The Key Signs You’re Not Healthy & How To Fix It w/ Casey Means, MD EP 1252

Metabolic health is the cornerstone for living a healthy life. But most people don’t even know what it is, let alone how to manage it. But knowing what your body needs and how it reacts to food can help you strive for better metabolic health. In this episode of the School of Greatness podcast, CEO of Greatness Media Lewis Howes interviewed Levels’ Dr. Casey Means on metabolic health, the failings of traditional healthcare, and how you can take control of your wellbeing today.

3:15 – The similarities in different diseases

Dr. Casey said we look at diseases as unique and separate, but they often have underlying similarities or root causes.

The way we’ve approached it is we’ve looked at these as all isolated silos. We think of them as all different things like, huh, we wouldn’t treat diabetes the same way we treat cancer or kidney disease the same way we treat Alzheimer’s, but when we look at these through the root cause approach that you talked about and the fancy term for this in medicine is systems and network of biology. What is the network between diseases rather than how are they all different? When we treat at that level it’s so much more efficient and we can actually generate good health in the body as opposed to just reacting to symptoms and managing conditions. I think that’s what a lot of doctors are waking up to. They’re sick and tired of being reactive, practicing sick care, practicing this end of the line medicine and they want to help generate health in people’s bodies.

13:53 – Avoid the spikes

If you can minimize your glycemic variability and prevent major spikes and valleys, you’ll feel better and be healthier.

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

17:19 – The lack of metabolic flexibility

Dr. Casey said that most people are not metabolically flexible because their insulin keeps spiking and dipping drastically.

The average person is not metabolically flexible and the reason is because they’ve been on the glucose roller coaster, their body is so used to seeing glucose that those pathways are super active. They’re constantly on that craving hit, they want more of it. They haven’t really given their… Because glucose is the preferential fuel the body will use, it’s the first thing it’s going to grab. It’s that easier thing to use. It will never go and burn fat if there’s glucose. It will not burn significant amounts of fat if there’s glucose readily available. So, something that we can do, essentially train our bodies is to give it opportunities to burn fat. So this is where you start thinking about things like time restricted feeding or fasting or potentially doing a fasted workout, where you’re actually intentionally keeping your blood sugar levels in the low normal range signaling to… And of course the downstream effect of that it’s going to be insulin will be low because if you’re not having a glucose spike then insulin will be low and that insulin being low takes away that signal to not burn fat. Now your body’s like cool, insulin’s low, glucose is low, I’m going to tap into my fat stores.

27:58 – Food is foundational

Food both nourishes your body and provides the molecular information that tells your body how to function properly.

I think that food is the foundation. Food is the substrate. Food is both what physically builds our bodies, and it’s also the molecular information that tells our body how to function. We eat about one metric ton of food per year, two to three pounds per day. This is just straight up chemical information that builds our body and tells our body what to do. We’re turning over constantly. The body we have today is not the same body we have in a week, from a physical atomic perspective. We’re shape shifters. We’re constantly changing. So food is, it’s incredible. It’s magical. It’s this incredible thing that we’re just constantly transmuting into ourselves, so we’ve got to get that right. But, while it’s necessary, it’s not sufficient for optimal health. You still got to dial in the other factors. And when I really think about the pillars, I’m thinking about seven things. I’m thinking about food. I’m thinking about stress management, exercise, sleep, our micronutrient status, so not just the macros we’re getting, but what are the actual micronutrients, vitamins, minerals and antioxidants, our microbiome, how that’s doing, and then our exposure to environmental toxins. So yes, while food is the foundation, you’ve really got to get those other things dialed in. Any one of those things can shift you off course.

32:52 – Increase your elasticity

The healthier your system is, the more elastic it will be. Too much rigidity and static regularity can be bad for your body.

You want elasticity in the system and that can sometimes have some irregularity to it. Sort of the way I think about it is, a stiffer system is going to be a little bit more regular. These are subtle. It’s not like you can feel it in your pulse if you just feel your pulse, but you can pick it up. And so we want more heart rate variability. And usually less, lower heart rate variability, is an objective measure of stress. And I’ve worn these things and been giving a talk on Zoom or something like that, and I’m looking at my data afterwards and my heart rate variability plummeted during the talk. Or I’m processing email, my heart rate variability goes down. And then of course, glucose may go up. And so you see these things happening together. And the immediate thing I think is, this is where our tools come in. This is where the deep diaphragmatic breath, where the mindfulness, where having awareness of this happening, and then there are so many things we can do to modify that stress response.

37:29 – The failings of traditional healthcare

Dr. Casey said the traditional healthcare system sometimes uses fear to convince people to follow a certain medical path.

I think that the healthcare system, the conventional healthcare system, unfortunately uses fear as a way to control patients in a lot of ways. You think about a conversation between a physician and a patient and it’s like, “Your cholesterol is a little high. You need to take a statin.” And the patient might say, “Well, can I have some time to work on diet and lifestyle?” “Well, I mean, it’s your choice. I mean, I’d recommend the statin right now, because, obviously, I don’t want you to have a heart attack. But sure, if you want to try diet and lifestyle.” That’s the type of thing that’s happening every day, where this fear of bad outcomes is, I think, driving very much a pharmaceutical and invasive intervention type of strategy. I think that that really was unsavory to me, because it’s very disempowered. It’s like, if I can drive fear in a patient, then I can essentially get them to do whatever intervention I recommend.

46:01 – The definition of cellular dysfunction

Symptoms and diseases are the result of cellular dysfunction happening on the individual level. The more it happens, the worse your body reacts.

What is a symptom? What is disease? That is cellular dysfunction happening on the individual level. If that’s happening in mass, that might be tissue dysfunction. If that’s happening in a bigger way, it’s organ dysfunction, and that’s when we see symptoms of disease. We have to really zoom in on what’s happening in the cell. A cell is getting its information from what you’re eating, what it’s being built from, which is your food. What stress hormones its seeing binding to its little cell membrane. What’s happening with your hormones, which of course is dictated by stress, and by sleep, and by exercise, and by food. It’s the super complex milieu, that can only be optimized by the choices that we’re making every day. Day in, day out consistently. Even by the sunlight we’re exposing ourselves to in the morning.

54:18 – The four pillars of health

Dr. Casey said the four most important building blocks of your health are food, sleep, stress, and sedentary behavior.

The four most important pillars are food, sleep, deprivation and interruption in sleep. Just the beeping, and the buzzing, and the blue light late at night that interrupts our sleep quality. The chronic low grade stress, and the fear that so many people are dealing with, and then the sedentary behavior. The fact that most Americans are sitting more than eight hours a day. Sitting creates inflammation in the body. It keeps that glucose in your bloodstream, and not going into the muscles. The exercise one I think, a really empowering just a tip for people. It doesn’t have to be like, go out and run five miles. Do a high intensity annual training workout. Do a crossfit workout. It literally is as simple as walking. Maybe walk 15 minutes after a meal, especially if a high curb meal. Even walking for two minutes every half hour, has been shown to statistically significantly reduce, insulin and glucose levels throughout the day. The study was a minute and 40 seconds. It was looking for people who just walked for 30 minutes in one chunk of the day, but otherwise sat during the day. Versus people who walked for 30 minutes, but broke it up into one minute and 40 seconds, every 30 minutes throughout the waking day. Those people that moved more frequently but the same quantity, had much lower glucose in insulin.

1:12:35 – The prevalence of metabolic disease

If you eat the standard American diet, you have a good chance of ending up with a metabolic disease. But if you take ownership of what you eat, you can prevent some of that.

If you’re just living your life standard, American diet, more likely than not, you’re going to end up with a metabolic disease. That’s just now common reality. And so having some information to both see what the trajectory is over time, have a real sense of ownership over what’s going on metabolically in your body, I think that’s really empowering. Like right now you kind of get crumbs of information from your doctor once a year. But imagine if you could really have ownership over that foundational asset of your health. So that’s one thing is just like the awareness. And then the bigger piece is to have this closed loop biofeedback on everything you’re eating and everything you’re doing to keep glucose more stable, because we want to get off those ups and downs swings not only to improve our day to day functioning and the subjective experience of our days, the energy, the mood, the cravings, the fatigue, but also to set us out for like the long term avoidance of sort of the glucose related metabolic diseases.

1:15:20 – How to modify your diet

Dr. Casey said changing your diet doesn’t always mean avoiding certain foods, but finding ways to eat them in a more healthy manner.

You want to avoid that naked carb situation. So I see oatmeal with chia seeds, which has tons of fiber and protein. A little bit of almond butter, which has fat, protein and fiber. Add a few maybe low glycemic berries, like a couple blueberries or raspberries or whatever, which have a good amount of fiber and antioxidants. Maybe some flax seeds on top, which is going to be fiber and fat. Mix it all together. And you’re going to probably absorb the glucose slower. It’s going to slow digestion. The fiber can actually block the amount of glucose that gets into the bloodstream. The fiber also has the effect of feeding the microbiome, which has downstream positive effects on metabolic health. So it’s like keep the oatmeal, but modify it. And if you’re not wedded to oatmeal, then start experimenting with other breakfasts.

Dr. Casey Means (00:00:00):

It’s not working.

Lewis Howes (00:00:01):

Right.

Dr. Casey Means (00:00:01):

We’re getting sicker. Every single year we’re getting sicker, we’re getting fatter and we’re getting more depressed, as a country and I think the key problem with this is that…

Lewis Howes (00:00:10):

Welcome to the School of Greatness. My name is Lewis Howes, former pro athlete turn lifestyle entrepreneur and each week we bring you an inspiring person or message to help you discover how to unlock your inner greatness. Thanks for spending some time with me today. Now let the class begin. You went from, I guess, being a doctor to saying, “Well, how can I help people in a holistic approach to preventing chronic illness and disease?” I’m hearing you say that it starts with metabolic health, is that correct?

Dr. Casey Means (00:00:44):

Yes.

Lewis Howes (00:00:44):

So, what is metabolic health then for people and how can they optimize this?

Dr. Casey Means (00:00:49):

Yeah. Well, first of all, I think you hit the nail on the head. There is a movement and a tribe of doctors who are waking up and realizing that we are missing the elephant in the room of modern American healthcare and the elephant in the room is that, first of all, the vast majority of things that are killing Americans today are conditions based in our dietary and lifestyle choices over the course of our lifetime, which means that we have huge amount of agency in changing our fate in terms of these diseases.

Lewis Howes (00:01:23):

How many diseases would you say are caused by food and nutrition alone or our diet?

Dr. Casey Means (00:01:28):

Nine of the 10 leading causes of death in the United States are either, not only just caused by food and lifestyle but are directly attributable to dysfunctional blood sugar or are worsened by elevated blood sugar.

Lewis Howes (00:01:42):

Wow. Really?

Dr. Casey Means (00:01:42):

Nine of the 10.

Lewis Howes (00:01:43):

What’s the 10th one?

Dr. Casey Means (00:01:44):

Well, to go through the ones that we’re, like what we’re talking about so we’re looking at things like Alzheimer’s dementia, which is now being called Type 3 diabetes because it’s so related to blood sugar. Heart disease, Type 2 diabetes. Cancer is very much driven by blood sugar. Chronic kidney disease, which is very much a problem of the small vessels in the kidney becoming narrowed and part because of metabolic dysfunction and erratic blood sugar control. Chronic lower respiratory infections is one of the leading causes of death and we know that people with unstable elevated blood sugar have much higher mortality, even with something like influenza or pneumonia.

Dr. Casey Means (00:02:25):

Having high blood sugar actually can get into the fluid of the lung and feed the bacteria that leads to some of these issues. Of course, with COVID, we’ve known now since the very beginning of the pandemic that having metabolic dysfunction diabetes is a key accelerator and driver of mortality and morbidity. There’s some odd ones on there too, for instance, suicide is actually on the top 10 list of killers in the United States and people with diabetes or metabolic dysfunction actually have higher risk of suicidality.

