Eating Ourselves to Death
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I'm Barry Weiss, and this is Honestly.

Back in 2008, when the Obamas arrived at the White House, there was a lot of talk in the country at the time, and certainly from the White House, about the obesity epidemic. New numbers had just come out showing that most American adults, 68% of us, were either obese or overweight, and about 17% of American children were classified as obese.

As First Lady, Michelle Obama started this government program. You might remember it. It was called Let's Move. B-ball, tennis, and busting a move at the White House today. First Lady Michelle Obama marked five years into her healthy lifestyle campaign. Happy birthday, happy Easter, now let's move! Issuing another challenge. We're asking Americans of all ages to give me five ways they're leading a healthier life.

Five jumping jacks, eating five new vegetables, maybe doing a "Gimme Five" dance. Yep, you might have seen it on Ellen. And the goal was to reduce the childhood obesity statistic by 5%. Or perhaps during her mom dancing with Jimmy Fallon. Plenty of A-list celebs from Big Bird... Oh, my God! This is so much fun! Fruits and vegetables. ...to the "So You Think You Can Dance" All-Stars are all in the action.

There were all of these initiatives to get more veggies and less pizza into public school lunches. There was a task force of professionals that were hired to understand and tackle the problem of childhood obesity. The First Lady teamed up with Beyonce to promote exercise and better eating. And...

None of it worked. It's been an uphill battle. When Obama initially tried to up the nutritional standards in the federal school lunch program, which serves 31 million children, she was faced with a rebellion. Kids tweeting out pictures of the mandatory fruits and veggies, calling them gross and yucky mystery mush. Teens posting YouTube videos complaining they were hungry because of the cap on calories. Not only did the childhood obesity statistic not drop at all,

It went up. Right now, 73% of Americans are either obese or overweight. And yet, here we are, fatter than ever, and no longer talking about it. See, in the years since Michelle Obama zumbed with those kids on the South Lawn of the White House, the conversation around weight and obesity has dramatically changed. No longer are pop icons like Beyonce campaigning for nutrition or working out.

Instead, the conversation is more about fat acceptance or healthy at any size than it is about healthy living. I got us donuts. Those are so bad for you. Oh, no. Are they moldy? I mean, are they poisoned? Are you allergic? No, I'm just saying. You're judging my food choices based on a false standard of health again, aren't you? Guilty. Every single body is different in how it functions physically.

In fact, in some circles today, there's even a blanket denial that there's anything unhealthy about being obese. What really bothers me are the fake doctors in the comments saying, "Oh, you have this, or you might have this condition." No! What if I'm just fat? What if this is just my body? Bodies are not all designed to be slim with a six pack. Or when a pop star like Adele loses a lot of weight, there's a backlash.

There's accusations that she's a terrible influence on her young fans or a sense that she's really giving up on her authentic self. Now, a few things I should know. The first is I think it's fundamentally wrong and immoral to shame people for being overweight. I think fat shaming is wrong.

I myself have struggled with my weight for years, and I will never forget an incident probably 10 years ago now. It feels like it was yesterday where someone gave up their seat for me on a subway because they thought I was in the early stages of pregnancy. Suffice it to say, I was not pregnant, but the kind of embarrassment I felt stayed with me. The second thing is I think it's possible to both not shame people for being overweight and

and also talk honestly about the epidemic of obesity in this country and its very serious repercussions. And so for today, a conversation about why America is so fat and what we can do about it.

My guest is Dr. Casey Means. After graduating from Stanford Medical School, she dropped out during her ninth year of her residency when she realized just how backward our medical system had become and decided she wanted to do something about it. She now runs a digital health company called Levels, which allows individuals to monitor their own physiology. And you'll hear more about that in the conversation and what it means.

I recently gave a speech at the new University of Austin called The New Founders America Needs. We shared it here on the podcast. And I think Casey Meads is one of those people. She's part of a group of Americans who aren't just complaining about what's wrong with the system, but are trying to build what we need to fix it. Stay with us.

