How insulin resistance effects the whole body | Casey Means, MD

In this episode of the Lindsey Elmore Show, Dr. Casey Means dives into the causes, signs, and solutions of metabolic dysfunction. It’s increasingly clear that modern habits are not serving humans well. To break the cycle of fatigue, weight gain, and chronic illness, you have to take steps to get off the glucose rollercoaster.

The definition of metabolism

In its simplest form, metabolism works by turning the food we eat into energy.

Metabolism is the set of processes in the body that convert food to energy. That’s really what metabolism is. We eat about literally a metric ton of food per year. It’s crazy. And all of that, the purpose of that is to be converted to energy, and to be used as a building block in our body, and to be used as a chemical messenger system to tell ourselves what to do. But that energy piece is what metabolism is. We convert that substrate to a form of energy that our cells can use.

Modern living is not normal

The lifestyle and diet we take for granted is drastically different than our bodies were designed for.

What’s happening is that our modern life, our industrialized chemical food that we’re eating, the chronic low grade stress that we’re under, the chronic low grade sleep deprivation that we’re getting, the sedentary behavior that is just so normal and in our everyday lives, that was so abnormal about 100 years ago. The 150 pounds of refined sugar the average American is eating versus about 100 years ago was one pound. So 150 times the amount of sugar. All these things about modern living are not normal, and they’re totally breaking our metabolic processes. They’re getting hijacked by this way of living. And we are no longer efficiently producing energy from food. That’s fundamentally what metabolic dysfunction is.

Metabolic dysfunction is like a tree

Most medical providers picture medical issues as an individual issue, or “tree.” In reality, most issues are branches off of the main tree of metabolic dysfunction.

I think about metabolic dysfunction as the trunk of the tree of all these branches that are actually quite connected. And metabolic health being the trunk of the tree of really just feeling well kind of all over. Unfortunately, our healthcare system as I know you know does not see that tree. It does not see a tree with a trunk that is the same thing with all these things branching from it. It sees them all as separate trees. Like erectile dysfunction is one tree, and depression is another tree, and dementia is another tree, and heart disease is another tree, and we have to treat them separately. But that’s not actually really the way it works. Fundamentally, they’re all linked by this core process that is totally hijacked by our modern diet and lifestyles, which is not normal. It’s totally new. And we really have to get back to dialing in those dietary and lifestyle habits if we want to really create a healthy tree.

The two main sources of energy

Our bodies are fueled by glucose and ATP. Proper metabolism allows us to flip back and forth between the two.

So there’s really two main sources of energy that we can use in the body to fuel the cells like we were just talking about. There’s glucose, which can be converted through processes in the cell to what’s called ATP, which is a currency of energy that we can use in the cells. So glucose is primary form of energy. But the other one we can use as fat, and fat can be converted to energy as well. So metabolic flexibility means that we’re able to use glucose when it’s available. And when there’s not a lot of glucose available, we can tap into our fat stores and use those for energy. And that’s metabolic flexibility. You can flip flop back and forth. But the thing is, is that when glucose is elevated in the body because of what we’re eating, then the body signals to not use fat. It says, “Okay, we have enough of this really quick, easy-to-use energy in the body with glucose. So we don’t need to use that fat.”

The benefit of fasting

Our bodies need time to churn through the glucose we’ve already stored. Instead of reaching for low-fat snacks, try waiting a few extra hours until your next meal.

Eat low fat. Low fat is good. This is what the ’90s is all about, right? It was low fat and eat six meals a day. Essentially the opposite of what you need to do for fat burning. Because every time you’re eating one of those low fat, therefore likely high carb snacks, you’re getting a spike in glucose, you’re getting a spike in insulin. So basically all throughout the day, you’re putting that break on that fat burning. Really, the way that we can get into that fat burning is when we limit our exogenous glucose. So that’s things like intermittent fasting. Or when you stop eating at 5:00 PM and then you don’t eat the next day till 10:00 AM, your body’s churning through a lot to that stored glucose in the body and having to actually flip the metabolic switch into fat burning. And that’s what we want. We want to give the body the opportunity to work those muscles.

Signs of metabolic dysfunction

If you often find yourself tired, hangry, or struggling to lose weight, you may be experiencing metabolic issues.

So it’s these daily pain point symptoms like hanger, really being hungry in between meals, some fatigue in between meals, kind of being tired, refractory weight loss. Those are some of the things I would really highlight to answer your question. And then some of these really educating yourself about whether conditions you have like erectile dysfunction, infertility depression, whether there might be a link, and actually digging deeper. So that’s some of the things I would talk about subjectively. And then there’s of course lab tests that can kind of pick up on this. Even if you don’t have a continuous glucose monitor, one thing I would definitely recommend to people is look at your cholesterol panel a little bit more deeply.

Get off the glucose rollercoaster

To make a change for the better, begin by cutting refined sugar and carbs from your diet.

One of the lowest hanging fruits that you can do is keep your blood sugar more stable for more of the day, and just get off the glucose rollercoaster. So obviously, simplest thing to do, cut out refined sugars and refined carbohydrates. Lowest hanging fruit, just get rid of them. We don’t need a single gram of refined carbohydrates or refined sugar in our diet. So that is number one. And then you can dial into it a little bit more deeply. For instance, if you do have a little finger stick glucometer or continuous glucose monitor, you can start to understand how other foods that may not be refined carbohydrates or refined sugars are affecting your glucose. Because lots of them can still put you on the glucose roller coaster.

Determine your trigger foods with a CGM

Some foods seem safe and healthy, but adversely impact our bodies. Only a CGM like Levels can help determine which foods those are.