Lewis Howes (00:02:57):

Really?

Dr. Casey Means (00:02:57):

So it’s all across the board and so what’s really fascinating is the way in which these dietary lifestyle factors are essentially linking so many of the conditions that are killing Americans today.

Lewis Howes (00:03:15):

Right.

Dr. Casey Means (00:03:15):

The way we’ve approached it is we’ve looked at these as all isolated silos. We think of them as all different things like, huh, we wouldn’t treat diabetes the same way we treat cancer or kidney disease the same way we treat Alzheimer’s, but when we look at these through the root cause approach that you talked about and the fancy term for this in medicine is systems and network of biology. What is the network between diseases rather than how are they all different? When we treat at that level it’s so much more efficient and we can actually generate good health in the body as opposed to just reacting to symptoms and managing conditions. I think that’s what a lot of doctors are waking up to. They’re sick and tired of being reactive, practicing sick care, practicing this end of the line medicine and they want to help generate health in people’s bodies.

Lewis Howes (00:04:05):

Wow, interesting.

Dr. Casey Means (00:04:05):

That’s a totally different way of practicing.

Lewis Howes (00:04:12):

Right. Yeah. That’s inspiring. So what I’m hearing you say is blood sugar management or control is one of the key factors of either being healthy or potentially linking to one of these other diseases. Is that right?

Dr. Casey Means (00:04:25):

That’s right. Yeah and what it really comes down to, which gets at your question of what is metabolism. Metabolism is fundamentally the way that we make energy in the body.

Lewis Howes (00:04:36):

Okay.

Dr. Casey Means (00:04:36):

So we eat food and food has fat and glucose in it and either fat or glucose, glucose is sugar, can be used to convert into a type of energy that our cells can use, which is called ATP. So we take in this substrate but we have to convert it through our mitochondria in our cells to a form of energy we can use.

Lewis Howes (00:04:58):

Right.

Dr. Casey Means (00:04:58):

The currency that our body understands and can use. That process of conversion is metabolism and this is happening in every single one of the 37 trillion cells in our body and it has to work properly.

Lewis Howes (00:05:12):

So break it down for me then. Fat or glucose or, I guess carbohydrates, enters the body through the foods we’re eating, right?

Dr. Casey Means (00:05:19):

Yep.

Lewis Howes (00:05:20):

What happens after that? How is it processed in the body, through the cells, through the mitochondria? How is it processed?

Dr. Casey Means (00:05:27):

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

Lewis Howes (00:06:14):

So ATP is the power, is the fuel.

Dr. Casey Means (00:06:16):

The power. It’s the fuel. It’s the battery in our body.

Lewis Howes (00:06:20):

Okay and so the way it’s processed is it’s based on the foods we eat, whether it be fat or sugar that comes through. Does that determine how the quality of the energy or what does that mean within, is it all equally the same when it converts an ATP or…

Dr. Casey Means (00:06:36):

Well, I think the way to think about it is to really focus on the mitochondria.

Lewis Howes (00:06:39):

Okay.

Dr. Casey Means (00:06:40):

This is the energy factory of the cell. This is the powerhouse of the cell and the thing that people really need to understand is that our diet and our lifestyle in the modern Western world, so past 50 to a hundred years, so much of it is actually damaging the mitochondria of our cell and creating problems in that conversion process. So for instance, when we eat too much sugar, okay, and these days the average American-

Lewis Howes (00:07:06):

Is eating a lot of sugar.

Dr. Casey Means (00:07:07):

… a hundred times more than we were a hundred years ago and through the rest of human history.

Lewis Howes (00:07:11):

Yeah.

Dr. Casey Means (00:07:11):

It’s like this massive overload of this substrate. What that does is it causes stress on the mitochondria and creates damage. One analogy I sometimes use is, imagine you had a factory that was making something like cheese and all of a sudden you get a hundred times more of the raw product, like milk delivered to the factory. The workers would be like, “We don’t know where to put this. We can’t work.” They’d go on strike. There’s nowhere to store it. There’s no refrigerator. It would all go bad. All of a sudden you actually produce less cheese, even though you have more substrate.

Lewis Howes (00:07:44):

Interesting.

Dr. Casey Means (00:07:45):

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

Lewis Howes (00:08:16):

Wow.

Dr. Casey Means (00:08:16):

So it actually puts up a block, which is called insulin resistance, which is that cellular process that leads you towards problems like diabetes. So what’s happening now is the body-

Lewis Howes (00:08:25):

And that’s why you’re storing fat or you’re storing other dead cells that you don’t need to keep in the body, I guess, right?

Dr. Casey Means (00:08:32):

Right, because insulin is the signal saying tons of glucose around for energy so we don’t need to burn fat for energy. So insulin is also a block on fat burning. It’s this chemical signal saying too much glucose around, blocking it from getting into the cell and also telling the body not to burn fat. So, of course, for people who are dealing with trouble losing weight, insulin is the hormone we really, really need to be thinking about and so we reduce our insulin sensitivity. Now we have lots of glucose circulating in the bloodstream but it’s not able to efficiently get into the cell and then you’ve got all these other things that can hurt our mitochondria and really a mitochondria energy centric view of health can really help us. Some other things that can hurt the mitochondria are oxidative stress.

Dr. Casey Means (00:09:19):

I know you talked about this a little bit on the podcast with David Perlmutter but aside from glucose, eating too much fructose, this comes with sodas or fruit juice or things that have really high concentrations of fructose, it’s not going to actually stimulate insulin in the way that glucose does but what it does is it goes into the cell and it’s converted into something called uric acid and that uric acid creates oxidative stress, which is this damaging reactive molecule in the mitochondria and creates mitochondrial damage. So now again, you’ve got more trouble processing energy through the mitochondria. Environmental toxins are actually a huge problem as well. They can directly damage the [inaudible 00:09:57] of the mitochondria. So we’re thinking about things like pesticides and a lot of the fragrances in our personal care products and a lot of the fragrances and chemicals in our home care products. These things actually go into our bodies, damage our mitochondria, make it difficult to produce energy effectively.

Lewis Howes (00:10:13):

Interesting.

Dr. Casey Means (00:10:14):

Chronic stress can damage our mitochondria through cortisol and through our stress hormones. It’s interesting to think about how all these different aspects of modern life fundamentally feed down into damaging this precious part of our cell that creates energy and when we have-

Lewis Howes (00:10:30):

The mitochondria.

Dr. Casey Means (00:10:31):

The mitochondria and when we have problems creating energy in our body, this can happen in any cell type. Again, 37 trillion cells, dozens of organs in the body, where this is showing up most prominently in the body is where you’re going to see symptoms and this is why metabolic dysfunction and blood sugar dysregulation can look like so many different things. It can masquerade as so many different symptoms and in the conventional system, we see those all as separate. But when we think about it as this is actually just where a fundamental core problem is showing up in different cell types. If you can address that, you can potentially melt a lot of things away. Just as some concrete examples, if metabolic dysfunction is showing up in the blood vessels, well, if it’s most prominently showing up in the penis that could look like erectile dysfunction. If it’s happening in the heart, it could look like heart disease. If it’s happening in the liver, it could look like fatty liver disease. If it’s happening in the ovaries, it could look like polycystic ovarian syndrome, which is a leading cause of infertility in the United States.

Lewis Howes (00:11:35):

Wow.

Dr. Casey Means (00:11:35):

Which is a metabolic problem and if it’s happening in the brain, it could look like Alzheimer’s dementia. So, it’s got all these different faces but fundamentally is rooted in a core dysfunction in how our body is converting food to energy and a lot of that has to do with this chronic over nutrition, overloading ourselves with too much to process, gumming up these systems. Then the many other lifestyle factors like toxins, stress, sleep deprivation and sedentary behavior that can also hurt the mitochondria.

Lewis Howes (00:12:11):

Right. So blood sugar management and metabolism management, is that right? Some of the main things we should think about.

Dr. Casey Means (00:12:15):

Yeah.

Lewis Howes (00:12:16):

How does blood sugar and metabolism work together?

Dr. Casey Means (00:12:19):

Yeah. So, the way that those things link up is that if your blood sugar is quite erratic, let’s say it’s going up and down in big spikes and valleys-

Lewis Howes (00:12:28):

Every day. Yeah.

Dr. Casey Means (00:12:29):

Every day.

Lewis Howes (00:12:29):

You’re having lots of sugar. You’re, yeah, you just eating poorly.

Dr. Casey Means (00:12:32):

Yeah.

Lewis Howes (00:12:32):

You’re stressed. You’re overwhelmed.

Dr. Casey Means (00:12:34):

Yeah and the majority of foods on the shelves in our grocery stores now have added sugar, well over 60%. So it’s not unusual for an American to be on that blood sugar rollercoaster, up, down, up, down, up, down and that’s called glycemic variability. That process of glycemic variability is very damaging to our metabolism through the mechanisms we spoke about of causing insulin resistance by stressing the body to make too much insulin over and over. But those high blood sugar spikes in their own right can cause damage as well. When your blood sugar acutely goes really high, after eating a pop-tart or eating a pastry or something like that or a big bowl of pasta, that spike can lead to inflammation, it can lead to oxidative stress because of the way that it’s overwhelming our systems and creating free radicals.

Dr. Casey Means (00:13:27):

It can also cause a process called glycation, which is where sugar sticks to things in the body. And so, if you can imagine, if your concentration of blood sugar is really high, it’s going to just stick to things more like your blood vessels and proteins and that’s not good. That’s like a signal for the body that something’s wrong and so all of these things coalesce to just creating problems. The more that we can minimize our glycemic variability and go from spikes and valleys to more gentle rolling hills, the better we are, the better we’re going to basically be treating ourselves. It’s not just the cellular optimization we’re trying to do, it’s also the way you feel.

Dr. Casey Means (00:14:14):

I think a lot of us have had that experience where we have a really high carb meal, a big dessert and we feel like we have a crash afterwards. It’s like that post meal crash. We feel lethargic. We may need to have another cup of coffee or even feel jittery after it, like a big high carb meal. We really understand how that works. The body sees a huge load of glucose from a high carb meal. The body then surges out that insulin, overcompensate, soaks up all that glucose and you crash and in that crash state is when we feel fatigue, potentially some anxiety and it’s when people usually feel cravings. So by learning-

Lewis Howes (00:14:54):

You want more when you crash.

Dr. Casey Means (00:14:55):

You want more to bring yourself back up because you’ve crashed.

Lewis Howes (00:14:59):

Because it’s up and down, up and down.

Dr. Casey Means (00:14:59):

And then you’re on the vicious cycle. I think the majority of American bodies are on that cycle because you think about what we eat. It’s breakfast, it’s cereal, juice, toast, pop-tarts, pastries, sweetened coffee beverages. That’s all refined sugar and refined grains. Then you go to lunch and it’s bread, tortillas, wraps, chips, all of that stuff and then you go to dinner, pasta, potatoes, whatever and then it’s dessert and it’s like if you’re not, if you’re just going along the normal American cultural treadmill of what’s normal to eat, you’re on a glucose roller coaster. That means that your day might be highly labial in terms of the energy, mood, performance, cravings and so learning just simple ways to balance out that glucose rollercoaster can be an amazing life hack and really a superpower for essentially getting your day under better control, making you feel better in the moment.

Lewis Howes (00:15:57):

Yes.

Dr. Casey Means (00:15:57):

And, off course creating the cellular conditions to set you up for long term longevity and health and prevent that whole downstream insulin resistance cascade that we know is related to so many causes of death in the United States.

Lewis Howes (00:16:13):

So let’s speak to people that are listening or watching who maybe have active lifestyles, they like to work out so they need energy for working out. They’re driven, they’re passionate in their careers or entrepreneurship. They have a lot of friends and activities they like to go to. They need energy throughout the day. How can they get the energy without the glucose rollercoaster happening? What are the best foods to be eating throughout the day? How many times should we be eating and does it really matter or does it really depend on each individual’s body type?

