The School of Greatness - The Key Signs You're Not Healthy & How To Fix It w/Casey Means, MD EP 1252

Episode Date: April 11, 2022

Today's guest is Dr. Casey Means, the Chief Medical Officer and Co-founder of metabolic health company Levels. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tech-enabled tools that can inform smart, personalized, and sustainable dietary and lifestyle choices. Dr. Means’s perspective has been recently featured in the the New Yorker, the Wall Street Journal, New York Times, Men's Health, Forbes, Business Insider, Techcrunch, Entrepreneur Magazine, The Hill, Metabolism, Endocrine Today, and more. In this episode, you will learnLife Hacks to improve your overall metabolism.How your mind can control our metabolism.How to achieve metabolic flexibility.The core definition of health. For more, go to lewishowes.com/1252Mel Robbins: The “Secret” Mindset Habit to Building Confidence and Overcoming Scarcity: https://link.chtbl.com/970-podDr. Joe Dispenza on Healing the Body and Transforming the Mind: https://link.chtbl.com/826-podMaster Your Mind and Defy the Odds with David Goggins: https://link.chtbl.com/715-pod  

It's not working. We're getting sicker. Every single year we're getting sicker, we're getting fatter, and we're getting more depressed as a country. And I think the key problem with this is that... Welcome to the School of Greatness. My name is Lewis Howes, former pro-athlete turned lifestyle entrepreneur. And each week we bring you an inspiring person or message to help you discover how to unlock your inner greatness. Thanks for spending some time with me today. Now let the class begin.

You went from, I guess, being a doctor to saying, well, how can I help people in a holistic approach to preventing chronic illness and disease? And I'm hearing you say that it starts with metabolic health. Is that correct? Yes. So what is metabolic health then for people and how can they optimize this? Yeah. So, well, first of all, I think you hit the nail on the head. There is a movement and a tribe of doctors who are sort of waking up and realizing that we are missing the elephant

in the room of modern American healthcare. And the elephant in the room of modern American health care. And the elephant in the room is that, first of all, the vast majority of things that are killing Americans today are conditions based in our dietary and lifestyle choices over the course of our lifetime, which means that we have a huge amount of agency in changing our fate in terms of these diseases. How many diseases would you say are caused by food and nutrition alone or a diet? Nine of the 10 leading causes of death in the United States are either not only just caused by food and lifestyle, but are directly attributable to dysfunctional blood sugar or are worsened by elevated blood sugar.

Nine of the 10. What's the 10th one? Well, to go through the ones that we're like, what we're talking about. So we're looking at things like Alzheimer's dementia, which is now being called type three diabetes because it's so related to blood sugar, heart disease, type two diabetes, cancer is very much driven by blood sugar, chronic kidney disease, which is very much a problem of the small vessels in the kidney becoming narrowed in part because of metabolic

dysfunction and erratic blood sugar control. Chronic lower respiratory infections are one of the leading causes of death. And we know that people with unstable elevated blood sugar have much higher mortality, even with something like influenza or pneumonia, having high blood sugar actually can get into the fluid of the lung and feed the bacteria that leads to some of these issues. And of course, with COVID, we've known now since the very beginning of the pandemic that having metabolic dysfunction, diabetes is a key accelerator and driver of mortality and morbidity. There's some odd ones on there too. For instance, suicide is actually on the top 10 list of killers in the United States. And people with diabetes or metabolic dysfunction actually have higher risk of suicidality.

Really? So it's all across the board. And so what's really fascinating is the way in which these dietary and lifestyle factors are essentially linking so many of the conditions that are killing Americans today. And the way we've approached it is we've looked at these as all isolated silos. We think of them as all different things. Like, huh, we wouldn't treat diabetes the same way we treat cancer or kidney disease the same way we treat Alzheimer's. But when we look at these through the root cause approach that you talked about, and sort of the fancy term for this in medicine is

systems and network of biology. What is the network between diseases rather than how are they all different? When we treat at that level, it's so much more efficient and we can actually generate good health in the body as opposed to just reacting to symptoms and managing conditions. So I think that's what a lot of doctors are waking up to. They're sick and tired of being reactive, practicing sick care, practicing this end-of-the-line medicine, and they want to help generate health in people's bodies. And that's a totally different way of practicing. Right. Yeah. That's inspiring. And so what I'm hearing you say is blood sugar management or control is one of the key factors of either being healthy or potentially linking to one of these other, I guess, diseases. Is that right?

That's right. Yeah. And what it really comes down to, which kind of gets at your question of what is metabolism, metabolism is fundamentally the way that we make energy in the body. So we eat food and food has fat and glucose in it. And either fat or glucose, glucose is sugar, can be used to convert into a type of energy that our cells can use, which is called ATP. So we take in this substrate, but we have to convert it through our mitochondria in our cells to a form of energy we can use,

a currency that our body understands and can use. That process of conversion is metabolism. And this is happening in every single one of the 37 trillion cells in our body. And it has to work properly. So break it down for me then. Fat or glucose, or I guess carbohydrates, enters the body through the foods we're eating, right? What happens after that? How is it processed in the body, through the cells, through the mitochondria? How is it processed in the body through the cells, through the mitochondria? How is it processed? Yeah. So looking at carbohydrates, for instance, they go into our digestive tract.

They're broken down and absorbed into the bloodstream, broken down into simple sugars like glucose and fructose. These go into the bloodstream. And let's say we're talking about glucose, which is blood sugar. go into the bloodstream. And let's say we're talking about glucose, which is blood sugar. This signals to the body, particularly an organ called the pancreas, to release insulin, which is a hormone. That hormone allows you to take that sugar out of the bloodstream through the cell membrane into the cell. Once it's inside the cell, it's broken down even further and then goes into the mitochondria to go through a chemical processing that then creates ATP, which is this molecule that can be then used to essentially power all the millions of cellular processes that are happening every second. So ATP is the power. It's the fuel. It's the battery in

our body. Okay. And so the way it's processed is it's based on the foods we eat whether it be fat or sugar that comes through Does that determine how the quality of the energy or what does that mean within is it all? Equally the same when it converts an ATP or well, I think the way to think about it is to really focus on the mitochondria This is the energy factory of the cell this is the powerhouse of the cell and This is the energy factory of the cell. This is the powerhouse of the cell. And the thing that people really need to understand is that our diet and our lifestyle in the modern Western world, so past 50 to 100 years, so much of it is actually damaging the mitochondria

of our cell and creating problems in that conversion process. So for instance, when we eat too much sugar, okay, and these days the average American is eating a lot of sugar like a hundred times more than we were like a hundred years ago and through the rest of human history. It's like this massive overload of this substrate. What that does is it causes stress on the mitochondria and creates damage. sometimes use is like, imagine you had a factory that was making something like, like cheese. And like, all of a sudden you get like a hundred times more of like the raw product, like milk delivered to the factory that the workers would be like, we don't know where to put this. We can't work. Like they go on strike. There's nowhere to store it. There's no refrigerators. It would all go bad. All of a sudden you actually produce less cheese, even though you have more substrate,

you know? And so it's like, we are giving so much of the substrate to the body that it's gumming up the system. It's breaking down the factory and creating problems. And the molecular way this is happening is that each time you have these glucose spikes from eating these refined products or added sugars, your body's releasing more of that insulin. It's saying, okay, more glucose in the bloodstream, so we have to produce more insulin to get it out of the bloodstream. And over time, the body sees all this insulin circulating, and it's like, we can't bring more of this into the cell.

There's too much. And so it actually puts up a block, which is called insulin resistance, which is that cellular process that leads you towards problems like diabetes. And so what's happening now is the body... And that's why you're storing fat or you're storing other dead cells that you don't need to keep in the body, I guess, right? Right, because insulin is the signal saying tons of glucose around for energy, so we don't need to burn fat for energy.

So insulin is also a block on fat burning. So it's this chemical signal saying too much glucose around, blocking it from getting into the cell, and also telling the body not to burn fat. So of course, for people who are dealing with trouble losing weight, insulin is the hormone we really, really need to be thinking about. And so we reduce our insulin sensitivity. Now we have lots of glucose circulating in the blood stream, but it's not able to efficiently get into that cell. And, um, and then you've got all these other things that can hurt our

mitochondria and, and really a mitochondria energy centric view of health can really help us. Some other things that can hurt the mitochondria are oxidative stress. So, you know, you talked about this a little bit on the podcast with David Perlmutter, but, um, aside from glucose, eating too much fructose. So this comes comes with sodas or fruit juice or things that have really high concentration of fructose, it's not going to actually stimulate insulin in the way that glucose does, but what it does is it goes into the cell and it's converted into something called uric acid. And that uric acid creates oxidative stress, which is sort of this sort of damaging reactive molecule in the mitochondria and creates mitochondrial damage. So now, again, you've got more trouble processing energy in the mitochondria.

