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The Missing Piece to Better Health: Optimizing Your Metabolic Health with Dr. Casey Means

Episode 96, duration 1 hr 24 mins
Episode 96

The Missing Piece to Better Health: Optimizing Your Metabolic Health with Dr. Casey Means

Americans are getting sicker year after year, despite ever-increasing healthcare spending. Dr. Means believes we are focusing on the wrong problem entirely.

Metabolic dysfunction.

In this podcast, expect to learn about the world of cellular health, the five pillars that contribute to optimal function, the best ways to nourish your cells with the right nutrients and foods, the unique needs of women's health, including hormonal considerations and why fasting might not be the best approach for women (especially during pregnancy).

This podcast sheds further light on the connection between fertility and metabolic health and the 5 biomarkers you can get checked for FREE during your yearly physical to gain valuable insights into your metabolic health.

We also touch on how simple changes in your eating habits can significantly lower your risk of disease.

This episode is packed with valuable insights into how you can optimize your metabolism and cellular health for a longer, healthier life.

Casey Means, MD is a Stanford-trained physician, Chief Medical Officer and Co-founder of metabolic health company Levels, and Associate Editor of the International Journal of Disease Reversal and Prevention.

The Missing Piece to Better Health - Optimizing Your Metabolic Health with Dr. Casey Means

In this episode we discuss:
– The five pillars that contribute to optimal function
– The best ways to nourish your cells
– Unique needs of women’s health,
– Hormonal considerations
– Why fasting might not be the best approach for women

00:00:00 – Decline in Metabolic Health: From 12% to 6.8% in Americans

00:08:35 – The Wakeup Call: A Surgeon’s Shift to Metabolic Health Focus

00:17:01 – Optimizing Diet for Cellular Function: Key Nutritional Components

00:25:28 – Intermittent Fasting and Women’s Health: Balancing Hormones

00:33:38 – Simple Biomarkers for Assessing Metabolic Health

00:42:10 – The Power of Walking and NEAT for Metabolic Health

00:50:42 – Sleep Consistency: A Key Factor in Metabolic Health

00:59:31 – Communicating with Mitochondria: Diet, Cold Exposure, and Exercise

01:07:46 – Reframing Exercise: Movement as a Foundation of Health

01:16:16 – Healthcare Education Initiatives and the Cost of Convenience


Casey Means

Dr. Casey Means, thank you so much for coming on the show, former surgeon, physician, and truly a trailblazer. Dr. Lyon, I am so thrilled to be here with you in person. This is great. We’re going to have an amazing conversation. You’ve been doing a lot of work on overall metabolic health. And before I say that, let’s take a step back and recognize the fact that you are a trained surgeon. I’m actually an ENT and from Stanford, no doubt or surprise, a fine institution. But you, for some reason, switched gears and now focus on metabolic health.


For me, I was in my fifth year of surgical training as a head and neck surgeon. And I was sort of in this world and looked around me and kind of had this wake-up call where I’m like, Americans every single year are getting sicker. We are getting sicker. We’re getting heavier. We’re getting more depressed. We’re getting more infertile as a population every single year despite more health care dollars being spent every year, $4 trillion now, and doctors working their butts off. I mean, everyone in the health care system, everyone’s running around kind of like a chicken with their head cut off in the hospitals, and yet patients are getting worse. And so as I was finishing my residency and looking down the barrel of a 40-year career in health care, I had to stop and say, what is going on? The more we spend, the sicker we’re getting. The more research we’re doing, the sicker we’re getting. The more medicine becomes hyper-specialized, the sicker we’re getting. So what is going on here? And what’s going on is that we’re pointing the arrow at the wrong issue. We’re focusing on whack-a-mole, symptom management, and we’re not focusing on the root cause of why people are sick, which is fundamentally metabolic dysfunction. It’s a problem inside the cells that unfortunately no medication or surgery can get to, right? This is how we interact with ourselves with our diet and our lifestyle. And this was, I mean, this like ripped me out of a slumber. You know, I’m like 32 years old. I have been training, you know, Stanford, Stanford, OHSU in the operating room, killing myself to become a surgeon. And I looked around and I thought, you know, I’m a doctor and I went into medicine to help people thrive and to create health. And right now I am just managing disease. And then what happened, unfortunately, soon after this revelation is that it showed up in my family with my mother. And my mother, unfortunately, is kind of an archetypal situation for what I think so many Americans are going through on the chronic disease, you know, pill farm sort of treadmill, which is that, you know, she, as she was getting into her fifties and sixties, she had the high blood pressure crop up. They gave her an ACE inhibitor. She took her pills. Her blood sugar started going up. They gave her the metformin. She took her pills. Her cholesterol started going up. They gave her the statin. She took her pills. And then she’s 72 years old and she’s taking a hike with my dad near their home in Northern California and she had a pain in her stomach and she goes to her primary care doctor and they say, Oh, this is unusual for you. Let’s get a CT scan. She gets a CT scan. The next day she gets a text message that says stage four, widely metastatic pancreatic cancer. And 13 days later, she was dead. And we’re, yeah, I did. First of all, I did not know that. Yeah.

 That is major. Yeah. And a massive wake up call. Huge wake up call because you know, she was the classic American patient who’s living her life trying, but these diseases and these symptoms are cropping up throughout her 40s, 50s and 60s. And like a diligent patient, she’s going to every specialist. She was being seen at the Mayo Clinic. She was being seen at Stanford and Palo Alto Medical Foundation. Best doctors in the world, right? Best institutions in the world and was doing everything they said. She was trying to eat healthy. She was taking all her pills. She was following up and yet her cells never healed because that is not.

Because that is not the priority in our American healthcare system. We’re not focused on true physiologic intracellular healing. We’re focused on disease management. So unfortunately, you know, it was it was wild when her oncologists after the diagnosis and then rapid decline towards death. They looked at us and sincerely, the oncologist said to my family, like, I’m so sorry. This is so unlucky. And I knew enough to know, was this really unlucky or was this totally predictable? If we are looking in the conventional Western paradigm of siloed medicine, you know, 42 medical subspecialties, there’s the liver doctor for the fatty liver disease. There’s the cardiologist for the heart disease. There’s the endocrinologist for the diabetes. There’s a neurologist for the early brain fog and early dementia in that system. Of course, her high cholesterol, her high blood pressure, her high blood sugar and her cancer were totally random things. But through a root cause physiologic lens, where we’re really looking at the connections between diseases, it was totally predictable. And what I wish and this is why I wrote the book, this is why I’m on this life mission, is that if earlier in this treadmill of chronic disease management, someone could say to the patient, this is how your suffering is connected. And this is what you can do. You have to heal your mitochondria. And it’s not that hard. The system wants to make you think it’s complicated. It’s not. And if you can do that, you know, if she could have done that, if she had been told that, if I had known earlier, I think she’d still be alive today. So that’s what drives me. That is very meaningful.

 And I think that the viewers and listeners can really relate to being on purpose and creating a mission that can help change the trajectory for everybody. And I just pulled up. So this is I’ll link to it here. And this is a site or an organization all about pancreatic cancer, this network, risk factors associated with pancreatic cancer.

 Yes, family history, but also diabetes, obesity, diet, alcohol, chemical exposures. Yeah, things we can control. Things that we actually can control.

 And you’re on an amazing mission. And your mission is to share about metabolic health from a root cause approach, symptomology, symptoms of unhealthy lifestyle. How do we address it early on?

 And you’re on an amazing mission. And your mission is to share about metabolic health from a root cause approach, symptomology, symptoms of unhealthy lifestyle. How do we address it early on?