Dr. Casey Means (00:16:48):

Yeah. I think for the type of person you’re describing, the key concept we want to think about is achieving metabolic flexibility.

Lewis Howes (00:16:57):

Okay.

Dr. Casey Means (00:16:57):

So metabolic flexibility means that we are able to use different forms of energy to make ATP, based on what’s available. What I mean by that is, if there’s sugar around, we can efficiently burn sugar to make ATP but if there’s not, the body’s fine, it’s cool. We’ve got fat to use to burn energy.

Lewis Howes (00:17:18):

To burn, yeah.

Dr. Casey Means (00:17:19):

The average person is not metabolically flexible and the reason is because they’ve been on the glucose roller coaster, their body is so used to seeing glucose that those pathways are super active. They’re constantly on that craving hit, they want more of it. They haven’t really given their… Because glucose is the preferential fuel the body will use, it’s the first thing it’s going to grab. It’s that easier thing to use. It will never go and burn fat if there’s glucose. It will not burn significant amounts of fat if there’s glucose readily available. So, something that we can do, essentially train our bodies is to give it opportunities to burn fat.

Dr. Casey Means (00:18:03):

So this is where you start thinking about things like time restricted feeding or fasting or potentially doing a fasted workout, where you’re actually intentionally keeping your blood sugar levels in the low normal range signaling to… And of course the downstream effect of that it’s going to be insulin will be low because if you’re not having a glucose spike then insulin will be low and that insulin being low takes away that signal to not burn fat. Now your body’s like cool, insulin’s low, glucose is low, I’m going to tap into my fat stores.

Lewis Howes (00:18:34):

So, that’s when it starts to burn the fat.

Dr. Casey Means (00:18:35):

Exactly.

Lewis Howes (00:18:36):

Interesting.

Dr. Casey Means (00:18:36):

Exactly. And-

Lewis Howes (00:18:37):

So if you work out for, in the morning without eating, you’re more likely to be burning fat. Is that what I’m hearing you say?

Dr. Casey Means (00:18:42):

That’s right and there’s actually a lot of athletes that are using this type of metabolic science to their advantage. There’s a whole community of endurance athletes now that are doing low carb training and the purpose of that is that they don’t want to be super dependent on glucose during their event where they’re just every half hour having to take a goo or a bar or an energy drink or something like that and have these big spikes throughout their event. Instead, they’ve actually trained their bodies to use fat during an endurance workout and there are literally marathoners now who will run the entire thing fasted.

Lewis Howes (00:19:19):

Really.

Dr. Casey Means (00:19:20):

Because they can so efficiently burn fat, but that’s not, those pathways have to be worked and developed-

Lewis Howes (00:19:27):

Trained.

Dr. Casey Means (00:19:27):

… to be able to do that and that’s metabolic flexibility.

Lewis Howes (00:19:30):

Flexibility. So how do you train metabolic flexibility for yourself?

Dr. Casey Means (00:19:33):

I would say the key thing is to minimize these excessive glucose spikes, to give your body an opportunity to be more in the stable, healthy, low range for more time of the day, to keep insulin in a lower and healthy range so that your body knows to burn fat. One way that you can do this is of course with a continuous glucose monitor, you can, which are becoming popular now, where it see what spikes your glucose, modify it and try and get to a more stable range.

Lewis Howes (00:20:04):

Interesting.

Dr. Casey Means (00:20:04):

Or measure your ketones, which a lot of people are doing now. This is a finger prick device or there are breath monitors, you can also check in your urine and ketones are a byproduct of fat burning. So if your ketones are super low or zero, it means you’re not burning really any fat and if your ketones are higher, like above 0.5 or up into the ones and twos, you are proving to yourself that you have gotten to a state where your glucose and insulin are essentially stable enough that you’re burning fat for energy and so something I like to see if I’m tracking these things is, okay, if I’ve kept my glucose quite stable and low for a couple days based on the choices I’m making around diet and lifestyle, I start to see ketones rising up. That to me is proof of metabolic flexibility.

Dr. Casey Means (00:20:52):

I can test things like, okay, if I do the Peloton ride first thing in the morning after not eating, does it increase my ketones later in the day and start to do some experiments like that. Another thing that people can do is ask their doctor to do a fasting insulin test. It’s not a test that’s normally done on a regular yearly panel but it’s a really powerful test because again, if insulin is quite elevated, it’s going to be that block on fat burning. If insulin is a low and healthy range it’s a signal that your body’s probably likely very insulin sensitive, you’re not far down that insulin resistance pathway. I like to see it between about two and six and shockingly the reference range and a lot of labs will say that anything under 25 is normal, but that would be very, very, very elevated.

Lewis Howes (00:21:38):

Sure.

Dr. Casey Means (00:21:39):

You want it to be tight and low to know that you’re just giving your body that opportunity to burn fat.

Lewis Howes (00:21:46):

Sure.

Dr. Casey Means (00:21:46):

And to work those different pathways.

Lewis Howes (00:21:48):

So many people are talking about fasting or intermittent fasting these days. Is it different for men and women on the ways to fast in order to burn fat or is it the same for both?

Dr. Casey Means (00:21:59):

I would say it’s different for every single person.

Lewis Howes (00:22:01):

Sure.

Dr. Casey Means (00:22:02):

Even, and definitely for different genders but it’s different day to day. I think intermittent fasting and time restricted feeding is a… It can be a stress on the body and so I tend to think of it as we’ve got a certain capacity within the body to manage different stressors and we know that certain stressors can be helpful in building adaptations in the body to help us improve. So, cold exposure, heat exposure, fasting, high intensity interval training, but there’s also stressors in our life that are maybe somewhat out of our control, like work stress or family stress or things like that and we don’t want to overload our body.

Lewis Howes (00:22:47):

Right.

Dr. Casey Means (00:22:47):

So, if a woman is potentially in a part of her cycle, for instance, where her body’s also already quite taxed-

Lewis Howes (00:22:56):

You want to do it then.

Dr. Casey Means (00:22:57):

You want do it then and on a day that I’m, I don’t have as much sleep, on a day that I might be doing a big podcast or something like that, like today.

Lewis Howes (00:23:05):

You’re not fasting.

Dr. Casey Means (00:23:06):

I’m probably not going to add… I’m going to be thinking very deeply about food though, because you also don’t want to be eating a big meal and then crashing during that time when you have to perform.

Lewis Howes (00:23:16):

Right.

Dr. Casey Means (00:23:16):

So it’s more about keeping things really stable and not fluctuating. So I think about it more that way.

Dr. Casey Means (00:23:25):

I think that fasting is great if you’re otherwise very well resourced, with sleep, with resilience, psychological resilience, not putting your body probably under intense physical stress during that time. I tend to do more zone two workouts, low intensity during fasts, so as not to add too much stress.

Lewis Howes (00:23:47):

Stress the body.

Dr. Casey Means (00:23:47):

And ultimately too much stress can lead to breakdown.

Lewis Howes (00:23:51):

Really?

Dr. Casey Means (00:23:52):

So, just thinking of everything in a really holistic picture.

Lewis Howes (00:23:55):

If you stress the body too much, does the blood sugar go up? Or what does that do to blood sugar and metabolism?

Dr. Casey Means (00:24:01):

Yeah, stress has a fascinating relationship with blood sugar. Psychological or physical stress can both cause blood sugar to acutely go up, even if you’re fasted, even in the absence of any glucose.

Lewis Howes (00:24:15):

Really?

Dr. Casey Means (00:24:16):

And the reason for this is that any stress signal to the body will release stress hormones, like cortisol and catecholamine, noradrenaline, epinephrine, things like that. These signal to the body that there’s a threat. And the body has trouble interpreting the difference between a physical or a psychological threat, and so it’s going to produce the same stress hormones.

Lewis Howes (00:24:37):

So, if there’s an event that happens in life, let’s call it something we witness or something we see or something we hear or experience, we think of a thing that causes a stress hormone to go to the body. Is that what I’m hearing you say?

Dr. Casey Means (00:24:51):

Yes.

Lewis Howes (00:24:51):

There’s a thought that we have associated with the event or the stressful, or the thing that we think is stressful.

Dr. Casey Means (00:24:57):

Yes.

Lewis Howes (00:24:58):

And then that causes a stress hormone to enter the body.

Dr. Casey Means (00:25:01):

Yes.

Lewis Howes (00:25:01):

Does it go throughout the entire body? Does it go to the heart? What happens? And then does it just spike the blood sugar up?

Dr. Casey Means (00:25:07):

Exactly. It goes to the whole body and I would say simply put, in many ways, our mind has huge control over our metabolism.

Lewis Howes (00:25:17):

That’s what it sounds like.

Dr. Casey Means (00:25:17):

Yes.

Lewis Howes (00:25:18):

Because we can think a thought and stress ourselves out and have high blood sugar just based on thought alone.

Dr. Casey Means (00:25:23):

You can think your way into metabolic dysfunction, I think.

Lewis Howes (00:25:26):

But can you think your way out of it, too?

Dr. Casey Means (00:25:29):

In some ways you can. And it should be a part of our strategy for optimal metabolic health. The way it works is that, these stress hormones, they travel throughout the body and they actually tell the liver, we’ve got a threat. There’s a lion chasing us. We need to run. We need to have fuel for our muscles so that we can flee. It’s fight or flight. So the liver actually stores about two hours of really quickly accessible glucose in the form of something called glycogen. It’s change of glucose. It’s like our debit account. It’s short term, it’s ready to go, but it’s only a couple hours worth. Okay. So you’ve got your circulating and then you’ve got your stored glucose.

Lewis Howes (00:26:07):

Stored in the liver, like all the time?

Dr. Casey Means (00:26:09):

All the time. Yeah.

Lewis Howes (00:26:10):

Unless you burn it for those two hours, then it’s-

Dr. Casey Means (00:26:12):

Exactly. It depletes and you deplete your liver glycogen, so that hormone says dump it. So you flood the bloodstream with blood sugar to feed the muscles. And you can imagine, if you are doing a high intensity interval training workout and go to 90%, your VO2max in five seconds, that is a stress signal, but you’re going to use that glucose. Your body’s actually… So you’re going to see that rapid spike. And it’s actually fascinating to see on a continuous glucose monitor. I will do a sprint workout or a CrossFit workout, and it’s within two minutes, my glucose is going up and it can look like a big food spike. But the muscles are there using it.

Dr. Casey Means (00:26:52):

And the really cool thing about muscle is that it’s one of the only cell types in the body that doesn’t need insulin to take up glucose. So it actually can just take it up from the contraction. So it’s not like it’s really feeding into that pathway of insulin resistance like we were talking about. It’s a sync for that glucose. So there’s a supply sort of use match, which is good. But when you think about psychological stress, you’re literally just, you’re sitting in your chair, you’re on your computer, you get an email that’s stressful-

Lewis Howes (00:27:17):

And you’re reacting to it.

Dr. Casey Means (00:27:18):

Your body has that spike, but you’re not moving.

Lewis Howes (00:27:22):

Isn’t that crazy?

Dr. Casey Means (00:27:22):

Yeah. You’re not using those muscles. It’s just sitting there causing damage. And you can think about, we’re doing this probably 100 times a day in our regular life.

Lewis Howes (00:27:31):

Or ruminating on something from the past or stressing about something in the future or reacting to the news or whatever it might be that we can react to. How much of the psychological aspect is related to the disease in our life, versus just the straight food itself, without the psychological, I guess, thoughts that come with it?

Dr. Casey Means (00:27:54):

I think it’s so multifactorial. I always really say, I think that food is the foundation. Food is the substrate. Food is both what physically builds our bodies, and it’s also the molecular information that tells our body how to function. We eat about one metric ton of food per year, two to three pounds per day. This is just straight up chemical information that builds our body and tells our body what to do. We’re turning over constantly. The body we have today is not the same body we have in a week, from a physical atomic perspective. We’re shape shifters. We’re constantly changing.