Environmental toxins are actually a huge problem as well. They can directly damage the machinery of the mitochondria. So we're thinking about things like pesticides and a lot of the fragrances in our personal care products and a lot of the fragrances and chemicals in our home care products, these things actually go into our bodies, damage our mitochondria, make it difficult to produce energy effectively. Chronic stress can damage our mitochondria through cortisol and through our stress hormones. So it's interesting to think about how all these different aspects of modern life fundamentally feed down into

damaging this precious part of our cell that creates energy. And when we have the mitochondria, and when we have problems creating energy in our body, this can happen in any cell type. Again, 37 trillion cells, dozens of organs in the body. Where this is showing up most prominently in the body is where you're going to see symptoms. And this is why metabolic dysfunction and blood sugar dysregulation can look like so many different things. It can masquerade as so many different symptoms. And in the conventional system, we see those all as separate. But when we think about it as this is actually just where a fundamental core problem is showing

up in different cell types. And so if you can address that, you can potentially kind of melt a lot of things away. So just as some concrete examples, if metabolic dysfunction is showing up in the blood vessels, well, if it's sort of most prominently showing up in the penis, that could look like erectile dysfunction. If it's happening in the heart, it could look like heart disease. If it's happening in the liver, it could look like fatty liver disease. If it's happening in the ovaries, it could look like polycystic ovarian syndrome, which is the leading cause of infertility in the United States, which is a metabolic problem.

And if it's happening in the brain, it could look like Alzheimer's dementia. And so it's got all these different faces, but fundamentally is rooted in a core dysfunction in how our body is converting food to energy. And a lot of that has to do with this chronic overnutrition, overloading ourselves with too much to process, gumming up these systems, and then the many other lifestyle factors like toxins, stress, sleep deprivation, and sedentary behavior that can also hurt the mitochondria. Dr. Right. So blood sugar management and metabolism management, is that right? So the main things we should be thinking about?

Dr. Yeah. Dr. How does blood sugar and metabolism work together? Dr. Yeah. So the way that those sort of things link up is that if your blood sugar is quite erratic, like let's say it's going up and down in big spikes and valleys. Every day, yeah. You're having lots of sugar. You're just eating poorly.

You're stressed. You're overwhelmed. Yeah, and the majority of foods on the shelves in our grocery stores now have added sugar, like well over 60%. So it's not unusual for an American to be on that blood sugar roller coaster up, down, up, down, up, down. And that's called glycemic variability. And that process of glycemic variability is very damaging to our metabolism through the mechanisms we spoke about of causing insulin resistance by stressing the body to make too much insulin over and over. But those high blood sugar spikes, in their own right, can cause damage as well.

When your blood sugar acutely goes really high, like after eating a Pop-Tart or eating a pastry or something like that, or a big bowl of pasta, that spike can lead to inflammation. It can lead to oxidative stress because of the way that it's overwhelming our systems and creating free radicals. It can also cause a process called glycation, which is where sugar sticks to things in the body. And so if you can imagine, if your concentration of blood sugar is really high, it's kind of going to just stick to things more like your blood vessels and proteins. And that's not good. That's like a signal for the body that something's wrong. And so all of these things kind of coalesce to just creating problems. So the more that we can minimize our glycemic variability and go from

spikes and valleys to more gentle rolling hills, the better we are, the better we're going to basically be treating ourselves. And it's not just, um, it's not just the sort of like cellular optimization we're trying to do. It's also the way you, you feel. I think a lot of us have had that experience where we have a really high carb meal, a big dessert, and we feel like we kind of have a crash afterwards. It's like that post meal crash. We feel lethargic. Like we may need to have another cup of coffee or, or even feel jittery after it, like a big high carb meal. Um, that's, we really understand how that works. The body sees a huge load of glucose from a high carb meal. The body then surges out that insulin overcompens, soaks up all that glucose, and you crash. And in that crash state is when we feel fatigue, it's potentially some anxiety, and it's when people usually feel

cravings. So by learning, you want more to bring yourself back up because you've kind of crashed. And then you're on the vicious cycle. And I think the majority of American bodies are on that cycle because you think about what we eat. It's like breakfast, it's cereal, juice, toast, pop tarts, pastries, you know, sweetened coffee beverages. That's all refined sugar and refined grains. Then you go to lunch and it's bread, tortillas, wraps, chips, you know, all of that stuff. And then you go to dinner, pasta, potatoes, whatever. And then it's, and then it's dessert. And it's like, if you're not, if you're just going along the normal

American cultural treadmill of what's normal to eat, you're on a glucose roller coaster. And that means that your day might be highly labile in terms of the energy, mood, performance, cravings. And so learning just simple ways to balance out that glucose roller coaster can be an amazing life hack and really a superpower for essentially getting your day under better control, making you feel better in the moment. And of course, creating the cellular conditions to set you up for long-term longevity and health and prevent that whole downstream insulin resistance cascade that we know is related to so many causes of death in the United States. So let's speak to people that are listening or watching

who maybe have active lifestyles. They like to work out, so they need energy for working out. They're driven, they're passionate in their careers or entrepreneurship. they have a lot of friends and activities they like to go to, so they need energy throughout the day. How can they get the energy without the glucose rollercoaster happening? What are the best foods to be eating throughout the day? How many times should we be eating? And does it really matter or does it really depend on each individual's body type? Yeah. So I think for the type of person you're describing, the key concept we want to think about is achieving metabolic flexibility.

Okay. So metabolic flexibility means that we are able to use different forms of energy to make, you know, ATP based on what's available. And what I mean by that is if there's sugar around, we can efficiently burn sugar to make ATP. But if there's not, the body's fine. It's like, cool, we've got fat to use for energy. The average person is not metabolically flexible. And the reason is because they've been on the glucose roller coaster. Their body is so used to seeing glucose that those pathways are super active. Um, and they're constantly on that sort of like craving hit. They want more of it. They haven't really given their, because glucose is the preferential fuel the body will use. It's the first thing it's going to grab. It's kind of like that easier thing to use. It will never go and burn fat if there's glucose. It will not burn significant amounts of

fat if there's glucose readily available. So something that we can do, essentially train our bodies, is to give it opportunities to burn fat. So this is where you start thinking about things like time-restricted feeding or fasting or potentially doing a fasted workout, where you're actually kind of intentionally keeping your blood sugar levels in the low normal range, signaling to, and of course the downstream effect of that, it's going to be insulin will be low. Because if you're not having a glucose spike, then insulin will be low. And that insulin being low takes away that signal to not burn fat. So now your body's like, cool, insulin's low, glucose is low. I'm going to tap into my fat storage. So that's when it starts to burn the fat. Exactly. Interesting. Exactly. So if you

work out in the morning without eating, you're more likely to be burning fat. Is that what I'm hearing you say? That's right. And there's actually a lot of athletes that are using this type of metabolic science to their advantage. There's a whole community of endurance athletes now that are doing low carb training. And the purpose of that is that they don't want to be super dependent on glucose during their event where they're just like every half hour having to take a goo or a bar or energy drink or something like that and have these big spikes throughout their event. Instead, they've actually trained their bodies to use fat during an endurance workout. And there are literally marathoners now who will run the

entire thing fasted because they can so efficiently burn fat. But those pathways have to be kind of worked and developed to be able to do that. And that's metabolic flexibility. So how do you train metabolic flexibility for yourself? I would say the key thing is to minimize these excessive glucose spikes, to give your body an opportunity to be more in the stable, healthy, low range for more time of the day to keep insulin in a lower and healthy range so that your body knows to burn fat. One way that you can do this is, of course, with a continuous glucose monitor, which are becoming popular now, wear it, see what spikes your glucose, modify it, and try and get to a more stable range.

Or measure your ketones, which a lot of people are doing now. And this is a finger prick device or there are breath monitors. You can also check in your urine and ketones are a byproduct of fat burning. So if your ketones are super low or zero, it means you're not burning really any fat. And if your ketones are higher, like above 0.5 or up into the ones and twos, you are proving to yourself that you have got into a state where your glucose and insulin are essentially stable enough that you're burning fat for energy. And so something I like to see if I'm tracking these things is,

okay, if I've kept my glucose quite stable and low for a couple days, based on the choices I'm making around diet and lifestyle, I start to see ketones rising up. And that to me is proof of metabolic flexibility. And I can test things like, okay, if I do the Peloton ride first thing in the morning after not eating, does it increase my ketones later in the day and start to do some

experiments like that. And another thing that people can do is ask their doctor to do a fasting insulin test. It's not a test that's normally done on a regular yearly panel, but it's a really powerful test because, again, if insulin is quite elevated, it's going to be kind of that block on fat burning. And if insulin is a low and healthy range, it's a signal that your body's probably likely very insulin sensitive. You're not far down that insulin resistance pathway. I like to see it between about two and six. And shockingly, the reference range in a lot of labs will say that

like anything under 25 is normal, but that would be very, very, very elevated. And so you want it to be tight and low to know that you're just giving your body that opportunity to burn fat and to work those different pathways. So many people are talking about fasting or intermittent fasting these days. Is it different for men and women on the ways to fast in order to burn fat? Or is it the same for both? You know, I would say it's different for every single person, even, you know, and definitely for different genders, but it's different day to day. You know, I think intermittent fasting and time-restricted feeding is a stress, it can be a stress on the body, you know? And so I tend to think of it as, you know, we've got a certain

capacity within the body to manage different stressors. And we know that certain stressors can be helpful in building adaptations in the body to help us improve. So like cold exposure, heat exposure, fasting, um, high intensity interval training. Um, but there's also stressors in our life that are maybe somewhat out of our control, like work stress or family stress or things like that. Um, and we don't want to overload our body. And so, you know, if a woman is potentially in a part of her cycle, for instance, where her body's also already quite taxed. You wouldn't do it then.