For me personally that I’ve learned, grapes, sweet potatoes by themselves, oatmeal, pretty much most grains. White rice, quinoa just put me way up. Way above the levels that were really ever supposed to be as people without diabetes. The International Diabetes Federation recommends not going above a glucose of 140 after meals. All the foods I just mentioned are putting me well, well above 140. So learning that helps me really tailor my diet. I mean, I might not know that. And it’s not actually like I’m having to deprive myself. I just eat something different. I just don’t eat grapes. And instead, I eat raspberries. Or instead of quinoa, I’ll eat cauliflower rice or broccoli rice.

Other factors that impact glucose

In addition to diet, sleep, stress, and exercise have a major effect on our glucose levels.

We also know that sleep, stress, and exercise have a huge impact on glucose control. When we don’t sleep enough, we will spike higher generally from the same food. If we on Monday eat a food and it causes us to have whatever glucose spike and then get five hours of sleep that night, that food is likely to cause a bigger glucose spike the next day. Because that sleep deprivation has just a massive impact on our hormones and all sorts of processes that make us essentially not respond to glucose properly. Same thing with stress. If we eat something when we’re having very little stress and then eat it under a stressful situation, like you just had a stressful call with a family member or you just heard some really bad news, very possible that we actually respond more to that food under the stressful situation. And then of course, exercise has a big impact.

Metabolic health is reversible

It used to be thought that your body could never fully recover from diabetes. Now, there is evidence that the damage from diabetes can in fact be reversed.

I think that it can be more challenging of course to turn the ship when things have really gone down the road a lot farther. But the really neat thing about metabolic health and metabolic processes is that you can always move in the right direction. Many people I think believe that diabetes is irreversible. And yet, we’re now seeing … and I’m seriously surprised it’s not on the front page of the New York Times. Diabetes is reversible in many people. Virta Health is a company that is really all about this. They are a diabetes reversal program. And they’ve shown in their research that in 10 weeks on a … they a focus on a low-carb ketogenic diet, which is one strategy that you can use. They focus very much on the dietary piece of this whole comprehensive stuff that we’ve been talking about. 10 weeks with low-carb ketogenic diet and coaching alone caused the reversal of diabetes in a large percentage of the people that they studied. I mean, that’s monumental. We thought these were just like once you have it, you’re going to have it for the rest of your life. That’s not necessarily true.

Lindsey Elmore: Welcome everybody to today’s episode of the Lindsey Elmore Show. Metabolic syndrome is a cluster of biological factors characterized by abdominal obesity, dyslipidemia, hypertension, and type 2 diabetes. When people have metabolic syndrome, there is an in increased risk of cardiovascular disease, arthritis, chronic kidney disease, schizophrenia, and several types of cancer, as well as early death. The connection between metabolic syndrome and an increased risk of illness has been described for many, many decades. The prevalence of obesity among U.S. adults has steadily increased since the 1990s and is now at epidemic proportions, with over two thirds of U.S. adults, either overweight or obese. Currently, the prevalence of type 2 diabetes and hypertension has also steadily increased, cumulating in substantial increases in the proportion of adults who meet the criteria for metabolic syndrome. Believe it or not, 88% of Americans have at least one marker of metabolic dysfunction. And no one is talking about how do we prevent everybody in the United States from having metabolic disease.

Lindsey Elmore: My guest today is Casey Means, a Stanford trained physician who is dedicated to helping people make better diet and lifestyle choices so that they don’t end up steadily walking a path towards diabetes over the course of 15 years. Instead, let’s prevent you from getting diabetes in the first place by working on our metabolic health, having personalized nutrition, and consciously crafting a stable blood glucose by assessing what foods are causing our blood sugars to be unstable. Let’s get to the show.

Lindsey Elmore: Welcome to the Lindsey Elmore Show, a podcast for people who deserve to be healthy. With honest, open, and enlightening conversations with doctors, thought leaders, creatives, and spiritual gurus, you’ll walk away with simple and tangible tips and tricks that allow you to live your healthiest life so you can pursue your dreams, overcome obstacles, and leave your mark.

Lindsey Elmore: Dr. Casey Means is a Stanford trained physician, chief medical officer, and co-founder of the metabolic health company LEVELS. And associate editor of the International Journal of Disease Reversal and Prevention. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tech enabled tools that can inform smart, personalized, and sustainable dietary and lifestyle choices. Dr. Means’ perspective has been recently featured in the New York Times, the Wall Street Journal, Men’s Health, Forbes, Business Insider, TechCrunch, Entrepreneur Magazine, The Hill, and many, many more. She has held past research positions at the National Institute of Health, the Stanford School of Medicine, and at New York University. Dr. Casey Means, welcome to the Lindsey Elmore Show.

Dr. Casey Means: It’s so great to see you, Lindsey, thank you for having me.

Lindsey Elmore: I think that it is a horrifying situation that we are in as Americans, as it relates to our metabolic state. We have so many people that are carrying around five extra pounds, 50 extra pounds, 150 extra pounds. We have people that are waking up every single day, not feeling like, they just can’t get going. They can’t get going. That thyroid hormone’s out of whack. The cortisol awakening response is out of whack. Melatonin secretion is out of whack. And cortisol is one of the things that can absolutely destroy our blood glucose relationship.

Lindsey Elmore: And the thing that I think is so saddening is that there are practical, tangible, easy to integrate into your daily life things that we can do that will stop the progression towards diabetes, because diabetes is the pinnacle. We interviewed Dr. Brian Mowll recently. And he’s like, “Look, diabetes is the pinnacle of metabolic dysfunction.” But there’s been years of metabolic dysfunction happening in our bodies well before diabetes manifest. So start us out by just simply describing what does it truly mean to be metabolically healthy?

Dr. Casey Means: Yeah. Well first of all, I think that was a great lead in. I mean, I think it is astronomical the level of metabolic dysfunction that we’re seeing in the Western world today, especially the United States. We’re dealing with 88%. Actually, this came out of your state at UNC. A study just about a year and a half ago showed that 88% of American adults have at least one biomarker of metabolic dysfunction. So we’re in the place now where it is almost inevitable as an American adult to have metabolic dysfunction.