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Dr. Casey Means, thank you so much for talking to me today. Thank you so much for having me, Barry. I'm thrilled to be here.

So I have been aware of your work for a while, partly because one of my producers is a super fan of yours and of the company called Levels that you co-founded, which we'll get to later in the conversation. But it was only in sort of preparing for this talk with you that I learned more about your personal story, which has some major parallels with my own. You know, most listeners will recognize this arc, not just from me, but from

several other people, many maybe at this point in public life, but it basically goes like this. You get into a fancy school, in your case, it was Stanford. You work your tail off for years. You think you're getting to exactly the place you want to be. You're at the top of the mountain. And then you look around at the view and you realize that something is very, very wrong with what you're looking at. And then you make a decision, which maybe looks insane to some people, but

to blow it all up, to scuttle your way down that mountain and start something new. I wondered if you could tell me about your moment. Where were you? How did you get there? And what were you seeing that so alarmed you that you decided to kind of pull the plug on the life you had been building toward to build a new one? The most alarming thing that I saw in the hospitals was

was the simple fact that the patients were not getting better. And everyone knows it. And the facts are really pretty simple. Every single year, patients in America are getting sicker, heavier, more depressed, and life expectancy is going down. And not only are the patients not getting better, but the practitioners have no time, no incentives, and no training to dig into why.

So I vividly remember, I mean, you asked about the moment and I kind of vividly remember this one patient from my fifth year of ENT head and neck surgical residency. So I'm now nine years into postgraduate training, Stanford Medical School. And now I'm at OHSU in Portland, Oregon for ENT head and neck surgery residency. And I'm in my last year.

And I saw this woman who was totally debilitated by her headaches. And we were actually the same age at the time. We were both 31. And in the past 12 months, she'd seen a neurologist who prescribed a litany of migraine medications and an ophthalmologist because she was so sensitive to light. She saw a psychologist for antidepressants for her depression. She had seen an endocrinologist for her prediabetes. She was obese and had, of course, seen her primary care doctor about

that. She also had like inflammatory arthritis that was affecting her knees. So she'd seen a rheumatologist and was developing some high blood pressure. She just had this like laundry list of conditions, which most patients end up coming in with this just laundry list. So overall she had seen 11 different doctors, limited communication between them, 11 separate treatment plans, way more than 11 medications and showed up to my office with like a five inch stack of like faxed chart notes. And yeah,

Success criteria from the standpoint of my department and the hospital would be to get her in and out of my exam room in 15 minutes, stay on schedule, that she has a new medication, and that I have a Loctite chart note that showed I'd done an appropriate physical exam that we could bill for, ordered some additional tests, and had ruled out any immediately life-threatening conditions like a brain tumor that were causing her headaches.

But there was no imperative, no incentive, and definitely no time or training for me to figure out how all these symptoms she had might be connected or how to fundamentally restore her health and well-being.

And so this is probably obvious to anyone listening, but it is definitely not taught in medical school, is that this woman was probably not suffering from 11 different things, but that her conditions were probably in some way related. And I just cannot overemphasize how this is not at all how we're taught to think in American medicine. And to make connections or think about shared physiology of symptoms across the body is actually antithetical to our system, which is based on beliefs

billing codes for individual maladies and symptoms, not for root cause connections between these things. You can't even code in the chart the

for shared physiology between diseases. So you're literally actually systematically forced in your documentation to think of the body as a million separate silos and not as a system. And that simple fact of us not learning to connect the dots between different symptoms and conditions is going to ruin us.

So just to be clear, you're in your ninth year of your medical training, right? And you need 10 years. You're six months away, as I understand it, from finishing your surgical residency when you quit. So you must have been seeing things that really alarmed you to basically say, screw that investment of my entire adult life. I got to pivot and do something else.

