Podcast

#257 – Join the “Good Energy” Levels book club and take charge of your health | Dr. Casey Means & Dr. Robert Lustig

Episode introduction

Show Notes

Why are we spending more on health care every year, yet people are getting sicker? “Good Energy,” a book by Casey Means, MD, details how you can take your health into your own hands with the power of food as medicine. Dr. Casey Means and Dr. Robert Lustig discuss the overarching themes of “Good Energy,” why we need changes in government and health care, and how people can overhaul their own health with actionable tips, such as eliminating ultra-processed foods from their diet. Plus, Means answers readers’ burning questions.

Helpful links

Key Takeaways

3:05 — Why Casey Means, MD, left her surgical residency program

Dr. Means recognized fundamental flaws in the medical system. She left to help focus on solving the metabolic health crisis.

When I realized there was more we could be doing to keep patients out of the operating room, it actually became a no brainer for me. Like, I can’t operate on people anymore until I actually figure out how we could keep them out of the operating room, because if I’m taking people to the operating room who I don’t think necessarily need it, to me it felt like I was out of integrity. And I felt that there was a power imbalance where I had information that I could be sharing, but the system is designed to really not give us time or space to have those conversations with patients. So as sort of a very principled person, I actually became almost like allergic to wanting to operate. I was like, “I can’t do this until I pursue this other avenue. So I went on that quest and I did leave and I never went back, because what I found was that I think we need more doctors. I really respect surgeons and I respect people doing the surgeries that need to be done that are totally unavoidable, but the vast majority, I believe, of what we’re operating on in the United States is avoidable if we actually really counseled people on how to actually generate real health in their bodies.

7:47 — The book “Good Energy” in a nutshell

Robert Lustig, MD, summarizes Dr. Means’ book.

“Good Energy,” of course, is about the mitochondria, but it’s really about what’s wrong from a medical standpoint. It’s what’s wrong with medicine from an educational standpoint, and it’s what’s wrong with government from a political standpoint.

9:50 — The problem with our mitochondria

Mitochondria are the powerhouses of  our cells, but in many cases, they have become dysfunctional.

And right now, in the vast majority of American bodies, that powering process of metabolic function is broken. It’s broken because of a unique set of circumstances that is the challenge that this moment in history has the opportunity to face and understand and overcome. But it’s a unique moment in history where the rapidly changing world of industrialization and urbanization and technology has made the world essentially much less conducive to our mitochondria functioning properly across all elements of our world, across our diet, our sleep patterns, our movement patterns, the way we interact with light and the outdoors, the toxins in our environment—everything is hurting our mitochondria all at once. And this chronic-disease, chronic-symptom epidemic that we’re seeing around us— people getting sicker every year, even though we’re spending more on health care every year—that is a result of our mitochondria, essentially saying, “We can no longer tolerate this environment that we’re existing in.” So the challenge for us as individuals and a society—from the individual to the family to the community to the government level—is to find ways in our modern world to create an environment that is conducive to mitochondrial thriving, to do that again.

16:20 — We’re getting too much of our food from ultra-processed items

Ultra-processed foods are a main reason why our mitochondria have become dysfunctional.

We’ve got to get rid of the ultra-processed food. Ultra-processed food—it’s 70% of our cells now and the calories that we’re eating. And yet what we kind of forget is that it is a 75-year experiment that we’ve sort of allowed to come into our culture and it is an experiment that has failed. We need to relegate it to the annals of history. It’s an experiment that failed. Ultra-processed food hurts ourselves, hurts our bodies, hurts our minds, hurts our mitochondria. And it’s the vast majority of the calories we’re eating. So that just means essentially eating as much of the real, unprocessed, organic food, ideally freshest (i.e., from the farmer’s market) as possible.

19:04 — How to reduce cravings

When we fuel our cells with whole foods, we give them what they need and want.

Moving towards a whole-foods diet—that is that is just step one because it will reduce your cravings. The more nutrients you put in, the less your body is going to be seeking food essentially. And so it’s going to diminish your cravings because when you meet the needs of the cells your cravings decline. It’s really that simple. And then the second piece is that we reduce a lot of the toxins that are in the processed foods, like the glyphosate and others that hurt us. So number one is real food. We’re basically molecularly made from food. We’ve got to get it right.

22: 06 — Different types of exercise send different signals to our mitochondria

We need to move more throughout the day and get a variety of exercise types to benefit mitochondrial health.

We get confused sometimes: Should I do zone two? Should I do resistance training? Should I do HIIT? What are these different things I should do? We need to think about each of them as how they are different signals for our mitochondria. So resistance training, building more muscle, muscle hypertrophy—we’re 3D printing new mitochondria. And we’re also disposing of glucose. HIIT training, high intensity interval training—we’re really stimulating mitophagy, which is the recycling of mitochondria. And then walking—that’s about glucose disposal. So each one hits a different thing. And, ideally, we’d kind of do a little bit of everything, but we cannot avoid the need for our bodies to be in motion more throughout the day.

29:42 — Modern medicine is designed to address disease when it’s already present

Instead, we need to be taking steps to prevent disease in the first place.

I have compassion for doctors because every element of the way we’re educated, the way research is pursued, the way doctors are even reimbursed on the institutional level all pushes us to essentially wait for disease to emerge and then play whack-a-mole medicine with the different symptoms, and that really doesn’t feel good as a doctor.

36:03 — Nutrition guidelines are fraught with conflicts of interest

Nutrition guidelines often ignore the science because of conflicts of interest with food companies.

We allow for 95% of the people on the USDA panel who create the food guidelines for America to have conflicts of interest with food companies. So the people writing the actual guidelines that go into school lunches and that go into what’s covered by SNAP, they have conflicts of interest, almost 100% of them. That’s not good. That’s not right. Because then of course it’s not just pure science or nutrition that’s going into the guidelines. There’s also financial interest. So things like the NIH, a huge portion of their budget comes from Big Pharma and the food industry. And so even though it’s a taxpayer-funded organization that should have exclusively the best interests of American health in mind, there are also interests from industry. So those types of things need to be unpacked and more closely monitored or even reported.

45: 16 — The need for addressing school lunches and SNAP

The Supplemental Nutrition Assistance Program (SNAP) needs an overhaul, as do school lunch programs.

I think people don’t really realize that right now 10% of all food stamps are going towards soda, and soda is essentially diabetes water. It has no nutritional value and it’s keeping people addicted and sick, especially minorities and the poor. So right now, that is literally 10% of SNAP. Billions of dollars in a direct funneling from taxpayer dollars to Coca-Cola and PepsiCo. That’s not great. So that’s something that could easily be adjusted. We have the USDA school lunch program, which serves 3 billion meals per year in the United States. . . These school lunches don’t even follow the USDA guidelines for what should be in them. They have astronomically more sugar, saturated fat—all sorts of things in them than they should. And I mean, if you’ve seen pictures of school lunches, many of them are—it virtually looks inedible, and this is not helping the brains and bodies of children thrive.

54:48  — Trends in glucose matter

When it comes to metabolic health, a single blood sugar spike is not a big concern, though it might have an impact on how you feel.