Dr. Casey Means (00:28:34):

So food is, it’s incredible. It’s magical. It’s this incredible thing that we’re just constantly transmuting into ourselves, so we’ve got to get that right. But, while it’s necessary, it’s not sufficient for optimal health. You still got to dial in the other factors. And when I really think about the pillars, I’m thinking about seven things. I’m thinking about food. I’m thinking about stress management, exercise, sleep, our micronutrient status, so not just the macros we’re getting, but what are the actual micronutrients, vitamins, minerals and antioxidants, our microbiome, how that’s doing, and then our exposure to environmental toxins.

Dr. Casey Means (00:29:16):

So yes, while food is the foundation, you’ve really got to get those other things dialed in. Any one of those things can shift you off course.

Lewis Howes (00:29:27):

So you said food, stress, exercise, sleep, macronutrients?

Dr. Casey Means (00:29:31):

Micronutrients.

Lewis Howes (00:29:32):

Micronutrients.

Dr. Casey Means (00:29:33):

Which we often overlook.

Lewis Howes (00:29:34):

Okay, what are those?

Dr. Casey Means (00:29:35):

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

Dr. Casey Means (00:30:12):

But when we think about metabolism in the mitochondria again, so your mitochondria is filled with all these little enzymes, these little protein enzymes, that are essentially doing the work. They are the factory line that’s taking that food and converting it to ATP. And every single one of those amazing little protein machines needs these micronutrients to actually work.

Lewis Howes (00:30:35):

Gotcha.

Dr. Casey Means (00:30:35):

And the way to think about it is they are lock and keys that bind into little pockets of these enzymes and create tiny, tiny structural changes that actually make it work. So if we’re deficient in selenium or magnesium or manganese or zinc or whatever it is, these aren’t working properly. The majority of Americans are deficient in at least one critical micronutrient, because we’re just, we’re not eating real food.

Lewis Howes (00:31:01):

Right.

Dr. Casey Means (00:31:01):

And because stress can actually deplete a lot of these chemicals.

Lewis Howes (00:31:05):

Sure.

Dr. Casey Means (00:31:05):

It all goes back to thinking about those molecular machines that are converting food to energy and what they need to function properly, and micronutrients is a big one.

Lewis Howes (00:31:18):

I’ve also heard examples of people who, let’s say, eat perfectly, but still have challenges. Maybe their relationships are off and they’re in a stressful environment in their relationship or their marriage or whatever it might be, or they just react poorly. They worry often to things they see and experience. They’re a worrier. And so every time they worry, I guess a stress hormone is spiking, and sending hormones to the body, which is spiking blood levels. Is that right?

Dr. Casey Means (00:31:47):

Yeah.

Lewis Howes (00:31:47):

Blood sugar. So it sounds like the psychological side of things is also extremely important to understand. And that every time you’re allowing your body or your mind to ruminate on a consistent basis, it’s sending a signal to the body in a negative way, which is helpful if there’s a real life threat, but not when it’s on a repeat every day. Is that right?

Dr. Casey Means (00:32:10):

That’s exactly right. It’s that chronic low grade stress that can be really damaging. Something that’s been really fun to experiment with is, there’s now heart rate variability monitors, like Oura Ring or WHOOP or Leaf Therapeutics. And what these do is heart rate variability is a metric that you can track that looks at actually the time between each heartbeat. And oddly enough, we want the time between each heartbeat to actually not be consistent, like a metronome. We want it to have some variability.

Lewis Howes (00:32:40):

Why?

Dr. Casey Means (00:32:40):

Maybe 0.7 seconds. And then 1… I’m sorry. .7 seconds, 1.1 second, 0.9 seconds. That’s variability.

Lewis Howes (00:32:49):

Why do we want that?

Dr. Casey Means (00:32:50):

It really is a symbol of a dynamic system. You want elasticity in the system and that can sometimes have some irregularity to it. Sort of the way I think about it is, a stiffer system is going to be a little bit more regular. These are subtle. It’s not like you can feel it in your pulse if you just feel your pulse, but you can pick it up. And so we want more heart rate variability. And usually less, lower heart rate variability, is an objective measure of stress.

Dr. Casey Means (00:33:18):

And I’ve worn these things and been giving a talk on Zoom or something like that, and I’m looking at my data afterwards and my heart rate variability plummeted during the talk. Or I’m processing email, my heart rate variability goes down. And then of course, glucose may go up. And so you see these things happening together. And the immediate thing I think is, this is where our tools come in. This is where the deep diaphragmatic breath, where the mindfulness, where having awareness of this happening, and then there are so many things we can do to modify that stress response, even telling your body you’re safe-

Lewis Howes (00:33:54):

Sure.

Dr. Casey Means (00:33:54):

Everything is actually okay, can have a huge difference. So really dialing into awareness, and then where can I apply the tool? So I would say I take about 100 times more diaphragmatic breaths now than I did a couple years ago, because I realized, wow, if this is happening all the time throughout the day without my awareness, that’s going to add up over the next 30, 40, 50 years and have a huge impact.

Lewis Howes (00:34:18):

Right.

Dr. Casey Means (00:34:18):

But it’s not actually just the chronic low grade stress. There’s been a lot of research showing that acute traumatic events like loss of a loved one or divorce or childhood events, adverse child events, which are usually, there’s an acronym in ACEs. People who have many of these tend to actually have worse metabolic health.

Lewis Howes (00:34:40):

Wow.

Dr. Casey Means (00:34:41):

And this actually may be related to changes in the brain that affect metabolism, so really changing our set point for stress thresholds early on in life. Sometimes we’ll have that patient like you talked about, who’s doing everything right. They’re eating really healthy, but they’re just really not quite making that progress towards thriving that they want. And a lot of those patients I’m thinking about, what is the deep core wounds and what’s the set point that’s causing you to feel that this world is not a safe place, that is causing you to be inherently hypervigilant.

Dr. Casey Means (00:35:17):

And doing that work even on myself has been so positive because I think what you start to unpack as you go down that journey is that your perception of the world and whether it’s safe is very much dictated by your lifetime of experience. I think for those of us who have been on a journey of therapy, and now people are very interested in, of course, how psychedelics can fit into this. And then other modalities, long term meditation, deep meditation events and things like this that can really unwind some of those amygdala based, fear based response in the brain. I think there’s huge potential there for that to potentially unlock a new level of health, because what it’s doing is changing the fundamental way you see the world as a place of threat, or a place of safety.

Dr. Casey Means (00:36:11):

Unfortunately, I think in our modern world, fear has become a currency that we’ve used to profit in a lot of ways. If we can get people to be fearful, we can get them coming back for information that assuages that fear. And we see that with social media, we see it with the news. There was that undercover reporting of one of the CNN executives, who was recorded saying, “If it bleeds, it leads.” That we need to get people fearful for them to come back and watch. And what that’s doing to our stress hormones, to our brain set point, to our desire to have dopamine stimulation to get some pleasure in the face of all this fear, the way that’s affecting our cellular biology is profound.

Dr. Casey Means (00:36:58):

I think all of this movement that we’re seeing right now towards helping people, towards normalizing mental health care, normalizing… Psychedelic use is not an end all be all, but I think it’s interesting how that’s now being talked about as a way to really help-

Lewis Howes (00:37:12):

Sure.

Dr. Casey Means (00:37:12):

people unlock some of this chronic fear. I think it’s going to have… could have positive impacts on the body. Because if we’re living with chronic fear, our bodies are not functioning properly. And many of us are.

Lewis Howes (00:37:25):

Oo. Did you live with chronic fear for a while?

Dr. Casey Means (00:37:29):

I think that the healthcare system, the conventional healthcare system, unfortunately uses fear as a way to control patients in a lot of ways. You think about a conversation between a physician and a patient and it’s like, “Your cholesterol is a little high. You need to take a statin.” And the patient might say, “Well, can I have some time to work on diet and lifestyle?” “Well, I mean, it’s your choice. I mean, I’d recommend the statin right now, because, obviously, I don’t want you to have a heart attack. But sure, if you want to try diet and lifestyle.” That’s the type of thing that’s happening every day, where this fear of bad outcomes is, I think, driving very much a pharmaceutical and invasive intervention type of strategy. I think that that really was unsavory to me, because it’s very disempowered. It’s like, if I can drive fear in a patient, then I can essentially get them to do whatever intervention I recommend.

Lewis Howes (00:38:46):

Wow.

Dr. Casey Means (00:38:46):

And as a surgeon-

Lewis Howes (00:38:47):

Medicines, procedures, anything.

Dr. Casey Means (00:38:49):

Right. Exactly. Oh, well, if we don’t treat this ear infection with antibiotics, then it could travel to the brain and create a brain infection.

Lewis Howes (00:38:57):

Oh, man.

Dr. Casey Means (00:38:58):

And most ear infections resolve on their own, without antibiotics. The overuse of antibiotics is causing huge, huge problems with our gut, which then leads to mental health issues and metabolic problems. But if people are scared of the potential outcome, that may be very rare, then of course you can get them to do stuff. I don’t think that doctors are intentionally doing this. I think we have an incentive system in Western healthcare that really drives people towards intervention. I also think that with COVID we saw this happen, where this fear of anyone being harmed from COVID or that we got people to do anything and everything, and we’re losing that rational sense of the risk that is inherent in living. We get in a car every day and there is risk involved in that-

Lewis Howes (00:39:58):

Sure.

Dr. Casey Means (00:39:58):

but we choose to do it. And I think that there’s just a lot of fear based thinking that happens in the healthcare system that unfortunately disempowers patients and pushes them to do interventions more quickly. When I think that there is so much opportunity to help coach them with diet and lifestyle, which takes longer, it’s harder, but ultimately it generates health, rather than just putting a bandaid on disease.

Dr. Casey Means (00:40:25):

There’s no medication that actually generates health. Only diet and lifestyle strategies generate health.

Lewis Howes (00:40:32):

Wow.

Dr. Casey Means (00:40:32):

And so that should obviously be the fund of our medical system, but unfortunately we’re not very well trained as physicians to know that information or to coach on it. But to answer your question, I think a large part of my personal journey has been trying to overcome fear.

Lewis Howes (00:40:48):

Personal fear.

Dr. Casey Means (00:40:49):

Personal fear. I think one of the biggest examples of this is, my mom just passed away, about a year ago from cancer. And just as any normal person, I spent my life fearing my parents’ mortality. It’s like, oh, this is going to be horrible and devastating. And I think a lot of people worry about premature loss of a parent. I think going through that experience and it actually being a very beautiful transformational experience. It was a sort of a surprise. She had two weeks between her diagnosis and her death.

Lewis Howes (00:41:26):

Oh, man.

Dr. Casey Means (00:41:26):

We had this beautiful time together as a family. She was actually very much on the same page about holistic health as me and knew in her heart that she was dying very rapidly. She chose to stay at home, be with the family. We were all together, had this spectacular two weeks. The hospital system, through every possible medium, was trying to pull her into the system. It was pancreatic cancer. So it’s like, “You need a liver stint. You need a liver biopsy. You need a blood transfusion. You need to start chemo immediately.” And the reality was, she knew, I’m dying right now. She ended up dying in two weeks. None of the interventions would’ve helped. We wouldn’t even had a…

Lewis Howes (00:42:08):

Would have it lasted maybe a few more months or a few more weeks, maybe? You don’t know.

Dr. Casey Means (00:42:13):

I actually don’t think… I think that-

Lewis Howes (00:42:15):

It might have caused more stress.

Dr. Casey Means (00:42:17):

Well, and it was COVID, so she would’ve been in the hospital and we could have not visited her.

Lewis Howes (00:42:21):

Oh, that’d be tough.

Dr. Casey Means (00:42:23):

Anyways, that experience of seeing her approach, seeing her pure joy in the face, she just ended her last two weeks very joyfully, was very at peace.

Lewis Howes (00:42:35):

Mm, that’s nice.