 Something that I’ve been sensing over the last few years is that patients and people are fatigued with so much of this focus on micro-optimization and the very rigid morning routines. And you have to check off all these protocols. And it’s more for us to do. And I think that one of the things that really concerns me about our current landscape of health care is that it’s really missing the joy. Like the joy and the sort of understanding of this miraculous nature of our bodies and the miraculous nature of being alive at this moment in eternity and having our health journey really be focused on in honoring of this cosmic, incredible opportunity to be here and to be conscious and to really have all of our health drive come from that. We live in a very de-spiritualized, de-sanctified Western culture. And there’s such a focus. There’s almost like this cult of there needs to be rigidness and protocols and evidence based and all of this. And what it does is it gets us all, I think, feeling a lot of pressure and feeling almost very confused. Because the research says so many different things. Everyone’s fighting on social media.

 80% of Americans are confused about nutrition, even though if you look at PubMed at the number of nutrition studies that have happened over the 50 years, it’s like an exponential increase. So the more nutrition research we’re doing, the more confused people are. And I think at the root of it, we have been asked by the system that profits off our illness to be totally divorced from our common sense and from our intuition about what’s right for our own bodies. And to be more in a flow with our health. And it’s so funny because we’re the only species in the world with experts. And we’re also the only species in the world with a chronic disease epidemic and obesity epidemic. And I think that there is a point of all the research and the experts, but there’s also a part of the conversation that needs to come back to truly trusting ourselves and our body awareness and the cues and the signals that are coming from our body constantly. Symptoms are a signal. Symptoms are a gift. And we’re basically told to ignore them. Think about what happens when you have a symptom, like a headache or an achy knee. You squash it. You have to, it’s intolerable. We have to take the Advil. You know, we have to take the anti-an acid for the reflux. We are not even curious about what’s going on with our bodies. And the system really benefits off that. If we can make people petrified of symptoms, really putting all of their empowerment in the hands of experts, then you divorce people from their common sense. And we start losing this sense of connection to our own health journey. And I think that’s really the missing piece of the conversation. And I think the beauty of the time we have right, like the beauty of being alive right now is that we actually have the opportunity to live the happiest and healthiest lives in human history. We have the opportunity, but we’re not. And I think that the way that we can get there and the reason that’s now and has really never been before is because we have two things. We have both the awareness that, you know, symptoms are a gift, symptoms are science from ourselves, that their needs are not getting met. And we can actually really reframe and learn to understand the signals from our body and how to interpret them. And I think functional medicine is really doing a great job of helping people understand that. But secondarily, in the past three years, for the first time in human history, we can get more information about our bodies ourselves, no doctor needed, than ever before in human history. We have to consumer lab testing companies like Function Health, like, like, levels like Next Health, like Inside Tracker, that literally you can get your own biomarkers with detailed interpretations. We have a bio wearables revolution where you can literally see internal biomarkers in real time in response to what you’re doing and like deeply understand your metabolic health, like your blood sugar.

 And we have access to wearable data like the Aura Ring and the Fitbit and the WOOP that can tell us our sort of more superficial biomarkers like heart rate 24 hours a day. So we both have the ability to have the body awareness and the technology that can tell us more than we ever knew about our bodies. And if we can learn how to really take ownership of our health in that way, find more joy in the health care journey, and really find empowerment and a sense of trust in ourselves, I think we could rapidly, rapidly heal. That’s fascinating. And what I’m hearing you say is the convergence of both. Yes. The convergence of what our innate feeling is, perhaps our intuition on the right nutrition plan or the right training and or just these symptoms that are showing us something combined with hard data, meaning biomarkers, meaning heart rate variability, things that we actually can look at. Is that accurate? It’s exactly what I’m saying. And where I think we’re falling short with the conversation is just totally absconding our responsibility, totally putting our faith completely outside of us in sort of this expert class that are warring even amongst themselves. And in doing so, we are very vulnerable. So I think it’s a lot about understanding our incredible power as individuals to understand our own bodies. And our system has systematically asked people to not trust themselves. Like you think about some of the language and the culture right now. Trust the science. And we should in many ways trust the science, but we should also trust ourselves. And we now have tools to understand how to trust ourselves more. And as we’ve been told to trust the science in this very like in a way that’s almost like very, I think, infantilizing to individuals, like don’t literally don’t be Dr. Google. You need to trust the science. What has happened? We’re getting sicker every year. So I think that this sort of blanket sense of following protocols from other people and ignoring what our body is telling us, it’s not really working for us. And I think there’s a level of getting back in touch with our own bodies, both through intuition and body awareness, but also hard science and wearables and data that together can really just help us feel super confident in our health journeys. Like I know for a fact my diet is right for me because I feel effing incredible and my biomarkers are totally optimal. And I want everyone to have that sense of confidence. The average person does not really know if they’re healthy and they’re confused. And that doesn’t need to be the case. I absolutely agree with you. Everybody is going to want to know what is your diet? What is it? Yeah. I mean, for me, and I talk about this in the book, I really focus on cellular biology when I think about diet and the diet that I’ve presented in Good Energy. It’s very first principles. It’s not dogmatic. It’s about what molecular components do we know support the cell and doing its best work? Because if a cell is functioning properly, like we don’t have symptoms. I think one framing when I talk about diet that people need to realize is that all symptoms and all disease are necessarily the results of cellular dysfunction. There’s no symptom or disease that arises in a vacuum. There is cellular dysfunction happening if you have a symptom or disease. And one of the key ways that we help our cells function properly is the 70 metric tons of molecular information that we put in our mouths in our lifetime, right? That both builds our body, literally builds the structure of the cells, and also tells the cells what to do, change our epigenetics, our cell signaling, our genetic expression. So really thinking about food as molecular information.

 When I was really looking at what are the components that cells can benefit from in their journey to function properly, there were five things that I think are important. One is, I’ll start with the one that is so relevant to you, which is healthy protein. Protein is an incredible signal. I’ll run through them all first and then we can talk about them all a bit. The five things that I think are really important for healthy cellular function that we should include in every meal is healthy protein, antioxidants, omega-3 fatty acids, a probiotic source, and a fiber source.

 And so for different reasons, each of those can signal to our cells good function. You talk about this better than anyone literally on the face of the planet, but healthy protein is like a signaling molecule. We have literally nutrient sensing cells in our gut that see the amino acids and it changes the expression of what they do. I think it’s so funny, the whole GLP1 agonist conversation and everyone, we’re having this fever pitch about these medications that are exogenous GLP1 analogs when in reality, when a nutrient sensing cell in the gut, the L cell, is stimulated by specific amino acids. Valine is one of the ones, but others, glutamine, arginine, others. When it actually senses those amino acids, it produces GLP1 in much higher concentrations. So certainly there is a utility for these drugs in certain patient populations, but everyone in America, given the obesity epidemic, should know how to stimulate their own satiety hormones with specific food nutrients. So protein for so many reasons. Obviously it’s also a signal to our cells for anabolic processes, for building and maintaining muscle mass, so many other purposes. But then we look at antioxidants. One of the biggest root causes of the diseases and the symptoms that we have today is excess oxidative stress. It’s this firestorm happening inside our cells that we have the power through three ways to actually improve with our diet. We can eat antioxidants, we can reduce our consumption of pro-oxidant foods, and we can also express antioxidant genes in our cells through other foods. So that’s a key one. Fiber of course is going to feed our microbiome, which is going to then produce short chain fatty acids, which have a whole range of positive metabolic benefits. Our probiotic sources, similar to the fiber, are going to support our microbiome and help us create the diversity and abundance of healthful bacteria in our gut that is so relevant to all aspects of mental and physical health. And the omega-3 fatty acids are so critical because if we’re eating good omega-3 sources, first of all, we’re going to be eating some really beautiful whole foods like fish and seeds and nuts that have these compounds. But they are so important as a signaling molecule in our inflammatory cascade. And just like oxidative stress, chronic inflammation is one of the key root causes of our chronic disease epidemic. And the symptoms we’re facing in omega-3s, which incorporate into the cell membrane, literally form a substrate for anti-inflammatory immune chemicals that can be very important in resolving inflammatory processing in the body. So all that is to say when we focus on getting those five components in most all of our meals, and the way we do that is by having a short list in our head of our favorite sources of each of those things of the protein, omega-3s, antioxidants, fiber, and probiotic sources. Have your little mental list of your favorite things in each of those categories. Stock your kitchen with them. And then it’s very mix and match. It’s like grab your hemp seeds, grab your sardines, grab your beef, whatever it is, and make a meal that has those.