Dr. Casey Means: And what that means, that term, it gets used a lot right now. But I think if you asked 10 people on the street what does metabolic dysfunction mean, they’d probably all say something different. It’s a little bit nebulous.

Dr. Casey Means: So I think breaking it down, what is it? Metabolism is the set of processes in the body that convert food to energy. That’s really what metabolism is. We eat about literally a metric ton of food per year. It’s crazy. And all of that, the purpose of that is to be converted to energy, and to be used as a building block in our body, and to be used as a chemical messenger system to tell ourselves what to do. But that energy piece is what metabolism is. We convert that substrate to a form of energy that our cells can use.

Dr. Casey Means: We have trillions of cells. Every single one needs energy to do the cellular processes to function. So our eye cells, they need energy to function. Our ovary cells, they need energy to function. Our brain cells need energy to function. They all need it.

Dr. Casey Means: And what’s happening is that our modern life, our industrialized chemical food that we’re eating, the chronic low grade stress that we’re under, the chronic low grade sleep deprivation that we’re getting, the sedentary behavior that is just so normal and in our everyday lives, that was so abnormal about 100 years ago. The 150 pounds of refined sugar the average American is eating versus about 100 years ago was one pound. So 150 times the amount of sugar. All these things about modern living are not normal, and they’re totally breaking our metabolic processes. They’re getting hijacked by this way of living. And we are no longer efficiently producing energy from food. That’s fundamentally what metabolic dysfunction is.

Dr. Casey Means: And the reason it can show up as so many different things, it’s like the great masquerader. It can look like almost anything. The reason that nine out of 10 of the leading causes of death in the United States are in some way related to blood sugar, either caused by the blood sugar problems or worsened by blood sugar problems, is because this is a core fundamental pathway that our modern lifestyle is just stomping on.

Dr. Casey Means: So what metabolic health means is that you are doing those processes efficiently. Your body is supported through everything you’re eating and the way you’re living in a way that our cellular machinery, our metabolic processes are just efficiently producing energy for ourselves without undue byproducts that are causing us harm. And our cells are able to live, and thrive, and do what they’re supposed to do normally.

Dr. Casey Means: When you have this sort of energy mismatch, this essentially what we would call metabolic dysfunction or ultimately insulin resistance, the downstream hormones are problematic. You get the cellular dysfunction, and then you get tissue dysfunction. And that’s what symptoms look like. So if this is showing up in the ovary, it could look like polycystic ovarian syndrome. If this is showing up in the brain, it could look like Alzheimer’s dementia. If it’s showing up in the liver, it looks like fatty liver disease. If it’s showing up in the vessels, it looks like heart disease, or erectile dysfunction, or retinopathy, all vessel diseases. If this is showing up in any organ essentially, it’s going to look like something different. All those conditions I just mentioned are fundamentally a metabolic disorder. PCOS, polycystic ovarian syndrome, insulin resistant of the ovaries. Number one cause of infertility in our country, fundamentally a metabolic disorder.

Dr. Casey Means: So you have to think I think about metabolic dysfunction as the trunk of the tree of all these branches that are actually quite connected. And metabolic health being the trunk of the tree of really just feeling well kind of all over. Unfortunately, our healthcare system as I know you know does not see that tree. It does not see a tree with a trunk that is the same thing with all these things branching from it. It sees them all as separate trees. Like erectile dysfunction is one tree, and depression is another tree, and dementia is another tree, and heart disease is another tree, and we have to treat them separately. But that’s not actually really the way it works. Fundamentally, they’re all linked by this core process that is totally hijacked by our modern diet and lifestyles, which is not normal. It’s totally new. And we really have to get back to dialing in those dietary and lifestyle habits if we want to really create a healthy tree.

Lindsey Elmore: Our listeners have heard it over, and over, and over again. There’s one root cause of basically every single problem that is out there. And the only way to nourish the tree is by the daily choices that we make. I think you are so correct that most people don’t know how to define metabolic disease. I have learned that as I’ve been preparing for this Metabolic Makeover Summit that I’m hosting in a few months. And you’d ask people, “Do you need help healing your metabolic disease?” And they’re like, “No.” And I’m like, “Okay, do you need to support your metabolism?” And they’re like, “Oh yeah, I definitely need to support metabolism.” It’s almost like our language around this metabolism means that I am healthy, and fit, and go to the gym. And I wear yoga pants. Whereas having small amounts of metabolic disease throughout the day every single day, it doesn’t click with people that that is what is really happening.

Lindsey Elmore: And I want to reiterate, the thing you just said is so brilliant, and I’ve never heard somebody say it this clearly. Metabolic dysfunction leads to cellular dysfunction, which leads to tissue dysfunction, which is where the symptoms manifest. Listeners, that is a sentence to take to heart. These small amounts of metabolic dysfunction are leading to small amounts of cellular dysfunction, which are eventually manifesting as Alzheimer’s disease, or PCOS, or diabetes, or whatever it is.

Lindsey Elmore: So let’s talk now about how do we know we’re broken? What are some signs that we have poor blood sugar control? Maybe I’m not wearing a continuous glucose monitor. Maybe I’m not checking my blood sugar several times a day. How do I know that I don’t have this metabolic flexibility that allows me to create stable blood sugars?

Dr. Casey Means: Yeah. So first of all, I think it’s … and I’m sure your listeners know this term, but just kind of define metabolic flexibility. So there’s really two main sources of energy that we can use in the body to fuel the cells like we were just talking about. There’s glucose, which can be converted through processes in the cell to what’s called ATP, which is a currency of energy that we can use in the cells. So glucose is primary form of energy. But the other one we can use as fat, and fat can be converted to energy as well. So metabolic flexibility means that we’re able to use glucose when it’s available. And when there’s not a lot of glucose available, we can tap into our fat stores and use those for energy. And that’s metabolic flexibility. You can flip flop back and forth.