Dr. Casey Means (00:42:36):

We had that time together. She was not just locked in the hospital, doing interventions that would not have helped very much. I realized, oh, something I’ve been fearing my entire life happened, was the most transformation growth experience I’ve ever had. I still feel way more connected to my mom than I ever could have imagined. No one can tell you, oh, you’re going to still feel connected until you maybe experience that. And it kind of made me realize-

Lewis Howes (00:43:03):

Wow.

Dr. Casey Means (00:43:04):

fear is not useful.

Lewis Howes (00:43:07):

Right.

Dr. Casey Means (00:43:07):

So I think that something like that, and I think that probably lots people have their own examples, just makes you realize the futility of living in fear and what does it do? It damages your body. It doesn’t really change the outcome. A little bit of healthy fear is useful, of course, you don’t want to cross the street without looking. But the idea that we should be fearful all the time, and that’s going to protect us, is such a fallacy.

Dr. Casey Means (00:43:33):

Turning to stoic philosophers, turning to some Eastern texts, Buddhist and Daoist texts, looking into traditions that have thought this way has been a really useful part of my journey, and I think needs to be a part of how the healthcare system reforms, because we weaponize fear of death as a way to control patients into doing anything we want. And I think fundamentally, overcoming your fear of mortality, which is the only thing we can be certain of in this world, and really approaching that with a sense of awe and a sense of curiosity and a sense of what can this teach us about how to live, I think is an absolute foundational part of what we need to do as individuals, but also the healthcare system. Because otherwise we’re just using fear as this thing, fear of death as this thing, to just wrangle people into as many interventions and pharmaceuticals as possible with the off chance that people think it’s going to somewhat reduce their chance of mortality.

Lewis Howes (00:44:39):

What I heard you saying there was that, there is no medicine that can actually make you healthier. Is that correct? Or that could actually solve the issue on the medicine itself?

Dr. Casey Means (00:44:50):

The vast majority of all medications, I probably wouldn’t say all on the record-

Lewis Howes (00:44:55):

Okay, yes.

Dr. Casey Means (00:44:55):

but I would say the vast majority-

Lewis Howes (00:44:56):

Most.

Dr. Casey Means (00:44:57):

do not generate health in the body. They manage symptoms.

Lewis Howes (00:45:01):

They don’t cure-

Dr. Casey Means (00:45:01):

No.

Lewis Howes (00:45:02):

the disease or whatever.

Dr. Casey Means (00:45:03):

If you take away a diabetes medication from someone, their diabetes is not gone. It’s right back there where it was. Whereas if you get someone to really foundationally improve their cellular function, which can only be done through consistent dietary and lifestyle habits, they can truly reverse their disease.

Lewis Howes (00:45:25):

Right.

Dr. Casey Means (00:45:25):

But there’s no medication that reverses diabetes, there’s no medication that reverses heart disease, there’s no medication that reverses Alzheimer’s dementia.

Lewis Howes (00:45:36):

They just kind of manage the symptoms.

Dr. Casey Means (00:45:37):

They manage the symptoms, and maybe-

Lewis Howes (00:45:37):

Maybe some relief a little here and there.

Dr. Casey Means (00:45:40):

Relief, life extension for some of them, but they do not create health. And what health is, health is optimal cellular functioning. We are just a big bag of cells. And each cell needs to be functioning properly for us to have health. What is a symptom? What is disease? That is cellular dysfunction happening on the individual level. If that’s happening in mass, that might be tissue dysfunction. If that’s happening in a bigger way, it’s organ dysfunction, and that’s when we see symptoms of disease. We have to really zoom in on what’s happening in the cell. A cell is getting its information from what you’re eating, what it’s being built from, which is your food. What stress hormones its seeing binding to its little cell membrane. What’s happening with your hormones, which of course is dictated by stress, and by sleep, and by exercise, and by food.

Dr. Casey Means (00:46:41):

It’s the super complex milieu, that can only be optimized by the choices that we’re making every day. Day in, day out consistently. Even by the sunlight we’re exposing ourselves to in the morning. Andrew Huberman talks about this all the time. Literally the consistent exposure of sunlight first thing in the morning, is chemical information to your body, through the sunlight’s energy, to tell your cells how to function. You can’t put that in a pill. It has to happen for these millions of years of evolutionary evolved processes. So yes. Medications can’t with their one pathway that they might be intervening on, truly generate foundational cellular health, which is what we need to achieve.

Lewis Howes (00:47:24):

They don’t bring wholeness back to the cell. I guess there’s some creams, or something that might help you heal a cut, or something like that. But we’re talking about a chronic illness medication. There’s…

Dr. Casey Means (00:47:37):

Even if you think about a cut, it seems so simple but it’s at actually so complex. For a cut, if you think about people with disease like diabetes for instance. One of the reasons that people with type 2 diabetes die, is because of chronic wounds. They have wounds that won’t heal.

Lewis Howes (00:47:55):

Interesting.

Dr. Casey Means (00:47:56):

Oh, yeah. That’s-

Lewis Howes (00:47:57):

Are they internal wounds, or external wounds?

Dr. Casey Means (00:47:58):

External wounds. Something that happens with people with diabetes, is they often have nerve damage, because of the way the blood sugar’s affecting the nerves. Their feet become numb, and then they might get a cut on their foot, they don’t feel it. That festers, and because of their high blood sugar, their immune cells don’t work. So they can’t heal the wound.

Lewis Howes (00:48:17):

They die from the wound.

Dr. Casey Means (00:48:19):

They get a huge systemic infection, that might lead to death or an amputation. The majority of lower limb amputations are caused by diabetes. Diabetic ulcers that are like wounds.

Lewis Howes (00:48:31):

How many people have type 2 diabetes in the US? Do we know the number?

Dr. Casey Means (00:48:34):

Oh, yeah. There’s 128 million Americans with prediabetes or type 2 diabetes. Of those 30 million, have full on type 2 diabetes.

Lewis Howes (00:48:44):

30 million of the what? What is that, 300 and something million people?

Dr. Casey Means (00:48:47):

Yeah. It’s about 13% of the population now.

Lewis Howes (00:48:49):

Has type two diabetes?

Dr. Casey Means (00:48:50):

Yeah. It was less than 1% in the 50s and 60s.

Lewis Howes (00:48:55):

Pre-diabetic, you’re saying a 100 million?

Dr. Casey Means (00:48:57):

Yeah. Around that.

Lewis Howes (00:48:57):

What is pre-diabetic mean? Who is someone who might be pre-diabetic?

Dr. Casey Means (00:49:04):

It actually can be quite surprising. There are lots of young, healthy people walking around who look otherwise fit, who have prediabetes and don’t know it. 90% of people with prediabetes, do not know that they have it.

Lewis Howes (00:49:16):

How do you know if you have it?

Dr. Casey Means (00:49:18):

The easiest way to do it is through a blood test. You basically get a fasting blood sugar test from your doctor. If it’s between a 100, 125 milligrams per deciliter of fasting glucose, that’s considered prediabetes.

Lewis Howes (00:49:32):

100 to a 125?

Dr. Casey Means (00:49:32):

100, 125.

Lewis Howes (00:49:32):

Where do you want to be at, what’s a healthy range?

Dr. Casey Means (00:49:35):

What’s considered normal, is a 100 or below. I would say that is way too lenient of a range. Because what we’ve figured out, is that people in the low end of normal, are much less likely to develop long-term problems. With heart disease, stroke, or diabetes. Even if you’re in the high normal range, and your doctor says to you, oh, your fasting blood sugar is 97. You’re great. You’re normal.

Lewis Howes (00:49:58):

That’s very close to a 100.

Dr. Casey Means (00:49:59):

You should see that as a huge red flag. You are metabolically dysfunctional if that’s the case. Really where you want to shoot for is about 70 to 85 milligrams per deciliter.

Lewis Howes (00:50:10):

People get a test that they can order and do this themselves, or do you have to go? What are these-

Dr. Casey Means (00:50:15):

You can actually buy it at CVS or at the pharmacy. You just prick your finger.

Lewis Howes (00:50:19):

What are these called?

Dr. Casey Means (00:50:21):

They’re called glucometers. They’re literally $20 on Amazon. There’s Keto-Mojo-

Lewis Howes (00:50:28):

You just prick your finger, and then it’ll tell you right away in a few minutes?

Dr. Casey Means (00:50:30):

In five seconds.

Lewis Howes (00:50:31):

So then it just tells you what your level’s at?

Dr. Casey Means (00:50:34):

What it is. It’s cool to check it actually, day to day for a few weeks. One thing you’ll find is that… Let’s say you have one poor night of sleep. Let’s say had a big work thing due, and you got six hours instead of eight hours. Your blood sugar in the morning might be 10 points higher.

Lewis Howes (00:50:49):

Come on.

Dr. Casey Means (00:50:50):

Oh, for sure. Let’s say you had a really late meal the night before, your blood sugar might be higher the next morning. What it starts putting together for you is, this is very dynamic. If I did these activities day after day, year after year for my whole life, I’m building. Figure out what allows you to be in that 70 to 85 range. Maybe it’s a really awesome workout in the middle of the day prior. Getting to bed a little bit earlier. Getting morning sunlight exposure, and doing some deep breathing in the morning.

Dr. Casey Means (00:51:19):

All of a sudden you’re like, oh, cool. My blood sugar is 72 milligram per deciliter. Fasting for 16 hours, or something like that. Figuring out what works for you to stay in that low range, and then dial it in for as many days of the week as possible as you can. The other really interesting thing about fasting blood sugar as a test, is that the body like we were talking about with the insulin resistance. It’s very adaptable. When the body starts becoming insulin resistance, it’s saying we’re seeing too much glucose around. We’re producing, we’re going to create an insulin block. What the body does is it’s like, we’ve got to get this glucose out of the bloodstream. It starts producing more insulin. Your insulin levels will actually start rising as you become insulin resistant, to push more of that glucose into the cells.

Dr. Casey Means (00:52:10):

A study in the Lancet at a big medical journal showed, that you can actually keep your blood sugar levels normal for 13 years prior to them elevating. All the while insulin is rising, but it’s compensating to keep glucose low. Unfortunately, because we don’t check fasting insulin in this country, we’re missing that window. Where people are clearly becoming insulin resistant, but their glucose still looks normal in their yearly check. To just make this concrete, you and I could both go to the primary care doctor, and have a fasting glucose of 80 milligrams per decilitre. The doctor says to both of us, you’re both in perfect health. If I’m really insulin resistant, because I’m on that glucose roller coaster. I’m getting poor sleep. I’m chronically stressed and not managing it. I have childhood trauma that I haven’t addressed. Blah, blah, blah, all that stuff.

Dr. Casey Means (00:53:01):

I could be at 80, but I’m doing that by my insulin being elevated to 35 or 40. Your insulin might be two, so your body’s not working hard at all to keep your insulin at 80. My body is having to preserve so much insulin. I am clearly on the path towards metabolic disease, diabetes, and all the associated conditions. Heart disease, stroke, cancer Alzheimer’s dementia, fatty liver disease, gout, infertility, or [Ito cells function 00:07:26] blah, blah, blah, blah.

Dr. Casey Means (00:53:27):

You’re in the clear, but our doctor tells us that we’re the same. This is why I recommend that every patient ask their doctor for a fasting insulin check, because you have a sense of what’s actually happening under the hood. If you’re in that early range, and of course, this is talking about people who are in the normal range. That’s not even included in the 128 million Americans, who actually have a diagnosis of prediabetes. This is people in the normal, who still may be on their route to problems. It’s now becoming like, the majority of the country is dealing with a fundamental problem. In how they make energy in the body, which is a core process that allows every cell to function.

Lewis Howes (00:54:09):

You’re saying there’s seven factors to this, but what would you say are the main couple? Is it food and lack of exercise, or what?