You wouldn't do it then. And on a day that I'm, I don't have as much sleep, on a day that, you know, I might be doing a big podcast or something like that. Like today, you know, I'm probably not going to add, you know, um, I'm going to be thinking very deeply about food though, because you also don't want to be eating a big meal and then crashing right during that time when you have to perform. So it's more about keeping things, keeping things really stable and not being highly fluctuate, you know, fluctuating. Um, so I think about it more that way. I think that fasting is great

if you're otherwise very well resourced with sleep, with resilience, psychological resilience, not putting your body probably under intense physical stress during that time. I tend to do more like zone two workouts, sort of low intensity during fasts. So as not to add too much stress. Stress the body, yeah. And ultimately too much stress can lead to breakdown. And so kind of like bringing those things, just thinking of everything in a really holistic picture. If you stress the body too much, does the blood sugar go up? Or what does that do to blood sugar and metabolism?

Yeah. Stress has a fascinating relationship with blood sugar. So psychological or physical stress can both cause blood sugar to acutely go up, even if you're fasted, even in the absence of any glucose. And the reason for this is that any stress signal to the body will release stress hormones like cortisol and catecholamine, like noradrenaline, epinephrine, things like that. These signal to the body that there's a threat. And the body has trouble interpreting the difference

between a physical or a psychological threat. And so it's going to produce the same stress hormones. So if there's an event that happens in life, let's call it something we witness or something we see or something we hear or experience we think of a thing that causes a stress hormone to go to the body is that what I'm hearing you say there's a thought that we have associated with the event or the stressful or the thing that we think is stressful yes and then that causes a stress hormone yes to enter the body

does it go throughout the entire body does it go to the heart what it what happens and then does it just spike the blood sugar up? Exactly. So it goes to the whole body. And I would say, simply put, in many ways, our mind has huge control over our metabolism. That's what it sounds like. Yes. Because we can think a thought and stress ourselves out and have high blood sugar just

based on thought alone. You can think your way into metabolic dysfunction, I think. Can you think your way out of it too? In some ways you can, and it should be a part of our strategy for optimal metabolic health. So the way it works is that these stress hormones, they travel throughout the body and they actually tell the liver, we've got a threat. There's a lion chasing us. We need to run. We need to have fuel for our muscles so that we can flee. You know, it's fight or flight. So the liver actually stores about two hours of really quickly accessible

glucose in the form of something called glycogen. It's change of glucose. And it's like our debit account. It's short term. It's ready to go, but it's only a couple hours worth. Okay, so you've got your circulating and then you've got your stored glucose. Stored in the liver like all the time? All the time, yeah. Unless you burn it for those two hours, then it's... Exactly, it depletes and you deplete your liver glycogen. So that hormone says dump it.

So you flood the bloodstream with blood sugar to feed the muscles. And you can imagine if you are doing a high intensity interval training workout and go to 90% your VO2 max in like five seconds, that is a stress signal, but you're going to use that glucose. Your body's actually, so you're going to see that rapid spike. And it's actually fascinating to see on a continuous glucose monitor. Like I will do a sprint workout or, you know, a CrossFit workout. And it's like within two minutes,

my glucose is going up and it can look like a big food spike, but the muscles are there using it. And the really cool thing about muscle is that it's one of the only cell types in the body that doesn't need insulin to take up glucose. So it actually can just take it up from the contraction. So it's not like it's really feeding into that pathway of insulin resistance, like we were talking about, like it's a sink for that glucose. So there's a supply sort of use match, which is good. But when you think about psychological stress, you're literally just like you're sitting in your chair, you're on your computer, you get an email that's stressful. And you're like, how are you reacting to it?

Your body has that spike, but you're not moving. Isn't that crazy? Yeah. You're not using those muscles. It's just sitting there causing damage. And you can think about like, we're doing this probably a hundred times a day in our regular life. Or ruminating on something from the past or stressing about something in the future or reacting to, you know, the news or whatever it might be that we can react to. How much of the psychological aspect is related to the disease in our life versus just

the straight food itself without the psychological, I guess, thoughts that come with it. You know, I think it's so multifactorial. I always really say, I think that food is the foundation. You know, food is the substrate. Food is both what physically builds our bodies, and it's also the molecular information that tells our body how to function. We eat about one metric ton of food per year, two to three pounds per day. This is just straight up chemical information that builds our body and tells our body what to do. You know, we're turning over constantly. The body we have today is not the same body we have

in a week from a physical atomic perspective. We're shape shifters, we're constantly changing. So food is, it's incredible, it's magical. It's this incredible thing that we're just constantly transmuting into ourselves. And so we've gotta get that right. But while so it's, it's got, we've got to get that right. But while it's necessary, it's not sufficient for optimal health. You still got to dial in the other, the other factors. And when I really think about the pillars, I'm thinking about seven things.

I'm thinking about food. I'm thinking about stress management, exercise, sleep, our micronutrient status. So not just like the macros we're getting, but what are, our micronutrient status. So not just like the macros we're getting, but what are the actual micronutrients, vitamins, minerals, and antioxidants, our microbiome, how that's doing, and then our exposure to environmental toxins. So yes, while food is the foundation, you've really got to get those other things dialed in. Any one of those things can shift you off course. So you said food, stress, exercise, sleep, macronutrients? Micronutrients. Micronutrients.

Which we often overlook. Okay. What are those? This is all the vitamins, minerals, and antioxidants that come from whole foods. So things we don't often think about like manganese and selenium and vitamin C and polyphenols and all, you know, trace minerals like chromium that actually, you know, they come from whole foods. And unfortunately, because our soils are becoming super depleted now because of our industrial agriculture practices and because of overuse of pesticides that are really hurting our soils, the nutrient composition of our food is declining and we're

eating less whole foods. But when we think about metabolism and the mitochondria again, so your mitochondria is filled with all these little enzymes, these little protein enzymes that are essentially doing the work. They are the factory line that's taking that food and converting it to ATP. And every single one of those amazing little protein machines needs these micronutrients to actually work. And the way to think about it is they are lock and keys that bind into little pockets of these enzymes and create tiny, tiny structural changes that actually make it work. So if we're deficient in selenium or magnesium or manganese or zinc or whatever it is, these aren't working properly. And the majority of Americans are deficient in at least one

critical micronutrient because we're not eating real food. And because stress can actually deplete a lot of these chemicals. So I really think about, it all goes back to thinking about those molecular machines that are converting food to energy and what they need to function properly. And micronutrients is a big one. I've also heard examples of people who, let's say, eat perfectly, but still have challenges. Maybe their relationships are off and they're in a stressful environment in their relationship or their marriage or whatever it might be, or they just react poorly. They worry often to things they see and experience.

They're a worrier. And so every time they worry, there's a, I guess the stress hormone is spiking, right? And sending hormones to the body, which is spiking blood levels. Is that right? Yeah. Blood sugar. So it sounds like the psychological side of things is also extremely important to understand. And that every time you're on, you're allowing your body or your mind to ruminate on a consistent basis, it's sending a signal to the body in a negative way, which is helpful if there's a real-life threat, but not when it's on a repeat every day. Is that right? That's exactly right.

It's that chronic low-grade stress that can be really damaging. And there's, you know, something that's been really fun to experiment with is, you know, there's now heart rate variability monitors like Oura Ring or Whoop or Leaf Therapeutics. And what these do is heart rate variability is a metric that you can track that looks at actually the time between each heartbeat. And oddly enough, we want the time between each heartbeat to actually not be consistent like a metronome. We want it to have some variability. Yeah. Like maybe 0.7 seconds and then one point, I'm sorry, 0.7 seconds, 1.1 second, 0.9 seconds. That's variability. Why do we want that?

