Dr. Casey Means: Transform Your Health by Improving Metabolism, Hormone & Blood Sugar Regulation | Huberman Lab

Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life.

I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

My guest today is Dr. Casey Means. Dr. Casey Means did her undergraduate degree at Stanford University and her medical degree at Stanford University School of Medicine.

She is one of the world's foremost experts in metabolic health. Today we discuss how metabolic function and dysfunction impacts our health.

In particular we discuss mitochondria which are involved in energy production within our cells.

And the various things that we can each and all do to ensure proper mitochondrial function which is essential not just for things like body composition and physical and mental energy but also our ability to regulate hormones, blood sugar and much more.

We discuss how exercise, even simple exercise like walking as well as sleep as well as more vigorous exercise and in particular nutrition including the types of foods we eat, the timing of food intake and the sources and quality of those foods impact our mitochondria and other aspects of metabolic function.

We also discuss how particular micronutrients within specific foods can directly impact mitochondrial and metabolic health.

Dr. Means explains how mitochondria, inflammation and reactive oxygen species which are the byproducts of metabolism in our cells can combine to create conditions of obesity as well as ways that we can manage those things or even reverse mitochondrial inflammation and reactive oxygen species dysfunction in order to reverse obesity, reverse diabetes and enhance our health in myriad ways.

By the end of today's discussion you'll have a clear picture of the cellular processes that occur in the brain and body that underlie metabolic disease and metabolic health.

And most importantly you'll have a very clear picture of the actionable items that we can each and all carry out every day and every week in order to ensure metabolic health proper mitochondrial function and indeed that can also impact body composition and overall feelings of well-being.

I would also like to share that Dr. Casey Means has a terrific new book coming out. I know it's terrific because I've read it. It is entitled Good Energy, the surprising connection between metabolism and limitless health.

If you're interested in the book we provided a link to the book in the show note captions. Before we begin I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.

It is however part of my desire and effort to bring zero cost to consumer information about science and science related tools to the general public. And keeping with that theme I'd like to thank the sponsors of today's podcast.

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AeroPress currently ships in the USA, Canada and to over 60 other countries around the world. Again, that's AeroPress.com slash Huberman. And now for my discussion with Dr. Casey Means. Dr. Casey Means, welcome.

Dr. Andrew human, thank you so much for having me.

Really excited to talk to you today about all things health. One of the things I love so much about your work is that you really give people a sense of agency through knowledge and actionable tools.

Which is very near and dear to my mission and my heart, but to kick things off, let's talk about metabolic function and dysfunction.

I think most people hear the word metabolism and they think, okay, the burning of energy. Maybe they think about ATP. Maybe they think about calories in calories out. That sort of thing.

But what are we talking about when we're talking about metabolic function and dysfunction because these are really important concepts for everyone to understand?

Yeah, I think you're exactly right. I think that when we hear the word metabolism, the first thing that comes to most people's minds is my weight. Do I have a fast metabolism or do I have a slow metabolism or something like basal metabolic rate?

And I think what's really important for people to realize is that metabolism is actually the foundation of all health.

It is the core foundational pathway that drives all other aspects of health. And it's also the core foundational pathway that's truly getting crushed in the modern American world and underlying nine of the 10 leading causes of death in the United States today.

It's really quite relevant to everyone in the spectrum of metabolic rooted disease is vast and actually really relevant to most Americans. The latest research from American College of Cardiology suggests that 93% of American adults have suboptimal metabolism.

And we can go into what that means. But fundamentally when we're talking about metabolism, we're talking about how we convert food energy to human energy.

So we take in a astonishing 70 metric tons or so of food in our lifetime. And that is potential energy. It's energy from the environment that's outside of us that through our metabolic pathways gets converted to a currency of energy.

That can then be used to pay for essentially every chemical reaction inside our body and the bubbling up of all of those chemical reactions is our lives.

And so when metabolism is not working properly, it's essentially creating underpowered cells and like any city or factory or machine, not having adequate power will lead to dysfunction.

And the reason that the metabolic spectrum of disease is so vast is because we have over 200 cell types in the body and underpowering in different cell types is going to look like different symptoms because underpowering in an astro site is going to look different than underpowering in ovarian thicacel or an endothelial cell.

It's going to look different, but the core foundational process that is dysfunctional can actually be the same. And I think the biggest blind spot in western healthcare and actually the reason that health outcomes are actually getting worse every year in the United States is because fundamentally we are ignoring

metabolic health and metabolic dysfunction. We are laser focused on the downstream symptoms that result from metabolic dysfunction in different cell types.

And we spend all of our energy focusing on those symptoms, playing whack them all with them and really ignoring that underlying foundational root cause of metabolic function. And what's so fascinating to me and what I saw in the healthcare system as like a super subspecialist as an ENT surging is that you know the more we specialize in healthcare, we have over 100 specialties now that we've just like invented in the health care system.

The more we specialize in healthcare, the sicker were actually getting so the more we do technological innovation in all these different specialties, the sicker were getting and I think what what the real nugget there that that everyone really needs to understand as we bought into a system where we value specialization. And this is the game in western medicine. But while we've done that what has happened to us, we're going to be able to get a new job.

While we've done that what has happened is we have the worst chronic disease epidemic and the lowest life expectancy of any high income country in the world.

And the reason is because in that specialization were focused on the downstream manifestation of underpowering of cells that the cell specific symptoms and not the metabolic function itself. So really our chronic disease epidemic in this country.

And it is a metabolic dysfunction epidemic and underpowering epidemic and that is the biggest blind spot in healthcare and I think a focus on metabolic function as the center of our healthcare system.

And we have a completely new paradigm for health that is urgently and I cannot over say enough it's urgently needed we know we're not in the right paradigm right now when we have a hundred isolated specialties and yet 85 to 90% of the conditions and those specialties if you go to the science and look at the real physiology is

function so that's kind of the landscape of what metabolic dysfunction is and how it's kind of creating a big blind spot in the healthcare system that really represents an outdated way of categorizing disease that unfortunately is killing us I would say.

Thank you for that I have several reflections in a question first off the analogy that comes to mind is an assembly line that's constructing let's say an automobile and it sounds like 80 to 90% of the automobiles that are coming off that assembly line are not working well.

And then the tires on the line and just working well transmission isn't working up as a bunch of issues and no factory no car manufacturer would tolerate that nor with the customers but we're tolerating that in ourselves it sounds like many people are and then accepting the fact that then a bunch of other businesses are going to crop up like the business that aligns the tires the business that goes and repairs the pistons and essentially when you talk about these multi specialties that have evolved in the medical care system.

They provide an opportunity to go and fix the problems are trying to mealy rate the problems but really what we need to do to make this analogy much prefer than otherwise would be just to go further up the assembly line figure out whether or not the hardware is correct the software is correct and where the hardware and software becoming deficient in this in this analogy where we are the automobile that's essentially coming off the conveyor broken and the good news is and I know this but I'm not sure if we can do that.

I know this because I've read your book and because I follow your work very closely.

The good news is that we each and all can take matters to some extent into our own hands collaborate with healthcare providers and repair metabolic dysfunction essentially make us metabolically functional.

The question therefore is I think most people when they hear metabolism they think energy and when we hear energy we think ATP sometimes but typically people think about mitochondria right the powerhouse of the cell so to speak.

So you talked about the trifecta or the big three mitochondria inflammation and oxidative stress as three critical factors underlying metabolic dysfunction and I'm presuming those are also the avenues to address in order to create metabolic function because ultimately what we want of course is an optimistic picture that we can actually take some control that we have some agency and all of this which I believe we do so.

So you would could you get us all on the same page about you know what are mitochondria and what do they do why are they so important then we can turn to inflammation and oxidative stress.

Yes absolutely so the mitochondria or are the structure within the cells we have 40 trillion cells and each cell might have a handful or many thousand mitochondria and they are the magical part of the cell that does that conversion process of food breaking down and then converting to energy.

Translating it to a currency of energy our body can recognize and so currently what's happening is that our environment the environment that our cells exist in across every single.

Fastest of our life over the past 50 to 75 years has changed rapidly you look at how our food system has changed from whole real food and good soil to industrial food our sleep habits of change we're sleeping less it's very fragmented our movement patterns have changed we're sitting 80% of the waking day our time in nature has changed we actually are indoors as Americans 93% of a 24 our periods that totally change our relationship with light.

We have 80,000 synthetic toxins in our food water air personal care products home care products we live a thermonutral existence now with our thermostat there's no real swings in temperature unless you're intentionally trying to.

And then our emotional health is very different we are very much exposed to low grade chronic stress triggers so across food sleep movement emotional health toxins light in temperature things are not what they once were and it's changed in the blink of an eye I mean the light bulb was

created in 1806 this is like 0.04% of human history that we've been had artificial light so things have changed and the the unique thing about all of these changes in our environment is that each one of those pillars each of those changes in our environment synergistically directly hurts the mitochondria through different mechanisms the chronic low grade stress the sitting the ultra process nutrient devoid food even the

blue light at nighttime all of it through different core biologic mechanisms synergistically hits this part of the cell the mitochondria so we have the food coming in but we're not doing a good job of converting it to an energy form we can use so we have these under powered dysfunctional cells because of my condo dysfunction caused by our environment and of course what happens if you've got energy substrate that you can't process it's going to be stored and that's of course

why we have in obesity and overweight epidemic that's affecting close to 80% of American so while it's it's just we talk about obesity like it's the problem obesity is one branch of a tree that's rooted in this mitochondrial dysfunction that's caused by our environment and just to back up a little bit to just sort of share kind of maybe like how I sort of started thinking about that

you know I I had trained as an ENT surgeon and I was at Stanford Medical School and I I was so fast by this idea of like the way that we're defining the diseases were treating in these in like a specialty like ENT is like I I saw

sinusitis day in and day out and we'd have these patients on the table that we'd be literally drilling into their skulls to suck out sinus pus and that's like the treatment for sinusitis and the way we diagnose the patients as we say like

okay this patient has sinusitis if they have facial pressure purulent pus you know nasal discharge nasal obstruction and low sense of smell so if they have these symptoms then they have this disease

but when you actually go to the science and you actually go to the studies of like what is actually happening to create this what you find is a lot of papers about mitochondrial dysfunction

because crop you know sinusitis is an chronic inflammatory condition where the cells are essentially sensing some threat and then they mount this immune response that creates swelling and then you get

a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and then you get a lot of blood and

then what does that do? And this gets your question about chronic inflammation and oxidative stress. Well, when you've got that dysfunctional mitochondria, let's say in a nasal amucosal tissue, that is a cell that can't do its job. That is a cell that's underpowered and what could be more threatening to the body than a cell that can't do its job. So interestingly, those cells will initiate a whole process which is called the cell danger response. It's work that's been done by Robert Navio at UCSD.

Where basically they understand the mitochondria is not working properly. This is of course caused by the environment and they will actually release extracellular ATP, which is not really supposed to go outside of the cell. And that creates a massive innate immune response saying like, I'm underpowered, I need help. My mitochondria is broken. This is the cell releases ATP outside of the cell. Usually the concentration of ATP is a million times higher inside the cell.

So releases it almost as a neurotransmitter, a purigenic neurotransmitter that massively activates the immune system to come and help. But the immune system comes and is like, not much we can do for you here because the problem is not something that the immune system can help with like grabbing a bacteria and lacing it or taking care of some cells infected with the virus.

The problem is outside the body. It's the environment. So you end up getting this tornado of dysfunction of mitochondrial dysfunction caused by the environment leading to the cell danger response, which leads to innate immunity.

And then on top of this, you get the oxy-ev stress, which is the third piece of the trifecta, which is essentially these mitochondria trying so hard to do their work, but they're not working properly. So they create damaging metabolic byproducts called oxy-ev stress, free radicals that cause more damage.

So this is happening in the nose. It's happening all over the American body because of our environment. So you've got these tornadoes of interrelated physiology of mitochondrial dysfunction, chronic inflammation, oxy-ev stress, which if you start going to the research as a clinician who's focused on symptoms and confusing those for the disease and look at what's the path of physiology of arthritis?

What's the pathophysiology of Alzheimer's dementia? What's the pathophysiology of type 2 diabetes obesity, fatty liver disease, polycystic ovarian syndrome, or autowel dysfunction?

It all traces back to this trifecta that no medication or surgery, you obviously can't operate on oxy-ev stress. You can operate on the downstream symptoms.

So that's the real secret that I really feel like we need to reorient the healthcare surround since 90% of healthcare costs go towards treating the downstream symptoms of these.

And for every marginal dollar we're spending on treating symptoms, we're getting...the rates are going up because they're doing nothing to actually affect that trifecta. But to really make it simple, I like to think of this trifecta of what I call trifecta of bad energy.

Try effect a underlying metabolic dysfunction of chronic inflammation, mitochondrial dysfunction, oxy-ev stress, as chronic inflammation is biochemical fear. It's response to a threat.

Mido-conereal dysfunction is kind of like rolling blackouts. It's not enough power. And the oxy-ev stress is like wildfires.

So it's kind of what's funny to me a little bit is like what's happening inside the cell is almost like what's happening in our society. It's like this is like living in California. It's like blackouts, fire, fear. And that's literally what's happening inside our cell because of the environment.

And again, the optimistic news that you alluded to is that we actually have tons of tools and tests that can actually help us understand our level of metabolic health and even give us hints about inflammation, oxy-ev stress, and mitochondrial dysfunction.

And it's very easy to improve if we know what we're actually focused on.

Well, that's reassuring and we're definitely going to go there. I appreciate the analogy to living in California. I've lived here my entire life. I have been outside of California, but perhaps the only thing you left out besides rolling blackouts fires and what was the other one?

Fear.

And fear is a high taxes. The taxes are the health debt on the body. So in any case, not to be too dark and pessimistic.