Dr. Casey Means (00:54:17):

I would say the four most important pillars are food, sleep, deprivation and interruption in sleep. Just the beeping, and the buzzing, and the blue light late at night that interrupts our sleep quality. The chronic low grade stress, and the fear that so many people are dealing with, and then the sedentary behavior. The fact that most Americans are sitting more than eight hours a day. Sitting creates inflammation in the body. It keeps that glucose in your bloodstream, and not going into the muscles. The exercise one I think, a really empowering just a tip for people. It doesn’t have to be like, go out and run five miles. Do a high intensity annual training workout. Do a crossfit workout. It literally is as simple as walking. Maybe walk 15 minutes after a meal, especially if a high curb meal. Even walking for two minutes every half hour, has been shown to statistically significantly reduce, insulin and glucose levels throughout the day.

Dr. Casey Means (00:55:21):

The study was a minute and 40 seconds. It was looking for people who just walked for 30 minutes in one chunk of the day, but otherwise sat during the day. Versus people who walked for 30 minutes, but broke it up into one minute and 40 seconds, every 30 minutes throughout the waking day. Those people that moved more frequently but the same quantity, had much lower glucose in insulin. I think the reason is because, if you think about sitting all day and then walking for 30 minutes, you’ve basically just been atrophying your muscles all day. You’re just this blob sitting there. Versus…

Lewis Howes (00:55:56):

The continuous of it constantly.

Dr. Casey Means (00:55:58):

Yeah. Again, thinking back to the cells, you’re activating these pathways. It’s all just information to the cell, activate the pathways, get them moving, clear the glucose every 30 minutes. It’s not like this is a lot of stuff you have to do, a simple walk makes a big difference. From looking at all this literature, one of the biggest takeaways I’ve realized, is that moving more frequently, even if it’s low intensity is key. It can’t just be that one chunk.

Lewis Howes (00:56:24):

Maybe if you’re in an office or something, or you’re not walking or have the ability to walk. Maybe you do some air squats, or pushups, or just anything where you’re moving your body. Some split squats, whatever might be. Just body weight stuff.

Dr. Casey Means (00:56:37):

For a minute. Minute, 40 seconds. Do 30 squats.

Lewis Howes (00:56:39):

Lift your knees up in the air.

Dr. Casey Means (00:56:40):

Yeah, exactly. I love that.

Lewis Howes (00:56:42):

That’s interesting. Some high knees. Wow, this is fascinating. 13%, is that what you said, has type 2 diabetes in the US? Is type 2 diabetes reversible?

Dr. Casey Means (00:56:55):

Absolutely.

Lewis Howes (00:56:57):

But beyond that it’s not reversible, is that right?

Dr. Casey Means (00:57:01):

Once you get into that range of type 2 diabetes, of course there’s a spectrum of how bad it is. It’s always easier to reverse these things earlier on.

Lewis Howes (00:57:14):

The type 2 diabetes is the… There’s not a type 3, or type 4?

Dr. Casey Means (00:57:15):

No. Basically-

Lewis Howes (00:57:18):

What does that mean when you have type 2 diabetes?

Dr. Casey Means (00:57:21):

Based on our criteria, it just means you meet a particular threshold of blood sugar levels. If your first thing in the morning, fasting blood sugar… You go to the doctor, they take your blood, if it’s below a 100, non-diabetic. 100 to 125, prediabetes. 126 or above, type 2 diabetes.

Lewis Howes (00:57:39):

Wow. You can reverse that the early you catch it, back to the pre-diabetic, or to the 100 to 125 then hopefully below that. With nutrition and lifestyle.

Dr. Casey Means (00:57:49):

Absolutely. There’s actually been studies showing… Virta health, Sarah Hall said, she’s an amazing that this company is showing reversal of type 2 diabetes, with a low carb, high fat diet and coaching. It’s not even an exercise intervention, it’s just diet, and they showed that in 12 weeks.

Lewis Howes (00:58:07):

What type of coaching?

Dr. Casey Means (00:58:09):

Just a nutritional coaching. For the doctor-

Lewis Howes (00:58:11):

Are you doing this every day, and just checking accountability?

Dr. Casey Means (00:58:13):

Exactly. They’re not even including exercise. It’s that simple. They are showing amazing reversal of diabetes. To the extent where the American Diabetes Association, they did not actually recognize reversal of diabetes, as something that’s possible until this past year. They’re actually calling it remission, which I think is a funny term. It’s basically reversal. You’re changing cellular function. You’re becoming more insulin sensitive. You’re lowering, you’re circulating glucose levels. The reason why you want to get on top of this early though, is because the longer you have diabetes… Again, coming back to the mitochondria, the more damage you’re doing to those cellular structures. So you want-

Lewis Howes (00:58:54):

It’s harder and harder to reverse.

Dr. Casey Means (00:58:56):

It’s harder.

Lewis Howes (00:58:56):

How big of a business is type 2 diabetes in the US alone a year?

Dr. Casey Means (00:59:01):

Incalculable.

Lewis Howes (00:59:04):

How much money is spent on the management of type 2 diabetes?

Dr. Casey Means (00:59:08):

You’ll see lots of different numbers. Usually somewhere between 200 and 600 billion.

Lewis Howes (00:59:13):

200 to 600 billion?

Dr. Casey Means (00:59:15):

Yeah.

Lewis Howes (00:59:16):

Just for type 2 diabetes?

Dr. Casey Means (00:59:18):

Our healthcare costs are $4 trillion per year. About 17% of our GDP. We spend more than of course, any other country in the entire world.

Lewis Howes (00:59:28):

70% you said, how much?

Dr. Casey Means (00:59:30):

Lewis Howes (00:59:33):

17%. [crosstalk 00:59:33] is healthcare the USA?

Dr. Casey Means (00:59:34):

Yeah.

Lewis Howes (00:59:35):

What is Canada?

Dr. Casey Means (00:59:36):

I don’t know.

Lewis Howes (00:59:36):

Okay, got you.

Dr. Casey Means (00:59:37):

But if you look at the curve, it’s like all these little dots down in the lower left corner, and there’s the US up here in terms of cost and-

Lewis Howes (00:59:45):

200 to 600 billion of that is in the type 2 diabetes-

Dr. Casey Means (00:59:48):

Metabolic management.

Lewis Howes (00:59:50):

Holy cow.

Dr. Casey Means (00:59:54):

On top of this, our life expectancy is going down. What’s ironic about the American healthcare… For three years, our life expectancy has been going down. You would think… This is what perplexes me about physicians right now. Is that as a physician, you’re really a steward of the system. You are the person calling the shots, and doing the treatment. You look at this system and okay. Every single year we’re increasing healthcare costs. Every single year it’s an increasing part of our GDP. We’re now spending $4 trillion on healthcare. We’re literally throwing money at it, and outcomes are getting worse every single year. If you’re not stopping and thinking, what is going on? What are you doing with your time?

Dr. Casey Means (01:00:44):

It’s not working. We’re getting sicker every single year. We’re getting sicker, we’re getting fatter, and we’re getting more depressed as a country, and just throwing money at it. I think the key problem with this is that, the modern American healthcare system has produced miracles literally. A hundred years ago, if you transported someone from 1900 to today. And they looked at what’s life expectancy, and infant mortality, and what happens when we get an acute illness, they would be shocked. It’s unbelievable. But that’s because we are very good at managing acute illnesses. If you have an infection, something like childbirth, if you break your arm, if you’re in a car accident, we can manage these things.

Lewis Howes (01:01:25):

Whereas before we weren’t good at that. People would die or have massive complications with those.

Dr. Casey Means (01:01:29):

Absolutely. That’s great. We can manage that, but chronic disease is where we are abjectly failing. Chronic diseases are 90% of our healthcare cost. They are the things that are killing Americans, and they are based in diet and lifestyle. Those are the things that we are doing having… This is worse outcomes, the more money we spend.

Lewis Howes (01:01:52):

90% of the 4 trillion, is that what it is?

Dr. Casey Means (01:01:55):

Goes towards chronic disease management.

Lewis Howes (01:01:56):

Chronic diseases. What else besides type 2 diabetes is included in that?

Dr. Casey Means (01:02:01):

This are the diseases that are long term considered, to be developed over time, and are generally rooted in diet and lifestyle.

Lewis Howes (01:02:09):

Heart disease.

Dr. Casey Means (01:02:11):

Heart disease. Alzheimer’s dementia, chronic respiratory illnesses, chronic kidney disease, chronic liver disease. There’s depression, anxiety, chronic pain, chronic fatigue syndrome, gout. There are things that don’t just come and go like a cold, or-

Lewis Howes (01:02:28):

It’s not overnight.

Dr. Casey Means (01:02:29):

… come and go-

Lewis Howes (01:02:30):

90% of the money, is going towards chronic disease and illness?

Dr. Casey Means (01:02:35):

That’s right.

Lewis Howes (01:02:36):

What I’m hearing you say is, chronic disease and illness can be prevented with nutrition and lifestyle?

Dr. Casey Means (01:02:42):

Or reversed.

Lewis Howes (01:02:42):

Or reversed.

Dr. Casey Means (01:02:43):

In many cases. Of course not all.

Lewis Howes (01:02:45):

Most of the cases I’m assuming, a lot of the cases?

Dr. Casey Means (01:02:48):

I think a huge burden of that disease could be prevented or reversed. Obviously there was going to be cancers that you can’t reverse with diet and lifestyle, but a lot of the cancer we’re seeing today could likely be prevented. We’re not trained on how to do that effectively, as physicians or any practitioner.

Lewis Howes (01:03:05):

How much money could we save if we just invested in the prevention, and the lifestyle, nutrition, training and coaching? Versus just spending money on these things, that are masking and not solving the problem.

Dr. Casey Means (01:03:17):

I think trillions of dollars.

Lewis Howes (01:03:18):

Wow.

Dr. Casey Means (01:03:20):

The funny thing is that, what taxpayers don’t realize is that they’re paying for this four times over.

Lewis Howes (01:03:25):

It’s crazy.

Dr. Casey Means (01:03:26):

We are paying taxpayer money to of course fund healthcare, Medicare, Medicaid, all these things. We are then going to the doctor and paying our Copays. We’re paying our insurance premiums. We’re paying for that service. We are also paying taxpayer money, for the farm bills and for the food subsidies, that are making all the disease promoting foods cheaper for Americans. We spend $31 billion on our farm bills, which directly subsidize the foods that cause disease, making them artificially cheaper. This is corn, sugar, soy, wheat, and other foods like that. Does not go towards the vegetables and the fruits, which actually part of a separate, very small horticulture bill. Which is not even a fraction.

Lewis Howes (01:04:15):

10 million or something. So small.

Dr. Casey Means (01:04:16):

It’s a tiny little amount. They’re paying for those that then make us sick. Then of course we’re paying for the environmental damage, of those terrible farming practices. Of the foods that make us sick, that are then ruining our top soil, and creating horrible runoff in our rivers and oceans. Literally you walk into the store, and you grab Skittles, or you grab Wonder Bread. I think what people don’t realize, is that if that had a real price tag on it, it would be a $150. Because it’s the healthcare cost. It’s the cost of the food. It’s the cost of the taxpayer money for healthcare for others. It’s the cost of the environmental damage, and it’s the cost of the farm bills. We’re paying all that, and yet it’s $3.

Lewis Howes (01:05:04):

What I think that’s cool with you’re doing, and a lot of other of your peers are doing, is trying to give people information and access to take back control of their own health. Prevent a lot of these things from happening, by just making better choices every day. Having the information and the education of what makes you sick, and what keeps you healthy with all these different factors you talked about. Also, just staying on track with it. Staying on track consistently, to prevent and stay healthy as long as possible. The challenge is there’s so much temptation in the world. There’s so much temptation, and so much available at all the times to make poor choices. Whether it becomes nutrition, diet, sugar, all these different things. Processed foods. It’s very challenging for lot of people. Even myself, I want to try consider a healthy person, active. I just ran a marathon three days ago for my first marathon.