It is the trends that we care about. Some people do find that they feel crummy after a single glucose spike. So this is more of the subjective feeling, because after a big spike, you might have a crash because your body soaks up all that glucose and you overshoot. And that’s called postprandial hypoglycemia. And that’s essentially the body going below its baseline and then us having this subjective experience, essentially pushing the body to try and get it back up to normal. Because hypoglycemia is also a fear signal for the body. And so this will be when people feel intense cravings for carbohydrates, when they feel fatigued, when they feel jittery—things like that. That’s that post-meal crash.

57:49 — Dr. Lustig shares his thoughts on “Good Energy”

“Good Energy” tackles the need for change at the societal level and the individual level.

It is a masterpiece at two levels. It’s a masterpiece of being able to relate science to individual health and to societal health. And it is a masterpiece of writing in terms of explaining the passion that you have for this field, for what’s going on in society and why everyone should basically rethink their lives. It is a true tour de force, and I am so proud of you, and I am so happy that you wrote this.

Episode Transcript

Casey Means (00:00:06):

When I talk to doctors, investors, venture capitalists, anyone who I can get in front of, I always say we need to be very clear on what a good outcome is. With our company’s investments, our practice, it is a cell that is working better. It is a cell that is fundamentally more functional. If the intervention or investment, or company, or whatever is not actually leading to a cell that’s functioning better, you should not focus on it. And so that just needs to be a very clear paradigm for people. So an example of this would be, we can say it’s great to create companies around making it more efficient for doctors to see more patients. And in a sense, maybe there’s some good aspect to that, but is that actually leading to healthier cells? If it’s more doctors practicing in the same broken model? No, versus something like levels, for instance, which the more people who use levels, the more healthier cells we are going to have in people.

Ben Grynol (00:01:11):

I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health. And along the way, we have conversations with thought leaders about research backed information so you can take your health into your own hands. This is A Whole New Level.

(00:01:41):

In May of 2024, many loyal Levels followers know that Dr. Casey Means, Level’s co-founder released a book, amazing book on metabolic health and overall good energy. And the book is called Good Energy. It’s this idea of how do we take all these inputs to our life and focus on root cause or focus on the very foundational level of health. And that really starts with our mitochondria, the little energy factories inside of us that help us to maintain a healthy lifestyle. And so Haney and Casey recorded a podcast when the book dropped May 14th, 2024. And because we’ve got inside access to Casey, we thought it’d be great to have a little bit of a book club. So Dr. Robert Lustig, Levels’ advisor and friend, and Casey, the two of them sat down and they had a community book club with many of our levels, community members. The idea was to have a live podcast where they could talk through some of the concepts in the book, but also go through a few different questions that come up from within the community.

(00:02:45):

And so some of the things that Rob and Casey covered were ideas around things like energy influence in our body. How does diet, sleep, exercise, stress impact our mitochondria and our overall ability to make good energy? As Dr. Lustig calls it, or Rob, mitochondrial insults. When we aren’t treating our mitochondrial well or with respect, it’s a bit of an insult to our mitochondria to say, “Hey, you could be doing a better job at fueling mitochondria so that you can really have these efficient little energy factories within your body to live a long and healthy life. One of the other things is this idea of societal influences that lead us to eat or act, basically choose lifestyle behaviors in certain ways. Sometimes there’s a lot of societal pressure to either eat in a certain way or exercise in a certain way. People get confused with all this information that’s out there.

(00:03:38):

And then there are political influences, the idea that policy can create the conditions, sometimes negative for us to become sick and treat sickness instead of prevent illness and focus on things like root cause. So with companies like Levels, with books like Good Energy, it’s very much this mindset around having a proactive outlook on functional medicine decades before we actually get, air quotes, sick or we face disease or illness. And so in the book, Casey talks about a number of things, and Robin Casey went through some of these factors in good energy, the idea of eating a better diet, eliminate ultra processed food as a first step and focus on consuming whole foods, especially when you know the source. Second is get movement, the idea that people don’t get enough movement in a day. And sometimes you don’t need to focus on vigorous exercise, just continuous micro micromovements throughout the day to keep your cells very active and receiving and uptaking things like glucose so that you can be more efficient in your energy production. Get more sleep.

(00:04:43):

Often, we don’t get enough sleep as a society, and this can have a detrimental effect on our overall health. Avoid things that impact or sleep and natural sleep cycles, things like technology, blue light, et cetera. Get sunlight, get outside, and really make sure that you’re getting that sun in a day. There’s not enough time where people are getting natural light, and this is critical for ourselves to function well. Fifth is express gratitude more often. People who express gratitude and practice mindfulness tend to have shown lower rates of metabolic disease across the board. And then lastly, this idea of environmental factors. So chemicals and obesogens in the environment can really impact our cells and result in a disruption of our hormones and our mitochondria in the body. Anyway, there are a number of great things that Rob and Casey covered. And as you can expect, Good Energy, it’s a fabulous book. If you haven’t read it yet, it is a game changer, so make sure you get yourself a copy. No need to wait. Here is Casey, Rob and the Levels community.

Robert Lustig (00:05:47):

Welcome to A Whole New Level. And this is a very special level, a level I don’t think we’ve even achieved before. I am here with my colleague, my good friend, my redhead of the century, Dr. Casey Means. And Casey has the auspicious distinction of being a New York Times number one bestselling author as of two days ago for Good Energy. Congratulations, Casey, and well-deserved.

Casey Means (00:06:24):

Thank you so much, Rob. You were a huge part of getting it to this place. You were one of the first people to read the book, and I am so indebted to you and so grateful to you for both just the inspiration, but also helping me with the brass tacks of getting this out into the world.

Robert Lustig (00:06:40):

Well, when I read it, I said, this is frigging good. This is amazing. This is off the charts. It was amazing for two reasons. It was amazing because of the science, but it was also amazing because of your story. I said on the back of the cover, on the blurb, part memoir, part manifesto, and I want to just focus on the memoir side for just a minute. Okay? You were an ear, nose, and throat resident at Stanford University Medical Center, one of the top 10 universities in the country, and one of the top 10 ENT programs in the country. And with six months to go, you gave it all up. In the words of Jay Leno asking Hugh Grant about his dalliance, what were you thinking?

Casey Means (00:07:32):

A lot of people ask me that question, “What are you thinking?” when I left just shy of finishing my residency and launching out to be a faculty surgeon, probably making mid six figures and just sort of having this life of being an ENT surgeon. And for me it became very philosophical and very principled for me once the genie was out of the bottle for me that the way we’re practicing medicine in the United States is essentially all wrong, I think. Not to sugarcoat it, but-

Robert Lustig (00:08:09):

We’re going to get there.