Well, that's the health care cost. I maintain great hope and still a lot of love for California. It's pretty great. It's got its great aspects and it's not so great aspects. And I can say that as a lifelong California resident, there are other wonderful places to live.

A couple of questions. First of all, about places to live, you've been talking a lot about in the United States.

Yeah.

Are some of the same issues with metabolic dysfunction occurring outside of the United States. I would imagine so.

Yeah. Any country where we've exported the standard American diet and some of the other norms of Western living or starting to see the same rates of of chronic disease. But like it is worth not missing words here of all high income countries in the world.

United States has the worst chronic disease rates and the lowest life expectancy and our life expectancy is going down and we spend about twice as much on health care.

Then the second highest spending country in the world.

So we are we are objectively failing and that failure is predicated in our cult of siloing conditions into different, you know, different specialties and not focusing on this root cause.

And I want to just be super clear like there's a war being fought right now to get us to believe that siloing is the way because as you alluded to siloing is profitable.

If you can convince doctors and people that there are 10 different symptoms or separate things, then they're going to 10 different specialist office.

Meanwhile, 75% of American adults are overweight and obese, some of the highest in the world.

A full 50% of American adults now have prediabetes and type 2 diabetes 50% 30% of teens have prediabetes 40% of Americans have a mental health diagnosis.

Cancer is set to reach 2 million cases this year in 2024 highest ever in recorded history.

All timers is going up fat delivered disease is affecting 40% of adults 18% of teens, autoimmune diseases skyrocketing infertility is going up at huge rates.

All these things are going up all at once in the US and yes in many of the other countries that are eating our diet.

And there's no sign of it slowing down.

And so if you look at the research through this different lens, you'll find that all of those diseases trace back to metabolic dysfunction caused by our environment that no shot pill or surgery can really address unless we unpack the environmental piece.

Scary picture. I'm glad that you're...

But hopeful. We can fix it.

Exactly. I'm glad that you are creating solutions.

And I should say and just remind people I said this in my introduction, but you know you're talking about siloed medical care.

You're talking about the kind of standard medical system, but let's not forget.

I happen to be a faculty at Stanford. Did your medical training at Stanford? You are a medical doctor.

I mean you have MD and are highly trained. You were in ENT, your nose and throat doctor.

If anyone would be familiar with the industry and the practice and the educational system around this, it's you.

So you're not speaking outside your Ballywik.

So before we pivot to solutions, I know people are eager to hear solutions, but in order to understand how to best apply those solutions, I do think it's worth drilling into some of the issues here just a little bit more.

You talked about underpowered cells.

You've also alluded to the fact that most people are consuming enough and probably excess amounts of caloric energy.

So is it the lack of mitochondria or mitochondrial dysfunction that's at the root of the problem?

The analogy I come up with is you've got a power plant that can convert incoming power line to power that can be distributed to a community.

The community and this analogy being the organs and cells of the body. There's plenty of potential energy.

But there's something about the power plant that is inefficient or dysfunctional.

There are shorts, there are circuitry that's just not working such that the energy that the community can benefit from the cells and organs of the body is just not there.

So it's not a lack of input, it's a lack of conversion and output.

The consequence of this we see in the form of excess adipose tissue and all the downstream effects.

It's not just aesthetic, it's really all the downstream effects of visceral fats, subcutaneous fat, etc.

What is it that would improve access to energy and energy utilization in cells?

Is it simply a matter of getting the mitochondria to function better or is it that one can actually create more mitochondria?

This is the key question for how we can get healthy and it's really about creating capacity in the body to turn more potential energy to usable energy as opposed to taking that potential energy and shunting it to a storage form.

It's all just like I think about everything visually and I'm like you got the circular cell from high school biology textbook inside or all the little mitochondria with the squiggly lines inside.

And it's just like there's X's through those mitochondria.

So instead of you know after glycolysis and you've got the pyruvate instead of going through the mitochondria, it's being shuttled into something else.

And I mean this is fundamentally the cause of insulin resistance because when the body senses that the mitochondria can't do that conversion process, the cell basically says

because I can't convert this, I don't have the capacity to convert it to usable energy.

I'm going to take the substrates and I need to block them.

I mean you've got to turn them to basically a storage form which inside the cell can be toxic fats like ceramides and diacyl glycerol.

And I'm also going to block the cell from taking any more substrates because I can't do anything with them.

That is fundamentally a root of insulin resistance so the body says, okay, we're going to block the ability of the insulin receptor to transduce its

intercellular signaling pathway. We're going to block it.

And when that insulin binds, we're not actually going to allow for glucose to come in.

So essentially insulin resistance is the cell compensating for the mitochondria being broken and telling the insulin receptor that it, you know, that it's not going to be functional.

And so you don't get the gluten, you don't get the gluten receptors on the cell membrane to allow the glucose to come in.

So that's insulin resistance. Again, we talk about that as the problem, but the problem is actually inside the cell leading to that.

You know, so that's why just giving someone insulin isn't necessarily an answer.

We have to increase mitochondrial capacity to let the flow happen through it to energy, which then trickles up into relieving a lot of these problems.

So to answer your question, what we really want to do to increase our metabolic capacity from a first principles perspective,

it's we need to make more mitochondria. We need to get each mitochondria to be more functional.

And we need to have each more functional mitochondria processing more energy substrates. It's really that simple.

And the beauty is we can do all of those things. If you actually break down like what those three things mean, it means promoting mitophagy,

through recycling of old mitochondria to new mitochondria. It means promoting mitochondrial biogenesis.

It means increasing the oxidative capacity of our individual mitochondria. It means improving mitochondrial fusion,

which is actually when mitochondria come together to form long chains of mitochondria that are more efficient.

So there's like a lot of technicality to like what it means to print more mitochondria, have them HP more efficient and have each one do more work.

And that's really what we want to do. And that's when it just kind of gets into the simple habits.

Like there's simple things we can do for each of those things from mitophagy. You know, we can focus on various types of endurance exercise.

And high intensity interval exercise, there's compounds like ural ethenae that promote mitophagy.

When we talk about improving our, you know, oxidative capacity, this is things like the sprint workouts. We want to build more mitochondria. This is resistance training literally telling the body to make more.

So, but first principles, it's how do we get more of these working better doing more work every day.

And then we think about, you know, you look at the data on walking and it's like people who walk more than 7,000 steps a day have a 50 to 65% lower chance of dying.

In 10 year follow ups and it's like, yeah, because walking is literally a glucose disposal signal. So you're just simply asking, it's not a great biogenesis signal.

It's not a great mitophagy signal, but it's a great disposal. So if you're doing lifestyle habits that do one of those three things, which we can of course go into more.

You're improving the cells capacity to do that conversion process better.

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There's a lot of great science and a lot of great stuff related to testing and assessment of one's metabolic health that we should get into and we'll get into.

But since we touch on lifestyle and because we've been talking about this sort of dysfunctional dark side for a bit, maybe we could just touch on some of the lifestyle factors that you just mentioned.

Because I do think it's important that people really start to feel into their sense of agency and here we're talking about things that are relatively low time investment.

Certainly don't have much financial cost in the sense that they could be done in gyms and with fancy equipment, but they don't require that.

Again, I want to point out that these are not like strict prescriptives, but if you had a magic wand and because you are interested in the health of humans.

Let's talk about a few of these things that can improve glucose disposal and mitochondrial function, my topology, the removal of dead or dysfunctional mitochondria so they can be replaced.

Let's talk about the walking one first. You said 7,000 steps a day. I don't track my steps. What are we really talking about there?

We're talking about taking the stairs and trying to walk as much as possible. Maybe we were going to just give a really crude prescription. You're a doctor so you can prescribe things.

What would you tell people to do? How many short walks per day? Is it like three? Is it five? What are we talking?

I would say at least three. I would say aiming for more than that is good though.

So to just give a sense of the picture of walking, if walking were a pill, it would be the most impactful pill we've ever had in all of modern medicine. There was a paper in JAMA, 6,300 participants followed for 10 to 11 years.

The people who simply walked 7,000 steps per day compared to less than that had in up to 70% lower risk of all-cause mortality in the follow-up period.

So not causality, but it's pretty incredible. They've done follow-up research with slightly different numbers showing, again though, like many thousands of people in the study followed for about 10 years, 8,000 to 12,000 steps per day was associated with 50 to 65%.

Lower all-cause mortality. And this has been played out in many studies showing about a 50% reduction in Alzheimer's, dementia, obesity, type 2 diabetes, depression, cancer, gastric reflux, just all across the board.

And I think the key thing is that it's not about the steps. It's about the fact that muscle contraction is medicine. When we contract our muscles, even in a very like low-grade way, like walking or doing a couple of air squats, you know, we're activating AMPK, and we are essentially causing that cell to have a stimulus to push glucose channels to the cell membrane.

Most of the time, the glucose channels are like, like, in vesicles, in little bags inside the cells. They're not on the cell membrane. So of course, that's going to keep the glucose in your bloodstream not being processed by the mitochondria.

So when we think about steps, it's a proxy metric for just moving more throughout the day. So let's take two people. You have a person who's walking for one to two minutes, every 30 minutes throughout the day.

Maybe they're exercising at the end of the day or the beginning of the day. Maybe they're not. That person is stimulating glucose channels to be at the membrane all day.

Now let's take another person who works out really hard for one hour in the beginning or the end of the day. They feel great about it. They've checked that off their box, but they're sitting the entire rest of the day. Yes, they have gotten the benefits from the exercise.

But for a lot of that day, those glucose channels are inside the cell, not doing the work they could be doing. So I think about these little teeny short walking breaks or push up breaks or air squat breaks every 30 minutes or so throughout the day.

As me essentially inside the cell, pushing the glucose channels, the cell membrane to make them constitutally active, it's totally different physiology and it's so easy. So it's not about the steps. It's about muscle contraction regularly throughout the day.

And this has been shown out in actually more clinical research, which has taken, there's been several studies, two that I think are fascinating where they basically took two groups and they said, okay, we're going to have you walk 20 minutes before each meal three times a day, 20 minutes after each meal.

So that's also three times a day or for like two minutes every 30 minutes throughout the day.

So these are three separate groups, either 20 minutes before either 20 minutes after or two to three minutes every 30 minutes, okay, all added up to 60 minutes of walking or light jogging a day.

I'm kind of paraphrasing two different studies that showed the same thing. One was jogging, one was walking, but it was basically chunks versus short walks every 30 minutes throughout the waking day.

So the groups that do the short movement regularly throughout the day, even though the total time is the same across all the groups have significantly lower 24 hour glucose level averages, 24 hour insulin level averages, they are metabolically healthier.

And I believe in the research mechanistically is shown that it's because we're consistently putting this, these channels of the membrane to take up the substrate, use the substrate.

This is not in to replace exercise, but I think it's a reframe.

I think the concept of exercise is something we're really very wedded to in our western culture, and you look at more like the blue zones and the centenarians and it's like they're kind of moving as built into their everyday life.

So we've taken movement out of our everyday life as these knowledge workers as we've been industrialized, and then we think that exercise replaces that all day movement, but biochemically it does not.

So I think a big part of kind of digging ourselves out of this chronic disease mess and creating capacity for mitochondria is finding ways to take a lot of the activities we do now seated and just find a way to do more of them moving, standing or walking.

Or if that's tough, you really need to sit at your desk all day, then every 30 minutes taking two minutes to do some just light movement, flex those muscles, get the glucose channels of the membrane, get the mitochondria active.

And I think another fascinating stat is like our gym memberships in the US have doubled since the year 2000 and obesity has gone up in the same period. So there's some mismatch between our obsession with exercise and our actual outcomes that we're seeing.

And I think it's that we have not actually rebuilt constitutive movement into our daily lives.

Very interesting because I think a lot of people are now working out so to speak was doing resistance train, which I think is terrific used to be such, you know, so restricted to niche sub culture stuff like bodybuilding, preseason, football, military, etc.

And now it's more ubiquitous for everybody, men, women, young, old that's terrific. Same thing with things like yoga and cardiovascular training.

It like to study the history of exercise culture and it wasn't, but in the 60s when jogging was considered kind of like, whoa, that's like a really esoteric niche culture thing. So lots changed.

I love the prescriptives you gave because it's just very straightforward, a couple of short walks. It just makes so much sense. And I love the visual and I hope people will really hold it in mind.

So I'll reiterate it. The the translocation of these energy utilization stores, vesicles, as you call them, these little packets from the center of the cell out to the cell surface where then they can be involved, involves, excuse me, and metabolic processes and the utilization of energy in ways that otherwise they wouldn't and glucose disposal being a big part of this.

So I have heard that a short walk after a meal will reduce blood glucose in a way that's really dramatic huge amount 30, 35% just taking a walk around the block after meal. That's definitely a prescription. I think everyone should do because the research is so strong on it is that building in simply a 10 minute walk around the block or a dance party in the kitchen moving your muscles for 10 minutes after a meal can drastically reduce your glucose response because you're just bringing all the water.

And you're taking up the glucose you're using it. It's a whole different physiology than sitting on the couch after a meal that's very high impact. It's high leverage of its after a meal. So highly recommend that and the levels data and clinical data has shown that out time and time again.

Whenever I go to a city like New York when I am forced to walk more, I always just feel so much better. We also know that the optic flow that one experiences with walking has some interesting effects on the limbic pathways and quieting of some of the anxiety and stress related pathways.

This links up with things like EMDR although their factors that are separate from EMDR basically moving through space, not outer space but walking through space with optic flow has a certain anxiety reduction function in the brain which their beautiful data there in my opinion.

Okay, so that touches on walking you did mention higher intensity exercise so let's keep it within the cardiovascular realm for now. So getting heart rate way way up, you know, getting breathing hard for you know some minutes each week maybe a couple times per week.

It seems that's a good way to increase mitochondrial function and mitochondrial number is that right. Yeah, so you take sort of each each type of exercise we've got walking we've got resistance training we've got high intensity interval training we've got endurance training and then we've got sort of more like zone two.