Dr. Casey Means (01:05:58):

Congratulations.

Lewis Howes (01:05:58):

Thank you. I still feel like I’m not in the best shape that I could be in, because of the nutritional aspect. I can go months of eating super clean and healthy, and then other months where I’m like, I feel great. Let me just have some sugar every day now. It’s the accountability, it’s the structure, it’s the accessibility. There’s so much processed foods, which I think is challenging for a lot of people. I think that’s what’s one of the hardest things is, just the discipline it takes. The personal discipline. How do you manage it personally, knowing all this information? Do you still eat a lot of sugar, or are you like cut sugar out of your life now?

Dr. Casey Means (01:06:41):

First of all, I think the points you made are so important. It is hard. That is why I’m excited about technology that helps people eat better, because continuous glucose monitoring. Of course, what we’ve started with levels is because, it’s not like I want to walk around and see everyone being a cyborg with technology on their arm. I’m actually a very crunchy granola person. I’m not the most tech savvy person. I want to just be in the back country unplugged. That is my ideal. However, the cards are stacked against us so monumentally in the ways we’ve talked about. The past 50 to a 100 years, the human body has had to be bombarded with all these external signals. That it’s never had to deal with the tens of thousands, hundreds of thousands of years of evolution. It’s breaking our bodies. We have broken bodies by and large in America, as evidenced by the fact that six in 10 American adults have at least one chronic disease. We’re breaking. Those cards are stacked against us. Of course there’s governmental factors. There’s all this stuff. There’s food marketing, our school lunches for kids are awful. In the face of that modern reality tools to empower ourselves, to make decisions that are better, I think are very important. Ideally, you could use these tools to gain awareness, to gain learning, to gain knowledge of how to eat and live in a way that keeps your blood sugar more stable. That keeps your metabolic health on point. Maybe you don’t have to use anymore. Maybe it’s just a window. I’m not wearing one right now. I’ve been at this for three years, and I can go months now without wearing one. It can be very helpful for accountability at this point, but-

Lewis Howes (01:08:27):

But you know what works and what doesn’t work now.

Dr. Casey Means (01:08:30):

Yes. It’s a nuanced balance. That’s what I’m so excited about is empowerment. I think that is the key word. Your doctor might say to you, oatmeals, you’ve got high cholesterol. So eat oatmeal. This is a heart healthy whole grain thing.

Lewis Howes (01:08:45):

But that might be that bad for you.

Dr. Casey Means (01:08:47):

Put a blood sugar monitor on your arm, and eat the oatmeal and see what happens. Maybe for you, your blood sugar stays quite stable and you don’t have a big spike. For me because I’ve tested this, one serving of Quaker rolled oats caused me an 80 point glucose rise and crash, which is about four times higher than the highest I want to go. I want to go up like 20 points after a meal.

Lewis Howes (01:09:12):

Wow. You want to stay like here, not here. Right?

Dr. Casey Means (01:09:14):

Exactly. So for my body, terrible metabolic choice. For yours, maybe it’s okay.

Lewis Howes (01:09:19):

Maybe it works.

Dr. Casey Means (01:09:19):

But the fact that the doctor’s saying it sort of works for everyone, that’s where we can get into trouble because every single body is different. We are so biochemically individual and what works for you and me might be very different in terms of what causes a blood glucose spike. And it can also be different day to day. Again, if I’m sleep deprived, it might hit me a lot harder than on the day that I’m not. So knowing what those variables are can be really useful information. So for me, when I started wearing continuous glucose monitors, when we started Levels, I was almost 100% plant based, and what I learned super quickly was that there were-

Lewis Howes (01:09:58):

Before the monitor, you were plant based.

Dr. Casey Means (01:09:59):

And I’m still like 93% plant based, but I’ll eat a little bit of really thoughtfully sourced animal protein now. But what it did for me was make me realize that within my plant based diet, there were certain foods that were causing really big spikes and how I could modify plant foods and balance them with adding fat, protein and fiber to my carbohydrates to keep the spikes much less, so it-

Lewis Howes (01:10:25):

Interesting, because you can be plant based and be unhealthy.

Dr. Casey Means (01:10:27):

Absolutely. Oh my gosh. You can be-

Lewis Howes (01:10:29):

You can be having sugar all day long and be spiking left and right still.

Dr. Casey Means (01:10:31):

You can just be trashing your health that way. I think that one of the things I’m most excited about with this personal biofeedback data about nutrition is that I think it’s going to pull the rug out from diet wars and from all these really-

Lewis Howes (01:10:45):

Just show the proof, here’s the evidence. Yeah.

Dr. Casey Means (01:10:46):

Exactly. Because I can look, someone who’s carnivore, and this has happened, can be ripping on vegans on social media. And if I can come out and say, “Here are my blood sugar curves. They’re flat. My insulin is three. My cholesterol is X, Y, Z. My inflammation markers are this, my vitamin D is this and my Omega-3 levels are this,” how can you fight with me? This is working-

Lewis Howes (01:11:10):

This is healthy. Yeah, yeah.

Dr. Casey Means (01:11:11):

… for me. And it might actually look identical to their lab work because the body is such a complex system. There are many different redundant pathways to getting to the same outcome. But the key is you have to be so thoughtful about how you’re doing it. The run of the mill vegan diet is probably not going to be great for people.

Lewis Howes (01:11:32):

Yeah, the processed sugar.

Dr. Casey Means (01:11:33):

Neither is the run of the mill carnivore diet.

Lewis Howes (01:11:34):

Exactly.

Dr. Casey Means (01:11:35):

So just having insight into that, but I think, again, the proof is in the pudding, and that’s where I’m excited to see more data helping to quell some of the debate on what’s better.

Lewis Howes (01:11:47):

Yeah, smart.

Dr. Casey Means (01:11:47):

Because each body’s different and-

Lewis Howes (01:11:51):

That’s interesting. So tell me about Levels then. What are you guys doing at Levels with this … Is it called constant glucose monitor? Is that what it’s called?

Dr. Casey Means (01:11:59):

Continuous glucose monitoring.

Lewis Howes (01:12:00):

Continuous.

Dr. Casey Means (01:12:00):

Yeah, CGM.

Lewis Howes (01:12:02):

Where you essentially put on a monitor in your skin for two weeks. Is that what it is? And then it monitors your blood levels for 24, 7 for two weeks. Anything you consume or don’t consume it ma it tells you what’s happening. You have an app that shows you in tracks it. So why is this essential for someone to be curious about and to potentially want to try this out?

Dr. Casey Means (01:12:26):

Yeah. The reason why it’s something that I think is relevant to pretty much everyone is because of the rates of what we’re seeing in our country. Like if you’re just living your life standard, American diet, more likely than not, you’re going to end up with a metabolic disease. That’s just now common reality. And so having some information to both see what the trajectory is over time, have a real sense of ownership over what’s going on metabolically in your body, I think that’s really empowering. Like right now you kind of get crumbs of information from your doctor once a year.

Dr. Casey Means (01:12:58):

But imagine if you could really have ownership over that foundational asset of your health. So that’s one thing is just like the awareness. And then the bigger piece is to have this closed loop biofeedback on everything you’re eating and everything you’re doing to keep glucose more stable, because we want to get off those ups and downs swings not only to improve our day to day functioning and the subjective experience of our days, the energy, the mood, the cravings, the fatigue, but also to set us out for like the long term avoidance of sort of the glucose related metabolic diseases.

Dr. Casey Means (01:13:35):

And so that’s really the reason to use it. And what I love about it is like, just like with the oatmeal example, try a food, see what happens. The cool thing is even if you do spike, it doesn’t necessarily mean you have to get rid of that food forever. It means that you can potentially modify it and work with it. So let’s take the oatmeal example for instance. If you love oatmeal, like you’re just like, I do not want to live without oatmeal. That’s fine.

Dr. Casey Means (01:13:58):

One thing we’ve seen in our data set, so we’ve had about close to 25,000 people go through our program. We have over 50 million glucose data points. So we have a lot of information here. People who eat like rolled oats, like instant oats, which are fairly processed spike higher than people who eat less processed forms of oats like steel cut oats or groats, which are kind of like a chewy, very whole food form of oats. So eat one of the less processed ones potentially, or add fat protein and fiber to that carb. The carb alone if you’re eating what I call like a naked carb, essentially a meal that’s just like dominant carbs.

Lewis Howes (01:14:34):

Carbs. Yeah. No fat protein.

Dr. Casey Means (01:14:36):

Yeah, like two bananas or oatmeal or Skittles. Like you think of about some candies, like Skittles are basically just like sugar. Whereas like a Snicker’s bar actually has-

Lewis Howes (01:14:47):

Got some peanut butter.

Dr. Casey Means (01:14:47):

Peanut butter and nuts and chocolate. And crazily enough Skittles have an over 80 point glucose spike in our data set and Snickers is like 35 or something. So it’s like half and because Skittles are more of a naked carb. And so Skittles are actually the highest spiking food in our entire data set.

Lewis Howes (01:15:06):

Come on.

Dr. Casey Means (01:15:06):

Yeah, number one.

Lewis Howes (01:15:07):

Just a straight sugar ball.

Dr. Casey Means (01:15:08):

Straight sugar ball. Skittles, candy corn, milk duds. It’s like, they’re all very similar. Jelly beans.

Lewis Howes (01:15:14):

Yeah. It’s like sugar coated on sugar with more sugar. It’s crazy.

Dr. Casey Means (01:15:20):

So yeah. So you want to avoid that naked carb situation. So I see oatmeal with chia seeds, which has tons of fiber and protein. A little bit of almond butter, which has fat, protein and fiber. Add a few maybe low glycemic berries, like a couple blueberries or raspberries or whatever, which have a good amount of fiber and antioxidants. Maybe some flax seeds on top, which is going to be fiber and fat. Mix it all together. And you’re going to probably absorb the glucose slower. It’s going to slow digestion. The fiber can actually block the amount of glucose that gets into the bloodstream. The fiber also has the effect of feeding the microbiome, which has downstream positive effects on metabolic health. So it’s like keep the oatmeal, but modify it. And if you’re not wedded to oatmeal, then start experimenting with other breakfasts. So for me, I’m like, I couldn’t care less about oatmeal.

Dr. Casey Means (01:16:08):

So if I saw that it spiked me and I think I never ate it again. I’m like, I don’t even like this. I just thought it was healthy. So for me, that’s gone. And if you look in our data set at what some of the best scoring breakfasts are, we see things logged like eggs and avocado, eggs and greens. We see frittata, we see chia pudding. Actually one that we see is like green… There’s a particular smoothie that we actually see logged a lot. It’s called the fab four smoothie, it’s popularized by Kelly LeVeque.

Lewis Howes (01:16:44):

Yeah. She’s great.

Dr. Casey Means (01:16:44):

She’s amazing. And it basically is a really well balanced smoothie that’s low sugar, high protein and fiber and healthy fats. And there’s some vegetables in there as well. And a lot of our community logs that. And so it’s actually got a very low glucose spike. What you can see from all from this amazing data set is that there’s all these options that have like less than 20 point glucose spike. So choose those-

Lewis Howes (01:17:08):

Choose those options.

Dr. Casey Means (01:17:09):

…as opposed to.

Lewis Howes (01:17:10):

Interesting. So someone signs up for this. I guess there’s a waiting list right now. But what does it do for them? Does it coach them on the foods to eat? Does it tell them you just ate this and it’s not good for your system right now, add this to it. If you want to keep eating it kind of coaches you for those two weeks or what’s it do?

Dr. Casey Means (01:17:28):

Yeah. It does everything that you just said, basically. So a levels member will actually use it for a full month to start. So the sensors are on the arm for two weeks. So the first month of level is two sensors. So you put one on for two weeks, you peel it off, you put a new one on. And so it’s 28 days total. And throughout that process, it’s doing exactly what you’re saying. You log your food, you take a photo of it. And then you get a score for each of those meals. So the score is essentially a one to 10 zone score is what it’s called that tells you about the glucose impact of that meal. So you’re shooting for tens, and one is like lower. For example, I could eat sushi, which of course has white rice. And sometimes the white rice has sugar actually added to it. And for me sushi usually scores like a two or three. I have a very, very high spike.