Casey Means (00:08:09):

… we’re not focused on the right issues, and we’re missing the elephant in the room of metabolic dysfunction. And once I realized that and started digging into PubMed and papers in a different way, looking for, what could we actually be doing to nudging these core pathways towards resolution, I realized there was a whole different way of practicing medicine that I could help these patients with, these ENT patients who were having these dramatic operations in the operating room that I was doing. And when I realized there was more we could be doing to keep patients out of the operating room, it actually became a no-brainer for me. I can’t operate on people anymore until I actually figure out how we could keep them out of the operating room. Because if I’m taking people to the operating room who I don’t think necessarily need it, to me, it felt like I was out of integrity and I felt that there was a power imbalance where I had information that I could be sharing, but the system is designed to really not give us time or space to have those conversations with patients.

(00:09:14):

So as sort of a very principled person, I actually became almost allergic to wanting to operate. I was like, I can’t do this until I pursue this other avenue. So I went on that quest and I did leave, and I never went back because what I found was that I think we need more doctors. I really respect surgeons, and I respect people doing the surgeries that need to be done, that are totally unavoidable, but the vast majority, I believe, of what we’re operating on in the United States is avoidable if we actually really counseled people on how to actually generate real health in their bodies. And so that’s what I’ve committed my life to, and that’s obviously been an incredible journey to becoming a metabolic evangelist.

Robert Lustig (00:09:59):

I got to tell you, I was in the system for 40 years. And for the first 20, I did what I was told to do and I realized people weren’t getting better. And for every one patient I saw, 10 patients showed up at my door, and I knew something was wrong. I stayed in the system, I didn’t know how to leave it. And ultimately when I retired, I did leave it, and I’m now in a very different place. And I realized it was good that I stayed because it gave me the gravitas, but at the same time, it’s also good that I left because I needed to leave. You just realized it earlier. You got it. I didn’t get it so quick. You got it a lot quicker, and so I salute you for it.

Casey Means (00:10:55):

Yeah. Thank you. I do think there’s a place for doctors who are aware to some of these systems issues and the biologic issues, and who are in the systems still and can help nudge it from the inside. There’s also space for people to go outside the system and be more educators and write books and things like this. So I think it’s… For us to really turn this Titanic ship of $4 trillion of healthcare towards the right issues, I think it’s going to take people from all sides. But for me, and really reflecting on what my purpose was, I knew it was going to be outside of the operating room. And just to also get back to your question of how’d you do it, why’d you do it, I think a lot of people said, “Why wouldn’t you just finish and get board certified and just get all those stamps and everything?”

(00:11:40):

But I think what people don’t think about is that there’s an opportunity cost to not finishing, of course, and to leaving something that you know is not right for you, but there’s also an opportunity cost to staying. Because if I had stayed those six, seven months and then done the year of getting board certified and starting a practice, that’s a couple years of time to be devoting to what you really need to be doing on this planet. That is also an opportunity cost, the prime years of your life. If I had stayed… That was the time when I met my Levels co-founders and we started Levels, and that may have just never happened for me had I stayed. So I always want people to think about there’s an opportunity cost to quitting, but there’s also an opportunity cost to not quitting something that’s not right for you. And time is our most precious asset, and so that’s always the other side of the coin that I think about.

Robert Lustig (00:12:34):

That is a very noble and a very mature way to look at it, I got to tell you. But when I first heard your story, I went, what the hell is wrong with this one?

Casey Means (00:12:45):

I love your honesty.

Robert Lustig (00:12:46):

Having said that, you clearly have good energy, and I am wearing my good energy shirt to match your book, and you are wearing your red and white dress to match the book as well, and we both have some really good energy going here. So let’s talk about good energy. In preparation for this, I realize that Good Energy, of course is about the mitochondria, but it’s really about what’s wrong with people from a medical standpoint, it’s what’s wrong with medicine from an educational standpoint, and it’s what’s wrong with government from a political standpoint.

(00:13:29):

And so what I want to do is I want to slice and dice those things in the 20 minutes that we have before we entertain listeners questions. Let’s talk about people first. Okay? Mitochondria, oh, I love them. Okay? And so should everyone on this podcast. Okay? Because they’re what make you either alive or dead, and what make you healthy or sick, and what make you happy or miserable. That’s mitochondria. Okay? And I can’t say that about any other organ in the body. So what about the mitochondria can you tell people today that will actually make them realize how important this is and what they should do about it for themselves?

Casey Means (00:14:20):

The mitochondria, I love the way you talked about them. It resonates so much. But I think the thing that people need to realize is that they are what create all the power for our body, and power to our body is what allows every one of the trillions of chemical reactions that’s happening every second to occur. It’s how we fuel all of it. And our lives, our minds, our feelings, our thoughts, our ability to move, every single aspect of our life that we think of as Casey or Rob, all of it is fundamentally rooted in that power. Our life is just the bubbling up of those trillions of chemical reactions that are happening every second that all need power to happen.

(00:15:06):

And right now in the vast majority of American bodies, that powering process metabolic function is broken. It’s broken because of a unique set of circumstances that is really like the challenge that this moment in history has the opportunity to face and understand and overcome, but it’s a unique moment in history where the rapidly changing world of industrialization and urbanization and technology has made the world essentially much less conducive to our mitochondria functioning properly across all elements of our world, across our diet, our sleep patterns are movement patterns, the way we interact with light and the outdoors, the toxins in our environment. Everything is hurting our mitochondria all at once. And this chronic disease, chronic symptom epidemic that we’re seeing around us, people getting sicker every year, even though we’re spending more on healthcare every year, that is a result of our mitochondria essentially saying we can no longer tolerate this environment that we’re existing in.

(00:16:13):

So the challenge for us as individuals and a society, from the individual to the family, to the community, to the government level is to find ways in our modern world, to create an environment that is conducive to mitochondrial thriving, to do that again. And it doesn’t mean going back in history and all becoming farmers again and being outside all day moving. It means being creative about how to support the needs of our cells and our mitochondria in the context of our modern world. And that world is going to have to look different than what it does right now. And I think one of the most overt things that highlights what’s happening is that infertility is going up every year. We actually… Infertility is going up 1% per year. Extrapolate that a little bit. It’s not good.

Robert Lustig (00:17:02):

No, I got it. I got it.

Casey Means (00:17:02):

That’s not good. And so we have female infertility going up 1% a year and sperm counts going down 1% a year. And we know that both of those things are fundamentally rooted in metabolic dysfunction. The leading causes of infertility are metabolic issues. And so I mentioned that because what could be more of an overt way of the body communicating to us that this world we’re living in is no longer conducive to life essentially than saying, we are not going to let you create new life. We need to take heed of this signal and not just focus on, oh, we’re going to make more assisted reproductive technology and IVF.

(00:17:44):

Those things are great for individual people, but we need to really take stock of what our bodies yelling, which is that the world is no longer supportive of, in many ways life. And then the next step, which is, I think, the more hopeful side of the conversation is we need to figure out how to understand where we are on the metabolic spectrum. So that’s the amazing accessible biomarkers that we have access to, many of which are very cheap, which can help us understand where we stand and how we’re moving. And the second piece is understand which factors of our lifestyle and our own lives are hurting our mitochondrial health across food, sleep, movement, emotional health, toxins, light temperature, et cetera, all these pillars of metabolic health take stock in our own life of where we can make improvements, and then take on a few changes in our life that feel manageable, commit to them and do them, and then track our progress.