It really is a symbol of a dynamic system. You know, you want elasticity in the system and that can sometimes have some irregularity to it. Sort of the way I kind of think about it is like a stiffer system is going to be a little bit more regular. And there's sort of that, and it's, these are subtle, you know, it's not like you can feel it in your pulse if you just feel your pulse, but you can pick it up. And so we want more heart rate variability and usually less lower heart rate variability is an objective measure of stress. And I've worn these things and been giving a talk on zoom or something like that. And I'm looking at my, my data afterwards and my heart

variability plummeted during the talk, or I'm processing email, my heart variability goes down. So using, and then of course, glucose may go up. And so you see these things happening together. And the immediate thing I think is, this is where our tools come in. This is where the deep diaphragmatic breath, where the mindfulness, where having awareness of this happening. And then there are so many things we can do to modify that stress response, even telling your body you're safe. You know, everything is actually okay. It can have a huge difference. So really dialing into awareness and then where can I apply the tool? So I would say I take about 100 times more diaphragmatic breaths now than I did a couple

years ago because I realized, wow, if this is happening all the time throughout the day without my awareness, that's going to add up over the next 30, 40, 50 years and have a huge impact. But it's not actually just the chronic low-grade stress. There's been a lot of research showing that acute traumatic events like loss of a loved one or divorce or childhood events, so adverse childhood events, which are usually, there's an acronym in ACEs, people who have many of these tend to actually have worse metabolic health. And this actually may be related to changes in the brain that affect metabolism. So

really changing sort of our set point for stress thresholds early on in life. And so, so sometimes we'll have that patient, like you talked about, who's doing everything right. They're eating really healthy, but they're just really not quite making that progress towards driving that they want. And a lot of those patients I'm thinking about, want. And a lot of those patients I'm thinking about what is like the deep core wounds and the, what's the set point that's causing you to feel that this world is not a safe place that is causing you to be inherently hypervigilant. Um, and doing that work even on myself has been so positive because I think what you start to unpack as you go down that journey is that your perception of the world and whether it's safe is very much dictated by your lifetime of experience. And I think for those of us who have been on a journey of like therapy and now people are very interested in, of course, long-term meditation, you know, deep meditation events and

things like this that can really unwind some of those kind of amygdala-based, fear-based responses in the brain. I think there's huge potential there for that to potentially, like, unlock a new level of health because what it's doing is changing the fundamental way you see the world as a place of threat or a place of safety. And unfortunately, I think in our modern world, fear has become a currency that we've used to profit in a lot of ways. If we can get people to be fearful, we can get them coming back for information that assuages that fear. And we see that with social media. We see it with the news. There was that undercover reporting of one of the CNN executives who said, was recorded saying, if it bleeds, it leads, that we need to

get people fearful for them to come back and watch. And what that's doing to our stress hormones, to our brain set point, to our desire to have dopamine stimulation, to kind of get some pleasure in the face of all this fear, the way that's affecting our cellular biology is profound. And so, you know, I think all of this movement that we're seeing right now towards helping people, towards normalizing mental health care, normalizing, you know, psychedelic use is not an end-all be-all, but I think it's interesting how that's now being talked about as a way to really help people unlock some of this chronic, you know, fear. I think it's going to have, you know, could have positive impacts on the body because if we're living with chronic fear, our bodies are not functioning properly. And many of us are.

Did you live with chronic fear for a while? I think that the healthcare system, the conventional healthcare system, unfortunately uses fear as a way to control patients in a lot of ways. You think about a conversation between a physician and a patient, and it's like, you know, your cholesterol is a little high, you need to take a statin. And the patient might say, well, can I have some time to like work on diet and lifestyle? Well, I mean, it's your choice. I mean, I'd recommend the statin right now, because obviously, I don't want you to have a heart attack. But like, you know, sure, if you want to try diet and lifestyle, like that's the type of thing that's happening every day, like, where this fear of bad outcomes is, I think, This fear of bad outcomes is, I think, driving very much a pharmaceutical and invasive intervention type of strategy.

And I think that that really was unsavory to me because it's very disempowered. It's like, if I can drive fear in a patient, then I can essentially get them to do whatever intervention I recommend. And as a surgeon... Medicines, procedures, anything. Right, exactly. You know, oh, well, if we don't treat this ear infection with antibiotics, then it could travel to the brain and create a brain infection. And it's like most ear infections resolve on their own without antibiotics. And overuse of antibiotics is causing huge, huge problems with

our gut, which then leads to mental health issues and metabolic problems. And it's like, but if people are scared of the potential, you know, outcome that may be very rare, then of course you can kind of get them to do stuff. And I think that I don't think that doctors are intentionally doing this. I think we have an incentive system in Western healthcare that really drives people towards intervention. But I think that, you know, I also think that with COVID, we saw this happen where, you know, this fear of, you know, anyone, you know, being harmed from COVID or, you know, that we, you know, kind of got people to do anything and everything. And we're kind of losing this, we're losing kind of that rational sense of the risk that is inherent in living. You know, we get in the car every day and like there is risk involved in that, but we choose

to do it. And I think that, you know, there's just a lot of sort of fear-based thinking that happens in the health care system that unfortunately disempowers patients and pushes them to do interventions more quickly. When I think that there is so much opportunity to help coach them with diet and lifestyle, which takes longer, it's harder, but ultimately it generates health rather than just putting a Band-Aid on disease. There's no medication that actually generates health. Only diet and lifestyle strategies generate health. And so that should obviously be the foundation of our medical system. But unfortunately, we're not very well trained as physicians to know that information or to coach on it. But yeah, to answer your question, I think a large part of my personal journey has been trying to overcome fear.

Really, personal fear. Personal fear. I think one of the biggest examples of this is my mom just passed away about a year ago from cancer. And just as any normal person, I spent my life fearing my parents' mortality. It's like, oh, this is going to be horrible and devastating. And I think a lot of people worry about premature loss of a parent. And, you know,

I think going through that experience and it actually being a very beautiful transformational experience, um, see, it was a very, it was sort of a surprise. And, um, she had two weeks between her diagnosis and her death oh man we had this beautiful time together as a family she was actually very much on the same page about sort of holistic health as me and and knew in her heart that she was dying very rapidly um she chose to stay at home be with the family. We were all together, had this spectacular two weeks, the hospital system through every possible medium was trying to pull her into the system. You know, it was pancreatic cancer. So it's like, you need a liver stint, you need a liver biopsy,

you need a blood transfusion, you need to start chemo immediately. And the reality was she knew I'm dying like right now. She ended up dying in two weeks. None of the interventions would have helped. We wouldn't even had a, um, you know, would have lasted maybe a few more months or a few more weeks. Maybe you don't know. I actually don't think at all. I think that, um, might've caused more stress and more. Well, and it was COVID. So she would have been in the hospital and we could have not visited her. So anyways, that experience of seeing her approach, um, seeing her pure joy in the face, she was just ended her last two weeks very joyfully. It was very at peace. Um, we had that time together. Um, she was not just like locked in the hospital doing

interventions that would not have helped very much. I realized, oh, something I've been fearing my entire life happened was the most transformational growth experience I've ever had. I still feel way more connected to my mom than I ever could have imagined. No one can tell you, oh, you're going to still feel connected until you maybe experience that. And it kind of made me realize fear is kind of not useful. So I think that something like that, and I think it probably lots of people have their own examples, just kind of makes you realize the futility of living in fear. And what does it do?

It damages your body. It doesn't really change the outcome. A little bit of healthy fear is useful, of course, like you don't want to cross the street without looking. But the idea that we should be fearful all the time, like that's going to protect us is such a fallacy. So turning to Stoic philosophers, turning to, you know, some sort of Eastern texts, Buddhist and Taoist texts, like sort of looking into traditions that have thought this way has been a really useful part of my journey. And I think needs to be a part of how the healthcare system reforms because we weaponize fear of death as a way to control patients into doing anything we want. And I think fundamentally overcoming your fear of mortality, which is the only thing we can be certain of in this world. And really

approaching that with a sense of awe and a sense of curiosity and a sense of what can this teach us about how to live, I think is an absolute foundational part of what we need to do as individuals, but also the healthcare system, because otherwise we're just using fear as this thing, fear of death as this thing to just wrangle people into as many interventions and, um, and as pharmaceuticals as possible with the, with the off chance that people think it's going to somewhat reduce their chance of mortality. So what I, what I heard you saying there was that there is no medicine that can actually

make you healthier. Is that correct? Or that could actually solve the issue on the medicine itself? The vast majority of all medications, I probably wouldn't say all on a record, but I would say the vast majority do not generate health in the body. They manage symptoms. They don't cure the disease or whatever. If you take away a diabetes medication from someone, their diabetes is not gone. It's right back there where it was. Whereas if you get someone to really foundationally improve their cellular function, which can only be done through consistent dietary and lifestyle habits, they can truly reverse their disease. But there's no medication that reverses diabetes. There's no medication that reverses heart disease. There's no medication

that reverses Alzheimer's dementia. They just kind of manage the symptoms. They manage the symptoms, you know, and maybe... Maybe some relief a little here and there. Relief, you know, life extension for some of them, but they do not create health. And what health is, health is optimal cellular functioning. We are just a big bag of cells, and each cell needs to be functioning properly for us to have health. What is a symptom? What is disease?

for us to have health. What is a symptom? What is disease? That is cellular dysfunction happening on the individual level happening in a, you know, if that's happening in mass, that might be tissue dysfunction. If that's happening, you know, in a bigger way, it's organ dysfunction. And that's when we see symptoms of disease. So we have to really zoom in on what's happening in the cell and what is a cell is being being getting its information from what you're eating what it's being built from which is your food um what stress hormones it's seeing binding to its little cell membrane um you know what's happening with your hormones which of course is dictated by stress and by sleep and by exercise and by food it's the super complex milieu that can only be optimized by

the choices that we're making every day, day in and day out consistently, even by the sunlight we're exposing ourselves to in the morning. And, you know, Andrew Heuermann talks about this all the time, but literally the consistent exposure of sunlight first thing in the morning is chemical information to your body through the sunlight's energy to tell your cells how to function. You can't put that in a pill. You know, it has to happen through these millions of years of evolutionary evolved processes. And so, yes, like medications can't, with their, you know, one pathway that they might be intervening on, truly generate foundational cellular health, which is what we need to achieve.