 And eating becomes much, much simpler. So anyways, that’s really how I try and focus my eating is component-based more than dogma-based. And those components could go from they could work for keto, they could work for vegan, they could work for paleo, they could work for ancestral diets, maybe not carnivore just because I do talk about fiber. But one fascinating thing about fiber and carnivore, and I actually make this caveat in the book, is that one of the short-chain fatty acids that your body makes when you eat fiber is butyrate. And we also make butyrate on a very low-carb diet in a different way by actually producing it through fat oxidation. And so even though carnivores aren’t eating fiber, they’re still making a very similar molecule to what the microbiome makes and are kind of getting it in a different way. And so that’s the one I would say exception. But long story short, that’s, yeah, I focus on getting those five components and eliminating all refined grains, refined sugars, and refined seed oils. And that’s how I focus on my diet. It’s interesting because it shows how adaptable the body is. You had mentioned carnivore. And yes, the carnivore diet is low in fiber, but the body can adapt and make butyrate.

 The body is amazing, and I would argue that it can adapt to various types of diet. You talked about protein. You talked about antioxidants, omega, probiotic, and fiber. What are your favorite– and I want to go through each of these because I’m curious to know what your favorites are. What’s your favorite protein source? I’ll run through them super fast. And basically, if you go to my kitchen, and I’ve posted videos of my kitchen, this is essentially what is my kitchen based on what I’m about to say. It’s my favorite sources of each of these things. So for protein, I have a freezer full of ground game meats, which I get from both hunters and also from Force of Nature, other really wonderful regenerative companies. So for protein, it’s ground elk, ground bison, ground venison, ground grass-fed beef, ground regenerative pork. I also have– I’ll have pasture-raised chicken breast, chicken thighs, turkey, things like that. So basically, lots of really sustainably sourced meats. I also do happen to love beans and legumes for protein, and they don’t affect me at all in a negative way. I know this for a fact because my HSCRP is less than 0.3. So for people who say that they’re inflammatory, check your biomarkers.

 But beans and legumes and meat. And then I like eggs, but eggs also aren’t the best protein source. Like six grams per egg. So I usually supplement a little bit of my protein each day with about three eggs. But mostly, it’s the meat that I get the protein from, really regeneratively sourced. What about the antioxidants? Antioxidants, it’s just a kitchen full of farmers market fruits and vegetables, as colorful and rich colors as possible.

 So I just try and get as many– I basically shop for my fruits and vegetables based on color, not based on type because I can cook with any vegetables and low-glycemic fruits. So purples, reds, yellows, greens, et cetera, lots of colorful fruits and vegetables. But the main antioxidant, the highest antioxidant sources are actually spices, tea, cocoa. And so using a lot of cocoa in my cooking, like 100% organic cocoa, tons of spices, and then teas as a drink, like green tea, those are some of the highest antioxidant sources. And then some nuts and seeds have antioxidants. The highest antioxidant nut of all of them is pecans, actually. So by a large margin, so I eat a lot of pecans.

 For probiotic sources, I love sauerkraut. I have five different types in my fridge from the farmers market, organic beet and cabbage sauerkraut, carrot sauerkraut, things like that. I love kavass, which is a low-sugar kombucha alternative. Instead of using sugar and tea to make a drink, a fermented drink, it actually just uses beets and water, and that’s it. So the fermented drink is basically from fermenting the carbohydrates with beets. I love kimchi, and I love unsweetened, full fat, grass-fed yogurt. And so those are my main probiotic sources for fiber. It’s basil seeds, hemp seeds, chia seeds, flax seeds, beans, legumes, raspberries, which is the highest fiber, fruit, and avocados, which are very oddly super high fiber. So those are my main fiber sources. I know. It is odd when you look at the breakdown. It’s like 13 grams of fiber. But chia seeds and basil seeds are great because they have like 5 grams of fiber per tablespoon, and they’re easy to sprinkle on salads.

 And then for omega-3s, it’s a pantry full of canned wild-caught fish that I put on top of lots of different things. So I have wild-caught salmon, wild-caught mackerel, wild-caught sardines from Wild Planet. I love those. Those will have like 2,000 milligrams of omega-3s per package. And then in terms of plant-based omega-3s, I love hemp seeds, flax seeds, basil seeds, and chia seeds. And then certainly, regeneratively raised beef has a decent amount of omega-3. So that’s kind of the spectrum of pretty much what I eat. And it seems pretty easy. It’s pick and choose. You include one of those servings in each of your meals. And when you were coming up with this, were you thinking about the distribution of how many times someone should eat? And I know that this is you, an N of 1. But again, you have outlined these protocols in your book. Do you have thoughts on the amount of time an individual should eat and how much they should consume at one time? Have you thought much about that?

 Yeah, certainly. I think there’s a couple of ways that I think about that. One is that we obviously want to give our body time in a state where it’s not eating because that’s good for our biology. It gives our cells time to relax, in a sense, and keeps our insulin low. So because of that, I’m certainly a believer in thoughtfully chosen intermittent fasting and trying to limit our eating window to as short as we can in a way that doesn’t stress our body excessively. So for me, that’s usually about eight hours a day. Probably from 11 to 7 is my eating window.

 And for me, that allows me to have 16 hours a day when I’m not eating, when my insulin’s low and my body can really start to move through my glucose and start fat burning. And I know that I get into fat burning because I’m testing my ketones. And we’re going to talk about all that. I want to hear what the top biomarkers are and how you think about this. Yes, yes. So intermittent fasting for sure. I think the average American now has 11 eating events per day. That’s a lot. Where did you get that? Is that from any means data? There’s data. Yeah.

 I’m not sure where that exact source is, but it’s wild how much we’re eating. And when we’re eating, what we can see on continuous glucose monitors is that often when we’re eating, we’re spiking our blood sugar, which means we’re spiking our insulin. And so if you think about the amount of insulin your body is exposed to over the course of the day where you’re eating all the time, it’s a lot. So when I’m eating and choosing my eating times, I’m thinking about, I want to have a discrete eating period where maybe my insulin and glucose go up a little bit, and then I want to give it a break. And then I’ll do it again.

 So certainly finding ways to limit your eating window to give your body a break and an opportunity to become more metabolically flexible. I think the research supports that immensely. There’s some controversy about this when it comes especially to women’s health and hormones, because it’s thought that this hormetic stress or this extra strain on the body of fasting can be problematic for the delicate cycle of women’s hormones. And I think that’s another example of where you really need to tune into your body and how you’re feeling. And based on how metabolically flexible you are, you may be able to tolerate more fasting than another person. And that can change dynamically over time. I think it’s a really good point, this idea of fasting. And I think that we should also question, is it really fasting or is that how humans are designed to eat? We weren’t designed to eat three square meals a day.