(00:18:38):

So it’s a tough time right now for our cells. It’s showing up as our chronic disease epidemic, one branch of which is this infertility that I mentioned, but many other things. And then we need to measure, track, and make some changes, all with a sense of compassion for our cells in our mitochondria who are struggling right now.

(00:19:08):

This is Dr. Casey Means, co-founder of Levels. If you’ve heard me talk on other podcasts before, you know that I believe that tracking your glucose and optimizing your metabolic health is really the ultimate life hack. We know that cravings, mood instability, and energy levels and weight are all tied to our blood sugar levels. And of course, all the downstream chronic diseases that are related to blood sugar are things that we can really greatly improve our chances of avoiding if we keep our blood sugar in a healthy and stable level throughout our lifetime. So I’ve been using CGM now on and off for the past four years since we started Levels, and I have learned so much about my diet and my health. I’ve learned the simple swaps that keep my blood sugar stable, like plaques, crackers instead of wheat-based crackers. I’ve learned which fruits work best for my blood sugar.

(00:20:01):

I do really well with pears and apples and oranges and berries, but grapes seem to spike my blood sugar off the chart. I’m also a notorious night owl, and I’ve really learned with using Levels, if I get to bed at a reasonable hour and get good quality sleep, my blood sugar levels are so much better. And that has been so motivating for me on my health journey. It’s also been helpful for me in terms of keeping my weight at a stable level much more effortlessly than it has been in the past. So you can sign up for Levels at levels.link/podcast. Now, let’s get back to this episode.

Robert Lustig (00:20:44):

You mentioned that the mitochondria of the powerhouses of the cell, and of course they are, but they’re much more than that. They are also the source of steroids, and steroids are the source of fertility, both androgen, estrogen, progesterone. The bottom line is we know that mitochondrial dysfunction causes defective steroidogenesis, so it shouldn’t be surprising that, in fact, fertility rates have changed, that polycystic ovarian syndrome rates have gone through the roof. And that in and of itself is at one of the arbiters of decreased fertility. As an endocrinologist, this is, shall we say not wasted on me. On the other hand, when I mentioned this to an other endocrinologist, they’re like deer in the headlights. They don’t understand what those two things could be referring to. So then the question is, all right, what can we do to make those mitochondria work better today? And the answer is, get rid of the toxins.

(00:21:48):

Well, they’re everywhere. They’re in the ionizing radiation, and we got more ionizing radiation hitting the earth than we ever did before, vis-a-vis the amount of skin cancer that we see. So there’s stuff going on in the atmosphere. We’ve got air pollution which alters mitochondrial dysfunction. There are the toxins themselves, the most important of which is the ones we eat, like for instance, fructose, which is a direct mitochondrial toxin at three separate enzymes. There are a whole host of different things that are going on. As you said, this is the conglomeration, today is the conglomeration of all of these mitochondrial insults all at once. So what can people do to help themselves today?

Casey Means (00:22:42):

The framing is we want to do the things across all those pillars that I talked about that support mitochondrial capacity to process energy, and we want to reduce the things that are overwhelming them in hurting them.

Robert Lustig (00:22:54):

So top three, top three.

Casey Means (00:22:57):

Top three. One, we got to get rid of the ultra processed food. I think of ultra processed food, it’s 70% of our shelves now and the calories that we’re eating, and yet what we kind of forget is that it is a 75 year experiment that we’ve sort of allowed to come into our culture, and it is an experiment that has failed. We need to just relegate it to the annals of history. It’s an experiment that failed. Ultra processed food, hurts ourselves, hurts our bodies, hurts our minds, hurts our mitochondria, and it’s the vast majority of the calories we’re eating. So that just means essentially eating as much of the real unprocessed organic food, ideally freshest, i.e. from the farmer’s market as possible. And this is not… I used to think this was frivolous. Oh, get the food from the farmer’s market. Does it really matter?

(00:23:47):

The reason it matters to have fresh food is because the average piece of food is traveling 1500 miles now from the farm to your plate, and it’s losing nutrients. And our mitochondria need molecules like vitamins, minerals, cofactors, antioxidants. They need them as lock and ke cofactors for it to work. So we want food filled with as many nutrients as possible. So either fresh or food that was immediately frozen upon picking, those are going to be our best options. So real food, that is number one, eliminating the liquid sugar, the added sugars, the ultra, ultra refined, ultra process grains, which make up so many of our calories, and the industrially manufactured factory made oils like the seed oils like vegetable oil, canola oil.

Robert Lustig (00:24:33):

I remember going to the American Diabetes Associations years ago, and there was this wonderful talk about what are the mitochondria made of? And they are made of fatty acids.

Casey Means (00:24:45):

That’s right.

Robert Lustig (00:24:45):

The cristae of mitochondria are fatty acids. But it turns out that depending on the fatty acids you consume, the fatty acids in the mitochondria will be different, and certain fatty acids make mitochondria work better than others. The ones that are the best are the ones that have two double bonds. So for instance, linolenic acid, the omega3s. The omega3 make mitochondria work best.

Casey Means (00:25:15):

Yes.

Robert Lustig (00:25:15):

Well, unfortunately, the omega3s are the ones that are in shortest supply. And so how to fix that at both the individual level and also at the societal level poses enormous challenges.

Casey Means (00:25:32):

Yeah. Yeah. But real food, moving towards a whole foods diet, that is just step one, I think, because it will reduce your cravings. The more nutrients you put in, the less your body’s going to be seeking food essentially. And so it’s going to diminish your cravings. Because when you meet the needs of the cells, your cravings decline. It’s really that simple. And then the second piece is that we reduce a lot of the toxins that are on the processed foods, like the glyphosate and others that hurt our… That’s number one, is real food. We’re basically molecularly made from food. We got to get it right. The second one, I think is more that is so key and so easy and free is actually just moving more throughout the day. I had such an awakening while writing this book that actually, part of the problem with why we’re not getting where we want to get in our health is because we are so obsessed with this concept of exercise.

(00:26:30):

And I think in a way, it’s actually hurting us, but stick with me. I know that sounds crazy because exercise obviously-

Robert Lustig (00:26:36):

No, it doesn’t.

Casey Means (00:26:37):

It’s obviously amazing for us to get our heart rate up and to do resistance training, but this is the issue. Throughout all of human history, we didn’t have cars. We didn’t have bikes. We had to go grow our own food or find our own food. We were moving all the time just as part of the activities of daily living. And now we don’t have to do that. We can press a button and food is delivered to us. We do all our work at computers. Movement is no longer required for the fabric of everyday life, so we sit all day. We’ve taken movement out of the fabric of everyday life, and then we’ve told people that you can replace that with a one hour workout.

(00:27:13):

And the key thing that I think people really can benefit from is that those two things are biochemically different, exercising for an hour or moving throughout the day. When we’re moving a little bit here and there throughout the day. So after we all finish this call, getting up and walking for two minutes around our yard or around the block or around the house,-

Robert Lustig (00:27:32):

Walking the dog.