So we've got these different flavors of how we get our heart rate up how we get the blood flowing what we signal to the cells and each one actually has like a slightly different impact on the mitochondria when we think about biogenesis we're thinking mostly like endurance exercise and really more of that zone two and like that is really going to be a stimulus inside the cell to print more mitochondria.

When we think about improving mitochondrial fusion high intensity interval training is really really good for that when we think about resistance training it's like that's like muscle hypertrophy we're going to be creating more muscle cells and we need more mitochondria for those so each one has kind of a different impact and I think this is where honestly I think the regular guidelines that we have even by our government you know actually make a lot of sense it's like work every major muscle group three times a week in a resistance type training and then work to get 75.

To a hundred and fifty minutes of modern strontium activity so 75 minutes of strenuous activity or a hundred and fifty minutes per week of modern activity so that actually makes a lot of sense 80% of Americans are not meeting those very basic guidelines and 20% of Americans don't get any physical activity really at all activity for the average American is 3000 to 4000 steps per day which is less than two miles.

So we are not even close to even meeting the basic recommendations that are out there but I think those are pretty reasonable resistance training two to three times a week most major muscle groups and working to you know get the get the heart rate up moderate level.

So for a hundred and fifty minutes a week or strenuous for 75 minutes a week those are going together to be potent stimuli for biogenesis mitophagy mitochondrial fusion for increasing antioxidant enzymes that are going to protect the mitochondria from that oxy of stress.

And the one that's just actually not in there in the sort of the basic recommendations for Americans is the walking and I would just absolutely add to that at least 7000 steps per day based on what the data showing which honestly would probably take less than an hour total to do if you if you break it up throughout the day is just a few minutes a day so that right there are going to be like a big multifaceted set of signals for increasing my

different ways terrific what what are your thoughts on under the desk treadmilling I don't own one of these but and I try and get walks and I definitely do my three resistance training exercise sessions per week different muscle groups on different days so it ends up being each muscle group is hit directly once and indirectly a second time but I like to do a long hike once on the weekend run in the middle of the week that's 30 maybe 35 minutes and then some VO 2 max really short workout 12 minutes total where this is going to be a lot of work.

So I'm just going to go to the total where this is going for the feeling that my hardest going to jump out of my chest and I'm going to get going to die from gas me there but luckily that's why I haven't died nonetheless the total time commitment isn't that great but I find that I'm at a desk a lot and I have a standing desk is it wise to get a treadmill to treadmill under the desk seems like it would be one of the best things one could do I'm a massive fan of under treadmill because genuinely I believe that if we if we move more of our daily activities that we're doing is going to be a lot of work.

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people really didn't like the idea that this was any different than so called neat non-exercise and activated thermogenesis. So it's known that people that fidget a lot or move around a lot burn a lot of calories. This actually goes back to some really beautiful work. Several decades or more ago from Rothwell and Stock who talked about like the fact that animals and people who fidget a lot burn a lot of energy. They tend to be thinner. They tend to have lower adipose tissue stores. And it's because they're just burning a lot more calories. And it's because they're just burning a lot more calories. And it's because they're just burning a lot more calories. And it's because they're just burning a lot more calories. And it's because they're just burning a lot more calories. And it's because they're just burning a lot more calories. And it's because they're just burning a lot more calories. And it's because they're just burning a lot more calories. And it's because they're just burning a lot

and this is actually what people who suffer from anorexia, which is by the way the most deadly of the psychiatric condition. So it's, which I'm not true anorexia are encouraged not to do because they either do it spontaneously or they learn that it's a very efficient way to burn calories. And that's not what they need. But many people do need to burn more calories. So bouncing the knee, that thing that drives everybody crazy if you're not the one doing it. Solius pushups. What are your thoughts about this in that study? We don't have to pick it apart in detail. But I thought it was kind of a

interesting. It's all coming back to just moving the body as much as possible during the day, contracting muscles, contracting muscles. It's medicine. And I find the concept of neat just endlessly fascinating, you know, because we kind of come up with this term non exercise activity, thermogenesis. And the data is really good about it. Like it's basically shows that this is a prime potential intervention for the obesity epidemic. And it all goes back to the cell. Like it's essentially a stimulus that's telling us

that we're in the body to stay metabolically active as opposed to keeping all those metabolic pathways, you know, dormant during the day. And I think that it just, it is funny though that like we have these acronyms for basically like this is just the way life was a hundred years ago. If you look at like the 1800s, almost 100% Americans lived on a farm basically like pre industrialization, pre urbanization. Most Americans, not 100% but the most Americans.

But close lived, they grew some of their own food, they lived either on a farm or had a large garden. Now that number is less than 1%. So like movement was just built into everything we did. And you think from there, like what has happened, like we were outside, we were moving our activities of daily living involved movement. And if you just take the grocery example, then it moved to like, okay, maybe farmers markets and sort of like, you know, outdoor open air markets, then it's super markets, then it's, you know,

now it's literally buying food online with the click of the button. And now some people aren't even doing that. They're literally on the food delivered to them with Uber Eats. So at every level, we've taken away movement from every day life. And now we have sort of an acronym to like bring it back in. But really it's about just, you know, giving the body stimulus stimuli that the cells have been entrained to expect throughout all of human history and building the back into our modern life. So I think neat, it's incredibly important.

And I think it also brings up this point that like is so critical, which is like, I really think our way out of this chronic disease epidemic. And even for people who are listening, don't have a chronic disease, any real chronic symptoms we're dealing with. And just the fact that we're not feeling as good as we could. Like the way out is pretty simple. Like it's, it's some of these basic things like walking more throughout the day, moving more throughout the day, getting outside, you know, eating clean, unpoiled food.

The, the, a lot of these things that have the best data are so simple. And I think it's like really important to just always remember like the game and the industry. It's all about how complex can we make it like specialization, talking about some of the minutia, but like at the end of the day, all the simple habits that we know are healthy, like fundamentally improve cellular biology. And like some of these things like the neat, like the walking, like, the

it's emblematic of the fact that some of the simplest solutions are the ones that are by far the most effective. And I think, I think the biggest misconception in health care right now is that the way out and the way to get really back to true incredible health is complicated. Like it's really not that complicated. We've got to move more, you know, throughout the day. That's one of them. And, you know, on each pillar that we touched on earlier food, sleep all of this.

You know, when we talk about the simple habits that we know work, the reason they work is because they all positively impact that mitochondria, they positively impact doxay of stress, they positively impact inflammation. So yeah.

Yeah, I love it. I love simple solutions that hit multiple cellular pathways that can make everybody healthier. I'd like to just take a quick break and acknowledge one of our sponsors inside tracker inside tracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and help you reach your health goals.

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I'd like to talk about assessment blood tests in particular. I remember in college, I was just very curious about blood testing and I had read a little bit about it. It was really hard to access.

I actually went to the student health center and said, can I just get my lipids measured, some hormone stuff measured. I was in great health. I just wanted to do that and they're like, no, what's the issue?

Why would you do that? Now it's very easy to find places that will do blood tests, but there is some cost often.

Nowadays, thanks to your efforts, your innovative and engineering efforts and the efforts of others, there are ways to measure what's in your blood and blood glucose in particular with continuous monitoring and with snapshot monitoring.

Let's talk about blood tests. What do you think are the three to five things that basically everybody, if they can, should know about what's circulating in their blood. I'm imagining LDL, HDL, this kind of thing. I guess APOB is a big favorite of our friend Peter Tia.

Fasting blood glucose, continuous blood glucose, post meal, etc. Just kind of evaluating how exercise food, etc. impacts blood glucose. Then I'll leave the other categories open.

That's my point here is not to answer the question. That's what comes to mind.

You've got the big ones. This is key is that every single person listening, I hope, after this episode, will go to their health record or send their doctor a message and at least get the following test.

The first seven that I'll mention are very basic and people might take umbrage to them because obviously there's a lot of debate about what's everyone's favorite lab tests.

I think about it as what are the basics that everyone should know and what's the next tier up that are easy to access and are cheap that will give you a lot more richness, but which you still might have to fight your doctor for.

So the first few that you will not have to fight your doctor for and are often free on an annual physical and literally define metabolic syndrome are fasting glucose, fasting triglycerides, HDL cholesterol, hemoglobin A1C, total cholesterol, waist circumference and blood pressure.

Okay, sorry. I hate to interrupt and my audience hates it even more, but I'm going to just could you just explain what each of those is and what it what it corresponds to.

Great thing. And I will say first of all, the reason I'm choosing these it's not it's not even my own choice really it's two reasons one is that the two studies over the past five years that have shown us in large populations that the vast majority of American adults are metabolites as functional use those biomarkers.

So I think because of that it's important to know them and the two studies that I'm referring to are one from UNC in 2018, which showed that based on those biomarkers 88% of American adults are have suboptimal metabolism and then follow up study from the journal of the American college of cardiology from last year,

so that that number has gone to 93.2% of American adults are suboptimal in their metabolism and these are the metrics that they use and they're very basic if you had to pay out a pocket, they would be less than $100.

So let's talk through them. Why they're great is because together they give you kind of like a tapestry of what's actually happening inside the cell if you choose to look at them that way if you read the tea leaves of them.

Are the doctors often if they see all these lab tests that will be an electronic health record we've all been through this experience experience they'll come up on the screen and there'll either be like a green orange or red color next to it like it's high it's low it's borderline and the doctor will basically it's very algorithmic oh,

you know your LDL's high we need to bring it down or your glucose is high we need to bring down or your blood pressure is high we need to bring it down but what I'm inviting people to do is understand a little bit about each test and then read the tea leaves of what it's telling us about our mitochondria so let's start with fasting glucose.

So fasting glucose when you look at these studies that I'm referring to they call optimal less than 100.

So to define whether you were in that 88 or 93% you had to essentially be in the their their optimal range for all biomarkers not on medication so I'll quickly run through what their ranges were my ranges for optimal or tighter than these but fasting glucose less than 100 triglycerides less than 150 HDL above 40 for men or 50 for women.

Himaloba and see less than 5.7% total cholesterol to HDL ratio less than 3.5 to 1.

Waste or conference less than 35 inches through in or 40 inches for men and blood pressure less than 120 over 80.

If those things were in those ranges and you were not medication for blood sugar or blood pressure or whatnot you were considered optimally metabolic healthy that's now 6.8% of Americans.

All of these biomarkers are easy to change in one to two months I would say with simple lifestyle habits.

Could you remind us what human globin A1C is I think most people are familiar with HDL cholesterol being the quote unquote good cholesterol and LDL being the bad cholesterol and as I say that I know I'm going to get dog piled.

Yeah totally.

I'm not sure that I adhere to that I'm not sure I don't adhere to that I'm not sure about a lot of things but I am sure that most people think of them that way.

So just as a to stay functional here what will frame it that way for now with with the caveat that that might not be the whole story isn't the whole story.

But triglycerides fat in the blood fatty stuff.

So key to understand about the triglycerides it's not people we don't want to confuse triglycerides with eating more fat triglycerides are a storage form of excess carbohydrates in the blood.

So this is why it can tell us something about and I know you and you and Rob Lustig talked about this at length but it's I and Lane Norton Lane.

Yeah I mean one of the things that's really tricky gosh is that the the language around nutrition and health is complicated because people hear the word fat they think body fat.

But then they also think the macronutrient fat we just need more words to better parse the reality in biology we call the two major groups of people lumpers and splitters.

Lumpers like to lump everything together it oversimplifies and complicates splitters like to split everything give a name for everything individual name for everything it complicates and so there's a middle ground right there's a there's a land of reasonable people.

And no main culture and unfortunately that does not exist on the internet nor does it exist in any one specific subfield of medicine or science I mean so much of the confusion out in the world is because of a lack of adequate language right in order to explain so okay so the triglycerides are a reflection of excess carbohydrate intake and how it's helping us with that tapestry of understanding the trifecta of bad energy is that if you think about it let's just go back to that cell and that poor mitochondria that's being absolutely decimated by our.

And it's capacity is low okay so that might get my doctor is like I can't process glucose or fatty acids to H.P. very well so I'm going to block their entry into the cell so now you got glucose rising in the blood stream so okay fasting glucose that was one of our biomarkers if that's going up that is a little bit of that tapestry of maybe something's going on inside the cell that's blocking the entry into the cell so it's rising the blood stream okay well where's all that the body does not want lots of glucose floating around in the bloodstream.

Because it can literally independently cause endothelial dysfunction which is basically blood vessel problems it can cause oxidative stress in the blood stream it can cause a glycation which is sugar literally just sticking to things we the body doesn't want that glucose high in the bloodstream so it converts it to triglycerides to be stored in a storage form of energy.

That's a key point that I think is helpful to understand is that the body it's always trying to like kind of keep things in the right range so it'll convert things so then triglycerides a picture in your blood of glucose being high and triglycerides being high is very much should signal to everyone when they look at their labs that there's probably something going on site inside the cell that's blocking the cell from me able to use and process a sign of mitochondrial dysfunction and chronic over nutrition.

Too much substrate not enough processing glucose is going to go up triglycerides are going to go up and so again so then if you kind of squint and read the tea leaves it's like huh I think metabolic dysfunction and what's fascinating is that the travesty in our healthcare system is that a patient might go into the doctor and they're fasting glucose is 99 one point under what we'd consider the normal range and their triglycerides are 149 one point under what we'd consider the normal range from these things.

That doctor might say to that patient you're totally fine both glucose and triglycerides are normal but that's just really problematic because they're on the upper end of normal for both of those and so really what that would say to me is someone thinking about the mitochondria is like this person is definitely metabolically dysfunctional they're on the highest end of normal for both triglycerides in glucose there's something there's definitely insolence going on here I would much rather see that glucose and that's going to go up and so that's going to be a good example.