They don't bring wholeness back to the cell. Yeah. I guess there's what, some creams or something that might help you heal a cut or something like that, but we're talking about like a chronic illness medication, right? Yeah, but even if you think about a cut, you know, I mean, a cut is like, it seems so simple, but it's actually so complex. It's like for a cut if you think about people with disease like diabetes for instance one of one of the reasons that people with type

two diabetes die is because of chronic wounds they have wounds that won't heal interesting oh yeah and i mean internal wounds or external external wounds people can get um something that happens with people with diabetes is they often have nerve damage because of the way the blood sugar is affecting the nerves. So then their feet become numb. And then they might get a cut on their foot. They don't feel it. And then that festers. And because of their high blood sugar, their immune cells don't work.

So they can't heal the wound. And then they die from the wound. And then they get a huge systemic infection that might lead to death or an amputation. So the majority of lower limb amputations are caused by diabetes, diabetic ulcers that are like wounds. How many people have type 2 diabetes in the US? Do we know the number? Oh yeah. Well, there's 128 million Americans with prediabetes or type 2 diabetes. And of those 30 million have full on type 2 diabetes. 30 million out of what? 300 and what is that?

300 something million people? Yeah, it's about 13% of the population now. Has type 2 diabetes. Yeah, and it was less than 1% in the 50s and 60s. And pre-diabetic, you're saying 100 million. Yep, around that. What does pre-diabetic mean? Who is someone who might be pre-diabetic?

Well, it actually can be quite surprising. There are lots of young, healthy people walking around who look otherwise fit who have pre-diabetes and don't know it. 90% of people with pre-diabetes do not know that they have it. How do you know if you have it? Well, the easiest way to do it is through a blood test. So you basically get a fasting blood sugar test from your doctor and if it's between 100 and 125 milligrams per liter of fasting glucose that's considered pre-diabetes 100 to 125 what do you want to be at what's a healthy range so what's considered normal is 100 or below 100 below but

i would say that that is way too lenient of a range because what we've figured out is that people in the low end of normal are much less likely to develop long-term problems with like heart disease, stroke, or diabetes. So even if you're in the high normal range and your doctor says to you, oh, your fasting blood sugar is 97, you're great. You're normal. You should see that as a huge red flag. You are metabolically dysfunctional if that's the case. And so really where you want to shoot for is about 70 to 85 milligrams per deciliter. Can people get a test that they can order and do this themselves?

Or do you have to go? For sure. What are these? You can actually buy it at CVS or at the pharmacy. What's it called? You just prick your finger. Or what are these called? One drop.

They're called glucometers. So you can just, they're like literally $20 on Amazon. There's Keto Mojo. Just prick your finger and then it'll tell you right away in a few minutes. In five seconds, yeah. So then it just tells you what your level's at. What it is. And it's cool to check it actually day to day, like for a few weeks, because one thing

you'll find is that let's say you have one poor night of sleep. Like let's say you had a big work thing due and you got six hours instead of eight hours, your blood sugar in the morning might be 10 points higher. Come on. Oh, for sure, yeah. Or let's say you had a really late meal the night before, your blood sugar might be higher the next morning.

So what it starts putting together for you is this is very dynamic. And if I did these activities day after day, year after year for my whole life, I'm building. So figure out what allows you to be in that 70 to 85 range. Maybe it's like a really awesome workout in the middle of the day prior and getting to bed a little bit earlier

and getting morning sunlight exposure and doing some deep breathing in the morning and all of a sudden you're like, oh cool, my blood sugar is 72 milligrams to rest leader, you know, or fasting for, you know, 16 hours or something like that. But figuring out what works for you to stay in that low range and then dial it in for as many days of the week as possible as you can. The other really interesting thing about fasting blood sugar as a test is that, you know, the body, like we were talking about with the insulin resistance, it's very adaptable. And when the body starts becoming insulin resistant, so it's saying,

we're seeing too much glucose around, we're producing, like, we're going to create an insulin block. What the body does is it's like, well, we've got to get this glucose out of the bloodstream. So it starts producing more insulin. So your insulin levels will actually start rising as you become insulin resistant to push more of that glucose into the cells. And so a study in the Lancet, a big medical journey journal showed that you can actually keep your blood sugar levels normal for like 13 years prior to them elevating. And all the while insulin is rising, but it's compensating to keep glucose low. Unfortunately, because we don't check fasting insulin in this country, we're missing that window where people are clearly becoming insulin resistant, but their glucose still looks normal

and they're yearly check. So to just make this concrete, you and I could both go to the primary care doctor and have a fasting glucose of 80 milligrams per deciliter. And so the doctor says to both of us, you're both in perfect health. If I'm really insulin resistant because I'm on that glucose rollercoaster and I'm getting poor sleep and I'm chronically stressed and not managing it. And I have childhood trauma that I haven't addressed, blah, blah, blah, all that stuff. I could be at 80, but I'm doing that by my insulin being elevated to like 35 or 40 and your insulin might be two. So your body's not working hard at all to keep your insulin at 80. And my body is having to present so much insulin. So I am clearly on the path towards

metabolic disease, diabetes, and all the associated conditions, heart disease, stroke, cancer, Alzheimer's, dementia, fatty liver disease, gout, infertility, retinal dysfunction, blah, blah, blah, blah. And you're in the clear, but our doctor tells us that we're the same. So this is why I recommend that every patient ask their doctor for a fasting insulin check because you have a sense of what's actually happening under the hood. And if you're in that early range, and of course,

this is talking about people who are in the normal range, that's not even included in the 128 million Americans who actually have a diagnosis of prediabetes. So this is like people in the normal who still may be on the route to problems. So it's now becoming like the majority of the country is dealing with a fundamental problem in how they make energy in the body, which is a core process that allows every cell to function. And you're saying there's seven factors to this, but what would you say are the main couple? Is it food and lack of exercise or what? I would say the four most important pillars are food, sleep deprivation, and interruption in sleep, you know, just the beeping and the buzzing and the blue light late at night that interrupts our sleep quality. The chronic low-grade stress and the fear that so many people are dealing with.

And then the sedentary behavior, the fact that most Americans are sitting more than eight hours a day. And that is just sitting creates inflammation in the body. It creates, it keeps that glucose in your bloodstream and not going into the muscles. Um, and, and the exercise one, I think are really empowering. Um, just a tip for people. It doesn't have to be like, go out and, you know, run five miles or do a high intensity training workout or do a CrossFit workout. It literally is as simple as walking, maybe walk 15 minutes after a meal, especially if a high carb meal. And even walking for two minutes every half hour has been shown to statistically significantly

reduce insulin and glucose levels throughout the day. It's actually the study was a minute and 40 seconds. So it was looking at for people who just walked for 30 minutes in one chunk of the day, but otherwise sat during the day versus people who walked for 30 minutes, but broke it up into one minute and 40 seconds every 30 minutes throughout the waking day. Those people that moved more frequently, but the same quantity had much lower glucose and insulin. And I think the reason is because if you think about sitting all day and then walking for 30 minutes, you've basically just like been atrophying your muscles all day. Like you're just this like, you know, blob sitting there versus the continuous of it,

like constantly. Yeah. And again, thinking back to the cells, you're activating these pathways. It's all just information to the cell, activate the pathways, get them moving, you know, get the glue, clear the glucose every 30 minutes, you know? And so it's not like this is a lot of stuff you have to do. A simple walk makes a big difference. But I think one of the, from looking at all this literature, one of the biggest takeaways I've realized is that moving more frequently, even if it's low intensity is key. It can't just be that one chunk. Yeah. And maybe if you're in an office or something or you're not walking or have the ability to walk, maybe you can do some air squats or pushups or just anything where you're moving your body. Yeah. Some split squats, whatever it might be.

Yeah. Just body weight stuff. For a minute. Yeah. A minute, 40 seconds. Do 30 squats. Lift your knees up in the air or something. Yeah, whatever.

Yeah, exactly. I love that. That's interesting. Yeah. Some high knees. Yeah. Yeah. Wow, this, whatever. Yeah, exactly. I love that. That's interesting. Some high knees, yeah. Yeah. Wow, this is fascinating.

So 13%, as we said, has type 2 diabetes in the U.S. Is type 2 diabetes reversible? Absolutely, yeah. But beyond that, it's not reversible. Is that right? Well, type 2 diabetes is sort of the, that's like, once you get into that range of type 2 diabetes, of course, there's a spectrum of how bad it is, right? And it's always easier to reverse these things earlier on.

Type 2 diabetes is the, there's another, is that a type 3 or type 4? Okay. No, type 2 diabetes, so basically. What does that mean when you have type 2 diabetes? So it means, based on our criteria, it just means you meet a particular threshold of blood sugar levels. So if you're first thing in the morning fasting blood sugar, you go to the doctor, they take your blood. If it's below 100, non-diabetic. 100 to 125, pre-diabetes.