Dr. Casey Means: But the thing is, is that when glucose is elevated in the body because of what we’re eating, then the body signals to not use fat. It says, “Okay, we have enough of this really quick, easy to use energy in the body with glucose. So we don’t need to use that fat.” And that’s done through a hormonal signal, which is that glucose elevates this hormone insulin, right? That insulin then blocks the fat burning. So you actually have to have a lower glucose state in the body to take the insulin that break off of fat burning to get into that.

Lindsey Elmore: That’s through adiponectin. We’ve been educating our audience about adiponectin recently. So that’s what the insulin is blocking is that adiponectin hormone being able to create free fatty acids out of triglycerides.

Dr. Casey Means: Right. Yeah. So fundamentally, we need to keep the glucose more stable if we want to get into that fat burning. And we know that metabolic flexibility is an optimal state for health. We want to be adaptable like that. Adaptability is usually a sign of health and longevity.

Dr. Casey Means: The average American though is almost never getting into that fat burning state. And the reason is because let’s think about what we’ve been told. Eat six small meals a day.

Lindsey Elmore: Can’t even.

Dr. Casey Means: Right, eat low fat. Low fat is good. This is what the ’90s is all about, right? It was low fat and eat six meals a day. Essentially the opposite of what you need to do for fat burning. Because every time you’re eating one of those low fat, therefore likely high carb snacks, you’re getting a spike in glucose, you’re getting a spike in insulin. So basically all throughout the day, you’re putting that break on that fat burning.

Dr. Casey Means: Really, the way that we can get into that fat burning is when we limit our exogenous glucose. So that’s things like intermittent fasting. Or when you stop eating at 5:00 PM and then you don’t eat the next day till 10:00 AM, your body’s churning through a lot to that stored glucose in the body and having to actually flip the metabolic switch into fat burning.

Dr. Casey Means: And that’s what we want. We want to give the body the opportunity to work those muscles. If you don’t work these pathways, they’re going to be inefficient. So you’re giving your body the opportunity through managing your blood sugar throughout your eating, or intermittent fasting, or exercising. You’re moving through that glucose you can flip into the fat burning. So that’s kind of the metabolic flexibility story.

Dr. Casey Means: And I think that to answer your question about what are some signs that you may not be metabolically flexible? Well, a big one has to do with this need, this craving to eat all the time. You go three hours without a meal. And you’re like, “When’s lunch? What’s the next meal? What’s the next snack?” That’s a sign, or I would also say hanger that you get kind of anxious and angry before a meal. You are sort of stressed when you don’t have easily readily accessible glucose. That could be a sign that your body is not really able to flip into fat burning. Because you should be able to just flip on that other switch and not get super hungry after three hours. But if your body is just totally dependent on this outside form of quick energy, you may be getting some of that.

Dr. Casey Means: Another thing would be if you’re eating and after your meals, you just feel completely wiped out, that sort of post meal crash, that can be a sign that you’re going on this glucose rollercoaster after a meal, and going way up with your glucose, releasing tons of insulin, and then crashing down. And often, what happens is we actually overshoot after the meal because we’ve released so much insulin to soak up all that glucose into the cell. And that reactive dip, it’s called reactive hypoglycemia. That can lead to some anxiety. It can make you feel fatigued and tired. It’s the post-meal crash. So if that’s happening a lot, that could be a sign that your diet is putting you on this rollercoaster that’s ultimately going to lead to metabolic problems.

Dr. Casey Means: I’d say a really obvious one is if you’re having trouble losing weight. Like we talked about with fat burning, ultimately to lose the weight, we need to tap into fat storing. So this just goes exactly back to the metabolic flexibility conversation. To lose weight, you need to be able to be metabolically flexible enough to tap into fat burning, to use those stores and burn through them. That means insulin low, glucose store is low. And this applies to 74% of our country. 74% of our country is overweight or obese right now. So that’s a big sign, right? That’s something, we could probably be optimizing our glucose country and our metabolic processes.

Dr. Casey Means: And then there’s of course the more conditions that we hear about that you may not realize are related to metabolism, but are. So that’s for the women out there who might be dealing with menstrual irregularity, polycystic ovarian syndrome, infertility. Their OB/GYN may have never told them. They may have said, “You need to be on oral contraceptives for regular periods.”

Lindsey Elmore: And here’s the Metformin.

Dr. Casey Means: Here’s Metformin for your PCOS, which news flash, Metformin is a diabetes medication, right? But they’re not saying to the person, “Hey, you have insulin resistance of the ovaries. So we need to keep insulin and glucose under control so your ovaries can basically perk up to insulin, not be insulin resistant. And we can hopefully heal this in part from within.” We know that over time when glucose spikes are happening day in and day out over and over again with the way we’re eating, and those insulin spikes are happening over and over again because of the way we’re eating, that makes ourselves numb to the signal of insulin. That’s insulin resistance. And then our body has to pump out more insulin to overcome that resistance. So now we have higher levels of insulin. You can imagine what that does for our weight loss efforts. But then if we’re thinking about something like PCOS, all that insulin, a side thing that insulin does is stimulate the ovaries to make testosterone, which is what causes ultimately a lot of these infertility issues and menstrual regularity.

Dr. Casey Means: So we got to take it back to basics. Yes, Metformin and insulin sensitizing medication can help. But what about shifting our diet so that we’re not promoting all this insulin? So conditions like that, but there’s many other things like subtle symptoms that people might be having that also can relate to this.

Dr. Casey Means: We know that actually, depression and anxiety are higher in people with metabolic dysfunction. It’s not the only cause of depression and anxiety, but it is a contributor. And that’s fairly well known. So if that’s something that you’re dealing with and it’s quite refractory, it might be worth looking into getting some of these more deeper blood tests done.

Dr. Casey Means: For men, erectile dysfunction. That is really a clear sign of metabolic dysfunction. What’s happening is that there’s not adequate blood flow to the penis. And we know that that is generally caused by vascular dysfunction from metabolic disease. So men who are in their forties starting to have issues, they should absolutely be getting a really full metabolic health check.