I would rather see that glucose at 73 and that triglyceride at 50 which to me would say oh this cells processing through energy great and things are moving through and we're not backing up in the bloodstream we're not converting to triglycerides so that's where really optimal ranges get in but but so that's so that's glucose and triglycerides why if those are starting to creep up it's a sign that something is happening metabolically and then when we look at some of the other biomarkers so hemoglobin A1C is really so that's really good.

So that's a marker that's looking at how many of the hemoglobin molecules that are in the red blood cells that carry oxygen how many of those hemoglobin molecules have sugar stuck to them and that's glycation so you're looking at

glycated hemoglobin and you can imagine that if the concentration of glucose is higher over time more glucose is going to stick to red blood cells and that's going to create a higher percentage of glycated hemoglobin so that's why that lab is represented as a percentage so less than 5.7 is what we want you want those cells nice and smooth and slippery smooth no sugar stuck to them causing dysfunction

and because blood cells lasts for about 9 to 120 days hemoglobin A1C is giving us a basically a snapshot of average blood sugar levels over 9 to 120 days and if that average is higher again probably a sign that cells are rejecting glucose from the cell and it's causing the rise in the bloodstream

and then just talking about one other biomarker and that that we talked about which was blood pressure people might say well how does blood pressure relate to like what's going on inside the cell you know in the mitochondria and whatnot

and a really the fascinating link is that when that cell becomes insulin resistance which again is a compensatory mechanism for mitochondrial dysfunction

the insulin is going to rise in the blood because the body is insulin resistance the body is going to turn out more insulin to try and overcome the insulin block to drive the sugar into the cells so insulin levels rise

well insulin is one of the key activators of nitric oxide which is the molecule in the blood that dilates and relaxes blood vessels

and so when we become insulin resistant and we're not responding to that insulin signal we end up getting less nitric oxide activity so this is how kind of looking at even these very basic very cheap biomarkers to the lens of

basic cellular physiology we can start to see man my body might be like underpowered I might I might have a mitochondrial issue here so that's a few of those tests that we really want to shoot for

terrific and thanks for bringing up blood pressure again it's sort of comes across to many people as old school right but when a T.O. was here

one of the several times he was here he he really pushed on blood pressure is just such a key metric right I mean obviously if blood pressure is high you're getting less

not your oxide through for whatever means here vessels and capillaries are constricted cells aren't able to use the energy that's coming in there's excess energy there's build up of

metabolic waste there's all this stuff and now we can start to see the picture yeah it's trying to emerge and as you mentioned briefly these markers can be put into healthy range or maybe even

fantastic range in a very short period of time so we'll talk about how to go about that in terms of getting a basic blood test is your physician what's the secret code I'll give away one that

former guest who's also an MD shared which is oftentimes if you ask your physician for a blood test they will say well unless there's a particular need or you're

struggling with something they won't give it to you but if you have a shift from baseline in a symptom or in a number that can help all the physicians are going to come after me now with I guess with

death the scopes I'm willing to stand my ground if you want a blood test it's often useful to mention that there's been some market shift you want to be honest right but some market

shift in sleep and lifestyle in how you feel standing up sitting down I'm not trying to let you know lace people's minds with ideas to create narratives here but

oftentimes where physicians are resistant they'll be more amenable if they understand that hey like something's changing and the patient saying something's

changing actually would be irresponsible of them to not give the blood test so there you go bring it on mds so yeah truly and I think the nice thing about these again very

basic tests and there are so many other tests that I talked about in my book and that you talked about on your podcast apob uric acid fasting insulin home I R

HSCRP liver function test G GT all these other tests that are great that can really tell us more about mitochondria function oxidative stress chronic

inflammation but the ones I'm mentioning are the ones that you will not have to fight with your doctor about like the the everything I just mentioned like the

doctor should order on an annual physical and it's really about us learning to actually like read the tea leaves of what they're saying and not look at them in this algorithmic way but like how together if they're creeping up or if many of them are a little bit high like we need to

focus all of our energy on improving mitochondrial capacity basically and bring those numbers down which we can do very very quickly once you start getting the

mitochondria moving through more of those substrates a lot of them will just naturally come down now in the book I give scripts to literally

talk to your doctor with because you are going to get pushback often if you ask her fasting insulin I would say probably I mean even though doctors are waking up a little bit like maybe 85% of people are going to have their doctors

say they won't order that for them so I actually think there's a huge benefit I hate to say it but like going outside the system this is where I think innovation has been valuable there's a lot of like amazing

companies doing direct to consumer lab testing so you can basically avoid the hassle and some of them are very affordable there's a function health is a company that's doing 110 biomarkers including all the key

metabolic biomarkers for less than $500 and they'll do it twice a year so you don't ever have to and then they do interpretations inside tracker next health levels is doing labs and so

a lot of this springing up because I think people are sick of fighting with their doctors to get a crum of information about their health and it's it's

it's we should probably be testing these I would say three to four times a year and the beauty is is that like I think a lot of what keeps people down in the health world is that they're

confused about what to do there's a lot of noise there's a lot of different strategies you know do I do you know paleo keto carnivore vegan Mediterranean do I do hit or zone two or eccentric it's like there's so much noise and the beauty

that you're doing with having a plan for understanding your biomarkers regularly is that you can cut through all the noise triastrategy see where you stand re retest in a few months and see if you're

moving in the right direction you don't you don't have to trust your doctor you don't have to trust me you don't have to trust anyone you can literally trust your own labs and I I say to people like

your labs are optimal and the range they just mentioned are not optimal like we want to actually get to better than all of those if you want to be up if you're if you're key metabolic biomarkers are optimal if you feel absolutely freaking incredible and you have no symptoms then you're probably doing the right strategy

whatever that is vegan keto whatever like an exercise in your lifestyle because that is showing that your cells are fundamentally working properly so I think that's just a really empowering message now there's phenomenal companies that are cropping up to basically help

allow people to do this on their own schedule which I think is really the future of health and actually will help lessen I think some of the intensity of the

diet wars you know because it's like people can just say like I trust my strategy I know I'm doing what's right for me because like look at all my biomarkers and I feel great you know so

yeah what used to be the before and after you know pre diet exercise post diet exercise photos on social media are now starting to also include numbers which is kind of interesting I mean obviously these aren't randomized control trials

cool to see people posting their numbers yeah of things that are not just related to aesthetics but are or body weight but are related to health metrics yeah it's it's it's fun I think it it speaks to a more scientific or at least a more quantitative

approach to things and I think it's inspiring for people thanks for putting those scripts in the book that people can refer to let's say that I go in for these blood tests I

do the basic seven and I find that my fasting glucose is a little high my triglycerides are a little high my LDL is a little high maybe a few other things are okay so I'm kind of in them you know not in the red zone but I'm in the like

should probably pay attention to these things what are some of the things that one can do in order to try and move those needles in the right direction I know we talked about walking

in movement before what are a few others and maybe we could start to touch into nutrition a little bit and then we'll pivot to insulin and blood glucose I think on the highest level it's about

running through what are the science based things that we know in our environment can lead to metabolic dysfunction and take honest stock of how those factors are playing out in your life and then

choose a few to start moving in a different direction so the ones that I think are ones that we can really control and that are we know based on the science or impacting our mitochondrial

metabolic health is the food the sleep the movement the emotional health the toxins are relationship with light and are relationship with temperature and your journey to optimal

and the health might be totally different from mine because I might really need to focus on the food and the sleep and the emotional health and you might really need to focus on the toxins and the light and the movement and so it's a lot of it is actually taking stock on where the

levers are in your own life where are you crushing it and where is there a lot of room for improvement so step one is knowing like that those are the thing those are the things in our

things we need to basically improve to have to give ourselves the best capacity and then of course checking your biomarkers to make sure your interventions are working but but food I think is one that is like totally unavoidable of those pillars those seven pillars food is one that most

of us are getting wrong and that we really actually have to get right to improve our metabolic health for a lot of reasons I mean our bodies are basically a hundred percent

food it's so wild it's so wild every time I think about that I can only close my mind like babies are 3D printed from food basically inside a woman's body it's wild to me and then what's so cool

about the body what brings me just immense awe every day is that like we have this conception in our western world that the body is like a thing that

we're with throughout our life because we kind of look the same and we like age slowly so it's like Casey is a thing and Andrew is a thing but the

body is actually a process the body and there's this amazing Taoist statement like life is a process not an entity I love that I'm sorry to interrupt I'm just I always you know wish that if people could

understand that with biology and health understanding the nouns and the names is important but it's verbs it's verbs verbs verbs if you understand that things are

processes or processes depending on who you are and where you live in the world it all becomes so much more tractable yes and it's so much more hopeful because if I'm a process if you're a

process than every day we're eating we are changing the process whereas if you think you're a thing then there's no hope because I'm just I'm Casey and that's why I am and I have this

disease you know and I think so much in our language actually of health care both our western sort of desperialized nature like we don't really have a lot of curiosity with with process but even like the

ideas the way we talk about disease I have diabetes you know and I I and we don't even talk about diabetes cures which now a lot of people are

trying to do it by a bit is we call it remission like it's this thing that's a part of you and I think I just love this idea of like we're evolving every day and food is so important because again we take in 70

metric tons of food in the lifetime 2 to 3 pounds per day one metric ton per year on average and that is like the printer ink that's the 3d printer

ink to create tomorrow's version of ourself which is molecularly different than the Casey of today that's a hopeful message because if we can give the

body food which you know I think we again our conception of food I think is very limited food is the molecular building blocks the body it is the cell signaling functional molecules that tell our

cells what to do they act as transcription factors of genetic modifiers cell signaling pathway intermediates and it's also of course the substrate to change

with the microbiome does and the composition of the my my microbiome which is basically a pharmacy inside our bodies to create different molecules that can affect our health so food is certainly a calories a

calorie from the concept of thermodynamics but from the concept of molecular information it has 3 massively important parts that are unavoidable for creating cellular health so I would just say

that that is the pillar that we can drill it be happy to drill into of like what do we really do to you know build build as much medical health as possible yeah I want to focus now if you're

willing on food not just macronutrients proteins fats and carbohydrates not just calories although that as well but things like timing things like fasting and micronutrients which I think is a highly

under explored topic so with respect to food gosh I feel like we've all been exposed to pretty much every variation of you know it's all calories in calories out and by the way I believe in the laws of thermodynamics so yes total

caloric load matters total energy expenditure matters without question within the framework of not consuming excess calories there's a lot to explore however I can just say for myself for what it's worth I'm not very hungry until 11 am noon or one I'm okay not eating until then and just

water electrolytes and caffeine does mean just fine I can exercise etc but once I start eating I really enjoy eating and I mostly like the proteins I like meat and fish and eggs and like cheese and vegetables and carbohydrates and fruit and all of it I like all the stuff and I tend

to like singular few ingredient foods I just naturally do so I've been lucky in that way but I know a lot of people like sandwiches process foods things that

are combinations of ingredients what do we know about kind of I don't want to say optimal but if one we're going to explore different ways of eating for sake of adjusting these biomarkers in the right direction and improving

metabolic health is there kind of a generic jumping off point would most people for instance be wise to cut back on the total number of sugars or the total amount of sugar

or perhaps reduce the amount of carbohydrate and replace it with some lean quality protein I mean are there generalizations that we can make or is it really all just about not getting excessive calories and trying to get those calories from the most

nutrient rich sources well just drilling it on two things you just said there so one thing you said that was interesting was that you're lucky that you like all of those foods and then the second

thing was it just about not getting excess calories but I think what's interesting about both of those is that I would argue that the reason you like those foods is because you have given your body enough whole real foods that now everything

your biology neuro biologically your rewards circuitry your micro biome your satiety hormone threshold all of these are now basically creating a situation in which you like those foods

and then the caloric thing fits into that because the reason we're eating excess calories the reason chronic nutrition is happening and the reason we are quite literally in the United States eating ourselves to death for the first time in human history is because we're not eating real food and we're eating 60 to 75% of our calories of ultra processed

nutrient depleted foods that fundamentally don't give ourselves what they need and a real premise that I think is so important to realize is that our cells are brilliant and if the cells aren't getting what they actually need to function properly they will drive you to eat until they get their needs met

unfortunately because the ultra processed food is designed to be highly addictive and it's devoid of what the cells actually need for good function we end up eating ourselves into a grave and now almost 80% of Americans are overweight or obese close to 50% of the country is obese

we literally gloss over this as a culture it has become so normal in such a short amount of time but I always think about the fact that like there are really no other animal species in the world that have obesity and chronic disease epidemics and they don't have social media they don't have experts and I have pub med they don't have the FDA they don't have the USDA they don't have any of it and they have somehow figure out a way to stay at a healthy weight and to not get heart disease and it's because they're eating real food that meets the needs.

And so I think to just boil that down the root cause of the promise that we have a toxic food supply that's no longer filled with the molecular information that our body needs to know to be satiated and to function properly and so through the complex biology of satiety hormones and neuro biology and microbiome function we are driven to eat so so so much more so truly

truly the jumping off point for anyone on the quest to better health is to eat as much real unprocessed food from good soil as possible and a really of any dietary philosophy they want truly I think if someone's eating real unprocessed food from good soil who is you know plant based or who is keto

they are going to have such a higher chance of meeting their bodies actual fundamental needs and the good thing about biomarker testing is they contract themselves if they are having good cellular function with that strategy.

There's been studies that have pan this out you know we know that the moral to process food you eat the higher risk of obviously obesity but also chronic diseases are but then of course there's amazing study from Kevin Hall.

Just recently where he basically locked people up at the NIH any for two weeks he had the meat ultra processed food and for two weeks he had the meat real food and people eight seven thousand more calories in the two week period.

When they were eating ultra processed food versus the unprocessed food we were locked at the NIH I mean I've been to NIH quite a bit I don't it's great for a day job or a day visit I don't know that I want to be locked there that sounds like a that sounds like the Stanford prison.

Prisoner experiment I say this tongue in chic and with such admiration for what he had to do but I think it's so amusing that you know we have this totally franken food toxic food system that's that's largely ultra processed and it took.