126 or above, type 2 diabetes. Wow. And you can reverse that the earlier you catch it back to the pre-diabetic or to the 100 to 125 and then hopefully below that. Yeah. With nutrition and lifestyle. Absolutely. Yeah. And there's actually been studies showing, I mean, Virta Health, Sarah Halstead, she's an amazing, this company is showing reversal of type 2 diabetes with a low-carb, high-fat diet and coaching.

I mean, it's not even an exercise intervention. It's just diet. And they showed that in 12 weeks... What type of coaching? Just a nutritional coaching, like with a doctor. Hey, are you doing this every day? Exactly. And just checking accountability.

Exactly. They're not even including exercise. It's that simple. And they are showing amazing reversal of diabetes to the extent where the American Diabetes Association, they did not actually recognize reversal of diabetes to the extent where the American Diabetes Association, they did not actually recognize reversal of diabetes as something that's possible until this past year. They're actually calling it remission, which I think is a funny term. Like it's basically reversal. I mean, you're changing cellular function. You're becoming

more insulin sensitive. You're lowering your circulating glucose levels. And, you know, the reason why you want to get on top of this early though is because the longer you have diabetes, again coming back to the mitochondria, the more damage you're doing to those cellular structures. So you want- It's harder and harder to reverse it. It's harder. It's harder.

How big of a business is type 2 diabetes in the US alone? Oh. A year. Incalculable. So- How much money is spent on the management of type 2 diabetes? You'll see lots of different numbers, usually somewhere between like 200 and 600 billion. 200 to 600 billion?

Yeah. Just for type 2 diabetes? Well, our healthcare costs are $4 trillion per year, about 17% of our GDP. We spend more than, of course, any other country in the entire world. 70% is it? How much? 17. 17%. Yeah, yeah, 17%. Four trillion is healthcare in the USA. Yeah. What is Canada? I don't know. Okay, gotcha. But if you look at the curve, it's like all these little dots down in the lower left corner, and there's like the U S up here in terms of cost and 200 to 600 billion of that is in the type two diabetes metabolic management. Yeah. Holy cow. And on top of this, our life expectancy is going down. So what's, what's ironic about the American

healthcare system. And for three years, our life expectancy has been going down. You would think, right? Like, this is sort of what perplexes me about physicians right now, is that, you know, as a physician, you're really like a steward of the system. Like, you are the person sort of calling the shots and doing the treatment. You look at this system,

and okay, every single year, we're increasing healthcare costs. Every single year, it's an increasing part of our GDP we're now spending four trillion dollars on health care we're literally throwing money at it and outcomes are getting worse every single year Wow if if you're not stopping and thinking what is going on what are you doing with your time you know it's like it's not working right we're getting sicker every single year we're getting sicker we're what are you doing with your time? You know, it's like, it's not working. We're getting sicker.

Every single year we're getting sicker, we're getting fatter, and we're getting more depressed as a country and just throwing money at it. And I think the key problem with this is that, you know, the modern American healthcare system has produced miracles, literally. We have, 100 years ago, first today,

if you transported someone from 1900 to today, and they looked at what's, you know, life expectancy and infant mortality and, and what happens when we get an acute illness, they would, they would be shocked. It's unbelievable, but that's because we are very good at managing acute illnesses. So if you have an infection, you know, something like childbirth, if you break your arm, if you're in a car accident, we can manage these things. Whereas before we weren't good at that. And so people would die or have massive complications with those. Absolutely.

Yeah. And so that's great. Like, we can manage that. But chronic disease is where we are abjectly failing. And chronic diseases are 90% of our health care costs. They are the things that are killing Americans. And they are based in diet and lifestyle. And those are the things that are killing Americans, and they are based in diet and lifestyle. And those are the things that we are doing, having, this is worse outcomes, the more money we spend.

So 90% of the four trillion, is that what it is? Goes towards chronic disease management. Chronic diseases, which is what else besides type two diabetes is included in that? These are the diseases that are like long term, are considered to be, develop over time, and are generally rooted in diet and lifestyle. Like heart disease. Heart disease, Alzheimer's, dementia, chronic respiratory illnesses, chronic kidney disease, chronic liver disease. There's like depression, anxiety, chronic pain, chronic fatigue syndrome, gout. There are things that don't just like come and go,

like a cold or come and go. So 90% of the money is going towards chronic disease and illness. That's right. And what I'm hearing you say is chronic disease and illness can be prevented with nutrition and lifestyle. Or reversed. Or reversed.

In many cases. Of course, not all. Most of the cases, I'm assuming. A lot of the cases, right? I think a huge burden of that disease could be prevented or reversed. Obviously, there's going to be cancers that you can't reverse with diet and lifestyle,

but a lot of the cancer we're seeing today could likely be prevented. But we're not trained on how to do that effectively as physicians or any practitioner. How much money could we save if we just invested in the prevention and the lifestyle nutrition training and coaching versus just spending money on these things that are masking and not solving the problem? I think trillions of dollars. Yeah. And the funny thing is that what taxpayers don't realize is that they're paying for this, like four times over. It's crazy. We are paying taxpayer money to of course fund, you know,

healthcare, Medicare, Medicaid, all these things. We are then going to the doctor and paying our co-pays. We're paying our insurance premiums. We're paying for that service. We are also paying taxpayer money for the farm bills and for the food subsidies that are making all the disease-promoting foods cheaper for Americans. So we spend $31 billion on our farm bills, which directly subsidize the foods that cause disease, making them artificially cheaper. So this is corn, sugar, soy, wheat, and other foods like that does not go towards the vegetables and the fruits, which are actually part of a separate, very small horticulture bill, which is like not even like a fraction. Like 10 million or something. It's a tiny little amount. So they're paying for those that then make us sick. that then make us sick. And then of course, we're paying for the environmental damage of those terrible farming practices of the foods that make us sick that are then ruining our top

soil and creating horrible runoff in our rivers and oceans. So literally, like you walk into the store, and you grab, you know, Skittles, or you grab Wonder Bread. And I think what people don't realize is that if that had a real price tag on it, it would be like $150, because it's the healthcare costs. It's the cost of the food. It's the cost of the taxpayer money for healthcare for others.

It's the cost of the environmental damage and it's the cost of the farm bills. We're paying all that. That's crazy. And yet it's $3. Yeah, what I think what's cool that you're doing and a lot of your peers are doing We're paying all that. That's crazy. And yet it's $3. Yeah. Yeah. What I think what's cool, what you're doing and a lot of other of your peers are doing is trying to give people information and access to take back control of their own health and

prevent a lot of these things from happening by just making better choices every day. Having the information and the education of what makes you sick and what keeps you healthy with all these different factors you talked about and also just staying on track with it, staying on track consistently to prevent and stay healthy as long as possible. The challenge is there's so much temptation in the world. There's so much temptation and so much available at all the times to make poor choices, whether it becomes nutrition,

diet, sugar, all these different things, processed foods. It's very challenging for a lot of people. Even myself, which I consider a healthy person, active. I just ran a marathon three days ago for my first marathon. Congratulations. Thank you. But I still feel like, oh, but I still, I'm not in the best shape that I could be in, right? Because of the nutritional aspect, I can go months of eating super clean and healthy. And then other months where I'm like, I feel great. Let me just have some sugar every day now. So it's the, it's the accountability. It's the structure. It's the, the accessibility. There's so much processed foods, which I think is challenging for a lot of people. And I think that's what's one of the hardest things is just the discipline it takes, the personal discipline.

So how do you manage it personally, knowing all this information? Do you still eat a lot of sugar or are you kind of like cut sugar out of your life now? Yeah. Well, first of all, I think the points you made are so important. Like it is hard. And that's why, that is why I'm excited about technology that helps people eat better because like continuous glucose monitoring. And of course, what we've started with levels is because it's not like I want to walk around and see everyone being a cyborg with technology on their arm. I'm actually a very like crunchy granola person. I'm not the most tech savvy person. And like, I want to just like be in the back country unplugged, you know,

like that is my ideal. However, the cards are stacked against us so monumentally in the way we've talked about the past 50 to a hundred years, the human body has had to be bombarded with all these external signals that it's never had to deal with in the tens of thousands, hundreds of thousands of years of evolution, and it's breaking our bodies. We have broken bodies by and large in America as evidenced by the fact that six in 10 American adults have at least one chronic disease.

We're breaking. And so those cards are sort of stacked against us. Of course, there's governmental factors. There's all this stuff. There's food marketing. Our school lunches for kids are awful. And so in the face of that modern reality, tools to empower ourselves to make decisions that are better, I think are very important. And ideally, you know, you could use these tools to gain awareness, to gain learning, to gain knowledge of how to eat and live in a way that keeps your blood sugar more stable, that keeps your metabolic health on point. And then maybe you don't have to use it anymore.