That's exactly right. You know, I really had a wake up call where I realized, and this patient is really an example of that, of like, I don't know why she's sick. I mean, I knew how to take a history, do labs, diagnose her, give her a label for what was going on, attach the right medication to that, choose the right surgical intervention.

absolutely knew how to do that, knew how to do the operations, but I did not have a clue what was actually causing her to be sick in her body. And that seemed like a big problem. And that was really a wake-up call. And I just, you know, I said, I'm not cutting into more people or prescribing more and more endless medications until I figure out what's really going on in the increasingly, rapidly increasingly chronically ill American body.

And I knew I had to leave the system to do this because the system is an engine whose business model is totally predicated on more long-term sick patients being in the system. So it was very, very clear to me that if I was going to be the doctor I wanted to be, which is a doctor who restores health, not just manages symptoms and diseases, I had to find a different way to do it.

And, you know, the literal unofficial mantra of my department was don't be a pussy. That was told to us all the time when I was in the operating room as a 26 year old intern, first year resident, it was chanted to me as I was making my incision in the neck with a scalpel.

And, you know, nothing is considered more of like a pussy move in healthcare than nutritional interventions. I mean, we could crack a chest open. We could drill into a sinus. You know, we could like, why would you like use food? And I started to really see how this is a big problem because again, 90% of our healthcare costs are going toward chronic disease. Chronic disease is caused by diet and lifestyle by and large.

And so there is something going on here, some weird gaslighting situation where we are being systemically sort of trained to think that the thing that causes the diseases that are literally going to create insolvency in our economy are not a tool that we should use and that it's like wimpified if we do that.

And then there was another social trend emerging that was disturbing, which was that almost like this inability to talk to patients about diet and exercise because it could actually be construed as elitist or ableist.

or even racist because it's like, well, what if they can't access healthy food in their neighborhood? What if they can't walk? What if they don't have a leg? We definitely don't want to offend anyone. And particularly after the Affordable Care Act happened,

And the quality payment program, which is a disaster and sort of hot air about value-based care, which ties reimbursements to patient satisfaction. So you start talking to a patient about what they can do and the hard work they have to do and that they need to lose weight and all these things. And all of a sudden it becomes a liability for your reimbursements. And so...

There was just a couple really strange trends I was noticing that made me feel like we are not going to be able to dig ourselves out of this monumental problem, which is corrupting the ability of the American mind and body to have health, happiness, and reach their full potential.

Before we talk about your pussy approach to solving the problem that we're talking about, let's explain the problem a little bit. Let's talk about what you call the very ill American body. Well, 74% of Americans now are overweight or obese. Of that 74%, 42% are obese. And in some ethnic groups, that number of obese is over 50% of the population.

And about 52% of American adults have essentially completely preventable prediabetes or type 2 diabetes.

And of note, 90% do not know that they have it. Okay. I think it's worth doing a brief science tangent to kind of just like set the stage for what these words mean, because I think it's very easy to gloss over. I've seen this happen a million times at dinner parties, you know, oh, diabetes, it's not sexy. Don't want to talk about it. Also, like I'll get a medication if I have it. Like, is it really that big a deal? So let's just understand a little bit about what diabetes means because it's

actually more likely than not, the physiology of this process is affecting you and causing problems in your life, even if you don't have an overt diagnosis. So essentially, prediabetes and type 2 diabetes are the body's cells not making energy properly. It's like our battery's not working, okay?

We can use blood sugar or fat to make cellular energy in the body. And that's what actually runs our cells processes. The body has around 37 trillion cells. Every single cell needs energy to function properly. And when groups of cells don't function properly, that is symptoms and that is disease. That is what causes symptoms of disease. Cells not working properly. And if this is showing up in the brain,

Poor energy production in a group of cells could look like depression or Alzheimer's or stroke. If it's the ovaries, it could look like infertility. If it's the penis, it could look like erectile dysfunction. If it's the testicles, it could look like low sperm count. If it's the heart, it could look like heart disease, hypertension, etc.