 From my perspective, we were designed to go through periods of feeding and to go through periods of fasting.

 From the data that I’ve looked at, fasting’s benefits really are, again, this compressed feeding window definitely helps for gastrointestinal health, also helps with individuals that are struggling with, again, snacking, those kinds of things. It really does allow for that, allow for helping an individual gain control. It’s an interesting point that I think that we should chat about this whole idea of women’s health. Women’s health, women’s hormones, sometimes they say fasting isn’t good for them.

 Sometimes fasting is, it’s a little bit all over the place.

 Here’s where I would say fasting is not good for women. Are you ready? Because I’ve seen this in clinical practice many times over. If a woman is trying to get pregnant, this is the time I don’t recommend that she fast. Do I think that a restricted feeding window of eight to nine hours is particularly stressful on the body? I don’t because we probably were supposed to be eating within that timeframe.

 Another time where I don’t recommend fasting is if an individual is older and trying to maintain skeletal muscle mass. Fasting is not the strategy. That’s super interesting. I’m curious your thoughts on this. With PCOS, polycytic ovarian syndrome being the leading cause of infertility in the US right now, which is fundamentally a disorder of insulin resistance, would you say that there’s probably this interesting balance that needs to happen between implementing fasting in the preparatory phase for pregnancy to get insulin levels under control, but in the actual time we’re trying to signal to our body, we’re making new life and we need to basically, we have all the resources we need. That’s a time to sort of stop fasting. Yes, because we do have to regain insulin sensitivity. The best way to do that is through affecting skeletal muscle.

 Through training, through exercising, and you can use a CGM to see and validate for yourself that when you’re getting up and when you’re moving, you’re able to lower your blood sugar. Again, when you exercise, you no longer require insulin to move blood glucose out of the bloodstream into the tissue. Very, very fascinating. PCOS, the linchpin is skeletal muscle. Regardless of where the defect is, whether it’s an insulin receptor defect or skeletal muscle defect, the treatment, the most effective way is addressing the health of skeletal muscle. Yeah, I mean, I think this needs to be so much more a part of the conversation, which is that the pregnancy optimization plan that we should really be talking about is optimizing insulin sensitivity in the most evidence-based ways, which of course is going to be increasing skeletal muscle. Absolutely. We’re going to be doing everything we can to support mitochondrial health so that we free up the mitochondria to do its best work, which then of course is going to decrease the cellular lipids and increase insulin signaling. That’s where we start to get into dietary strategies and things like that, really just helping the mitochondria do its best work. It’s like skeletal muscle and the dietary lifestyle strategies to support the mitochondria. Absolutely. The majority of the mitochondria in the body is in skeletal muscle.

 That is one of the reasons why I love that you’re talking about metabolic health, because metabolic health, there’s many levers that we can pull and also use something interesting about this idea of first principles. What are the first principles? What are the basic things that we need to do so that we can improve these biomarkers? What are your top biomarkers? And also, did you uncover particular things while you were researching, writing this book that illuminated things for you that you hadn’t thought of before? In terms of biomarkers, the great news is that pretty much everyone can understand a basic picture of their metabolic health with five simple biomarkers that are pretty much free to us with our annual physical chest. Lay it on me, girl. Lay it on me. This is the biomarkers of metabolic syndrome. This is triglycerides, fasting glucose, HDL cholesterol, blood pressure, and waist circumference.

 These are five biomarkers that can tell us whether we are in the 12% of Americans who are considered metabolically healthy. In research out of– Wait, 12% of Americans are considered metabolically healthy? Actually unfortunately, based on the most recent research that was published in the American Journal of Cardiology, only 6.8% of Americans are metabolically healthy. But the UNC research that was done in 2018, which showed that 12% are metabolically healthy, was based on those five biomarkers. And so basically over the past five years, we’ve seen a decline from 12% to 6.8%.

 But regardless, people should know and should prioritize knowing whether they are in that 12% above almost anything else. Because if you are metabolically healthy, your chances of dying from almost any of the major causes of mortality in the United States prematurely plummet. So those five biomarkers, like I said, are triglyceride, HDL, fasting glucose, waist circumference, and blood pressure. And to be considered by this criteria to be normal, it’s triglycerides under 150, fasting glucose under 100, HDL cholesterol above 40 in men, and 50 in women, waist circumference less than 35 inches in women, and less than 40 inches in men, and blood pressure less than 120 over 80. So for people who fit all those criteria and are not on medication, you would be part of that 12%.

 It’s interesting that they chose HDL rather than APOB. And it’s interesting that they left out fasting insulin. Right.

 It is interesting. I would be very curious as to what those numbers would be should they include them. I think we would– well, I think there’s two things. One is that as you hear those numbers, I would imagine that you agree that many of them are far too lenient. They call those normal. But fasting glucose, anything less than 100, that’s great. But ideally, we want fasting glucose to be more between 65 and 85, so a lower area of normal because all-cause mortality and risk of developing type 2 diabetes actually goes up in the high end of the normal range. So when you’re in that 85 to 100, which is still considered normal but is high normal, your risk starts going up. So they call less than 100 normal, but I would actually say it should be tighter. And then with triglycerides, less than 150 is a pretty lenient range. I like to see triglycerides less than 70 in terms of really decreasing our risk. Like being at the lowest part of the risk, you’re going to be looking at less than 70. So someone who’s up in the 140s for triglycerides, I would still think that person needs to do a lot of dietary and lifestyle changes to be optimally healthy. So if we actually were focused on optimal ranges for all of those five metabolic syndrome criteria, I bet we’re looking at less than 2% of the country who’s actually optimally metabolically healthy.

 Same with HDL. I think based on the research that I looked at for the book, really between 60 and 90 is probably optimal, but they’re saying that the standard criteria would be above 40 in men, above 50 in women. So that’s one problem. The second problem is what you mentioned, which is that some of these key early biomarkers of metabolic dysfunction like fasting insulin, like uric acid, ApoB are not even a part of the conversation. With all that said, those five biomarkers are essentially free on an annual physical. And I think most Americans can have those without any debate with their doctor, and they can give you a clue about where you are on that metabolic spectrum. So certainly everyone listening should go find those numbers from last year and understand whether you are in the category of what we’re considering metabolic health or not. Yes, absolutely. Guys listening, I’ve encouraged you to get your inside tracker or at least pull up your routine blood work. And I’ll just mention that individuals that eat a higher protein diet, because a lot of the people listening do, their blood sugar will remain higher in the 90s because of gluconeogenesis. But guys, if you’re listening, your insulin will be less than five, pretty low. So if you are eating a higher protein diet, I would expect for you to have a higher fasting blood sugar. Do not be concerned. Yeah.

 It’s a bigger picture. It is such a bigger picture. And I think someone whose fasting glucose is 95, but their insulin is three. That’s a person I’m not going to worry about. A triglyceride of 45, an insulin of two, and a fasting glucose of 96. You guys are doing great. You’re doing great. And so, but it’s all, it’s context dependent. I would say these are pretty broad brushstrokes that we’re talking about here, so that the average person who doesn’t have inside tracker can at least get a snap shot. Absolutely.

 And I will say I worked on some of the earlier studies out of Don Lehman’s lab. And what he did is he reduced carbohydrates to 140 and anything below that reduced triglycerides, roughly 20%. It’s amazing. Yeah. It’s a very fast way when you address diet to improve these metabolic markers. Absolutely. What else, and you are really interested in this metabolic health and the mitochondria and the cellular health. When you were researching for the book, did anything surprise you? It was unexpected.