You know, maybe it's just a window. You know, I'm not wearing one right now. I've been at this for three years and I can go months now without wearing one. I mean, it can be very helpful for accountability at this point, but. But you know what works and what doesn't work now. I've been at this for three years and I can go months now without wearing one. I mean, it can be very helpful for accountability at this point, but you know what works and what doesn't work now. Yes. And it's a nuanced balance. And so that's what I'm so excited about is empowerment. I think that is the key word because your doctor might say to you, um, oatmeal's you've got high cholesterol. So eat oatmeal. Like this is a heart healthy whole grain that might be bad for you well put your blood pull the blood sugar monitor on you know on your arm and and eat the oatmeal and see what happens and maybe for you your blood sugar stays quite stable and you don't have a big spike but for me because i've tested this one serving of quaker

rolled oats caused me an 80 pointpoint glucose rise and crash, which is about four times higher than the highest I want to go. I want to go up like 20 points after a meal. You want to stay like here, not here, right? Exactly. So for my body, terrible metabolic choice. For yours, maybe it's okay. But the fact that the doctor's saying it sort of works for everyone, that's where we can

kind of get into trouble because every single body is different. We are so biochemically individual and what works for you and me might be very different in terms of what causes a blood glucose spike. And it can also be different day to day. Like again, if I'm sleep deprived, it might hit me a lot harder than on the day that I'm not. So knowing what those variables are can be really useful information. So for me, like when I started wearing continuous glucose monitors, when we started levels, I was almost a hundred percent plant-based. And what I learned super quickly was that there were- Before the monitor, you were plant-based. And I'm still like 93% plant-based, but like I'll eat a little bit of really thoughtfully sourced

animal protein now. But what it did for me was make me realize that within my plant-based diet, there were certain foods that were causing really big spikes and how I could modify plant foods and balance them with adding fat, protein, and fiber to my carbohydrates to keep the spikes much less. So it could be plant-based and be unhealthy. Absolutely. Oh my gosh. You can be having sugar all day long and be spiking left and right still. You can just be, you know, trashing your health that way.

And I think that one of the things I'm most excited about with this personal biofeedback data about nutrition is that I think it's going to pull the rug out from diet wars and from all these really... Just show the proof. Here's the evidence. Because I can look... Someone who's carnivore, and this has happened, can be ripping on vegans on social media. And if I can come out and say, here are my blood sugar curves. They're flat. My insulin is three. My cholesterol is XYZ. My inflammation markers are this. My vitamin D is this, and my omega-3 levels

are this. Like, how can you fight with me? Like this is working for me. And it might actually look identical to their lab work because the body is such a complex system. There are many different redundant pathways to kind of getting to the same outcomes. But the key is you have to be so thoughtful about how you're doing it. The run of the mill vegan diet is probably not going to be great for people. Neither is the run of the mill carnivore diet, you know? And so just having insight into that. But I think it's, again, it's like the proof is in the pudding. And, and that's where I'm excited to see like more data helping to quell some of the debate of what's better because each body is different.

And, um, you know, that's interesting. So tell me about levels then. What is, what are you guys doing at levels with this? Is it called constant glucose monitors? I was called continuous glucose. Yeah. CGM where you put on, you essentially put on a monitor in your skin, right, for two weeks. Is that what it is?

And then it monitors your blood levels for 24-7 for two weeks. Yeah. Anything you consume or don't consume, it tells you what's happening. You have an app that shows you and tracks it. Yeah. So why is this essential for someone to be curious about and to potentially want to try this out? Yeah. The reason why it's something that I think is relevant to pretty much everyone is because of the rates of what we're seeing in our country.

Like if you're just living your life standard American diet, more likely than not you're going to end up with a metabolic disease. That's just now common reality. likely than not, you're going to end up with a metabolic disease. That's just now common reality. And so having some information to both see what the trajectory is over time, have a real sense of ownership over what's going on metabolically in your body. I think that's really empowering. Like right now, you kind of get crumbs of information from your doctor once a year, but imagine if like, you know, you could really have ownership over that foundational asset of your health. So that's one thing is just like the awareness. And then the bigger piece is to have this closed-loop biofeedback

on everything you're eating and everything you're doing to keep glucose more stable because we want to get off those ups and downs swings not only to improve our day-to-day functioning and the subjective experience of our days, the energy, the mood, of our days, the energy, the mood, the cravings, the fatigue, but also to set us out for like the long-term avoidance of sort of the glucose-related metabolic diseases. And so that's really the reason to use it. And what I love about

it is like, just like with the oatmeal example, try a food, see what happens. The cool thing is like, even if you do spike, it doesn't necessarily mean you have to get rid of that food forever. It means that you can potentially modify it and work with it. So let's take the oatmeal example. For instance, if you love oatmeal, like you're just like, I do not want to live without oatmeal. That's fine. One thing we've seen in our data set. So we've had about close to 25,000 people go through our program. We have over 50 million glucose data points. So we have a lot of information here.

People who eat like rolled oats, like instant oats, which are fairly processed, spike higher than people who eat less processed forms of oats, like steel cut oats or groats, which are kind of like a chewy, very whole food form of oats. So eat one of the less processed ones potentially, or add fat, protein, and fiber to that carb. The carb alone, if you're eating what I call like a naked carb, essentially a meal that's just like dominant carbs. Yeah. No fat protein. Yeah. Like two bananas or oatmeal or Skittles. Like you think about some candies, like Skittles are basically just like sugar. Whereas like a Snickers bar actually has peanut butter and chocolate and chocolate. And crazily enough, Skittles have an over 80 point glucose spike in our data set. And Snickers is like 35

or something. So it's like half. And because Skittles are more of a naked carb. And so Skittles are actually the highest spiking food in our entire data set. Yeah. Number one, straight sugar ball, Skittles, candy corn, milk duds. It's like, they're all very similar. Jelly beans. Yeah. It's like sugar coated on sugar with more sugar. It's crazy. So, so yeah, so you want to avoid that naked carb situation. So I see oatmeal with chia seeds, which has tons of fiber and protein, a little bit of almond butter, which has fat, protein, and fiber. Add a few maybe low glycemic berries, like a couple blueberries or raspberries or whatever,

which have a good amount of fiber and antioxidants. Maybe some flax seeds on top, which is going to be fiber and fat. Mix it all together. And you're going to probably absorb the glucose slower. It's going to slow digestion. The fiber can actually block the amount of glucose that gets into the bloodstream. The fiber also has the effect of feeding the microbiome,

which has downstream positive effects on metabolic health. So it's like, keep the oatmeal, but modify it. And if you're not wedded to oatmeal, then start experimenting with other breakfast. So for me, I'm like, I couldn't care less about oatmeal. So if I saw that wedded to oatmeal, then start experimenting with other breakfasts. So for me, I'm like, I couldn't care less about oatmeal. So if I saw that it spiked me and I think I never ate it again, I'm like, I don't even like this. I just thought it was healthy.

So like, for me, that's gone. And if you look in our data set at what some of the best scoring breakfasts are, we see things logged like eggs and avocado eggs and greens um we see frittata we see um chia pudding um we see um actually one that we see is like green some some there's a particular smoothie that we actually see logged a lot it's called the fab four smoothie it's popular it's by kelly lavette she's great she's amazing and she it basically is a really well balanced smoothie that's low sugar high protein and fiber and healthy fats and there's some vegetables in there as well and a lot of our community logs that and so it's actually got a very low glucose spike so what you can see from all from this

amazing data set is that there's all these options that have like less than 20 point glucose spike. So choose those. Choose those options. As opposed to. Interesting. So someone signs up for this, I guess there's a waiting list right now, but when they, what does it do for them? Does it coach them on the foods to eat? Does it tell them, you know, you just ate this and it's not good for your system right now. Add this to it if you want to keep eating it. It kind of coaches you for those two weeks or what's it do? Yeah, it does everything that you just said basically. So a Levels member will actually use it for a full month to start.

So the sensors are on the arm for two weeks. So the first month of Levels is two sensors. So you put one on for two weeks, you peel it off, you put a new one on. And so it's 28 days total. And throughout that process, it's doing exactly what you're saying. You log your food, you take a photo of it, and then you get a score for each of those meals. So the score is essentially a one to 10 zone score is what it's called that tells you about the glucose impact of that meal. So you're shooting for tens and one is like lower. So for example, I could eat sushi, tens. And one is like lower. So interesting. For example, I could eat sushi, which of course has white rice. And sometimes the white rice has sugar actually added to it. And for me, like sushi

usually scores like a two or a three, like I have a very, very high spike. And you want it to be a one? You want it to be a 10. 10. You want it to be a 10. So that's like a pretty, like that would look like a big sharp spiking crash. So what I learned and what the types of things that we talk about in the Levels app is like, okay, well, based on what other people have logged, if you log sashimi, you're probably going to score like a 10, a nine or a 10.

Because that's, of course, just like straight fish. People are now logging cauliflower rice sushi, which is kind of interesting, which has like almost no glucose spike. And there's actually restaurants offering this now. Or, I mean, I think like me, there's some people who just don't want to give up sushi. Like that's not like oatmeal. Like for me, I'm like, I'm not giving up sushi.