Dr. Casey Means: So it’s these daily pain point symptoms like hanger, really being hungry in between meals, some fatigue in between meals, kind of being tired, refractory weight loss. Those are some of the things I would really highlight to answer your question. And then some of these really educating yourself about whether conditions you have like erectile dysfunction, infertility depression, whether there might be a link, and actually digging deeper. So that’s some of the things I would talk about subjectively.

Dr. Casey Means: And then there’s of course lab tests that can kind of pick up on this. Even if you don’t have a continuous glucose monitor, one thing I would definitely recommend to people is look at your cholesterol panel a little bit more deeply. Most of us get that standard cholesterol panel with total cholesterol, HDL, triglycerides, LDL. And you can actually gain some insight into insulin resistance from that test by taking the total cholesterol to HDL ratio, or the triglycerides HDL ratio. And we can maybe link afterwards to some of the how to interpret those. But that can actually give you some insight into insulin resistance.

Dr. Casey Means: There are in my opinion some better tests that you can do, like a fasting insulin level. Of course, hemoglobin A1C is helpful, but I really like the fasting insulin. This is not something that your doctor is standardly going to order. Most doctors are not ordering a fasting insulin test. So that’s why I just mention the cholesterol panel. Learn how to interpret that to kind of get a clue about whether there’s insulin resistance going on.

Lindsey Elmore: Absolutely. And we can link to that in the show notes to how to better interpret the cholesterol. Because you mentioned the total cholesterol to HDL ratio. But another thing is looking actually at the particle size of your cholesterol. Because what we really want is all of our cholesterol to be hanging out together. It’s when we get these tiny, tiny little bits of cholesterol, just particles everywhere that it’s a sign that your metabolism is simply not working. So asking for cholesterol fractions is also a great way to really dive deep.

Lindsey Elmore: And you may have to find a functional medicine doc, or an integrative medicine doc, or a naturopath who really gets it. Because it’s such a shame. Physicians, pharmacists, nurses, we don’t get taught this in school. We don’t get taught these things. It’s LDL or bust.

Lindsey Elmore: And I so agree with what you said about erectile dysfunction as well. I heard a physician one time call it the canary in the cave. Because if the penis is not working, it is a clear and direct assessment of how effective your blood flow is throughout the body. And if your blood flow is bad there, guess what? It’s also bad to your brain. It’s bad to your heart. It’s bad every single place. So, okay. We’ll be right back after a word from our sponsors.

Lindsey Elmore: Metabolism is the process that your body uses to turn food into usable energy. Every single cell in your body requires energy, and a disruption and metabolic function can cause dysfunction throughout the entire body. Join me online for free between August 30th and September 5th for the Metabolic Makeover Summit. There, I will interview more than 30 industry leading experts about how we get to the root cause of metabolic disease, and how we transform it and heal it long term. Head to lindseyelmore.com/metabolicmakeover to sign up now. That’s lindseyelmore.com/metabolicmakeover to sign up for the Metabolic Makeover Summit happening free and online August 30th to September 5th. And now, let’s get back to the show.

Lindsey Elmore: I know some of our listeners are sitting here going, “I have cravings and infertility, and I’m carrying around 20 extra pounds. And I have done every diet under the sun.” How do we fix it? What do we do?

Dr. Casey Means: The key question, right? So I think first of all, there’s so many ways to approach this. It is so multifactorial, what goes into metabolic health and insulin health, or sorry, insulin sensitivity essentially. And we can go through a lot of that. I think one of the lowest hanging fruits that you can do is keep your blood sugar more stable for more of the day, and just get off the glucose rollercoaster. So obviously, simplest thing to do, cut out refined sugars and refined carbohydrates. Lowest hanging fruit, just get rid of them. We don’t need a single gram of refined carbohydrates or refined sugar in our diet. So that is number one. And then you can dial into it a little bit more deeply. For instance, if you do have a little finger stick glucometer or continuous glucose monitor, you can start to understand how other foods that may not be refined carbohydrates or refined sugars are affecting your glucose. Because lots of them can still put you on the glucose roller coaster.

Dr. Casey Means: Things like, we see this all the time. Oatmeal in our members at LEVELS just puts people through the roof, and people are eating it every single morning. I’ve gone up from a baseline of around 80 milligrams per deciliter of my glucose to 180 milligrams per deciliter with my glucose just with one cup of oatmeal. It’s amazing. So you might not ever know that. I mean, the box says heart healthy. And if I were trying to lose weight, there is no question that that would be significantly impairing my ability to lose weight, because I’m just going on a glucose, an insulin rocket ship, right? And just blocking fat burning probably for a lot of the day from that.

Dr. Casey Means: So other things for me personally that I’ve learned, grapes, sweet potatoes by themselves, oatmeal, pretty much most grains. White rice, quinoa just put me way up. Way above the levels that were really ever supposed to be as people without diabetes. The International Diabetes Federation recommends not going above a glucose of 140 after meals. All the foods I just mentioned are putting me well, well above 140. So learning that helps me really tailor my diet.

Dr. Casey Means: I mean, I might not know that. And it’s not actually like I’m having to deprive myself. I just eat something different. I just don’t eat grapes. And instead, I eat raspberries. Or instead of quinoa, I’ll eat cauliflower rice or broccoli rice. Instead of pasta, I’m have konjac root pasta, like new pasta it’s called, which gives me no glucose spike. Instead of corn, I’ll just choose a different vegetable that doesn’t spike my glucose. So it’s not like I’m having to cut all these things out or having to deprive myself. It’s just learning what works and what doesn’t work. So that’s where I think the monitoring can be helpful.