Amazing Kevin Hall to basically do an NIH you know funded study where people what I say by locked is that they were in patients at the NIH and every had ad live you know unlimited access to food during each of those two week intervention so it's two weeks of all process food two weeks of unprocessed or mentally processed food and they could eat whatever they wanted.

As much as they wanted in both groups and then they would weigh every single bite that was left on their trace they knew exactly exactly how many calories they ate and literally just giving people this ultra processed food which is.

Devoit of what our bodies need and and therefore will drive people to eat more they ate 500 calories more per day for a total of 7000 calories more in that two weeks and they gained about two pounds and then lost two pounds in the unprocessed group which makes sense of course because of pounds about 3500 calories and so.

We have to do these kind of crazy studies just to prove what we kind of know is true which is that this ultra processed food environment that's cropped up for the past 50 years is an experiment that has failed it has failed you know close to 45% of kids are overweight or obese now like it's not working and that really is.

The root cause so I think a lot of food is about quality and how do we actually really meet the needs of of the cells that are satiety hormones get secreted and we naturally stop eating because just telling people eat less calories but eat whatever you want that just doesn't work we have to inspire the body to not want to eat excess calories which we do by stimulating satiety hormones.

You know helping the microbiome support that process and then change our reward circuit tree which is done with nutrient rich the most nutrient rich food we can possibly get and that's why I mentioned the soil because our food is drastically depleted of nutrients so when we look at that 70 meter tons of food reading in the lifetime it's just fasting you know that's that's the information for our body what it's going to be built from how it's going to function well right now 60 to 75% is ultra processed.

So we slash the value because the ultra processing just like slashes the nutrients we slash the value of that 70 metric tons and then we have crappy soil because our industrial agriculture system which means the food in some cases has 70% less of key micro nutrients in it so that 70 metric tons what's actually useful for our body becomes so much smaller so what we want to do is basically expand the value of that substrate we're putting in the body.

And that means real food unprocessed from good soil meat the needs of the cells naturally don't be hungry maintain a healthy weight.

And you know something I talk about is that we could I mean we could talk about nutrition the biochemistry nutrition all day but in my review of sort of the biology and the biochemistry like there's five main things I think we can strive for in our food that can really help meet the needs of our cells.

And when it really comes there are obviously more things our body needs but if we strive for these five things we will ultimately I think eat a really healthy diet and that is fiber omega threes adequate healthy protein a good amount of probiotics and high antioxidant sources and if we build our diet around knowing a few things in each of those categories that we really love and stock our kitchen with it and make our meals a mixing and matching of each of those components.

And we get a good amount of those we will give the body a lot of what it needs to have mitochondrial health reduce chronic inflammation reduce oxidative stress.

It's interesting for me to take a step back from nutrition as it's typically presented and think about the brain the hypothalamic circuitry that drives hunger and satiety and things like that.

And to map that on to what I've heard and I believe to be true based on my view of the literature which is that we are largely meaning these circuits in the brain make us largely amino acid foraging machines because we need those amino acids in order to carry out metabolic processes and reconstruct any tissues that need repair and recovery.

I'm not just from exercise but just daily turnover removal of waste etc.

So we're foraging for amino acids unconsciously we're foraging for micronutrients and of course we need macronutrients we need enough energy from proteins fats and carbohydrates or some either combination of the three I feel like I'm sort of in the dying category of omnivores right I'm neither you know I'm not meat based and I'm not plant based on omnivores I think most people are omnivores actually but omnivores aren't discussed quite as quite as much as the other

categories at least not on social media but that you know where we think of ourselves as getting hungry and wanting to eat.

And I think eating the food some of them that I listed off before like meat and fish and eggs and vegetables and fruits and some I do like starches like you know rice or some pastas some sourdough breads and things I love butter who doesn't know butter.

Of course none of that stuff in excess olive oil but if one looks at of that buffet of of options you realize you can get some high quality amino acids you can get some high quality lipids you probably want to get more of them from olive oil then from butter but you can get the micronutrients you need provided those food sources are healthy now contrast that with a highly processed diet or even a minimally processed diet and you can get the taste you can get them macronutrients you can get them.

But you don't meaning the brain doesn't really have a sense of it can't directly map taste calories micronutrients on on to one another and so you can imagine that the neural circuits and here I'm a little bit of hypothesizing slash conjecture but that the neural circuits responsible for hunger and satiety would get immensely confused by what's in a highly processed food right a snickers bar if you like sweets tastes pretty good.

But it's unclear what's in it except sugar except some you know that it's got a certain snickers bar taste right but if the circuits of the brain are really trying to drive us to get amino acids and micronutrients for bodily health and repair well then highly processed and even moderately processed food is just got to be pure confusion sorry to go long here but it reminds me of the of an idea I had once where it like I was going to get a little bit of a sense of it.

Yeah I had once where like imagine if you took a pill that in greatly increased the level of dopamine or epinephrine acetocholine and serotonin all at once that's polypharmacology and it might make you feel a certain way maybe good maybe bad and then afterwards you'd probably have a bit of a crash from as the drug wore off no doubt you would.

But let's say you wanted more of that feeling you wouldn't really know what to go look for because you don't know what what was in it because it's polypharmacology so I feel like process highly processed food is polypharmacology.

Whereas when you are eating foods that create a more pure experience of micronutrients amino acid content calories and taste those four things map to one another that intuitively we can start to understand oh I like this food and it's good for me and this is enough of it.

I don't know anyone who of reasonable size that that eats like four ribeye steaks you know they eat one I'm sure there's some freaks out there that do that but you know one you know even small pieces of food.

So the whole piece of quality meat is very satiating.

Yeah you will self-regulate because the body like every other animal in the world is exquisitely designed to regulate hunger on a very intuitive level if we eat natural food.

It's you know it's I think it's almost ridiculous to talk about calories and isolation because the reason we're eating more calories is because we're eating ultra processed food.

And so but I love what you just said Andrew about the brain and the poly pharmacy I think that literally is it's I've never heard that said and I think it's like process food is like poly pharmacy of food it is the definition of process food which I know you talked about with Rob Lustig the Nova for criteria is literally it's

breaking down foods into these constituent parts that were never meant to be separated from each other like the endosperm of a wheat kernel separate from the brand and the you know the germ.

And then take that and like a little science experiment paired up with all these other individual components and synthetic chemicals that are made in a factory and put them together to create this thing that the body I truly think our

insatiable hunger again we're eating ourselves to death in the United States that's the reality are insatiable hunger and our chronology of the pandemic fundamentally is a lot of it's it's mass cellular confusion and when you think about what chronic inflammation is chronic

inflammation is bio chemical fear on the cellular level well when you put this stuff into the body that's never seen before obviously that's going to generate some confusion and you know you could you could trace that back to what that really means with leaky good and you know all the sorts of the real physiology of that but

there's a wonderful book that is called the end of cravings by Mark Schatz or he also wrote the Dorito effect but he talks a little bit about what you're talking about which is ideal that processed food is actually the ultimate sort of food based variable reward so in the way that it in like things that I mean I'm speaking back expert here but

it's not just the things that the body can't predict what the outcome is going to be are going to kind of get you in that dopamine motivation pathway and that's actually what process food is doing is it's every time we eat a different

for you think we're eating a tortilla but it's like completely different then all the other weird tortillas ultra processed tortillas on the shelf so every time we eat tortilla and our brain is this incredible prediction machine

and as it's coming towards our mouth we're predicting what the load is going to be but we have no idea is it a coke zero is it a diet coke with as per time is it is a regular coke it all tastes the same but the nutrients that are got are totally different so we end up actually triggering the motivation pathways because of

process food representing a variable reward whereas every time you eat a ribeye your body is pretty much getting a similar thing each time and so the prediction matching is going to be more

conducive to getting off the motivation treadmill for more which I think is so fascinating but I think backing up a little bit one one concept I have for food that really helps me

is really thinking about the bodies always trying to help me be satiated and trying to help reduce my cravings I literally just have to give the body what it needs I have to stimulate the body in a way that it will serve me and giving me satiety hormones to basically regulate my hunger and

with visuals I think it's so helpful I think about these cells lining our small intestine that literally have nutrient sensors like and literal receptors on the cell membrane in the luminal side of the gut that's facing all the food that are just sitting there like waiting to bind with these things in our food that will stimulate the

cell to make the satiety hormone that poof effortly makes us not hungry gets rid of that grip of attachment to cravings that all of us are so plagued by and like I think you know we have this intense conversation happening in society right now about

gpl1 analogs and ozemic and minjarra and all these things gpl1 agonist but like you know we rarely talk about the fact that like we have nutrient sensing cells of the gut the L cells of the gut that when stimulated appropriately will make gpl1 and when stimulated the way they want to be will secrete

the efforts of gpl1 for us and so how do we actually think about just literally giving the body what it needs to stimulate the satiety hormones and the process foods aren't giving us those things you know the things that are going to

stimulate those cells.

Well the things that will I mean this is kind of fascinating if you don't mind going down a little road.

Yeah, with the gpl1 conversation I feel like so missing from the conversation is the idea that like from a first principles perspective there's three ways our body could make more gpl1 we make more cells that make it else cells of the gut each of those

makes more gpl1 and importantly we can also inhibit the inactivator of gpl1 which is an enzyme called dpp4 so gpl1 actually gets rapidly degraded by dpp4 in the body so if we can figure out how to inhibit dp4 we can raise our gpl1

levels what is dpp4.

It's an enzyme that breaks down gpl1.

I think you said that and I missed it.

So on track to be the highest grossing met and human history and just like we talked about in the beginning of the episode the whole industry this four trillion dollar health care industry is desperate for us to not understand how to do the things that drugs could do for us so when we look at those three first principles approaches of how do we make more

gpl1 and then inhibit the breakdown of the inhibition of dpp4 for the first one we know that short chain fatty acids which of course are the byproduct of microbial fermentation of fiber in the diet stimulates the differentiation of more

short chain fatty acids more L cells can we translate that into support the gut microbiome more fiber more fiber and we had Justin Saunenberg from Stanford on a world expert in gut microbiome and he was a big proponent of based on work he's done with

the other Stanford so happens of ingesting one to three servings of low sugar fermented foods each day things like sourcrout kimchi again low sugar varieties probably best for yeah maybe not you

said not kombucha yeah that's going to be like the highest sugar of the fermented foods which people often go to but not costly to it and pretty costly the sourcrouts you can actually make your own sourcrout Tim Ferris had a great recipe for this in the

way you have to be careful because you know that you can create some unhealthy ferment you have to do it the way he describes the check out the recipe its online or you can buy sourcrout and the brines drinking the brine off the sourcrout or off seems to be good for the

good that's such a great point which is that ultimately we want the short chain fatty acids which is the the medicine that the microbiome are making for us the microbial fermentation process and we can basically do that in three ways one is we can eat more fiber which is

the best way to do that is to get the best out of the way we do that is to get the best out of the way we do that is to get the best out of the way we do that

so fermentation of polyphenols and fiber to short chain fatty acids which we absorb and then like you just said in a fermented food the bacteria in that food will be making short chain fatty acids by

fermenting the food in there and then if we drink that we're getting a short chain fatty acids directly so that's the kimchi sourcrout Greek yogurt kavas which I'm obsessed with which is like low sugar

kambucha it's like made with fermenting beats basically it's such good stuff at me so not so that's one that has been shown to differentiate more L cells in the gut we also know that people with type 2 diabetes have much fewer L cells in the

gut and it's hard to know what the causality is there but I think a safe assumption is like if we keep our blood sugar under better control and sort of stay out of that

diabetic range it probably lends itself I don't know what the chicken and the egg is there but blood sugar stability more L cell different region and then actually

jinsing has been shown to to improve L cell different jinsing so that's just sort of one one set of things and I don't think the dose on

jinsing has been has been settled but very high antioxidant component plant when we look at actually stimulating more GLP 1 you've talked about your Ramate I think having like a mild effect on GLP 1 but there's

actually a lot of other things in the literature protein of course very potently stimulate these nutrient receptor cells and specifically like valine and glutamine seem to have a potent

stimulatory effect on GLP 1 so you're going to find that in like me and turkey and eggs and things like that what are your thoughts on supplementing

L glutamine it's controversial I know that some people do it in an effort to relieve leaky gut but that's but there aren't any randomized control

trials for that so the depending on one stance on what's required for a kind of a threshold for for adopting something you know some

people say that's crazy other people really swear by supplementing a glutamine maybe it's through this this route of increasing L cells that some

they got relief might exist I guess we'd have to explore it so that's speculative folks so this is interesting these are ways to increase the cells that then

make GLP 1 so fiber prebiotic probiotic fiber and fermented antioxidants lowering blood sugar jinsing so those are kind of the

ones the actual secretion of more GLP 1 that one of the most potent ones and the study that looks at this like the bar graphs are very clearly statistically significant lots of

asterisk is actually thylacoids so I look at tell me more about that I look at is are so fasting thylacoids are actually a structure in plants that are part of the

class so you know chloroplasts and this also is fasting is chloroplasts are basically the plant version of mitochondria essentially and thylacoids are a molecule in the

chloroplasts and there's actually been research that shows that when you eat about a hundred grams of spinach which gives you five grams of straight thylacoid over 12 weeks daily it

is led to a significant increase in GLP 1 and again I don't remember the exact it was two or three full tire secretion so this is in part so so that's a direct

symmetry fact of the the L cells and so this is this equates to 3.5 ounces of spinach a day which is like nothing so just getting

a little bit more mature cooks I think I actually I don't think it actually it might have said in the methods but I would I would imagine raw because you want to get those undenatured

thylacoids in the gut so just kind of another and actually thylacoids do a lot of other interesting stuff they inhibit light

pace in the gut and so actually help more fat get down to the distal small bowel and promote satiety so this is one of the reasons why you talk about

the people who eat all these healthy foods in greens there less hungry it's like it's biochemistry like there's stuff happening in there that is

making the hunger signals go down through things like inhibiting light pace you know improving GLP 1 secretion so other things for