If there is a problem with how the body is making energy, it can show up and look like almost anything. So it's sort of a root cause trunk of the tree of many different conditions. And prediabetes and type 2 diabetes are the overt representation of that. And metabolism, the word metabolism, you're hearing a lot more about metabolic dysfunction these days.

metabolism is the process of the body converting food to energy. It's this process of making energy. And this is the process that is totally screwed up in the majority of American bodies because of the way that we are living these days in the modern industrial world, which uniquely feeds into a confluence of factors that hurts the parts of the cell that make energy in the body, which is called the mitochondria.

And so this is happening in unequivocally 52% of American bodies because that's prediabetes and type 2 diabetes. But it's actually more likely happening in 93% of American bodies because there's actually strong research that's come out of the last few years. There was a paper that came out actually on July 12th.

showing that now 93% of American bodies have at least one biomarker of metabolic dysfunction. So that's above and beyond glucose. There's some other biomarkers we can look at, like cholesterol and amount of fat in the body. And together, if you look at these, it's affecting 93% of Americans. So there's an energy crisis in our bodies that is a root cause pathway of pretty much every chronic disease we're seeing today. But we are just understaffed

objectively ignoring it, that root cause link, and we are abjectly failing at managing it. And I mean abjectly failing very seriously. There was actually a study done this year looking at the USPSTF, so like the Preventative Task Force of the US, looking at their data of 22,000 patients who were eligible to be screened for prediabetes in

Zero, not one patient got appropriate prediabetes treatment. Not one. It seems kind of counterintuitive because what you're saying is we have an energy crisis, but the energy crisis is caused from too much food. That seems counterintuitive to me.

That's such a great nuanced point. And this is really key is that when the metabolism machinery of our body is broken, we end up having a problem converting food to energy and epidermal

excess glucose, so excess of this raw material to make energy, overloading, pounding, beating our cells damages the machinery. So we're eating about 25 times more refined sugar than we were 100 years ago, around 100 pounds per year per person versus about six pounds in the 1800s.

And that just barrage of raw material totally hurts our ability and our machinery to do this. And that's one of many factors. There's several aspects of our modern diet and lifestyle that hurt these energy factories of the cell, the mitochondria. And just a slight, a point to kind of set us up for that I do think is important for people to realize is that

When the body, when this machinery is getting gummed up and broken, what happens is the cell essentially rejects glucose. It says we're overloaded. There's too much. There's no room in the end anymore. We can't do it. And it actually blocks the cell from taking in glucose from the bloodstream. Okay. So of course, what is prediabetes and diabetes? Blood sugar going up. So that's what's happening. There's a block.

But the body is super smart. The body goes, oh, well, we're going to overcompensate for that because we got to get that sugar out of the bloodstream. So the body churns out this hormone called insulin, which helps you actually drive blood sugar into the cells. And you start having what's called hyperinsulinemia, really high insulin levels to drive that glucose in.

And it actually can compensate for a while. So there's actually over a decade for most people that happens where your body's producing all this extra insulin, but your blood sugar kind of looks normal. So things are going off the rails in terms of what's happening in your body. But based on our standard criteria of testing for it, which is looking at blood sugar levels, it kind of looks fine. And the system has actually discouraged doctors from checking insulin levels in patients who

both the Endocrine Society, the American Medical Association, for perplexing reasons. Because if you looked at that insulin levels rising, showing compensatory functions in the body, you'd actually probably catch a lot of this much, much, much earlier. So by the time you even reach the prediabetes threshold and your energy processes are essentially off the rails, you've probably had high insulin levels for 10 years trying to overcompensate. But shockingly...

You've got the Endocrine Society of America telling people not to worry about their prediabetes. And this is a direct quote. There was a Washington Post article where they interviewed the head of the Endocrine Society, Dr. Robert Lash, who said, if you are older and have prediabetes, try to eat better, but don't worry.