Casey Means (00:27:33):

… what that does… Yes, exactly. It pushes glucose channels to the cell membrane so that they can actually take sugar out of the bloodstream and be processed by the mitochondria. If you have someone who’s sitting all day and then exercising for an hour, they’ve kept those glucose channels inside their cells kind of hidden away for the whole day, not disposing of glucose. And then we get the benefits of the hour, but not for the other 23 hours.

(00:27:59):

So one of the easiest unlocks for the health that people are seeking, I think, is to just find ways to move more throughout the day. That could be a treadmill desk. There are now walking pads that are like $150 on Amazon. It could be making sure that you’re sending a timer every hour to get up and move for three minutes, do some air squats, do some pushups, but get those glucose channels to the cell membrane by contracting muscle more throughout the day. Find a way to build movement into the fabric of our daily lives, even if we are knowledge workers. That’s number two. That’s a really, really big one. And then think of each exercise type. We get confused sometimes. Should I do zone two? Should I do resistance training? Should I do HITT? What are these different things I should do? We need to think about each of them as how they are different signals for our mitochondria.

(00:28:46):

So resistance training, building more muscle muscle hypertrophy, we’re 3D printing new mitochondria, and we’re also disposing of glucose. HIIT training, high intensity interval training, we’re really stimulating autophagy, which is the recycling of mitochondria. And then walking, that’s about glucose disposal. So each one hits a different thing. And ideally we’d kind of do a little bit of everything, but we cannot avoid the need for our bodies to be in motion more throughout the day. So that’s one of the biggest take homes, I’d say to people, and especially after meals, of course, to clear glucose more effectively. And then the third one, I would say, because you asked for sort of top three, the third one’s a little more off the wall, and they’re all important, getting rid of the toxins in the home and all of that, it’s all in the book, but this is one that I think is so important. We’ve got to figure out our emotional health.

(00:29:36):

As westerners, we have lost the village. We’ve lost tribe. We’re very isolated. We’re sitting with our phones. We’re on our phones 10 to 13 hours a day. We’re indoors 93.5% of the day. So we’re kind of like these… We’re these animals, we are animals, locked inside these little cages by choice. We’re inside our homes and cars all the time. We’re staring at a little screen, which is a little digital terrorism device that’s just streaming [inaudible 00:30:07] and media to our eyeballs all day long when we’re in bed,-

Robert Lustig (00:30:11):

I’m going to start calling it that.

Casey Means (00:30:11):

… at the dinner table. Digital terrorism.

Robert Lustig (00:30:14):

Digital terrorism.

Casey Means (00:30:14):

That’s what it is. That’s what it is. And we’re allowing it. And then we live in this western culture that’s isolated, and we’re not around people. We’re not getting all the hugs we need. We’re alone a lot. And we of course just went through lockdowns. Literally, we were home alone. And so we need to realize that this culture is not normal, and our bodies and our mitochondria, like you said, they’re not just the powerhouse of the cell. They do all sorts of other things. They’re the motherboard of the cell, and they’re constantly looking around to see, is the world safe? And if it’s not safe to divert energy towards defense, alarm, inflammation, essentially war. And so if we don’t examine that emotional health level of being this modern westerner in this digital world, our bodies will, as a default, believe the world is not safe and will channel tons of precious energetic resources towards defense.

(00:31:16):

We want to channel those resources towards thriving, building, repair, everything we want, hormone synthesis. So it is our job, unfortunately, because no one else is coming to save us in this, to manage our relationship with all these elements of fear that are essentially wired to keep us small, sick, dependent, addicted, and purchasing any possible product or service that could ameliorate our existential angst to make peace with those and find a way inside our bodies to create a sense of safety, because that is actually required to channel our energetic resources towards the life that we want. And right now, if we don’t manage that head on, we will probably default to a sense of biochemical disease in our body that is going to show up as metabolic dysfunction.

Robert Lustig (00:32:06):

You mentioned inflammation being one of the primary drivers of disease. You’re very familiar with Bob Naviaux’s work at UC San Diego, showing that when your mitochondria dysfunctional, you end up with a whole lot of extracellular ATP, which then drives that inflammatory process. So basically keeping your mitochondria tiptop shape, fresh so that they’re not senescent, and as you said, mitophagy, that is chewing them up and spitting out the ones is extraordinarily important. So, absolutely. So everybody, get on your mitochondria, start talking to them sternly and getting them to straighten up and fly right. Now, let’s turn to medicine that’s broken. Okay, three minutes. What can we do about broken medicine? You left it. I didn’t, but I should have. So how do we get doctors to understand what the real problem is and how to solve it? What is in your zeitgeist there?

Casey Means (00:33:19):

I think that there’s a spiritual crisis amongst doctors right now. I think doctors are very depleted from what I’ve seen. And I think it’s because we are working so hard and it’s good people trying to help, but we’re in a bad system that profits off illness and makes more money when we’re sick. And so you get these amazing bright minds in a great system who a huge system that on every level practices reactive sick care, and you get so far down this road and realize, “Oh my God, I’m not actually doing the type of medicine I wanted to, but you’re so far in and so in debt that it’s very hard to change. Depression and burnout in doctors is off the charts, and I think it’s part because they feel trapped in a system that is not really working. And so I think step one is naming it and sharing this information, because honestly, if any doctor even in the system can really understand networking systems, biology, metabolic health, the root cause of diseases, they can offer so much more to their patient.

(00:34:21):

They could even have a handout in their office to just say, “Hey, here’s some metabolic health principles. Try this out,” and just start to incorporate more of this true healing into their practice. So on the individual doctor level, I think it’s a lot about education and naming some of these issues that we kind of all know are there but don’t know what to do about. I think at the bigger level, this is going to be policy. We’re going to have to change from the top down, which we can certainly talk about a little bit.

Robert Lustig (00:34:50):

Something I learned from my colleague Jordan Shlain, whom you know, is sometimes you have to rebrand. Like for instance, we rebranded type two diabetes as processed food disease because that’s a teaching moment that actually tells people, oh, you got processed food disease. That’s a whole lot different than saying type two diabetes. Maybe what we need to do is rebrand healthcare as sick care, because what it is. And then doctors will say, well, wait a second, I’m just practicing sick care. How do I practice healthcare? And then have them realize that there’s actually a whole nother discipline that they never really learned that they ought to and that they actually like to learn in order to able to improve their understanding of what their role in society really is.

Casey Means (00:35:47):

Yeah, I do think we need that rebranding. And I feel for doctors, I have compassion for doctors because every element of the way we’re educated, the way research is pursued, the way doctors are even reimbursed on the institutional level, all pushes us to essentially wait for disease to emerge and then play whack-a-mole medicine with the different symptoms. And that really doesn’t feel good as a doctor. And so I think helping give people a different toolbox and actually helping them realize it’s not that complicated. You can reverse diabetes in your patients. You can in some cases reverse heart disease in your patients. And that is very inspiring to doctors who feel like, I think they have very little tools in their tool belt to really help people thrive.

Robert Lustig (00:36:34):

To me, we have to incentivize it. The way I see doing it is, why don’t we pay doctors for keeping their patients well? And when they don’t do well, when the patients get sick, penalize them?