Dr. Casey Means: But I think there’s a lot of other things that are really worth mentioning too. We also know that sleep, stress, and exercise have a huge impact on glucose control. When we don’t sleep enough, we will spike higher generally from the same food. If we on Monday eat a food and it causes us to have whatever glucose spike and then get five hours of sleep that night, that food is likely to cause a bigger glucose spike the next day. Because that sleep deprivation has just a massive impact on our hormones and all sorts of processes that make us essentially not respond to glucose properly.

Dr. Casey Means: Same thing with stress. If we eat something when we’re having very little stress and then eat it under a stressful situation, like you just had a stressful call with a family member or you just heard some really bad news, very possible that we actually respond more to that food under the stressful situation. And then of course, exercise has a big impact.

Dr. Casey Means: Muscles are so incredible, because muscles are one of the only tissues in the body that can take up glucose without insulin. Just the contraction of muscles takes up glucose. It’s an insulin independent way of clearing glucose from your bloodstream. So even when you walk for three minutes, you’re activating all these muscles that are taking up glucose. So there’s been so much research to show that even walking after a meal for 20 minutes can have a big impact on your post-meal glucose levels.

Dr. Casey Means: I think a key point is it’s not just about doing an intense one hour workout a day, which is very helpful for insulin sensitivity and very good. It’s also about moving more frequently throughout the day. And there was this great study that looked at three different conditions. A group of people who exercised basically 20 minutes, three times a day. So 20 little chunks, and that added up to six minutes per day. And people either did that before meals, after meals. Or they walked for two minutes, 30 times throughout the day. So all of those three scenarios added up to 60 minutes. But the people who walked for two minutes, 30 times a day had lower glucose levels than the other groups. And my rationale for that is that you’re just more consistently activating those pathways all throughout the day.

Dr. Casey Means: So just set that timer on your phone for every 30 minutes to remind you, a little buzz that tells you to just walk for two minutes. So there’s a lot of those things that go into it.

Dr. Casey Means: So those are the biggest levers we have. Food, exercise, stress management, and good sleep. And then for the longer term metabolic health, really dialing it in for the long term, I would just mention three other things briefly. Which is micronutrients in the body, our microbiome, and our exposure to environmental toxins. Micronutrients are, this is different than fat, carb, and protein. This is selenium, and vitamin D, and manganese, and magnesium.

Lindsey Elmore: And chromium.

Dr. Casey Means: And chromium. These are these little teeny molecules in the body that act like locks and keys to these metabolic machines and actually help them be activated. And these come from eating diverse whole foods, plant foods, non-processed foods that often strip micronutrients. Shopping in the produce section and really focusing on whole foods. Those micronutrients are critical. And for a lot of people, especially patients I’ve had who say, “I’m doing everything and I can’t seem to lose the weight,” or whatever. We really have to think about food quality. What are you getting those micronutrients?

Dr. Casey Means: We know that if your B vitamins are low for instance or magnesium, that’s associated with worse metabolic health. The microbiome piece is worth mentioning too. Another thing that is often overlooked, our microbiome make key metabolic byproducts. So we have to feed them. We have to nurture them. And we feed them again with whole foods, with fiber, prebiotics, probiotics support the microbiome. Think about your microbiome as part of your weight loss or your metabolic health arsenal. But you have to tend to them every single day. And the last one was just environmental toxins.

Dr. Casey Means: We know that the chemicals found in plastics, and pesticides, and these artificial fragrances in our personal care products, these can be endocrine disruptors. They can actually screw up our cellular processes. So the more we can focus on clean food, clean personal care products, clean home care products, it actually makes a difference.

Dr. Casey Means: So that’s a lot. It’s a lot of things, but it’s actually really hopeful. Because if you’re feeling stuck, there’s always something more we can try that may be causing that block that you just might not be maybe dialed into or aware of. So really just to say there’s lots of different parts of our lives that we can turn those knobs, pull those levers to get as metabolically healthy as possible. And you don’t have to be perfect on all of it. It’s really about just doing the best we can to give our body the best shot to how these processes work properly.

Lindsey Elmore: I agree so wholeheartedly with what you just said, because it is multifactorial. You can’t expect to do just one thing and it work for everybody. The other thing that I loved about what you just said is the monitoring piece. Because we have been taught that diets are prescriptive. That you can just say eat these things. Somebody in my family calls me and says, “I’ve got prediabetes. They’re putting me in the pre-diabetes class.” And I was like, “You spend six weeks doing all of the things I tell you to do every day, and you could probably turn all of that around.”

Lindsey Elmore: And it’s so sad. Because when you go into diabetes education or go into pre-diabetes education, it’s all about here’s your plate. Here’s what your plate should look like. Put the foods on the plate. When it’s like well, I don’t know if a white potato is going to spike my blood sugar the same or a different amount as a sweet potato. So the nutritional advice really that I think we all need to be giving for every disease state, it has to be personal for you. You cannot just make one diet for every single person.

Lindsey Elmore: So we have talked a lot about how glucose monitoring can help us to stop the progression towards diabetes. What if we have a listener who is taking Metformin, is taking insulin, is taking Exenatide, is taking whatever combination of medicines that they are doing? Because oftentimes when people get on these medications, especially the statin drugs and all of the accompanying drugs that go into the treatment of diabetes, they often end up with very marked nutrient deficiencies that leave them sometimes feeling worse.

Lindsey Elmore: So if somebody is saying, “That’s great that you want to prevent me from getting diabetes, but I’m ready there. I’m already there.” Is it the same techniques that you would recommend? Or how can you take these techniques and kind of make them more aggressive for people who need that extra leg up?

Dr. Casey Means: Yeah, it’s a good question. I think fundamentally, all those things that we just talked about apply to anyone along the metabolic dysfunction spectrum. The exercise, the sleep, the stress, the micronutrients, the microbiome optimization, avoiding environmental toxins, focusing on a diet that doesn’t spike glucose. All of those things work for someone who’s 21, and a college athlete, and is trying to really dial in their performance. It also works for someone with late stage diabetes who’s on insulin. Because we’re talking about the exact same pathways.