GLP 1 secretion the thylacoids also fibers been shown specific amino acids so high protein foods things that involve a lot of

healing and glutamine green tea and specifically the all logic the EC EC GC that is one of the compounds in green tea that's been shown to stimulate GLP 1

curcumin so there's several things that are all in that like whole food you know basically things you would associate with the healthy diet but we

actually know they stimulate GLP 1 so I you know those are all things I try to include in my diet and the last one is inhibition of DPP

and that one there's just actually when you look at the research there's some kind of random foods that tend to inhibit DPP 4

black beans Mexican oregano other forms oregano rosemary guava and I wrote this one down because it's a word I hadn't seen very much

before I started digging into this but muricetin which is found in berries cranberries and peppers and and Swiss

card so all that is to say ultimately many of us are gripped by cravings and the idea of have you know just sort of not being constantly driven to eat

more which I would argue that about 80% of Americans are feels really hard to overcome but a lot of it is literally just

to go into your cells in a clear way through food to help you be satiated and the science can show us how to do this and a lot of it comes down to eating

essentially what you were talking about how you eat omnivorous protein healthy sources with nutrient you know density and lots of colorful fruits vegetables

spices herbs things like that so yeah it's interesting again these aren't randomized control trials nor they peer reviewed studies but I have a few friends

who have known for most of my life who really struggled with their weight carried a lot of excess weight and we're starting to suffer health issues

in their even their 30s but in their 40s and 48 so they're my peers and so they're about that age range and they've all done extremely well meaning they lost a tremendous amount of body fat

are terrifically healthy now by way of basically restricting their food intake to proteins of fish and meat eggs fruits and vegetables

they basically just cut out starch isn't but I don't think it was the starches per se I think it was the satiety that comes from eating high quality protein fruits and vegetables

and from limiting the number of highly processed foods and actually the toughest thing for all of them was to stop asking me or themselves rather like can I include this condiment this this you know

and what's interesting is all of them now seem to really enjoy eating foods in their more pure form right and I'm not somebody that like pushes on this on my friends they just come to me and say like how do I lose 50 pounds

without having to exercise it all off you know as the only source of weight loss they all exercise as well but it's just so daunting to try and lose you know 20 30 40 pounds

and to do so quickly and then to keep it off because they've all had the experience of going on diet and then you're exercising a lot then the point here is that I really think there's something powerful about that relationship between taste macronutrient value micronutrient value

and satiety I think there's really those powerful associations because the brain is such an associative machine one thing that I should have said before

and I know most people are familiar with ozempic yeah and it's commercial names are I forget what the the ozempic is the commercial name and jaro and gov and yeah got it is that glp1 acts more less as an appetite

suppressant right yeah powerful appetite suppressant yeah so many millions of people are now taking glp1 analogue is that right I think there

were over 20 million prescription the United States last year is it expensive it's it's 20 thousand dollars per year does insurance cover it typically right now

insurance is covering it for indications but there is a all out assault from the pharmaceutical industry to essentially classify obesity as a genetic disease

and a chronic disease in order to be able to feed this medication more into the insurance pathway and essentially get more taxpayer dollars to pay for this medication

and it is extremely expensive and it's on track to be the highest grossing medication in human history because it's now being recommended for people with obesity type

disease and then the American Academy of Piatrics recently has talked about giving this to children as young as 12 as part of the first line for overweight

and you know I think really it's such a travesty based on the conversation we've had because what ozempic does not do in any way

shape or form is impact the toxic environment that we're living in that's hurting our mitochondria losing weight is different than improving mitochondrial function

and mitochondrial function is the root cause of basically every chronic illness and symptom that's torturing American lives today and so in many ways it represents like the

ultimate bandaid for an environment that is not changing and when you think about what we could do with $20,000 per year and it's a weekly injection

so people will say well per person like oh it's and it's a medication that is intended to be taken for life because when people come off this

medication many people are gaining back all of the weight or even more weight afterwards and then there's been conversations Peter T has waited on this about loss in lean mass you know part of the weight

loss is disproportionately muscle and so there's a lot of concerns about it above and beyond its ability to lower the number on the scale that we should all be very alert to because you know the reality

is is that the 40 trillion cells in our body are in an environment in the western world right now that is not conducive to core biologic functioning and there is obviously no shot that can mitigate the

multi-front assault on our biology that ultimately generates a body that's immensely profitable for those hundred specialties of health care so you know we're living in this this matrix in this game of you know

a devil's bargain between a $4 trillion health care and pharmaceutical industry and a $6 trillion process food industry that all want us to think that you know the answer is found in a shot

and we don't need to change anything about our lifestyle but of course you know these simple habits that we're talking about eating real food moving walking et cetera getting out in the sunlight rapidly can increase our mitochondrial capacity and you know are just the most

disruptive thing that we can do you know in our culture today is is learn about metabolic health and improve it and it's it's just interesting to see what's happening in the media with sort of the assault against these

empowering habits and very in favor of a medication like ozemic and then when you trace you know unfortunately incentives there a huge percentage of these outlets that cover you know ozemic is a miracle drug their bills are paid by

pharma 60% of mainstream media advertising budget is pharma and so you know I just I just say that because I think it's it's a scandal that we give so much air time to these medications and not

to simple metabolic habits that can make us feel you know so incredible and and really change our core biology so walking exercise eating minimally process or non-process foods

you also mentioned temperature yeah very very interested in that but before we go a little bit further down the path of what one can do in terms of having agency over their

metabolic health I just feel obligated to just entertain the possibility presumably somebody who's really struggled with their weight along time maybe because of excess cravings you know challenges and regulating their appetite or

whatever we don't know what the reasons are maybe they injured their knee and they can't exercise I mean this happens right at least not yet take a GLP analog like ozemic loses some weight probably

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the ability to upregulate antioxidant defense systems and quell some of that wildfire that we talked about that can hurt our mitochondria. So I put them lesser on my list, but you know, because we just can't we can't avoid the food and you know the sleep and the movement, but I think it's a great tool that we can use.

I love it. I will just point out that the reason the brown fat is brown at all is because of the density of mitochondria. Yeah. It's literally brown down the microscope. This is not the kind of fat that is subcutaneous, although it you know, it sits around the scapular neck up or back. There's other pockets of it on the body too and such an interesting tissue.

Yeah, I don't know why deliberate cold exposure is so controversial. I think it's because people who don't like it. And frankly, no one likes getting in it. The best part is getting out and how you feel afterwards.

But I think it nothing greats on people like deliberate cold exposure if they don't like deliberate cold exposure and there's no requirement for it. But I think it's a very interesting stimulus. And I think there's also a very interesting relationship between light and temperature because in most areas of the world as days get longer, meaning more sunlight available.

Temperatures go up. And nowadays we can really divorce ourselves from all this like day lengthening and shortening temperature fluctuations, which is not to say that we should all be running around in.

A minimal amount of clothing outdoors, but there's just such beautiful data from Dr. Susanna Soberg's work showing, for instance, that deliberate cold exposure then leads to one feeling more comfortable at cold temperatures because you become a, you know, a essentially more of a furnace more more more brown fat. Anyway, we could go on and on.

But I think it's yet another lever of autonomy in terms of taking control of one's health. As you said, not as critical as food intake and quality amount and maybe timing as well. Speaking of timing, what are your thoughts on fasting? And then of course movement and exercise.

The way I conceptualize the idea of fasting, obviously this is one where we need more words, right, because the word fasting is so limited, there's so many different parts of this, but skipping breakfast for me would be that or or skipping dinner. Sometimes I'll skip dinner sometimes I'll skip breakfast.

Right. I think that some of the most interesting data that I've seen has been about if we reasonably compress our eating into daytime hours during the heart of the diurnal cycle when we are supposed to be eating so essentially matching our chronobiology with our behavior, which, you know, we are diurnal organisms.

So we kind of need to respect that like when we do that and we compress it in a moderate way, our metabolic health is better. And so some of the studies that have looked at this one that was interesting was, and I think very hopeful for people is that if you take all the food, all the calories that you're going to eat and eat them in a six hour window versus a 12 hour window.

Totally same amount of calories, exact same food, this is a controlled experiment. People who eat the same amount of calories in a six hour period are going to have much lower statistically significantly lower glucose 24 hour glucose and insulin levels compared to people who just space it out over the course of a 12 hour period.

And it makes sense because if you're spacing that food out over the course of 12 hours, that is a different biochemical meal you in your body throughout the day. It's kind of similar to the walking, you know, it's like you are then stimulating insulin several more times you are exposing the bloodstream to insulin and glucose just more throughout the day.

And giving the bloodstream less of an opportunity to just sort of be clear from that glucose and that insulin and so compressing our eating window seems to be helpful for for metabolic health and it's a bang for your buck right like you can eat the same amount of food you just have to eat in a short period of time.

So for people who want to eat, you know, a lot maybe just consider compressing it into daytime hours six to eight hour window.

Yeah, for me six is tough. Six is tough. The one meal per day thing is tough. I have friends like Lex Friedman that do the one meal per day. I end up eating so much food at that meal that experience a lot of like kind of like mechanical distress as typically later in the day.

I think an eight to ten hour window has worked well for me most most days. I know as soon as we talk about intermittent fasting, which is what or time restricted feeding same thing, which is what we're talking about right now.

Sure, somebody's going to call up the there's been a study that's been circulating about a massive increase in cardiovascular risk in people doing intermittent fasting in particular the six hour window.

I just want to point out we're a study as far as I know I could be wrong, but as far as I know that study is still in abstract form. It's not yet peer reviewed.

It's like the fact that studies that haven't been peer reviewed aren't even close to being peer reviewed are being like put out there as news stories is really problematic because I can tell you as somebody who sat on the editorial boards of many journals for many years, I still sit on a few reviewed countless papers.

I've submitted and had to deal with reviews on countless papers. The fact of the matter is like until the reviews are done, the revisions are made like that paper may never see the light of day and it may end up in a journal that you is barely worthy of a placemat.

It might end up in a high tier of high quality journal, but it might not so just because there was a quote unquote a study done means very little, but it means especially little maybe nothing until it's peer reviewed.

Absolutely, in the methods were very poor in that study, it was a recall based study, I think for two days of recall of people's diets, which is notoriously very bad in terms of accuracy.

Yeah, and I think I'm not in any way suggesting that a six hour window is the optimal window I'm just sharing the data that suggests that compressing the window seems to have a favorable effect and I certainly don't do six hours, but I think when you look at what the average American is doing, which is the average American has 11 eating events per day and 50% of Americans eat over a 15 hour window per day.

I can recall those because I remember when I was writing the book, I was like, that's a long time, 15 hours and 11 events and every time you're doing that, you're going to be stimulating this glucose rise in the bloodstream exposed in the blood vessels that glucose you're going to be turning on all the pathways with insulin to basically store it or you know, and it's so it's it's strain for the body.

And so I think giving the body times intentionally to allow insulin to come down and to allow glucose to come down what that does is it generates metabolic flexibility, it gives our body an opportunity to have space to use accessible glucose and then convert into using stored fat.

But be and that ultimately is metabolic flexibility, the ability for the body giving the body opportunities to use glucose, but then have times when there's not high glucose and insulin around to actually get into the fat stores and I think one of the reasons why we have such a massive overweight obesity, you know,

rates in the country is because with the way the culture of eating right now 11 eating events today eating over the course of 15 hours per day, I would imagine the average American body is rarely if ever tapping into their fat stores for energy in a meaningful way because we always have glucose available to the body.

If you think about again, the stats about ultra processed food about 70% of the items on the shelves in the grocery store ultra processed food and those ultra processed foods are built on refined added sugars and refined added grains.

So we're just we've very rarely give the body the opportunity to rest and and move into fat burning and that's where compressing the eating window can be valuable.

Obviously people have talked about this before but fasting can be a stressor for the body, especially if your body's not used to using fat for energy and so it's something to ease into and go slow, but I think if you're slowing down enough to really hear what your body's signal are saying, you can kind of know whether I think your fasting is working for you or not.

I can tell if I've got too many other things going on, I haven't slept well, a lot of stress, I can tell that fasting's kind of making me jittery and not feel good versus if I'm really if I have good capacity, I can feel that it's actually making me feel really incredible.

And so tune in with your body, obviously, and you know, you can check your biomarkers if you have a CGM on you can see what's happening your glucose, if you have a ketone monitor, you can see what's happening your ketones and really actually track, which I think makes fasting actually even even more fun.

I'll mention one other piece of data that I think is actually really kind of fun as well with timing of eating.

There was a study that looked at people who ate the exact same meal at 9.30 a.m. or 8.30 p.m. So basically after dark, essentially in the part of the diurnal phase when we probably shouldn't be eating versus early in the morning 9.30.

And the glucose and insulin responses for the same meal at 8.30 p.m. were significantly higher than when eating at 9.30 a.m.

And so again, being for your buck, it appears that eating in that earlier part of the day when we're active and our chronobiology is set up for metabolism and activity, we have a lower glucose and insulin response.

There's also some evidence that melatonin, which is secreted, you know, as we get closer to sleep, has somewhat of an effect on impairing our insulin sensitivity transiently.

And so we may actually just be not absorbing the glucose from those meals effectively later at night. So I tend to kind of move a little bit more, a little bit more low carb.

I would say throughout the day, based on that data and what I've seen on my continuous glucose monitor, basically just higher spikes for the same meal later in the day. So why not just kind of move it up earlier.

Very interesting. Something I'll definitely try. I tend to push my carbohydrates to a little bit later in the day for sake of sleep.

Unless, of course, I've done resistance training, which I do three time, I aim to do three times a week and post resistance training, I try and get some starchy carbohydrate in just to replenish glycogen.