 Well, I think there were a couple of things that where the research was so strong and it was some of like the most simple strategies. I think it’s like some of the stuff you do. It’s like lifting weights, like, well, absolutely change your health and your life. It’s free. And yet we’re just not doing it, you know? And there were some things like that that were fascinating. One for me that was wild was just honestly the benefits of walking. It’s unbelievable. If walking were a pill, it would be the most successful pill in human history. I probably would say the same, of course, for weightlifting as well. But you look at research that’s been published in drama and really big journals and the average American is walking about 3,500 steps per year. If you look at certain– Wait, wait, wait. 3,500 a day. I’m sorry.

 Let me repeat that. The average American is walking about 3,500 to 4,000 steps per day, which basically takes about– that’s like 30 minutes of moving. And that is astonishingly low. You look at certain indigenous cultures that are still around today and some of them are walking up to 20,000 steps per day. So 3,500 is very paltry. If you look at the research, there’s something that shows that for people walking just 7,000 steps or more per day, there’s 11-year follow-up to this study. It reduced– just walking 7,000 or more steps per day reduced all-cause mortality in the 11-year follow-up by over 50% just by walking that amount. And then there’s other research that shows that walking between 8,000 and 12,000 steps per day in large populations can also decrease all-cause mortality by about 15% by about 50%. But you’re also looking at 40% to 60% declines in risk of obesity, type 2 diabetes, Alzheimer’s dementia, cancer, gastroesophil reflex disease, so many different diseases. So some of the things that were most astounding to me in the research for the book were actually some of the simplest things. There was other data like the power of eating slowly. So this is one of my biggest problems because I love–

 By the way, we are cooking today just so you all know. I have roped Casey in to cook with me, and she’s about to find out that I’m the world’s worst cook. And we have a 30G’s newsletter, which we include your recipes. We’re going to include this recipe. You guys, if you are not on the list, you can go to my website. It is totally free. These recipes are totally free, but she is going to thoroughly embarrass me. Oh my gosh. We’re going to have so much fun. We’re going to have so much fun cooking protein.

 So I think because of medical training– I don’t know if this is the case for you, but I basically learned to eat fast all the time. I was always wolfing down food. And the data actually suggests that when you look at people, the people in the fastest quartile of eating versus the slowest quartile of eating had a four times higher rate of metabolic syndrome and two times higher rate of type 2 diabetes. So just slowing down at a meal time, which isn’t changing anything about the food composition, it’s just the speed, actually has a measurable impact on disease outcomes. And it makes sense because as you’re eating more slowly, you’re triggering your satiety mechanisms more potently before you consume lots of calories, and you can self-regulate a little bit better. So that was fascinating.

 Another piece of information– How slow are we talking? It didn’t actually say. It was really just looking at quartile, so the fastest versus the slowest.

 I think there’s simple things that you can do. Obviously you can take a couple deep breaths between each bite. You can chew your bites 20 to 40 times before swallowing. Have you ever tried doing that? It’s really hard. It’s also– can you imagine it’s really annoying? Have you ever go and you’re at dinner with someone and it’s– I’m telling you because I have done it because I absolutely agree with you. How do we slow down? You guys should all try this at home. Sit down, go to dinner, and chew your food 40 times before you swallow that sucker. Impossible. It’s– oh my gosh. You know, one of the things that helps– You’re never going to be invited back to dinner. No, no, you’re going to take forever. But one of the things that’s helped me the most in terms of eating slower is just really committing to trying to eat more meals with other people.

 I am so fortunate to have a wonderful, incredible boyfriend who I live with. But prior to that, I was single for a couple years and I was eating a lot of my dinners alone and so I would just eat them very, very quickly. And then I read several studies that show that eating with other people and eating in a situation where you’re in community and in a calmer, more grateful state, it actually changes our metabolic response to the food. And I noticed that I eat so much slower now that I eat dinner every night with my wonderful partner because we’re talking and we’re interacting. And so I think literally it can be as simple as inviting– if you live alone or you’re eating moisture meals alone, one, schedule family dinners. Make sure you’re actually eating together at a table and sitting down and invite people over for dinner because you’re naturally going to eat slower if you’re having conversation. So that was a really, really big one. And Sean Stevenson has an amazing book. Just thinking about him as you’re talking about this. Eat Smarter Family Cookbook. He literally talks about how the average family in America I think is eating three or less meals together per week. And we digest food in a way that’s more optimal for health when we’re in more of a parasympathetic state when we’re eating, in a real rest and digest mode. And one of the ways that we can cultivate that is by slowing down, expressing gratitude for our food, taking a few deep breaths before we eat, and being with people that we trust and love. So I think that’s a part of the conversation that doesn’t even involve changing your food. It just involves changing how you eat.

 And then I’ll just mention two others that kind of were interesting to me in writing of the book that I hadn’t heard a lot about prior, which is one, the average American astonishingly is spending 93% of their time indoors, not outdoors. That’s major. And this is such a modern phenomenon. Like if you think about the concept of indoors, like it’s pretty recent phenomenon. And our biology, our cells are entrained by light signals. And so we’re literally just self-imposing this box around us that separates us from our source. And the research clearly shows that the more time you spend outdoors, the healthier you are metabolically, like less rates of obesity, less rates of diabetes. And of course, there’s a lot of reasons for that. People outdoors are probably being more active. But I think there’s probably a broader aspect to it too, which is one, obviously our circadian rhythms that control so many of our clock genes, our metabolic genes that are downstream of our light sensing regions of our brain, the super high isometric nucleus. And when we’re outside more, our body literally knows what time it is. And therefore, we’ll express the right genes at the right time. And on top of all of that, I think being outside is just one of the most pleasant, calming, awe inspiring things we can do because we’re connected with our source. And that is good for our biology too. So I think just literally making it a personal KPI to spend more time outdoors is something that I think can have major impacts on our health. So this is separate from the protocol of getting the sunlight first thing in the morning. This is literally just like the sun and the earth is our source. Be outside more. And you will probably be standing and moving. And that’s good for you and your joy and your hormones and all of it.

 And the last one I’ll mention, a surprise from the book, is this concept of social jet lag. Have you heard about this before? It’s really interesting. So we talk a lot about sleep quality and sleep quantity. And it appears that for sleep quantity, the optimal amount of sleep for metabolic health is between seven and eight hours. Of course, it’s individual. But the studies really show that seven to eight hours is great. But what people don’t talk a lot about is sleep consistency. So there’s quality, quantity, and consistency.

 Consistency means whether we’re going to bed and waking up at pretty similar times each day. The impact on our metabolic health of sleep consistency, I think, is far greater than people understand. I think people often think that if you’re getting eight hours of sleep, even if that’s between 10 and six or 12 and eight, that that’s the same. But it’s not. Because sleep is one of the three ways that we entrain our internal clock. We entrain our internal clock by bedtime and wake time, meal timing, and whether we see natural light first thing in the morning and get rid of the light when the sun goes down. Those are the three main ways. And I think we’re really screwing up sleep consistency. So social jet lag is a measure of sleep consistency, which basically looks at night to night.

 You are going to identify the midpoint of your sleep. So if you sleep from 12 to eight, your midpoint is four. And if you sleep from 10 to six, your midpoint is two. And if the midpoint, night to night, is more than two hours on average, it doubles our risk of metabolic disease. Give me an example.