Dr. Casey Means: With that said, I think that it can be more challenging of course to turn the ship when things have really gone down the road a lot farther. But the really neat thing about metabolic health and metabolic processes is that you can always move in the right direction. Many people I think believe that diabetes is irreversible. And yet, we’re now seeing … and I’m seriously surprised it’s not on the front page of the New York Times. Diabetes is reversible in many people. Virta Health is a company that is really all about this. They are a diabetes reversal program. And they’ve shown in their research that in 10 weeks on a … they a focus on a low-carb ketogenic diet, which is one strategy that you can use. They focus very much on the dietary piece of this whole comprehensive stuff that we’ve been talking about. 10 weeks with low-carb ketogenic diet and coaching alone caused the reversal of diabetes in a large percentage of the people that they studied. I mean, that’s monumental. We thought these were just like once you have it, you’re going to have it for the rest of your life. That’s not necessarily true.

Dr. Casey Means: So that’s just so hopeful that there is possibility here, even if you are fully in the metabolic dysfunction part of the spectrum. So you can always move along that spectrum in a positive direction. And I just think that’s really worth celebrating, that there’s a lot of hope there.

Dr. Casey Means: So I do highly recommend Virta. I think it’s a great program. I think they do a good job. I think continuous glucose monitoring can be very helpful. And I think for people who are really struggling, I do think going the functional medicine or integrative medicine route, finding a doctor who can really be a high-touch coach for you, order a lot of the really detailed lab testing that can sometimes unlock parts of the story that maybe really subtle in nuance, like a B vitamin deficiency or something like that. That I think is also a great strategy for people who can access that.

Dr. Casey Means: But there’s actually, that type of stuff is becoming more and more accessible now, too. There’s companies like Parsley Health, which are bringing functional medicine more to the mainstream in a lower cost way. It’s I believe $150 a month. And they’re giving access to that really deep sort of functional medicine approach. So those are some things I would probably recommend.

Dr. Casey Means: And then just also, I would say small thing, like doing it in community. Find support. It always is easier with support. So join groups, join forums. Get a team together to help with this. And I just think that that generally really helps with making the progress you want to make.

Lindsey Elmore: Also adding to that lab piece, find a practitioner who understands that what we consider normal labs are normal for 75% of the population. It’s a bell curve. Well, if 88% of Americans are metabolically unhealthy and 74% are overweight or obese, we don’t want that normal. We need physicians, and pharmacists, and nurses who help us to optimize all of the labs. You know? So it’s not just, “Well, your insulin is less than 10. That’s the cutoff of what is considered healthy.” But no, you want your fasting insulin to be like five. Get it really, really far down, and really optimize all of the labs.

Lindsey Elmore: Now we have have a lot of people with a lot of opinions about something that you mentioned earlier that I’d like to go back to. And that is intermittent fasting. I have so many social media followers that are staunchly against intermittent fasting, swear that it’ll wreck your metabolism. I love intermittent fasting, and it was one of the ways that I lost almost 20 pounds in the past couple of months was not eating 16 to 18 hours a day. So talk to us about the data behind intermittent fasting as a tool for metabolic health, and who it is appropriate for, and who it might be inappropriate for.

Dr. Casey Means: Yeah, absolutely. So fundamentally, intermittent fasting or time restricted feeding is this idea that you’re giving your body longer windows of times than normal when you’re not putting food in the body or calories. And when we think about really the cellular biology of that, it goes back to what we were talking about earlier. Which is that without that exogenous glucose coming in through the mouth, you are having to use the energy stores in your body. And the way that’s going to work is you’re going to burn through the circulating glucose. We always keep the glucose in the blood at, it never goes down to zero. That would be death, but we use the excess, right? First. Then we tap into the liver, which stores several hours worth of glucose. And then once we deplete that tank of short-term energy, we start flipping into the fat burning, and we start mobilizing those free fatty acids and using those. So that’s what intermittent fasting is really helping us do. And there’s a number of other side benefits as well. Just giving our digestive system a break. It’s positive for the microbiome, etc.

Dr. Casey Means: With that said, not eating, especially if you’re not really metabolically flexible can be a stressor for the body. It can be very, very stressful. And I think we’ve all felt this, especially when starting an intermittent fasting or a time restricted feeding regimen. It can be awful and feel psychologically distressing. I’ve definitely felt that. And even sometimes going 14 hours, it can be like, “Oh my God, I’m so hungry. I’m desperate for food. I would eat anything,” da, da, da.

Dr. Casey Means: So I think we do have to think of it as a stressor. And this is where I do think it can have that impact that people are talking about, like your social media followers are talking about where it can be if the body can’t handle that excess stress at that point in time, and that might not be a person specific thing, it could be just what time in their hormonal cycle they are. That they can’t handle that extra hormetic stressor essentially. Then it might not be the best option at that time.

Dr. Casey Means: Our body only has a certain amount of capacity to handle stressors. And so many things are stressors. Psychological stressors, exercise is a stressor, sleep deprivation is a stressor, fasting is a stressor. So you can’t just keep piling on the mountain of stress and expect the body to be okay. So you really have to be thoughtful about when you’re using this tool. And do you have the capacity at the time right there biologically to handle that? Because if you can’t, the body will break down. It’s like the book The Body Keeps the Score. It’s not going to just handle you putting on mountains of high intensity interval training, not eating, psychological work stress, and not sleeping. You’ll fall apart. And metabolism won’t work, even if you’re eating a perfect diet otherwise.

Dr. Casey Means: So I do think there’s some definite validity to that statement. And we really kind of have to read the room with these things. Is this a good time for me, for my body to put this extra stressor on it? Because if it’s not, it could be counterproductive.