So then there's other things that I'll suggest. Like for instance, add preload your meal with before the sushi have a salad with protein and fat. Cause there's been research that's shown that if you eat like, again, again fiber fat and protein before carbohydrate if you sequence the meal differently you actually have a lower glucose response so you can eat the exact same sushi but if there's some other stuff in your stomach first um you there's processing in a different way differently and it's changing the hormonal response the food or it will say, you're going up, your glucose is going up, take a 10 to 15 minute walk right

now. No way. And it'll bring it back down. Oh yeah, for sure. I mean, it can definitely bring it. Does this tell you live data? Is it like, okay, you need to add this or you need to go walk? It's telling you in pretty close succession.

Yeah. And helping you. Because if it sees a spike, it's going to say, when you're in this range, go take a walk or add this or eliminate that. Yeah. And actually, if you have a spike and you haven't logged anything, like we'll say to you, hey, like what happened here? What did you do? And some people will see spikes if they're exercising, like we talked about, because of the stress response.

Usually if someone's going above about 70 to 80% of their max heart rate, they're going to see a spike. When they're exercising. Because that's the stress response type thing. And people will be able to exclude that from their scores because we know it's not a food induced spike. It's not like the same as sort of a potentially damaging food induced spike. This is fascinating.

Yeah. Because it gives you information on your body. Yeah, and then we'll give people tons of swap options. Like for instance, if they log a tortilla. Like, let's say they log tacos and they have a really big spike. We have a ton of content on, like, here's 10 other tortilla alternatives that we know don't spike as much. So, for instance, like, jicama tortillas from Trader Joe's. There's now, there's keto tortillas.

Like, I just got to LA yesterday. First stop, Air One. Of course. Got their almond flour keto tortillas. I'm, like, in love with them. You spent $70 on those, yeah. Oh, yeah. They're, like, first stop, Air One, got their almond flour, keto torch. I'm like in love with them. I spent $70 on those. Oh yeah. They're like, you know, $40 a piece, but I love those tacos. Butter lettuce is great. Um, you know, so there's different, different options. So we'll give people those resources, give them Costco shopping lists, give them, that's pretty cool. Yeah. Okay. Now I'm excited to try this okay um what do people need

to do if they want to get on the wait list or or sign up to be a part of this so they just go to levelshealth.com and put your email address in and you'll be in the loop about about the wait list and getting off it because you're kind of like rolling it out like every few months to new people right yeah exactly yeah and then that'll also sign people up for the newsletter which has just like a ton of amazing information about a lot of the stuff we talked about today and a lot more tips. And you know, there's certainly people don't need a continuous glucose monitor to apply these metabolic health strategies. You know, you can, you can learn from what people in the program have learned and apply that to yourself. And so we try and put as much of that on the blog as

possible so that people can learn. This is fascinating stuff. And are you on social media a lot yourself too? I'm on social media at Dr. Casey's Kitchen, so Dr. Casey's Kitchen, and then Levels is at Levels. OK, cool. And we post a lot of experiments that our members are doing. That's cool. Yeah, and so get some fun ideas for people to try.

How many people are using it at one time? Do you know? Because you said 25,000 people have done it over the last couple of years, but how many are using it at one time? Do you know? Because you said 25,000 people have done it over the last couple of years, but how many people are on it right now? Do you know? It's a good question. Is it hundreds? Is it a thousand?

Oh, I'd say a couple thousand. Yeah, I don't know the exact number for sure, but around that. That's so interesting. Yeah. Really cool stuff. I've heard a lot of great things about it, so I'm going to have to try it myself.

And I guess I'll be wearing a patch for a couple of weeks, right? For a month. But it'll be cool. It'll be good to see the research it myself. And I guess we were in a patch for a couple of weeks, right? For a month, but it'd be cool to see the research on myself. Really cool. So guys go to levelshealth.com, check it out. Dr. Casey's kitchen. If you want to see more about Casey as well, what else should we be thinking about or how can we be a support to you or, or levels? Oh my gosh. Well, I think the best thing you're doing is just having these fabulous people on your podcast. You've had so many wonderful people

in the levels community on, and I think just spreading the word about holistic health and metabolic health. I mean, it's amazing how I think podcasts like yours and, you know, Andrew Heerman, David Sinclair, Dr. Perlmutter's podcast, like Mark Hyman's podcast, Drew Pruitt, David Sinclair, Dr. Perlmutter's podcast, like Mark Hyman's podcast, Drew Pruitt. Like these things are becoming the thing that people look to to figure out how to actually create health in their lives because they're not necessarily getting it from their doctor.

And so I think it's a really exciting time that we're in. I'm very grateful for the work that you do. That's cool. I appreciate it, Casey. All right, this is a question I ask everyone at the end called three truths. I think you know what's coming. Imagine it's the last day on earth for you, and you've lived an incredible life, done

everything you want to do, but for whatever reason, you've got to take all of your work with you to the next place. So no one has access to this conversation or your blogs or content or anything you've ever done, but you get to share three lessons you've learned from life with the world, and that's all we have left to kind of be remembered by you. What would you say are those three lessons or three truths? I think one of the biggest ones for me in terms of what brings joy and satisfaction to my life is to focus on the little things and just true awe in

all the amazing things going around us. I think if you just step back for like one second, you know, and look at what's going on around us, we're in this incredible cosmic journey. You know, we're hurling through space. We're made of trillions of cells, innumerable atoms. We're constantly, you know, it's like every time we eat, we're literally taking in matter from the universe and converting converting into our body and like shifting our shape every day. It's just, it's at, you know, we're part of this incredible just continuum of, of, of energy and matter. And like,

you know, I think it's just so awe inspiring. So just like step back, look at the awe, you know, the fact that the sun is shining and telling your brain, you know, what to do. It's fascinating. So I think like focusing on the little things and just having a sense of awe and reverence for everything around you, like brings me just such intense joy every single day and can help elevate you from some of the day-to-day stresses. Um, so awe, live with awe and focus on the little things. And of course that loops into being in the present moment because you have to stop and pause to see things. I think the second thing would be really, we talked about this a little bit earlier, but like really focus on death, you know, examine it, think about it, be curious about it. I think, you know, one of my favorite quotes, Steve Jobs talked about death as

life's greatest invention. And I think that's so true when we overcome our fear of mortality and have a good relationship with death and see it as not an end, but a part of the process that's very natural. Think about the way that energy cycles through generations, and we're a part of that. I think it's incredibly liberating. Like, you know, and again, getting back to the question of fear, like if you can not be fearful of death, like you have a lot of power to make your own decisions and not be controlled by external forces. And so there's a lot we can learn from it. So I would say on a practical level, like, yeah, read some of the Stoics, read some of the, you know, Buddhist or Zen thinkers, you know, read some Mary Oliver

poetry. You know, there's people who are grappling with this and it can really make life, I think, more joyful, ironically. And then I think the third thing would be just never stop asking why. just never stop asking why. And really, if anything is conventional wisdom or is being kind of spouted by the large majority in a loud way, or anyone's having to be coerced to believe something is true or manipulated or like ask why and think about the bigger picture when you keep asking why it just makes life so much fun so for me like looking at the health care system and being like we're spending more money people are getting sicker why why that was the best question of my life and led me to leave the surgical world get into functional medicine ultimately start levels and realize this incredible world of metabolic

health and how things are connected rather than how things are separate. And I think that I just, you know, hope that doing that at every stage will continue to just open up whole worlds of new opportunities. So I would say ask why and challenge conventional wisdom and think for yourself. That's beautiful. One of the reasons I keep asking questions on this show. After nine years, I'm still curious and I want to learn more. So I think those are great.

I want to acknowledge you, Kasey, for asking why many years ago and taking a shift in your career and your mission from being, I guess, in the practice of surgeries and prescriptions now into prevention and reversal of these, I guess, diseases for people and really helping people shift their thinking from having personal power, personal knowledge and information on their health. So I acknowledge you for taking the shift. It's a big change, I guess, for, it probably feels like a big change for a lot of

people in the medical world to think differently than what they've been taught for so long. So I acknowledge you for seeing things and allowing yourself to reinvent an identity that you once held onto probably for a long time and shifted into a different part of your identity. So I really acknowledge you for the process and all the great information you're giving people with levels. It's really inspiring to see what you guys are building. So congrats on that as well. Final question, Casey, what's your definition of greatness? My definition of greatness is being able to achieve and embody sort of thriving in this world and to be able to enact your purpose and fundamentally,

um, you know, be able to go out there and really, uh, really live your purpose and shine your personal light that really requires us being healthy. And so that is what drives me as a physician and as a health tech entrepreneur is if we can help create more function in people's bodies, they can go out and share their light, which is, you know, their greatness, um, make their minds healthy, help make their bodies healthy, help empower them to take control of their health. And, and so that's really just, um, how I think about how I think about greatness, being able to shine our light and embody our purpose. Love it. Casey, thanks so much. Appreciate it.

Thank you so much for listening. I hope you enjoyed today's episode and inspired you on your journey towards greatness. Make sure to check out the show notes in the description Good to see you. So share a review over on Apple and let me know what part of this episode resonated with you the most. And if no one's told you lately, I want to remind you that you are loved, you are worthy, and you matter. And now it's time to go out there and do something great.