 So basically, if you adjust the sleep or wake time two hours in either direction. So if, let’s say, during the work week, I’m sleeping from 10 PM to 6 AM, that’s eight hours. And my midpoint is 2 AM because that’s four hours from when I went to bed and four hours from when I woke up. Then let’s say on the weekends, I go to bed at 1 AM and I get up at 9 AM. The midpoint of that is like 4.30. So the midpoint is 2 AM on the weekday and 4.30 AM on the weekend. That’s a two and a half hour social jet lag.

 And that’s because we have two hours. And in that difference between essentially work days and weekends, it confers a much higher risk of metabolic disease. And likely that is because it’s representing a real alteration day to day between how we’re entraining our circadian clock. And that’s going to have lots of downstream impacts on our metabolic health and our insulin sensitivity.

 People are very aware of the importance of sleep quality and quantity. We really need to be dialing into consistency as well because that’s one of the main ways that we actually reinforce our natural internal clocks. Again, the three ways are meal timing, sleep consistency, like essentially bedtime and wake time, and then how we interact with light during the day. And these are really easy things to do to eat slower, spend more time outside, and go to bed and wake up at the same time. Nothing too complicated. And walk.

 What do you do? Target a certain amount of steps because in part of the conversation, we recognize that wearables are important. But I think that you’re also saying something that I believe and I think is really important is that we shouldn’t be so tied to those kinds of things. The electronic, whether you’re, did you hit this step count or not? These protocols that then become extremely rigid and create quite a bit of anxiety for people. I like the idea as one of my very dear friends always talks about the idea of setting standards, not setting a goal for how many steps you’re getting or not setting a goal for X, Y, and Z, but creating a life that is structured with standards over goals. Yes, I love that. Because we only have higher standards for our life. We’re here for a short time. You got to have high standards. Right. Do you think about, you’d mentioned that the data is pretty positive for between 8 and 12,000 steps. Do you think that that’s enough?

 So I think for people listening who maybe are not super active, although your listener base is probably very active, 10,000 might be intimidating to people. It’s not just a given that you’re going to get 10,000. So I would say at a very minimum aim for that 7,000. Once you’re consistent with 7,000, you’re going to get 10,000. So you’re going to get 7,000 pretty much every day.

 Bump it up to 8,000 because the research does show that above 7,000, you’re getting a huge increase in premature mortality. 8 to 12,000, we’re getting even bigger increases. And from my understanding of the literature, above 12,000, we’re not seeing huge additional benefits. However, my belief is that certainly it’s kind of like the more the better when it comes to gentle low-grade activity like steps. And so I think if people are really shooting for that 8 to 12,000, averaging 10,000, we’re in really, really great shape. And people, there’s controversy about steps. And I think the key point that is so important to make is that it’s not about the steps. It’s not about the activity of walking. It’s about activating major muscle groups frequently throughout the day. Because if you’re walking 10,000 steps a day, it’s sort of a proxy metric for getting up and moving your body, which means activating major muscle groups multiple times per day. And this is a key point that I really want to drive home, which is that why that matters is that every time you’re activating the muscle groups, it’s a signal to the body intracellularly– those muscle contractions. I know I’m totally preaching the choir here. But like– I love it. And we can never hear it in there. You are literally sending a biochemical signal inside the cell to push the glucose channels from inside the cell to the cell membrane– those Glute 4 channels that are going to take up glucose. You’re also stimulating the mitochondria to have to make energy to actually create that muscle contraction. So if you’re a person who’s walking 10,000 steps a day or by proxy just moving more frequently throughout the whole day, you are a person who has glucose channels at the cell membrane all day taking up glucose in an insulin independent way and using the mitochondria. Use it or lose it. If you are a person who sits all day and then exercises for an hour at the end of the day, you are a person who– awesome. You got those glucose channels to the cell membrane during that workout. But the rest of the day, they were stuck inside the cell. So it’s a proxy metric for essentially pushing our metabolic processes to be active constitutively throughout the day. It’s not about the steps. I mean, I think you could probably– they’re easy to count because we can measure them and whatnot. But it could be anything. It could be air squats. It could be doing a couple air squats every 30 minutes throughout the day. You basically want to think about those muscle contractions as pushing your glucose channels to the cell membrane and keeping them there so they become a person who’s constantly more metabolically active rather than someone who is sedentary with spurts of those pathways being activated. And that makes a lot of sense. And thank you for clearing that up because it is an important point. It’s not just about walking. It’s this idea of how are we moving our body? How does that become a standard for our life so that we can become metabolically healthy, metabolically flexible, age well, have a good life, all of the things that are associated with that. What about some of the auxiliary things? For example, when it comes to metabolic health, do you like a red light? Do you like a cold plunge? Are there things that aside from diet, exercise, and sleep that you think are really important? Yeah. Yeah. When I think about metabolic health, the framework that I use is I want more mitochondria working more effectively processing more substrate. And any dietary lifestyle or choice that I make is focused on doing one of those three things. More mitochondria, more efficient, producing processing more substrate. Love it. So when I think about cold plunge, I’m not thinking about checking a box of my 12 minutes of cold plunging off the list. I’m thinking about sending a thermal signal to my body to create more heat and over time to create more mitochondria to create more heat because a cold signal is going to push the body and the mitochondria to generate more heat, which ultimately does one of those three things that I mentioned. And over time, the adaptation is going to be making more brown fat, which is more mitochondrial dense. So now I’ve got more mitochondria doing more work. And that’s ultimately so good for metabolic health. So that’s what I’m thinking about. I’m thinking about with all my choices, how is it communicating with my body? We get a few ways that we can communicate with our body. We communicate with our body through molecules, through molecular information, which is like food and supplements and potentially pills. We communicate with ourselves through sound. We communicate with ourselves through thermal energy, like the heat and the cold.

 And so all of those, ideally, are going to– and then, of course, one of the big ones, which is light energy. So that’s red light. That’s blue light. It’s all these different types of light. So we have molecular energy, thermal energy, sound energy. And we have photon energy. And I think when we can start to really see our choices, that lens of how are we communicating with the cells to do the work we need to be healthy, everything becomes a lot simpler and easier. And if those choices are directed at the mitochondria, then they’re probably going to make you healthier. So when I’m thinking about, for instance, food molecules, it’s like, what does my mitochondria literally need to function properly? I know it needs micronutrients because there’s actually B vitamins, zinc, magnesium required for the electron transport chain. So I should probably eat those things because that’s communication with my mitochondria. To actually function properly. And with cold, it’s the same thing. With photons in the morning, it’s similar.

 Red light, I think there’s– I frankly, I haven’t dug deep into the literature on red light. And I actually don’t include that in my book.

 But from what I understand, there’s some good data on it. What do you think is the most important? So there’s the health of the mitochondria. And then there’s the volume. Do you think much about how do we improve the volume of the mitochondria? Well, I’m thinking about, certainly, quantity. Brown fat is the perfect example of this. People who have more brown fat have lower rates of obesity and diabetes. And this is literally mitochondrial dense fat that we can impact through our choices, primarily cold exposure.

 And then, certainly, as we’re thinking about building more skeletal muscle– I don’t know this for a fact. I’d be super interested to hear– I’m sure you know this. If we’re building more skeletal muscle, my assumption is that not only we have better functioning mitochondria, but we’re actually just 3D printing more mitochondria. But I haven’t looked at the actual cellular data of that.

 And then I’m thinking about mitophagy. I’m thinking about how do I recycle my old damaged mitochondria to actually create better, more functional mitochondria. So all those components. Which one is the most important? I don’t actually know for sure. But I’m kind of triangulating the whole spectrum. I love it. And definitely, with endurance exercise, it increases mitochondrial volume. Resistance exercise has a different impact on mitochondria. Very, very important.