Casey Means (00:36:46):

Well fundamentally, that is-

Robert Lustig (00:36:48):

Raise their salaries, raise their salaries, and have a penalty system as opposed to an incentive to do more.

Casey Means (00:36:56):

That is what I think was attempted with Obamacare and the Affordable Care Act. There was a movement towards value-based care. And in many ways, it sounds great. Instead of paying for services, i.e. the more you do to a patient, the more times you see them, the more you get paid, it would switch it to we’re going to pay for value. And the value equation is outcomes over cost. So we want the best outcomes for the lowest cost, which, of course, that would be basically eating healthy and encouraging people to exercise because a heart surgery could be hundreds of thousands of dollars. And so that sounds great. Unfortunately, because of the rampant conflict of interests in our healthcare system and between our food system, healthcare system, and government, what happened was that great effort got co-opted by pharma. And so the way that doctors would essentially get to be paid more in that system is by reporting on quality metrics. But the quality metrics ended up being astonishingly, essentially how many of their patients were on long-term medication. So here’s an example just to drive home the point you have a patient with-

Robert Lustig (00:38:04):

Like hypertension.

Casey Means (00:38:05):

Yeah, let say you have a patient with hypertension or asthma, I remember asthma ones were very poignant. I would think that a good outcome would be a patient that reversed their asthma and no longer has asthma. But in the value-based care system that was put forward, the good outcome was a patient on long-term control inhaler medication. So not a patient who reversed their asthma, but a patient who is well medicated. So because of that, you take a value-based care system, and then you actually funnel it essentially just towards more sick care. And so we’ve got to think very deeply about these systems issues, because they can get corrupted. And fundamentally, when I talk to doctors, investors, venture capitalists, anyone who I can get in front of, I always say we need to be very clear on what a good outcome is with our company’s investments, our practice. It is a cell that is working better.

(00:39:02):

It is a cell that is fundamentally more functional. If the intervention or investment or company or whatever is not actually leading to a cell that’s functioning better, you should not focus on it. And so that just needs to be a very clear paradigm for people. So an example of this would be we can say it’s great to create companies around making it more efficient for doctors to see more patients. And in a sense, maybe there’s some good aspect to that, but is that actually leading to healthier cells if it’s more doctors practicing in the same broken model? No. Versus something like Levels, for instance, which the more people who use Levels, the more healthier cells we are going to have in people. So I think it’s very black and white, but I think it gets muddied a lot of the time.

Robert Lustig (00:39:53):

Indeed. And of course, this is why your brother, Calley, who is your co-author, started his company called TruMed for just this exact same reason.

Casey Means (00:40:01):

Exactly.

Robert Lustig (00:40:02):

So I couldn’t agree more. Ultimately, healthcare is the goal, and sick care is what we need to deep six.

Casey Means (00:40:12):

Right. Yes.

Robert Lustig (00:40:13):

I couldn’t agree more. And then finally, this political system that’s broken. You and I engaged in a new sport last week, scrumming with congressman. You spoke at the Republican National Committee at the Capitol Hill Club, and I spoke testifying to the AG subcommittee, the appropriations committee, about getting soda off the food stamps. I think we both had our, shall we say, our moment of epiphany about what’s wrong with the political system. So what can understanding mitochondria do to help congressmen and/or governors and/or presidents and/or dictators actually help to fix the problem going forward? What do we need to do to impress upon the people who actually make policy?

Casey Means (00:41:14):

Yeah. So what Kelly and I have thought a lot about, and you as well, and Mark Hyman and several others, is what are the policy opportunities that would actually trickle down into healthier mitochondria? Because we can talk about the high level philosophy of this all day, but unless it’s a specific policy recommendation, it’s impossible for people to make change, really. And so there’s three buckets that I believe are very important to think about policy wise. There’s regulation around conflict of interests. There’s a lot around food policy. And then the third piece is actually how we regulate ads and control of media. So just to briefly touch on each of those, conflicts of interests are institutionally legal, essentially in our country. We allow for 95% of the people on the USDA panel to create the food guidelines for America, to have conflicts of interest with food companies.

(00:42:10):

So the people writing the actual guidelines that go into school lunches and that go into what’s covered by SNAP, they have conflicts of interest, almost a hundred percent of them. That’s not good. That’s not right, because then, of course, it’s not just pure science or nutrition that’s going into the guidelines. There’s also financial interest. So things like that. NIH, A huge portion of their budget comes from pharma and food industry. And so even though it’s a taxpayer funded organization that should have exclusively the best interest of American health in mind, there’s also interest from industry. So those types of things need to be unpacked and more closely monitored, or even reported.

Robert Lustig (00:42:50):

My own clinical vignette, in 2008, I stood for candidacy for the dietary guidelines advisory committee, and I spoke to the head of the advisory committee who was a friend, Janet King, who’s at Children’s Oakland across the bay. And I said, “Should I do this?” And she said, “Oh, Rob, you’d be the perfect person. Number one, you’re a pediatrician. Number two, you do both research and clinical medicine. Number three, you know everything there is to know about physiology. Number four, no one’s going to push you around. No one would be a better fit for this committee.” I said, “Fantastic, are you going to stand for candidacy again? because she had been the chair. She said, “Absolutely not.” And I said, “Come again. Pardon me?” She says, “I’m sick and I’m tired. We published a 480 page document about what was wrong with the food supply, and we gave it to the USDA. When it finally came out, it was only 80 pages, and everything we wrote about sugar and fiber had been basically removed from it.”

(00:44:01):

And I said, “How can that be? Don’t you have any recourse?” And she said, “We’re an advisory committee. We have no teeth.” And by the way, I was not appointed for all of those reasons.

Casey Means (00:44:15):

Wow.

Robert Lustig (00:44:16):

In fact, because I didn’t have conflict of interest, that’s why I wasn’t on the committee. What’s wrong?

Casey Means (00:44:26):

That is wild. You are the exact person who should be on those committees. It’s troubling. Yeah. And it’s big money.

Robert Lustig (00:44:35):

Oh, I hear you.

Casey Means (00:44:36):

There’s so much money to be had here. You were talking about snap. That’s what you were at Congress last week talking about. I think people don’t really realize that right now, 10% of all food stamps are going towards soda, and soda is essentially diabetes water. It has no nutritional value, and it’s keeping people addicted and sick, especially minorities in the poor. So right now, there is literally 10% of SNAP billions of dollars is a direct funneling from taxpayer dollars to Coca-Cola and PepsiCo. That’s not great. So that’s something that could easily be adjusted. We have the USDA school lunch program, which serves 3 billion meals per year in the United States. You’re on the board of Eat Real, an organization doing amazing work with reforming school lunches. These school lunches don’t even follow the USDA’s guidelines for what should be in them. They have astronomically more sugar, saturated fat, all sorts of things in them than they should.