And that's then tends to reduce my carbohydrate craving later in the day. I love bread and butter bread and olive oil pastas and the other day I found this Argentine place and I love the stakes there, but they had a new key that it took everything I had.

Every neural circuit that releases GABA in addition to my brain to not order three of those orders. It was so good.

But you can look after the new. Yeah, sure. I'll allow myself to do all say I'm not super restricted. But again, I tend to eat high quality foods. By the way, these blueberries are amazing.

Then you figure out where you got those because they're just tangy enough. I'm doing everything I can to just not take the jar and funnel them into my into my mouth.

Yeah, I think, you know, if we're looking at blood sugar blood glucose and insulin and as long as we're talking about that, I did use a levels tracker and yeah, full disclosure there is sponsor the podcast regularly and I learned a ton.

I'll tell you what I learned. I learned that indeed my blood sugar goes up after I eat that certain foods, although the foods that did this surprise me.

Certain foods tend to spike my blood sugar. I'm quite a bit grapes. That shouldn't be surprising.

Foods food order was very powerful for me. I know that the date on food order a little bit mixed and it's controversial. But I like to eat like the French. I like some soup. Then I like my entree. I like the salad at the end.

That turned out to have the steadiest and lowest rise in blood glucose for me and then across time I also found that I love hot sauna. I go so hot with the sauna that I've been accused by a rogue and another people I'm going to turn myself into a brisket.

But after the sauna, my blood sugar spikes presumably because I'm a bit dehydrated and it's the concentration of blood glucose. Is that possible? Does that make sense?

It does make sense, but also the heat can affect the accuracy of the sensor itself.

Ah, okay, so that could be it too. But yeah, basically what it allowed me to do is make a few adjustments in terms of foods that I eliminated or eat less of food ordering within a meal.

And I find that I'm very susceptible to if I don't include enough fat, dietary fat in the meal, then my blood glucose spikes, even if it's just like tuna.

But by including olive oil and other things, it really blunts it. And of course here we're doing correlative anacidata.

But for me, I felt far better when I included a bit more fat and when the food order was adjusted the way I mentioned before.

Always including a little bit of fiber really helped. And that makes sense, right? Slowly absorption of the food presumably.

So I found that it was a very valuable experiment for me. Again, this isn't an advertisement, it just so happens I did this and really benefit from it.

What are some other things that one can learn from continuous monitoring of blood glucose? What are some things to watch for that might signal a problem?

And what are some fun things that one could do to explore and experiment? Because I like to explore and experiment.

Yeah. Well, I mean, a lot of the things that you just naturally learned are the things that have been shown in data. And like you said, some of this data, it's like small studies, small groups of people.

But for instance, adding fat and fiber to meals has a significant and repeatable impact in populations on lowering glucose response.

Fat probably in some part due to slowing gastric emptying and actually slowing the digest in process. So the rise and the blood stream is going to slow down. And then fiber, both for that reason, but also because fiber can in a sense create like a mesh sort of blocking the absorption of some of the glucose that's in the meal.

So literally kind of actually preventing you from absorbing all of the carbs. And we've actually seen that in the levels data set that the more fiber people include with their meals, we see essentially a direct relationship with lowering of their their glucose excursions, which is really exciting because fiber is something that you can add to meals very easily.

I put basil seeds, chia seeds, hemp seeds, flax seeds on a lot of my food at this point, because it's essentially a little bit of fat, a lot of fiber.

And it's kind of just helps you kind of get more from your from your meal. So what you can learn. So I think step one, the way I think about a glucose monitor.

First of all, say the purpose of the glucose noniner is not to have to game the system and get flat glucose. The purpose of the glucose monitor is curiosity. It's to start to understand how.

It's essentially an MRI for how all of our different dietary and lifestyle strategies are creating this read out of glucose in our body, which I think can be really interesting.

And in a world where so many cards are stacked against us with that in lifestyle and where there's a lot of confusion about what's right for us. That can be like very helpful in actually reducing the confusion and the cognitive load of our choices.

We know that keeping your blood sugar through the course of a lifetime in a low and healthy range. So I don't mean up and down spikes during the day, but keeping your blood sugar healthy throughout the course of your lifetime is probably the best thing we can do for longevity.

Staying insulin sensitive, staying out of the diabetic range. And so one thing that the glucose monitor does for us is just give us more awareness and agency until like what the trends of our glucose are over time as opposed to a literally one data point snapshot once a year in the doctor's office, which is what the majority of us are used to.

I really love the idea that people who are able to wear glucose monitors every now and again, maybe once a year, maybe more than once a year.

They know what their glucose is. And so they're never going to walk into a doctor's office and have a bomb dropped on them about prediabetes type to diabetes because you have the data, which is ultimately I hope the world that we can move towards for a lot of biomarkers.

So you can see trends over time, which I think is very valuable. One thing that's fascinating in terms of early prediction of metabolic disease is that you can see how long it takes your glucose to come down after a meal.

So in a normal healthy insulin sensitive body, even if the glucose goes way up, it should come way down very quickly because the insulin is binding to insulin receptors and the glucose is getting taken up and it'll lower.

What is quickly over the course of it should be down by two hours, but from what I've actually seen in our like most insulin sensitive people and also in research that looks at young healthy populations, you should basically be spiking coming down spike about 45 minutes and come down hour and a half 90 minutes to two hours.

But if this is after sorry after last bite.

Although it's hard to kind of exactly know, but yeah, meal is over. I would say about 45 minutes to go up to the peak and then start coming down very quickly.

Now, if you start to see that glucose is going up and then trailing very slowly back down to normal, maybe taking more than two hours, three hours.

That is going to be one of those early indicators of potential insulin resistance. Your body's not clearing the glucose, but that's not a metric that we use in standard practice.

At all, and I've actually seen myself very insulin sensitive. My insulin is like 2.5 and you know, if I don't sleep and I am stressed and I have been sitting, my glucose will take way longer to come down. I have become trans-inly insulin resistant.

So I think that's just fascinating to see that. So looking what that ultimately the metric that we call that is area under the curve.

You want a low area under the curve, a UC after a glucose spike. So you want to spike and come down quickly. That's going to, if you shade the area under the curve, it's a small amount.

If you go up and then trail off for two to three hours, that's going to be a lot of shading under that curve and high AUC is associated with insulin resistance.

Basically, another thing that you can see is essentially glycemic variability and glycemic variability, GV is a metric of how spiky your curves are.

Fasting paper out of Michael Schneider's lab at Stanford in 2018 called glucose types reveal new patterns of glucose dysregulation. Totally landmark study. But basically they put concliners glucose monitors on non diabetic individuals who by standard criteria of diabetes do not have diabetes.

And he showed that on a CGM, a continuous glucose monitor, you have these low variability people that are pretty much flat throughout the day with little teeny little teeny rolling hills after their meals.

You have moderately spiky people and then you have very spiky people who are going up down, up down, up down, up down. When you correlate those different patterns of glycemic variability in non diabetic people, you find that the spikier they are, the worse their biomarkers are metabolically cross the board insulin triglycerides, etc.

So basically they're showing signs through variability of underlying dysfunction that you would never know from a standard test. Those are the people who I imagine are probably going to go on to develop diseases.

And yet based on standard criteria, their doctors telling them that they're fine that they're all the same.

So he also showed in that study that non diabetic individuals when you have a CGM on are going into the diabetic range and the pre diabetic range, a fairly significant amount. And we would never know that if you weren't, if you weren't actually tracking like a movie of the glucose.

So that's so glycemic variability area into the curve. Those are two things. Another really interesting thing you can know from a CGM is dawn effect. So dawn effect is basically a term in the literature for how high your glucose rises right when you wake up in the morning.

I don't know if you noticed this when you were wearing a CGM, but some people noticed that the second they wake up, their glucose jumps up 5, 10, 20, 30 points.

What's happening here is that the cortisol awakening response to actually get you to wake up and got it a bed that cortisol can cause you to dump a bunch of glucose from your liver because it's basically saying stress hormone cortisol.

We got to get up. We need glucose to fuel the muscles. Let's dump a little glucose.

So it's normal, but what the research shows is that magnitude of dawn effect is correlated with insulin resistance. So the more the dawn effect you're getting, I think it can signal maybe the more stress you're under the more cortisol you have floating around how big your cortisol awakening responses.

But also if you imagine if you're dumping all that glucose from your liver and your cells aren't taking it up well because you're insulin resistant that that response that dawn effect is going to be higher. So I don't have the numbers right in front of me, but typically I would want to see a dawn effect.

I think of like less than 10 points. So you wake up and you you may very well see a rise. This is absence of any food yet.

And you do not want to see that going up 20, 30, 40 points. Some people see a little bump again with caffeine in the morning because it's more cortisol. And so that's another thing that standard stuff would never tell you.

So those are kind of some of the looking at early predictors and metabolic dysfunction. More of the fun stuff is like actually just figuring out like how is food affecting your body.

And this is where people really enjoy it and like figure out like, oh my god, this food that I thought was healthy is actually not, you know, serving me and actually a lot of people I think who are trying to make healthy choices.

My boyfriend, like he when we started dating, he started using levels. His healthy snack. He worked in Venice would be to go to moon juice and get, oh gosh, I don't want to throw moon juice under the bus here.

But he would get like they do, but he would get this green juice that was sweetened with dates and it was like $9 and this is like the healthy choice.

And he saw the second he put on levels that it was causing a huge spike like 50, 60, 70 points and then he was crashing.

And he was actually trying to make a good decision. So now he's he swapped his snacks out for more like, you know, grass fed cheese and some flax crackers and maybe like a venison stick or something like grabbing ghost stuff that isn't spiking his glucose.

But I think it can help people figure out like which foods are doing what I want them to do and which maybe aren't.

And same thing happened for so many of our members with oatmeal, unfortunately oatmeal instant oatmeal is one of the biggest spikers in our data set for breakfast.

And a lot of people are making that choice because they think it's heart healthy. And in many people it's actually causing a big glucose excursion and crash.

And then in some other people it's not. And so it's it's really helping with what are the sneaky spikers and then where's the biochemical individuality and there was a phenomenal paper out of is real that from from sell about seven years ago called personalizing nutrition by prediction of glycemic responses it made big waves.

And it basically showed that you and I could eat the same handful of blueberries and have totally different glycemic responses.

So the idea of glycemic index as like a certain amount of food with a certain amount of glucose causes a certain glucose rise it kind of debunked that.

And that matters because repeated sustained glycemic variability over time is not good for our health we want to choose the foods or balance the foods that are going to keep us relatively more stable.

So that that's that's very helpful just understanding your personal response to food and then what are the lifestyle strategies you can use sleeping better walking after meals more resistance training cold plunging breath work that can actually serve to modulate the food in the food.

And then we can isolate the food environment to actually reduce the glucose spikes and people find that all of those things can positively impact glucose spikes especially the walks after the meals but.

And then we can see that the food is very fast and you see a lot of women especially like menopausal women in our community who find that their glucose patterns are getting worse because estrogen is dropping and that's going to you know really take a hit on insulin sensitivity they start resistance training glucose comes kind of right back down so because of the monitor they can feel more confident in the intervention they've chose to do to help with metabolism that kind of creates a virtuous cycle so.

So those are some of the big things is there big I can I mention one more I know I know I just I could obviously talk about this all day I think it's passing but this is just one more that I think it's passing because it was a paper in nature from.

Last year that talked about and this might actually be one of the most valuable things to people which is that again talking about cravings we all want to get off the craving grip this paper in nature showed that.

Essentially when people spike their glucose with high carb high-starchy foods they'll often have a big crash afterwards and the reason for that is because big spike leads to a lot of insulin secretion and then you soak up all the glucose and sometimes you can actually go below your baseline so a small spike usually won't lead to a crash but a big spike often will that's called reactive hypoglycemia post-prandial hypoglycemia a lot of people think they're dealing with hypoglycemia when in fact what they're really dealing with.

Is that they're spiking their glucose to high and then they're crashing I see and the paper showed that the extent of post meal dips the crash after the spike was predictive of 24 hour energy intake and cravings for carbohydrates and this makes sense if you crash low that is a signal to your body we have to get our glucose back up and it it will drive you to eat.

High energy foods carbohydrate rich foods and cravings so one of the best things we can do that I believe from my personal experience from members experience and with some data to support this is that.

One of the adjuncts we can use to monitor our to manage our cravings is actually to like lower the the extent of our spikes so that we crash less and so that was a fast saying study looking at CGM data.

That's interesting so the CGM's can reveal things not just in the immediate meal period but can relate to sort of downstream consequences yeah again I found it to be tremendously useful I'm so glad you mentioned sleep by the way I'm going to resist the temptation to rattle off 20 studies showing that.

You know even having too much bright light in a room wall want to sleeping at night even dim light which is you know I don't want to scare people into thinking they have to sleep in complete darkness although an I mask can be can be great can alter morning blood glucose levels in I believe it was adults and kids as well as a study in proceeds

and national academy of sciences I have to go back and check if it included kids but pretty striking and then it's there's something very clear about the fact that when people get the early night sleep of four to five hours but then don't get the

rem dominating you know last hour or two of sleep in the morning that resting blood glucose is altered it's so interesting to think about what's going on in sleep there's at least one paper that I'm aware of

where they had people breathing into a tube during sleep to measure what sorts of metatabolism they were undergoing and it's interesting during a full night sleep.

All of us seem to transition between different forms of metabolism I'll send you this paper it's really cool and I'll put a link to in the show note caption such that at one portion of the night were metabolites were a lot more on.

Let's just call it sugars for sake of some other times or more ketone dominant there's a market shifts in metabolism throughout the night it's almost like the brain and body cycle through all the different modes of metabolism throughout the night and then.

Almost like a rehearsal of the metabolic pathways if you know we can anthropomorphize a bit here but then if sleep is truncated it clearly has an effect on daytime.