 Mitophagy, that’s interesting. Do you cover that in the book? A little bit. Yeah. And again, this is the recycling of old mitochondria. How do we improve their function? Are there supplements that you like for mitochondrial health?

 There’s a couple different ways I think about supplements for mitochondrial health. The first is the micronutrient conversation. Literally, our electron transport chain, the final steps of ATU production, requires several micronutrients to work properly. So obviously, primarily, we want to get that from micronutrient dense foods, which means real unprocessed foods. Because processing is going to strip the micronutrients from the food. We also want fresh food, meaning as close to the source as possible. Because every day, your food is dead or out of the ground. It’s going to lose its micronutrient composition. This is why shopping at the farmer’s market actually matters. The average piece of food in the United States travels 1,500 miles to your plate. Every single mile it’s traveling, it’s losing its micronutrient composition. And every day, the longer it sits in the shelf, even if it looks pretty, yeah, it’s degrading. It is. Yeah, so I’m thinking about food. And then because, unfortunately, we are such an uphill battle with micronutrients in our country because our soil is so depleted from industrial agriculture that it’s just absolutely decimated the life of our soil. And the soil is what injects micronutrients into our food. Even if you’re eating a perfect unprocessed diet from the farmer’s market, we still might be behind. So I do take a high quality multivitamin every day in order to make sure I’m covering the bases on the B vitamins, the zinc, the magnesium, the vitamin C, and other micronutrients that I know are important for mitochondrial health.

 I’m also taking Urolithin A, which is a supplement from the company Timeline. It’s called Mitopure. We love them. We love them. And the reason is because it is really the only supplement on the market that has

 peer reviewed data to show that it improves mitophagy. And so it is– I mean, the Urolithin A story is so cool and I think could make anyone into a biology fanatic. But basically, when you eat pomegranates and other foods with certain aelagitannins, the microbiome will convert those food molecules into a– it can convert those food molecules into a substance called Urolithin A, which is essentially a postbiotic. It’s made by the microbiome, goes into the body, and tells the mitochondria to recycle their old damaged ones and make new ones. Incredible.

 Unfortunately, there are some people who do not do that conversion process of pomegranate, Urolithin A. Some people are inefficient at it. And you have to eat a lot of pomegranate, which has a lot of sugar, to make enough to really promote mitophagy. So this supplement basically bypasses the glucose spike and directly gives your body what the microbiome would make, which I think is fabulous. And then I’m also just thinking about other things. Like what damages the mitochondria, like oxidative stress? And too much– oxidative stress is both a cause and result of mitochondrial dysfunction. And chronic inflammation, cytokines actually in the bloodstream can damage the cellular processes that are essentially part of mitochondrial health. And so I’m also kind of just thinking about, OK, I want to decrease chronic inflammation. I want to decrease oxidative stress. So with supplements, I’m also thinking about omega-3 fats. So I take an omega-3 supplement because that’s going to have an impact on my inflammatory pathways of the body. And I’m thinking about taking antioxidants. So in my multivitamin, I take weenatal, which is a prenatal that’s filled with mitochondrial cofactors and antioxidants. And there’s actually research that shows that men on antioxidant supplementation have a four-time higher rate of having a successful pregnancy when they’re pursuing IVF with their partner. And if you really think about the biology here, you want sperm with healthy mitochondria. And antioxidants are one of the ways that you can do that. So omega-3 is antioxidants, micronutrients, urolithin A.

 Those are some of the main things I think about with my supplementation for mitochondria. I love that. Any others you would add? No. I think that those are great. Now, I want to switch the conversation a little bit. I’m curious as if you believe that we are missing anything from an exercise perspective. Do you feel that there’s things that we could be doing different, or is it just that we need to be moving more and reframing our thinking around it? Or are there things very specifically that we are not doing that we could be doing?

 For example, kettlebell swings or whatever it is.

 I think big picture. When we’re thinking about public health and the country as a whole, less than 28% of Americans are meeting the super basic recommendations for physical activity. So very small amounts of people are even doing the basic amount that’s enough. So I think big picture, it comes back to the beginning of the conversation. I think part of what we need to do is reframe about actually away from even the concept of exercise and more towards the concept of just movement. Our biology is optimized by being bodies in motion on every level. So at a very basic level, we need to just shift culture towards how do we– Yes, we have– a lot of us are knowledge workers. We’re working at computers. But how do we shift things that we in our current culture are doing sitting and think about how to do those moving? We just have to because everything we’re doing now is basically seated. And we’re not going to get healthy as a country unless we start just basically moving more throughout the day. There’s all this really interesting research about this concept of NEAT, which is not an exercise activity term in Genesis. I think it’s so funny that we have this fancy acronym for this word that basically is just what we used to do all the time, which was move. NEAT is any activity that you do that is not actually exercise, but that is still moving the body. And so this could be like walking from your car to the grocery store. This is gardening. This is playing with your kids. This is taking a walk with your partner after work. This is dancing.

 And the research on NEAT is understandably kind of astounding. The more NEAT that you do, the healthier that you are. And so I think one of the things that people can do is essentially look at their days every day and look at all the activities they do every day.

 And down to like the very, very simple ones like brushing your teeth and catching up with your partner at the end of the day and how you spend time with your kids and reading. And honestly, just start to think about like which one of these can I start to do with activity? This could be as simple as like committing to maybe instead of having drinks with your friends at the end of the day, you’re going to take a walk with your friends. And instead of catching up with your partner sitting on the couch, you’re just going to take a walk or throw a football back and forth with your partner at the end of the day. So just take stock of what you’re doing and see which ones could be done standing or moving. And of course, like a treadmill desk is a great way. I saw one here. We have one. My team moved it, but we have one. Yes. So I do that all the time. People should be taking meetings, standing, walking. All meet. And like one rule I have for myself is that if I’m doing social media, I’m doing it on my treadmill desk. Because essentially it’s like, OK, if I’m going to be doing that thing that I know I probably shouldn’t be doing as much of, like I’m going to be walking while I do it. And I kind of hate that we’re in a place in the world where like we have to talk about things like treadmill desks because it’s so unnatural. But because we are knowledge workers now, we have to spend some of that time standing. They are $100 on Amazon now, these walking pads. And there’s actually research on PubMed about the impact of standing– of treadmill desks. And it’s profound. There was one study that extrapolated from a two-week study that they did to show that if people were just walking on their treadmill desk, I believe it was two hours per day could lose around 40 pounds in a year if they were consistent. It was not a year-long study, but they were extrapolating from what they found in two weeks, which I thought was interesting. So again, it’s promoting those metabolic processes. So to get back to your question about exercise, one of the reframes I think we need to have is that exercise is not something to be checked off a list for health. We need to become a more movement-based culture.

 And that involves taking stock of how we’re living our lives and converting some of those activities to movement. That’s absolutely foundational. If you live in a neighborhood that has sidewalks, you have a lower risk of obesity. There are so many elements of culture that just need to shift.

 And then from the standpoint– you brought this up earlier, but I think when we are, exercising is, of course, amazing. But it’s sort of on top of this movement-based– we need to get the baseline of the movement-based culture. And then we need to start optimizing. And what’s amazing, like you said, for mitochondria, each different type of movement has sort of a different benefit. I think of walking, which is just foundational and baseline, as glucose disposal. How do we actually just work through more of the substrate in the body for more of the time and get the glucose channels to cell memory more of the time? That’s how I think of walking. There’s high-intensity interval training. There’s zone two training. There’s resistance training. And there’s more like pliability-based workouts like yoga. All of them have different benefits. And so I think the resistance training is a non-negotiable because we have to build our metabolic armor. I’m just quoting you here.