(00:45:32):

And if you’ve seen pictures of school lunches, many of them are… It virtually looks inedible, and this is not helping the brains and bodies of children thrive. That could easily be reformed. We’ve got the farm bills, which are billions of dollars each year going towards commodity crops, which are largely turned into processed food or feed for conventionally raised animals, none of which is good for health. And so we could redistribute some of that farm bill spending towards what we call specialty crops, which are essentially fruits, vegetables, and other foods that keep us healthy, which are right now, a minority of farm bill spending. And then the last one I would mention is that right now, because of our farm bill spending the most unhealthy food is the cheapest because it’s subsidized. We’re subsidizing-

Robert Lustig (00:46:16):

Absolutely.

Casey Means (00:46:16):

… ingredients for processed food manufacturers. So what companies like TruMed, My Brother’s company, is doing is actually allowing for us to use HSA and FSA funding, so the thousands of dollars we might put into HSA and FSA accounts, to actually be able to buy tax-free, healthier products, like healthy foods and exercise products. And the tax code actually allows for that right now. We can buy all our healthy food pre-tax and save a lot on it. However, it requires a letter of medical necessity from a doctor to state that this is a decision and a purchase to help prevent or reverse disease, which of course, healthy food does do that. But no doctors, I did not learn this. I imagine you did not learn this. No doctors learn that they can literally write a prescription for any patient to buy healthy food tax free, and that would be huge. So those are four things like basically expanding HSA and FSA funding for healthy products tax free, farm bills, SNAP, school lunch reform. That would totally change basically the ease with which people could get cheaper healthy products.

Robert Lustig (00:47:28):

To me, it’s about getting rid of the subsidies because the subsidies are what distort the market. So people say, well, if you got rid of the subsidies, the price of food would go up. Actually, the Giannini Foundation at UC Berkeley did this exercise several years ago. They asked the question, what would the price of food look like if we got rid of all food subsidies? You have to get rid of all of them in order to make that work. If you did that, the price of food would not change, except for two items, corn and sugar, which would go up. And that’s what we would want to go up, because if that goes up, that reduces effective availability, thus reducing health harms. So to me, it starts with the subsidies. And until we fix the subsidies, I don’t see the food pathway being a rational one. So that’s where we have to work on Congressman.

Casey Means (00:48:23):

Absolutely. And those are four specific policy things. The last one that I find really interesting is regulating ad spend for media basically. So right now, 60 to 75% of all ad spending for the TV that we’re all watching is from pharmaceutical industries. And so I think what people sometimes forget is that we get to see the TV for free, right? We’re not the customer. We’re not paying to watch that news program. A company is paying to have ad spots on the news program. So the customer is the pharmaceutical company. So therefore, because we are not actually the customer, we’re getting it for free, the media, in many ways, to appease its customer, which is the ad spend, which is the pharmaceutical industry, the news is filtered through an interest that benefits off people being sick. So you look at a situation like COVID where there was no information on mainstream media about how to improve your own immune system through exercise and through healthy eating and through vitamin D, and virtually not a minute on those topics.

(00:49:33):

It was all about pharmaceutical interventions, which of course have their place, but I don’t think we realize how much the actual information that we are getting can be distorted by the fact that we have unregulated ad spend for mainstream media, which almost no other country in the world, in the world allows for that, except for, I believe it’s the US and New Zealand. It’s crazy.

Robert Lustig (00:49:55):

The easy way for the audience to understand this is when we grew up, we would be able to sing the jingles of the processed food companies. And today, the kids are singing the jingles of big pharma.

Casey Means (00:50:06):

That’s right.

Robert Lustig (00:50:07):

It’s pretty bizarre when you think about it. It’s crazy. Well, let’s use the last 15 minutes to answer some questions from our audience. These are the most severe of levels users because they’re tuned into this online the middle of the day. Good for all of you, and we’re happy you’re here. Okay.

Casey Means (00:50:31):

Yes.

Robert Lustig (00:50:32):

Sally says, “I’ve nearly eliminated carbs, but I’m hesitant to do so for my growing 8-year-old. How should we think about children’s nutritional needs through the lens of functional medicine and good energy?”

Casey Means (00:50:45):

Ooh, this is a great question. I’ll give a few thoughts, and then I’d love to hear your thoughts, Rob. So the way I think about it, again, is ultimately we’re trying to create healthy cells in kids and all of us, and healthy mitochondria. And that does not mean that they do not see carbohydrates at all that does. Healthy body can absolutely process carbohydrates. We’re trying to build mitochondrial capacity. And so I think that what I would say is that kids do not need any ultra processed foods. They’re of no benefit to their cells, and they will overwhelm their little bodies. This is the liquid fructose, the added sugars, the ultra processed, refined white flour, different than whole grains, the white flour and these industrial seed oils that are just doing nothing to really help that growing body thrive. So we need to really separate out ultra processed carbs from natural carbohydrates, from fruit and sweet potatoes and potatoes and all those things.

(00:51:40):

A healthy body that has capacity to process energy can absolutely tolerate those carbohydrates and can get lots of healthful benefits from those foods, the polyphenols, the antioxidants. What the body really cannot process well is those ultra processed carbohydrates. So it’s about really trying to avoid and eliminate the ultra processed foods. And I would say be very comfortable with a normal amount of complex whole food carbohydrates, and then thinking about all the other levers that we can pull to improve the capacity of that body to process carbohydrates, which is good circadian rhythm, getting the children outside to see the sunlight during the day so their circadian rhythms are working properly, really good, high quality sleep, getting off the devices at night, making sure that we’re moving a lot throughout the day and not just sitting all day at little desks, and making sure that the emotional health is good and all of those things because all of that helps process those carbohydrates that you’re putting in the body by increasing mitochondrial capacity.

(00:52:41):

So long story short, eliminate the ultra processed foods. Carbs are absolutely fine when they’re in the whole food form. What do you think, Rob?

Robert Lustig (00:52:49):

So the way I would phrase it is the following, glucose is good and fructose is bad. And why is glucose good? Because glucose stimulates two enzymes that are necessary for normal mitochondrial function. It stimulates AMP kinase, which is the fuel gauge on the liver cell. It’s also the enzyme that directs the production of new mitochondria. It is the driver of mitochondrial biogenesis. So activating AMP kinase is a good thing. And the other thing it does is it activates an enzyme called HADH, hydroxyacyl-CoA dehydrogenase, which is necessary to cleave two carbon fragments and be able to burn them in mitochondria. So for lack of a better word, we can call glucose good. Fructose, on the other hand, inhibits three separate enzymes. It inhibits AMP kinase. It actually stops mitochondria from being generated, and it stops mitochondria from working. It inhibits ACADL, acyl-CoA dehydrogenase long-chain, which is necessary for generating those two carbon fragments, and it also inhibits CCPT1, carnitine palmitoyltransferase one, which is necessary to regenerate carnitine, which is the shuttle mechanism to get fats into the mitochondria for burning. In other words, fructose inhibits mitochondrial function.

(00:54:11):

If the goal is to make good, solid, happy, functional, productive, and tip top mitochondria, the glucose is not the problem. The fructose is. And when you are talking about ultra processed food, you are talking about sugar, because 73% of the items in the American grocery store have been spiked with added sugar, nevermind carbohydrate, added sugar very specifically for the food industry’s purposes, not for yours, because they know when they add it, you buy more. In other words, everything you said about ultra processed food is correct. That’s right. But it’s very specifically because of its effects on mitochondria. So that’s how I would say it.