Lewis Howes (01:18:17):

You want it to be a one.

Dr. Casey Means (01:18:19):

You want it to be a 10. You want it to be a 10. So that would look like a big sharp spike crash. So what I learned and what the types of things that we talk about in the Levels app is like, okay, well, based on what other people have logged, if you logged sashimi, you’re probably going to score like a 10. A nine or a 10, because that’s of course just like straight fish. People are now logging cauliflower rice sushi, which is kind of interesting, which has like almost no glucose spike. And there’s actually restaurants offering this now. Or, I think like me, there’s some people who just don’t want to give up sushi.

Dr. Casey Means (01:18:49):

Like that’s not like oatmeal. Like for me, I’m like, I’m not giving up sushi. So then there’s other things it’ll suggest, like for instance, add preload your meal before the sushi. Have a salad with protein and fat, because there’s been research that’s shown that if you eat again, fiber, fat and protein before carbohydrate, if you sequence the meal differently, you actually have a lower glucose response. So you can eat the exact same sushi. But if there’s some other stuff in your stomach first-

Lewis Howes (01:19:17):

It’s processing it in a different way.

Dr. Casey Means (01:19:18):

…it’s processing it differently, and it’s changing the hormonal response to the food. Or it will say your glucose is going up, take a 10 to 15 minute walk right now.

Lewis Howes (01:19:27):

No way. And it’ll bring it back down.

Dr. Casey Means (01:19:29):

Oh yeah, for sure. I mean it can definitely bring it-

Lewis Howes (01:19:31):

Does it tell you like live data? It’s like, okay, you need to add this or you need to go walk or?

Dr. Casey Means (01:19:35):

It’s telling you in pretty close succession. Yeah. And helping you.

Lewis Howes (01:19:41):

Because if it sees a spike, it’s going to say, when you’re in this range, go take a walk or add this or eliminate that.

Dr. Casey Means (01:19:46):

Yeah. And actually if you have a spike and you haven’t logged anything, we’ll say to you, hey, what happened here? What did you do? And some people will see spikes if they’re exercising like we talk talked about because of the stress response. Usually if someone’s going above about 70 to 80% of their max heart rate, they’re going to see a spike because that’s the stress response type thing. And people will be able to exclude that from their scores because we know it’s not a food induced spike. It’s not like the same as sort of a potentially damaging food induced spike.

Lewis Howes (01:20:17):

This is fascinating because it gives you information on your body.

Dr. Casey Means (01:20:20):

Yeah. And then we’ll give people tons of swap options. Like for instance that they log a tortilla, like let’s say they log tacos and they have a really big spike. We have a ton of content on like here’s 10 other tortilla alternatives that we know don’t spike as much. So for instance, like [inaudible 01:20:37] tortillas from Trader Joe’s, there’s keto tortillas. Like I just got to LA yesterday first stop, air one. Got their almond flour keto. I’m like in love with them.

Lewis Howes (01:20:46):

Spent $70 on those.

Dr. Casey Means (01:20:48):

Oh yeah, they’re like $40 a piece but I love those tacos. Butter lettuce is great. So there’s different options. So we’ll give people those resources, give them Costco shopping list.

Lewis Howes (01:21:00):

That’s pretty cool. Okay. Now I’m excited to try this. What do people need to do if they want to get on the wait list or sign up to be part of this?

Dr. Casey Means (01:21:10):

So they just go to levelshealth.com and put your email address in, and you’ll be in the loop about the wait list and getting off it.

Lewis Howes (01:21:16):

Because you’re kind of like rolling it out like every few months to new people, right?

Dr. Casey Means (01:21:19):

Yeah, exactly. And then that’ll also sign you up for the newsletter, which has just like a ton of amazing information about a lot of the stuff we talked about today and a lot more tips and there’s certainly people don’t need a continuous glucose monitor to apply these metabolic health strategies. You can learn from what people in the program have learned and apply that to yourself. And so we try and put as much of that on the blog as possible so that people can learn.

Lewis Howes (01:21:44):

This is fascinating stuff. And are you on social media a lot yourself too?

Dr. Casey Means (01:21:47):

I’m on social media at @drcaseyskitchen. So Dr. Casey’s kitchen, and then Levels is @levels. And we post a lot of experiments that our members are doing. And so get some fun ideas for people to try.

Lewis Howes (01:22:02):

How many people are using it at one time. Do you know? Because you said 25,000 people have done it over the last couple years, but how many people are on it right now? Do you know?

Dr. Casey Means (01:22:09):

It’s a good question.

Lewis Howes (01:22:10):

Is it hundreds? Is it a thousand?

Dr. Casey Means (01:22:12):

I’d say a couple thousand. I don’t know the exact number for sure, but around that.

Lewis Howes (01:22:16):

So interesting. Really cool stuff. I’ve heard a lot of great things about it, so I’m going to have to try it myself. And I guess I’ll be wearing a patch for a couple weeks. For a month, but it’ll be cool to see the research on myself. Really cool. So guys go to levelshealth.com. Check it out. Dr. Casey’s Kitchen if you want to see more about Casey as well. What else should we be thinking about? Or how else can we be support to you or Levels?

Dr. Casey Means (01:22:43):

Oh my gosh. Well I think the best thing you’re doing is just having these fabulous people on your podcast. You’ve had so many wonderful people in the Levels community on, and I think just spreading the word about holistic health and metabolic health. It’s amazing how I think podcasts like yours and [inaudible 01:23:00] David Sinclair, Dr. Perlmutter’s podcast, like Mark Hyman’s podcast, Drew Pruitt, like these things are becoming the thing that people look to figure out how to actually create health in their lives because they’re not necessarily getting it from their doctor. And so I think it’s a really exciting time that we’re in and I’m very grateful for the work that you do.

Lewis Howes (01:23:18):

That’s cool. I appreciate it, Casey. All right. This is a question I ask everyone at the end called three truths. I think you know what’s coming. Imagine it’s the last day on earth for you and you’ve lived an incredible life, done everything you want to do, but for whatever reason, you’ve got to take all of your work with you to the next place. So no one has access to this conversation or your blogs or content or anything you’ve ever done, but you get to share three lessons you’ve learned from life with the world and that’s all we have left to kind of be remembered by you. What would you say are those three lessons or three truths?

Dr. Casey Means (01:23:50):

I think one of the biggest ones for me in terms of what brings joy and satisfaction to my life is to focus on the little things and just true awe in all the amazing things going around us. I think if you just step back for like one second and look at what’s going around us, we’re in this incredible cosmic journey. We’re hurling through space. We’re made of trillions of cells, innumerable atoms. It’s like every time we eat, we’re literally taking in matter from the universe and converting into our body and like shifting our shape every day. We’re part of this incredible just continuum of energy and matter. And I think it’s just so awe inspiring. So just like step back, look at the awe. The fact that the sun is shining and telling your brain what to do.

Dr. Casey Means (01:24:44):

It’s fascinating. So I think like focusing on the little things and just having a sense of awe and reverence for everything around you brings me just such intense joy every single day, and can help elevate you from some of the day to day stresses. So awe. Live with awe and focus on the little things. And of course that loops into being in the present moment, because you have to stop and pause to see things. I think the second thing would be, we talked about this a little bit earlier but really focus on death. Examine it, think about it, be curious about it. I think one of my favorite quotes, Steve Jobs talked about death as life’s greatest invention. And I think that’s so true. When we overcome our fear of mortality and have a good relationship with death and see it as not at an end, but a part of the process that’s very natural.

Dr. Casey Means (01:25:38):

Think about the way that energy cycles through generations. And we’re a part of that. I think it’s incredibly liberating. Like and again, getting back to the question of fear, like if you can not be fearful of death, you have a lot of power to make your own decisions and not be controlled by external forces. And so there’s a lot we can learn from it. So I would say on a practical level, like yeah, read some of the stoics, read some of the Buddhist or Zen thinkers. Read some Mary Oliver poetry. There’s people who are grappling with this and it can really make life I think more joyful ironically. And then I think the third thing would be just never stop asking why. And really if anything is conventional wisdom or is being kind of spouted by the large majority in a loud way, or anyone’s having to be coerced to believe something is true or manipulated, ask why and think about the bigger picture. When you keep asking why it just makes life so much fun.

Dr. Casey Means (01:26:48):

So for me, looking at the healthcare system, being like we’re spending more money, people are getting sicker. Why? That was the best question of my life and led me to leave the surgical world, get into functional medicine, ultimately start Levels and realize this incredible world of metabolic health and how things are connected rather than how things are separate. And I think that I just hope that doing that at every stage will continue to just open up whole worlds of new opportunities. So I would say, ask why and challenge conventional wisdom and think for yourself.

Lewis Howes (01:27:25):

That’s beautiful. One of the reasons I keep asking questions on this show after nine years, I’m still curious and I want to learn more. So I think those are great. I want to acknowledge you Casey, for asking why many years ago and taking a shift in your career and your mission from being, I guess, in the practice of surgeries and prescriptions now into prevention and reversal of these, I guess, disease for people and really helping people shift their thinking from having personal power, personal knowledge and information on their health.

Lewis Howes (01:27:56):

So acknowledge you for taking the shift. It’s a big change. It probably feels like a big change for a lot of people in the medical world to think differently than what they’ve been taught for so long. So I acknowledge you for seeing things and allowing yourself to reinvent an identity that you once held onto probably for a long time and shifted into a different part of your identity. So I really acknowledge you for the process and all the great information you’re giving people with Levels. It’s really inspiring to see what you guys are building. So congrats on that as well. Final question, Casey, what’s your definition of greatness?

Dr. Casey Means (01:28:33):

My definition of greatness is being able to achieve and embody sort of thriving in this world and to be able to enact your purpose and fundamentally be able to go out there and really live in your purpose and shine your personal light. That really requires us being healthy. And so that is what drives me as a physician and as a health tech entrepreneur is if we can help create more function in people’s bodies, they can go out and share their light, which is their greatness. Make their minds healthy, help make their bodies healthy, help empower them to take control our health. And so that’s really just how I think about greatness. Being able to shine our light and embody our purpose.

Lewis Howes (01:29:18):

Love it. Casey, thanks so much. Appreciate it. Thank you so much for listening to this conversation. If you enjoyed it and you want to dive into another similar school of greatness episode, check out the links in the podcast as description. I’ve done more than 950 episodes over the past seven years. And I want to bring you more inspiration just like this.

Lewis Howes (01:29:44):

One more thing. We’ve been choosing four lucky winners each week, like Margaret from Antwerp, Belgium, Tara from Trumbull, Connecticut, Nadia from Dubai, and so many others. That’s right. They each won an Amazon gift card, but here’s why. I need your help to get to know you, my listeners, better. So I’ve created a short and simple survey. All you have to do is fill out a quick questionnaire at lewishouse.com/survey. And that’s it. It’ll only take a couple of minutes, but it’ll go a long way towards me figuring out how to help and serve you the best in this podcast experience at the highest level. That’s my goal for you. And as a thank you for completing it, I’m choosing four new winners every week to get a $25 Amazon gift card. So go right now to lewishouse. com/survey to fill it out right now.

Lewis Howes (01:30:35):

Thank you so much for listening. I hope you enjoyed today’s episode and it inspired you on your journey towards greatness. Make sure to check out the show notes in the description for a full rundown of today’s show with all the important links and also make sure to share this with a friend and subscribe over on Apple podcast as well. I really love hearing feedback from you guys. So share a review over on Apple and let me know what part of this episode resonated with you the most. And if no one’s told you lately, I want to remind you that you are loved, you are worthy, and you matter. And now it’s time to go out there and do something great.