, I've been using this for now for about 18 months, but in the first month I realized corn, rice, grapes, sweet potatoes, oatmeal, and most grains all sent me above 150. We're all told to eat whole grains. Right, and sweet potatoes and grapes. I mean, it's fruit.

Starting point is 00:55:22 And it's not to say those are unhealthy foods, but if I were trying to lose weight or if I were- It might not be good for you. They wouldn't have been right for me. So that's the type of behavior change we're really seeing. And I think athletes have been a fascinating one as well. A lot of athletes are eating the standard sort of recovery foods, whether it's a shake, a Gatorade, or a sports bar,

Starting point is 00:55:44 and seeing that they're just going to the moon, you know, and that that's actually not supporting their goal with recovery. So, so that closed loop biofeedback, the ability to have, you know, awareness control, sort of some agency. I think that's where we're really just seeing people, um, feeling great. It's not just about the food. It's about feeling like we finally have something to hold on to, some form of control in what is a very complex food ecosystem. Well, this is such a tremendous advance that now we have the technology at a relatively low cost to measure our blood sugar continuously. And it's just the beginning. I mean, Levels is going to be working on lots of other biomarkers that we need to measure insulin, for example. And then we're going to be

Starting point is 00:56:27 seeing this technology of biosensors, quantified self, wearables, becoming just part of the standard of care as a way of helping to understand what's happening in our bodies and giving us the ability to be proactive about it and to be in charge. And,, Chris Carr, got cancer and she decided she was going to take ownership of her own health because it was an incurable cancer. So she jokingly says she was the CEO of Save My Ass Technologies Inc. And I think that's sort of where we all need to be thinking because sadly our healthcare system is not a healthcare system, it's a sick care system and if you want to create health you have to learn how to do it outside of that system most of the time. And these companies like Levels and others that are helping people get the data that they don't traditionally get

Starting point is 00:57:17 from their doctor is going to just revolutionize healthcare. And I'm just so honored that you're on our podcast, we're talking about this. I'm honored to be an advisor investor to levels i i encourage everybody to check out uh levelshealth.com to learn more about what's going on if you want to get bumped up to the top of the list okay when i had 120 000 people which might be a little wait go to levels.link forward slash hyman that's levels.link forward slash hyman um if you levels.link forward slash hymen. If you've been listening to this podcast and you loved it, share with your friends and family.

Starting point is 00:57:51 Please make sure you subscribe wherever you are in your podcast. Leave a comment. How have you learned about your own blood sugar and how has it affected you? And check out that link to get on the waiting list for the levels so you can try it yourself and see what's going on because I learned so much from doing it myself. And we'll see you next time on The Doctor's Pharmacy. Hey, everybody.

Starting point is 00:58:17 It's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter.

Starting point is 00:58:33 And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you do is go to drhyman.com forward slash pics to sign up. That's drhyman.com forward slash pics, P-I-C-K-S, and sign up for the newsletter and I'll share with

Starting point is 00:59:03 you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode. Hi everyone. I hope you enjoyed this week's episode. Just a reminder that 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. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone

Starting point is 00:59:42 in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.

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The Dr. Hyman Show - The Secret to Longevity, Reversing Disease and Optimizing Health: Fixing Metabolism with Dr. Casey Means

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