Casey Means (00:55:04):

Yeah. And I’m sure people will be thinking, okay, well fruit has fructose, but for those who hopefully have read Metabolical, my favorite book right here on my bookshelf, when the fructose is-

Robert Lustig (00:55:20):

Well, here’s my favorite book.

Casey Means (00:55:20):

When the fructose is packaged with the fiber, which is what it’s going to be in the whole food form, it changes everything, right?

Robert Lustig (00:55:27):

Right.

Casey Means (00:55:28):

You can have a moderate amount of fruit sugar because it has the fiber around it and all those protective chemical. Is that right?

Robert Lustig (00:55:37):

When you consume your sugar with fiber, that’s called real fruit, not fruit juice, but real fruit, the fiber overwhelms the sugar, and ultimately the fiber makes that sugar food for the bacteria, not food for you. That’s the way to think of it. Basically, you have a partitioning system in your gut. Okay? Your gut is designed to partition part of the food to go to you, part of the food to go to your bacteria. That’s when you eat real food. When you eat ultra processed food, that partitioning breaks down, and now all of it goes to you and very little of it goes to your bacteria. And what have to do is you have to protect your liver and feed your gut. Well, the thing that protects your liver and feeds your gut at the same time is the fiber. The fiber is the good part of the fruit. The juice is the bad part of the fruit. The juice is nature’s way of getting you to eat your fiber. So fiber is good. Fiber actually helps mitochondria.

Casey Means (00:56:47):

Yeah.

Robert Lustig (00:56:48):

That’s how I would phrase it.

Casey Means (00:56:50):

Yeah, I’m sprinkling fiber on everything all the time. I’m sure many Levels members are too, because it’s kind of… But chia seeds, basil seeds, hemp seeds, flax seeds, lentils. I love beans.

Robert Lustig (00:57:02):

Full disclosure, I am the chief medical officer of a fiber company called Biolumen. And so people want to know about it, but they also want to know, “Well, why are you so fiber centric?” and I have to at least acknowledge my conflict. So that’s my disclosure, people. Okay? It is what it is. All right, here’s another question, and we’re going to end up having to wrap up pretty soon. Should glucose spikes be avoided as much as is humanly possible? And if so, how can that occur without eating five or more tiny meals per day? So this is more a levels question than a good energy question, but it does relate. And obviously, what’s the data to say that getting your glucose spikes down actually makes a difference?

Casey Means (00:58:00):

Yeah, I would say that I don’t think anyone should ever worry about a single glucose spike because our body knows how to handle it. And I think that the key thing to realize is we’re thinking about trends here and what we can learn from the glucose spikes. So from a biologic level, repeated glucose spikes, which we call glycemic variability, high glycemic variability, up, down, up, down, up, down, up, down, that’s not good for the body. We know that that is basically keeping your 24 hour glucose exposure in the bloodstream quite high. Sugar can then stick to things. It can cause what’s called endothelial dysfunction, which is the blood vessel linings being problematic. It can generate oxidative stress. So we don’t want to confuse a single glucose spike for what that looks like happening over and over and over again every day, every day of the week, every week of the year for years at a time. That’s two different situations.

(00:58:56):

But to avoid glycemic variability, we can often unpack what’s causing an individual glucose spike and learn from that, so we can create habits and trends that avoid this happening over the long term. So don’t fear a single glucose spike, but try to learn from a glucose spike so that we can avoid that long-term variability. So for instance, let’s say you do have a blood sugar spike to 150, 160, 170, pretty high for someone with normal insulin sensitivity. That might be because you had a very high carbohydrate meal, a bunch of fruit with no protein and no fiber and no fat, to kind of blunt that spike, and you ate it very, very quickly, and you were sitting down and didn’t move before or after. Well, from that, we can say, huh, I wonder if I added some fiber to that fruit that I had, it would lower the spike, or if I walked after it, or if I resistance trained that morning, or if I got a better night of sleep the night before?

(00:59:50):

All of that might modulate. Then we can take those learnings to help prevent the long-term glycemic variability over time. Yeah, so I would never want someone to think, oh my God, I’ve hurt myself. I had one glucose spike. I will say, while it’s not going to damage your body from a true biologic level, a single spike, at all, it’s the trends that we care about, some people do find that they feel crummy after a single glucose spike. So this is more of the subjective feeling, because after a big spike, you might have a crash because your body soaks up all that glucose and you overshoot, and that’s called postprandial hypoglycemia. And that’s essentially the body going below its baseline, and then us having this subjective experience, essentially pushing the body to try and get it back up to normal, because hypoglycemia is also a fear signal for the body.

(01:00:41):

And so this will be when people feel intense cravings for carbohydrates, when they feel fatigued, when they feel jittery, things like that. That’s that post-meal crash, maybe needing to take a little nap or have a frappuccino or something like that. So we’re not avoiding individual spikes because those are the problem for our long-term health. We’re avoiding them in order to not have them happen regularly and to make our days just generally feel better. I feel better if I’m not having big swings, even if it’s just one or two per day. So that’s how I’d kind of think about it. But certainly don’t stress about an individual spike.

Robert Lustig (01:01:17):

Right. Ultimately, the reason we have spikes is because we have a varied diet. If we didn’t have a varied diet, we wouldn’t have those spikes. So the spikes in and of themselves are not the big problem. But having said that, the spikes, by raising the blood glucose, do change endothelial cell function. Endothelium one is released, which can then alter blood pressure, and also, as you said, it raises insulin. And sometimes that insulin does not clear as quickly as the glucose and you end up with this reactive hypoglycemia, making you irritable and making you hungry, and so you end up eating more. So even more reason to be monitoring your blood glucose. And someday, hopefully soon, you’ll be able to monitor your blood insulin too. And don’t think that levels isn’t interested in this. We are. So having said that, there’s a long way to go before we get to, shall we say the perfect monitoring paradigm for everyone.

(01:02:26):

But in the meantime we have glucose, and glucose is good. Knowing what’s going on with your glucose is good. And of course, that’s why I’m an advisor to Levels. That is why, Casey, you were the chief medical officer of Levels and are now have dropped back to be an advisor like me as well. Okay? And of course, we are big, big fans of Levels, and it is a truly remarkable company, as hopefully all of the audience has already found out. What I would say is that this book, Good Energy, is a masterpiece. And it is a masterpiece at two levels. It’s a masterpiece of being able to relate science to individual health and to societal health, and it is a masterpiece of writing in terms of explaining the passion that you have for this field, for what’s going on in society and why everyone should basically rethink their lives. It is a true tour de force, and I am so proud of you and I am so happy that you wrote this. I’m so happy to have been even a very small part of it.

Casey Means (01:03:48):

My God, a huge part. You’re my hero, Tob. I am so appreciative of you and of everything you’ve ever said or written. It’s had such a profound impact on my life, and I know everyone listening. And thank you so much for this conversation.