 And then we can use zone two and we can use HIIT as really some fine-tuning to just amplify the number and the oxidative capacity of the mitochondria we do have. Absolutely. And I’ll just throw this out there to you guys listening. There’s a great paper. And the title of it, we can link it. It’s Resistance Exercise Training Altars Mitochondrial Function in Human Skeletal Muscle.

 It looks like it came out of Blake Rasmussen’s lab. I’ve been trying to get him on the podcast. He is now in San Antonio. And it’s nice because it highlights– there’s a lot of information out there about endurance activity. But this highlights the impact on skeletal muscle mitochondrial function, which is pretty cool. Amazing. There are things that stand in the way of the messaging and health. A lot of that is initiatives, things that seem to be enhancing, and things that also seem to be really creating roadblocks in understanding and learning. For example, Meatless Monday. To me, that that’s a roadblock for overall education to our families around health. Do you think there are– or can you speak to any kind of health care, food, education initiatives, and how you think that they’re influencing our health?

 Oh my gosh. That’s a big topic. It is. It is so important. Because stepping back, it’s like everyone kind of wants a piece of the conversation because it is so lucrative. Right now, health care is not only the largest industry in the United States. It’s the fastest growing industry in the United States. And processed food is right behind that. So there are so many initiatives, some of which that maybe seem positive on the surface, that ultimately, if you really trace it back, are driving people for more convenience food, to feel good about convenience food choices, and to feel good about essentially not being metabolically healthy. And so I’m always looking at follow the money, trace some of these initiatives back to what they’re actually leading to. And if an initiative is fundamentally not leading people towards better cellular health, then it’s probably not in your best interest. And there’s a lot out there, I would say.

 There’s some wonderful organizations that I think are having a really positive impact. One that I am a huge fan of is Eat Real, which is an organization that is trying to get more whole unprocessed regenerative food into school lunches. It’s absolutely astonishing to me that our national school lunch program is serving ultra-processed food, which we know is poison that is going to shorten the lives of children. The current generation of children growing up are on track to not outlive their parents’ lifespan. It’s astonishing. And so that’s a great organization.

 There’s many beautiful organizations that are focused on regenerative agriculture, and so many incredible regenerative farms that are creating more education, white buffalo land trust, lots that are getting us back to understanding how connected we are with the soil and our food.

 So some of those are very, very positive. But yeah, I mean, I think one of the biggest examples that you’re seeing right now is just the huge massive push about the GLP1 agonist. You’ve got Oprah talking about how we need to be creating accessibility to all these medications at the highest level. They’re on track to be the highest-grossing medication in human history and taxpayer-funded. And there is a place for these medications in very specific situations. But they are not the answer to the public health cultural crisis that we have right now, because what they don’t do– our metabolic crisis is fundamentally the response of ourselves to an environment they can no longer handle. That is what our metabolic crisis is. The environment has changed so rapidly in the last 100 years across the pillars of food, sleep, movement, stress, and the amount of toxic information we’re getting through our devices, environmental toxins, light exposure, and temperature. Across those seven pillars, our environment has changed in astronomical ways in the past 100 years. Our cells can no longer handle that, and they are becoming dysfunctional. And now we have a chronologies and metabolicies epidemic.

 Because a shot cannot fix the environment that is synergistically hurting ourselves, the shot will never fix the problem.

 Certainly, a shot can make you melt away fat. I mean, it definitely is more effective than any medication I’ve ever seen.

 And frankly, we use it in the practice all the time. But we don’t use it on an ongoing basis. We use it to really jumpstart people that have been struggling for a while. And we successfully are able to get people off the medication with proper training and good nutrition. And we don’t see effects on skeletal muscle. Because you’re having people train, right? And protein. But I think when you’ve got something like this that may have benefits, but that is being essentially weaponized by industry to be seen as the panacea to the problem, that’s where things start to go off the rails. It’s now being recommended by the American Academy of Pediatrics and kids as young as eight.

 And I think in a situation like that, we really need to start addressing every element of the environment before we go straight to something like that. Especially because for the $16,000 per person per year, that that medication will cost individuals, insurance companies, or taxpayers. You could take that $16,000 and totally reshape the environment that that person sells or living in. So when we talk about costs and access, we have to remember that someone’s going to be paying for that $16,000 for that medication per year. And we do as a culture and a medical community have the power to think about creative ways to reorient that towards creating a much more holistic, healthy environment for people. But we’re just not really thinking creatively, I think, as a medical community. That’s true. And listen, the creativity in medicine isn’t necessarily there. Typically, they are trained and as physicians should be very algorithmically, there’s a standard of care. Do you think there are a handful of really big misconceptions in health that you would love to clear up? Or are there or maybe not?

 The biggest misconception in the healthcare conversation is that being healthy is complicated.


 That is the biggest lie that we are being told right now. And we have to remember that our confusion is the fuel that drives over $10 trillion of industry. Our confusion is the product. Our confusion is what gets us to be insatiable consumers of solutions when, in fact, it is so, so simple to be healthy, which is basically everything we’ve talked about on this podcast. Being healthy involves eating unpoisoned, unprocessed food, moving your body, having skeletal muscle, getting decent sleep, avoiding environmental synthetic toxins,

 getting sunlight during the day, not having too much artificial light at night, and making sure, I would say almost most importantly, that we are preventing our eyes and minds from seeing a constant bombardment of fear-inducing media coming to the screens in our hands that we fall asleep with. Because that might be the most unnatural thing about our modern environment. Even aside from the close to 70% of our calories coming from ultra-processed, franken foods or the fact that we have 80,000 synthetic toxins in our food, water, air, and homes that have virtually none been tested adequately for safety, all that’s bad. But the fact that we have a screen in our hands that’s telling us the struggles and the fear of 8 billion other people 24 hours a day, which our brains, I don’t think were ever intended to handle that much fear-inducing information, that is putting a constant inflammatory fundamental nervous system grip on our bodies that is totally incondusive to optimal health. Because anything that is putting our body in a state of constant existential fear is going to divert our cellular resources towards defense and threat response and fear management away from thriving and optimal health. So I think if we really just focused on get rid of the diet wars, get rid of the exercise wars, it’s like eat unprocessed real food that’s not covered in pesticides, move your body, lift heavy things to build muscle, most of our health care costs would evaporate. But the confusion drives the industry.

 And so now we have been convinced that it is confusing when actually by and large it’s not. On the margins in the optimization realm, there’s a lot of room, I think, for debate. But for by and large creating a healthy cellular environment, it’s very simple.

 Well said.

 That’s kind of like dropping the mic and the bomb all at once. Confusion drives industry and our fighting amongst ourselves. All of the noise creates distraction and further makes people sick. I’m so glad you wrote the book, Good Energy. Where can people find you? You guys will love this book and we will share it. You also have to check out our recipes that we’re doing together. Where can people find more of you? Well, I am at I am Dr. Casey’s Kitchen on social channels.

 My company, Levels Health, which is at, has an incredible blog that talks all about metabolic health. And that’s, of course, the company that helps people get access to continuous glucose monitors.

 But yeah, my website and you’ll see a newsletter pop up when you go to my website. The newsletter is really, I put my heart and soul in terms of my hottest takes. Sign up for the newsletter and then, of course, Good Energy is wherever books are sold. And my hope is that this is a pretty straightforward guidebook for living your healthiest life and mentions Dr. Gabrielle Lyon many times in the book. Thank you so much, my friend. Thank you for taking the time to come here and sharing all your knowledge and your personality with us. Everyone’s going to love it. Thank you.