Dr. Casey Means: So I tend to do intermittent fasting when I really have other things in my life really dialed in. When I’m getting a lot of sleep and when my diet has been clean for a little while. I don’t want to go into intermittent fasting necessarily after a five day streak of really high carb foods and being on the glucose roller coaster, because my body’s not going to be in the most metabolically flexible state. And it might be really, really hard to kind of just jump into a 20 hour, 18 hour, 16 hour fast. I’d rather ease into it where I’ve kind of been keeping my glucose more stable over several, several days. Know that I’m kind of in that lower insulin state already, and then go into a fast, because I’m a little bit more ready for it.

Dr. Casey Means: So those are some thoughts on that. But generally, the data is very supportive of overall intermittent fasting and time restricted feeding being a good strategy for overall glucose control and keeping insulin stable.

Dr. Casey Means: And I think one other just thing I want to mention is that it’s not about necessarily reducing your total calories in a 24 hour period. So this is not just about starving yourself. This is about putting your calories into a tighter window. And of course, you can also do fewer calories if that’s your choice. But there’s some really interesting research that showed that there were two different groups of people. They both ate the exact same amount of calories, standardized meals, two groups. One group ate those calories between 8:00 AM and 8:00 PM. One group ate those same calories in a shorter window of 8:00 AM to 2:00 PM. So it was a 12 hour feeding window, or a six hour feeding window. The same amount of calories.

Dr. Casey Means: The six hour feeding window people had much better overall metabolic parameters. 24 hour glucose levels, insulin levels, etc. This makes total sense though, because even though you may have during that six hour window had big glucose spikes because you were eating all this food in a short period of time, your body had 18 hours with no glucose spikes, no insulin spikes. So you were able to actually tap into that metabolic flexibility. So yeah. So it’s not just about starving. It’s just about when you’re timing your calories, and the impact on your hormones from that timing.

Lindsey Elmore: Absolutely. It’s not a caloric restriction. It’s a time restriction. There are two different strategies for weight loss. I think time restriction is so much easier than caloric restriction because it also when you stop your feeding window by 4:00 PM, 5:00 PM, 6:00 PM, you’re going to have better sleep. And I also recognize if you’re really truly intermittent fasting, you’re not drinking alcohol, you’re not drinking sugary beverages after that point. And there’s nothing to stay up for. You might as well just go to bed at that point. And it also sets you up to get great sleep.

Lindsey Elmore: Now, you said something that has been a topic I’ve wanted to bring up on the podcast for so long. And you said it so fast, I doubt our listeners even caught it. You brought up the concept of hormesis. And you said this is a hormetic stressor. Tell us briefly, what does that mean? What is hormesis, and how does it help us?

Dr. Casey Means: Yeah. I would sort of define it as the fact that the body actually, this comes back to adaptability. So we want our body to be adaptive. We want every part of our body, our cells, our whole body to be quick on its feet, and to be able to kind of bounce back and forth between different conditions. Just like we want to be psychologically adaptive. This is good.

Dr. Casey Means: So by putting your body under low grade stresses, whether that’s cold therapy, or heat therapy, or time-restricted feeding, or high intensity interval training, these are stressors. This is a stress, but it’s a stress that makes us more adaptive. It’s a stress that is specifically causing pathways in the body to be upregulated that wouldn’t if you did not put it under that stress, and that those things can have positive outcomes.

Dr. Casey Means: For instance, like with heat. When we put ourselves under high heat situations, we may activate heat shock proteins, which are type of proteins that are associated with longevity. Those might never get activated or less frequently get activated if we’re not doing that hormetic stressor. So you’re kind of just unlocking these pathways within the body that are not going to be activated unless you create conditions in which they will be. And then you’re reaping the side benefit of them being activated. But you have to kind of go into that slightly discomfort, slightly stressor zone to get there.

Lindsey Elmore: Absolutely. I love that. Just small amounts of stress that make you more resilient. Dr. Casey Means, thank you so much for coming in today and sharing your wisdom about how our listeners can be metabolically more healthy. Listeners, if you want to find out more about Dr. Means’ company, head to www.levelshealth.com. Because you’re a listener on the show, they are offering you the opportunity to skip the wait list, which is currently sitting at 110,000 people. So jump ahead in line by heading to levels.link/lindseyelmoreshow. Be sure to use the code levels.link/lindseyelmoreshow so they’ll know that we sent you over there. Dr. Casey Means, thank you so much for coming today and being a guest on the Lindsey Elmore Show.

Dr. Casey Means: Thank you so much for having me. It’s been a great conversation, and it’s so wonderful to have the opportunity to be here.

Lindsey Elmore: Way too many people out there go to the doctor looking for solutions to real problems that they have in their lives, and are met with a brick wall where the only solutions offered are either medications, or surgery, or, “Let’s just check it again in six months.” The system is broken friends, and far too many people are left without options of knowing how can I heal myself and correct the root causes of what is genuinely making me sick?

Lindsey Elmore: That’s why I am so happy to announce that I have a new subscription platform. It’s called Wellness Made Simple, and it is a one-stop shop for everything you need to know about how to course-correct if you’re already experiencing symptoms, or how to prevent symptoms from happening in the first place. This is not a place to come and find out about the nitty gritty, and the perfect combination of supplements, or the exact right way to eat to be well. This is a place where you can get together with people who understand that sleep, stress, food, exercise, and relationships really matter to our overall health. From now until August 30th, you can lock in introductory pricing for life. That’s only $29 per month. Head to wellnessmadesimple.us. That’s wellnessmadesimple.us to sign up today and lock in introductory pricing for life.

Lindsey Elmore: The Lindsey Elmore Show is written and produced by me, Lindsey Elmore. Show segments are produced by Sue Procko and Kelsey Lorman. Production design, sound design, and editing is by Jive Media. If you have a question about this or any other episode of the podcast, send us an email to [email protected]. And hey, since you’re still here, take a moment to subscribe, rate, and review this podcast. And while you’re at it, go over and follow us on Instagram @lindseyelmoreshow. This helps us bring the pod to more people.