Fuel regulation just so interesting so getting sufficient sleep getting quality sleep is absolutely key there's a lot for people to pay attention to but you've given us a lot of tractable avenues for people to do that.

That are mostly behavioral there's a few don'ts but mostly some do's yeah we haven't mentioned that you know you don't need to even perhaps belong to a gym it's like and with the cold exposure thing I always say you know if anything it'll save you money on the heating bill so there's a there's a literally

negative potential negative cost there. I think levels and other c gms are really interesting and valuable to experiment with what sorts of other stuff is going to soon be monitored or not blood because for instance I would love to know continuous hormone levels lipid levels blood

blood sugar levels I mean are we moving past just blood glucose and are are there soon to be other things in these monitors so that when we and by the way if you haven't used this it's really cool you just take your phone you scan it over the the

sensor and then it basically gives you a chart graph of what's going on yeah bloodstream and now they're all the latest gen of each of them are all Bluetooth now so no more scanning which is kind of nice and the answer is yes there are several different

analyte that we're going to be able to track and Abbott which is one of the three main manufacturers of c gms has announced that they're they have a new product called the lingo which is going to actually be able to measure

ketones lactate and alcohol continuously which is pretty interesting from like a metabolic comprehensive metabolic standpoint different sensors for each not all in one so I think we'll have to

poke a dot ourselves if we're tracking all those things and then Dexcom which is the other main company that makes c gms has just announced they're coming out with an over the counter non prescription version of a c gm called the

Stella later this year so there's exciting things happening in the industry and I really do think continuous monitoring it's going to expand to a lot of these other things that you're talking about hormones etc and I mean it really needs to I think that

you know snapshots of dynamic system are just never going to really be able to give us a full picture on what's going on and what we really want to be able to do to dig our way out of this health

care crisis I think is is empowerment individually and understanding how this rapidly changing environment is affecting our own biology so we can make the targeted choices to

hopefully change the environment to be more conducive to cellular health and continuous monitoring is a closed loop biofeedback that can that can help us with that decision making and essentially

predict failure of the system rather than wait for failure of the system before we do something about it so yeah I think lots coming down the pipeline yeah

let's talk a little bit about mindset is a really interesting topic that you include in your book we've had guests come on and talk about growth mindset stress can be enhancing mindset I'm big on mindset

because I'm interested in how our cognitive reframing or cognitive framing can just change the way our biology works and vice versa of course but you talk about mindset in a certain context in one of the

favorite passages around that that I really enjoyed was the relationship between like trying to control everything and nature you know and how getting into nature itself can be valuable for us

so maybe touch a little bit on mindset if you will and you know what are your thoughts on nature literally getting out of doors yeah so I think I think that mindset and more broadly than mindset I think psychology and our

relationship specifically with fear and control I think they're probably the most under recognized thing that is impacting the metabolic health crisis the

chronic disease epidemic there has been data that's looked into this we know that there's study showing that loneliness impacts my

drill function and that loneliness is a risk factor and stress is a risk factor in these things and something really fast and actually with the CGM data is that many

people who wear a CGM I don't know if you saw this but when you feel stressed it actually has a diabetogenic effect it literally

causes our blood sugar to go up when we feel stress and that can be a fascinating unlock for people to realize I kind of feel like I'm okay right now but my body is telling

me something different it's telling me that biochemically I'm actually releasing energy stores from my liver glucose to fight some threat that you know I wasn't

really aware of so there's there's we definitely understand there's this link here but but it's certainly not made its way into clinical practice so the way I think about it is that what we know

about the cells and especially the mitochondria is that the mitochondria more than the powerhouses the cell they actually are a part of the

cell that is constantly tracking resources and threats and are basically modulating energy resources based on that and the threats can be

anything they can be a virus they can be and this is all coordinated through this thing called the cell danger response it can be a virus it can be a toxin in the

environment it can be lack of micronutrients for the electron transport chain that it needs to do its function it can also be psychological threats because of course our

psychological milieu translates through nerves and hormones and neurotransmitters and our microbiome to affect our cellular biology throughout our whole body

our cells here every single thought that we're thinking through biochemistry and when a cell and a mitochondria are getting the message that there is a threat or something to be afraid of they are going to

change metabolic function towards defense alarm threat response and away from repair homeostasis building essentially thriving so

that our and and I think what's really maybe the most unnatural thing about our modern world you know the food of course is unnatural 70% is ultra processed but

we also have this device in our hands literally with us all the time streaming fear inducing media into our brains and eyeballs every waking

day if we let it so we're glued to our screens and our devices and right now essentially the traumas and fears of eight billion people all over an entire globe are now ours to process and our cells and our mitochondria

there is no escaping it they are going to respond to that and so I think a big part of the metabolic health conversation is how do we create a sense of

safety in our bodies no matter what is happening outside of our bodies and this can come down to every person's journey will be different for this because the things that cause a sense of threat or fear for any two people are going to be different

and I think some of the main categories is one on resolve childhood trauma like something that I think is getting a lot more talked about these days but

what's embedded in our nervous system these limiting beliefs and memories that are really wired that create a sense of hyper vigilance and us sort of all the time what's coming in through our devices our phones our computers the media that were exposed to

that's constantly giving a fear signal and I think on a broader level a big western one that we don't talk about is literally like existential fear of mortality we have a very

desperationalized very uniquely death fearing culture like you look at other cultures eastern indigenous the stoics they all had intense curiosity about death we talk about the cycles of life there's this real

engagement with it that we are so afraid of in the in the western system to the extent that our entire health care system actually I think you know we've built it around like we're not going to

help you thrive we're just going to do whatever we can to make sure you don't die like that's it's built in everywhere and so we've got the devices we've got the childhood trauma we've got the fear of mortality we have a very

poor system of mental health care in the culture and I think that through all these things Americans are getting crushed mindset and psychology wise and that is a big big trigger of our mitochondria

essentially diverting resources towards defense threat and alarm rather than homeostasis building repair so again it comes back to taking really honest stock

of what are the true fear triggers in our lives across those and others and creating a sense of safety in our minds and bodies no matter what the external world looks like which may mean putting boundaries up to

you know the media doing the therapy doing the different modalities what I believe and I talk about in the book getting back to the question about nature

is one of the best things that we can do is actually literally just go outside and I it sounds so simple but one of the most astonishing stats I literally found in researching this entire book was at the

American spending 93.7% of their time indoors wild 93.7 that's in a car or in a building so we are locked in these cages staring at fear inducing media and our mitochondria are like what like

I don't know where to channel my energy it's just it's short circuiting I think so many things happen when we go outside as you know I mean even what the vision system is doing to our anxiety levels we are getting sunlight which of course for

for you know complex reasons is very helpful for a metabolic health separately in trains are you know chronobiology and

you know light light from the sun as an incredible regulator of our mitochondrial function.

But it also it's our best teacher you know when we're out in nature and we really look at how beautiful the world is and the cycles of nature we see the cycles of

you know the seasons and we see the awe of the sun and the trees and just this all this alchemy that's happening outside of us we see

you know spring to summer to fall to winter we see the tides moving in and out everything's in phases and I think when we reflect and meditate on all the cycles and the polarities in nature night and day cold and hot new moon you know

quarter moon full moon you know all these things it's actually it entrenched is on a subconscious and conscious level that there is a fundamental harmony and pattern to the world we're living in that is bigger than us and that is

fundamentally good and beautiful.

And we are locked inside of the four walls of our house I think we get very scared we get very controllable and the system wants it that way because when we are scared and we are

going to be able to do something potentially afraid we will literally do anything we will buy anything do anything watch anything that will in some way ameliorate that pain that we're feeling and we will take any pill will get any surgery anything that makes us feel like we're

seemingly out of control situation and that's what drives us into all the dopamine loops you know the social media the processed food the porn the gambling the alcohol all of it it's all to ameliorate I think ultimately fear and I think yeah I think by actually really just spending a lot more time trying to get that 93.7% down to like 50% spend as much time as you can outside we know that people who spend more time outside are metabolically healthier and I think it's for pleatropic reasons

but I think one of it is that it is the ultimate convincing of abundance and fundamental abundance in our world and of awe which I think is really the antidote to fear

and that has a profoundly soothing effect on our psychology and the sense of scarcity that drives a lot of the decisions that actually make us unhealthy it's fundamentally rooted in in scarcity and I think also when we realize we are part of nature again going back to that

and we're always statement we're a process not an entity realizing like you know all the trees around us and we take that walk even in a city we see all the trees all those plants all those leaves are making the oxygen that process that literally let us do oxy if us for a lesion and that sun and that leaf on the tree the sun's energy is literally being stored in the carbon carbon bonds that the plants are generating a photosynthesis that ultimately all metabolism is is unlocking the potential energy stored from the sun and that's the most important thing is that the natural energy is being stored in the carbon bond that the plants are generating a photosynthesis that ultimately all metabolism is unlocking the potential energy stored from the sun and that's the most important thing is that the natural energy is being stored in the carbon bond that the plants are generating a photosynthesis that ultimately all metabolism is unlocking the potential energy stored from the sun and that's the natural energy is being stored from the sun and that's the sun and that leaf on the tree the sun's energy is literally being stored in the carbon bond that the

sun to create the human energy that lets us love and move and live and think and do all the things we love to do and then it just becomes so obvious like of course we have to like eat real food and of course we have to not poison our soil with pesticides and of course we have to like you know care about the environment and we have to get outside and move and we have to be in the sunlight during the day because we are the environment we are a process that's constantly in dynamic conversation with it and

I think I think a lot of people will find that their health gets a lot better if they spend a radically more time outdoors and I think a lot of people might say like can't I work on a computer and I'm like you know Rome is burning like we're sick as hell right now we need to get creative like move your computer outside take a walking meeting open your mail outdoors chop your vegetables on your balcony at your apartment like we have to find a way to connect back with our source understand

that the world is abundant and harmonious re-entrench the belief in our connection with nature and then let all of our dietary and lifestyle strategies stem from that sense of gratitude and awe and that will lead us right where we need to go which is

a really I think joyful experience of our health journey that's rooted fundamentally in connection rather than us being siloed from all of this which going back to being in the conversation that's

fundamentally what's wrong with the healthcare system it silos and we have siloed ourself from all of the life giving things in our environment and that has ultimately led us to be very very very sick and we just I think we got to go back outside so that's one of the things but there's many other

things we can do to change those our relationship with fear but we can't change the world as a whole but we can change what happens inside our body in terms of how we respond to it and for our mitochondria's sake we have to we have to create a sense of safety in our bodies for our mitochondria to do the work we need

to do for health. I love it and I love it for many reasons I think it was my I know it was my friend and former guest on this podcast Rick Rubin who several times early in our friendship he said

back to nature the only truth and I asked him when he meant by that and you know because Rick can be a little bit I'm cryptic sometimes not always but sometimes and what he was saying is you know it's a real

thing you know you can immediately feel the connectedness between the human experience and life of other types plants animals you know sunlight the circadian rhythms and the rhythms of the light and dark because they impact us so

powerfully I mean if if there were ever a force in the world that impacts how we feel it's the circadian rhythm is the rising and setting of the sun it's on the impact of light and dark and then all the other things that you talked about today I can't help but reflect on kind of your take on kind of what a lot of not all but a lot of modern society attempts to do it

attempts to do a lot of good things to I believe I'm a believer in technology but that it if I were to translate it sounded like what you were saying is that it gives us a sense of loss of control by instilling fear like we don't have control and then

there are a number of let's just call them programs in the world that then sell back the illusion of some sense of agency little by little right temporary agency and then puts you back into the cycle

and then it's not going into nature which just removes one from all of that at least temporarily gives you a more basic understanding of the relationship to self and things around us even just looking being able to see it to a distance we know is powerful for the the brain reducing anxiety we know being outdoors for two hours or more per day reduces my opian near

this is independent of all the other effects of circadian rhythms etc. Anyway and on and on so I second and third and and here here all the all the statements you made before I also just have to say I really appreciate how you are able to tackle the

cellar biology the molecular biology the macroscopic things that we can all do walking resistance training cold exposure sleep

high intensity interval training and make make a case for each and all of those as it relates to the underlying biochemistry and we've all that together in a way that then you beautifully wrapped into this idea of connecting to nature and not divorcing ourselves from modern life but really looking at the ways in which certain components of modern life are really making us sick.

Not just the the behaviors not just the do's and the don'ts that it's kind of imparting on us but also kind of the psychology around it it's that it is quietly but powerfully oppressive is the is the message that I'm getting and that we have to take a stand against it in the way to take a stand against it is to do what are very basic and fairly easy to access things making better choices about food timing quality amount exercise and on and on so I'm running long

in my response to your much more eloquent description of mindset but what I want to say is on behalf of myself and everyone listening I so appreciate we appreciate the work that you're doing to be a medical doctor specialized in one of these silos and then to take a step out and say no not me I'm going to do what I see as best for the greater good terms of giving people tools giving people a sense of agency and autonomy to take control of their health this isn't some ways of heretical idea

but luckily the numbers of folks like you are growing and you're a real leader in this field by example and by the incredible work you're doing with technology and information sharing love love love the book

I did go through it front to back I haven't tried the recipes yet but thank you for bringing the blue areas I'll try the recipes at least one of them and I just want to thank you for sharing what you do and

for continuing to do what you do we we need it and we appreciate it so thank you thank you for joining me for today's discussion about metabolic function with Dr. Casey means if you're learning from and or enjoying this

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[Optimizing Metabolic Health and Mitochondrial Function with Dr. Casey Means]-[Dr. Casey Means: Transform Your Health by Improving Metabolism, Hormone & Blood Sugar Regulation]

📋 Summary

Restoring Metabolic Health: A First-Principles Approach

The Trifecta of Metabolic Dysfunction

Reclaiming Agency Through Simple Habits

Challenging the Pharmaceutical Paradigm

The Role of Mindset and Nature

🎯Key Sentences

📝Key Phrases

📖 Transcript