And they actually, in the article called prediabetes, not a disease, which I think if people have made it to this part of the episode, they realize that this is in fact, the body literally so damaged at making energy that it's rejecting glucose from entering the cell. And what we know is that high insulin levels, metabolic dysfunction, type two diabetes, erratic blood sugar, all kind of synonymous are related to either directly causing or worsening

Stroke, heart disease, cancer, chronic liver disease, chronic kidney disease, increased mortality from almost all viral infections, including COVID, gout, chronic pain, depression, anxiety,

female infertility, erectile dysfunction, low sperm count, migraines, and of course, obesity. So those are unequivocal, unarguable conditions that are worsened by, accelerated by, or caused by metabolic issues or erratic blood sugar. And we don't talk about that.

To me, it is part of a larger message that is pouring out of mainstream culture right now, which is that not only do we not know any of the statistics that you just shared. I was shocked when I looked at a lot of these numbers. I read a lot of newspapers. I read a lot of magazines. It's weirdly missing from the mainstream conversation. And instead, it's replaced by a very, very different kind of message, right?

which I don't know if you want to call it the healthy at any size movement or whatever it would be, but I'm on social media. I'm a woman at whom there are many, many ads directed because I buy things online, and I'm constantly getting the following messages. There's nothing unhealthy about being fat.

The only thing that hurts fat people is the stigma. You know, just have the dessert. It's no big deal. Body positivity. You know, and there's also all of these trends, you know, on social media. There's viral videos urging people to refuse being weighed at the doctor's office. And the sort of underlying argument here is your weight doesn't really matter except when you're talking about prescribing medication or putting someone under anesthesia. So can you just correct the record here? How should we understand...

the risks of being overweight. So I find it very interesting that right now the focus is on healthy at any size or healthy at every size when the actual movement should shift to the biologic reality of the situation, which is that we are unhealthy at every size in our country. So 42% of Americans are obese today.

As we talked about, yet 93% of American adults have metabolic dysfunction, which means that there's a lot of normal weight people or mildly overweight people whose bodies are still showing dysfunction in the core biologic process that allows our cells to run and work. There's almost like a mild advantage there.

of having some extra weight because you sort of have a signal that you should probably look into it and do something about it. The majority of normal weight people are still dealing with this issue under the hood that's brewing, that's going to make their lives worse.

and sicker and shorter that they don't really know is going on. Their doctor is certainly not going to tell them about. I mean, we look at the prediabetes stats. Okay, so metabolic dysfunction, lack of good metabolic health, one symptom of that is that we're fatter.

What else does that do if you have bad metabolic health? You mentioned erections before. Tell me how things like depression, anxiety, sexual dysfunction, you know, we have crazy levels of all of these things in America right now.

How does that relate to this? Because I think most people would say, okay, yeah, it kind of makes sense to me that it would be better to eat 300 calories of broccoli than 300 calories of French fries. But to be honest, I looked at, let's say, infertility and thought, eh, you know, a lot of great things happened to give women the kind of liberation and freedom we have. Maybe one of the downsides is that, you know, we're putting off pregnancy till too late. It's our fault. Or with depression, I'm like, look at the chaos of

of the world. Of course, people feel... I never would think to myself, in other words, it's because of what we eat. And that's what you're saying. It is. You're saying it's because of what we eat. Absolutely. I mean, something people need to realize is that we eat 70 metric tons of food in our lifetime, okay? This is the food that goes into our little bodies and we process. It builds our bodies. It tells our bodies what to do. And right now we are eating

ultra-processed, nutrient-depleted crap. The molecular information that is going into our body is crap. If you think about that for two seconds, the fact that about 70% of our diet now and only over the last 50 or so years has become this thing

food-like substance, totally different from what we've evolved to eat, from what our bodies are meant to be built from, from the signals that are supposed to be telling our genes what to do. It's totally different now. And I really like to think of health as a matching problem. We have this machine and we have all this stuff we put into it, food, sunlight, exercise, stress,

stress cues or relaxation cues, micronutrients, bacteria that might go into our microbiome, toxins or lack of toxins, all these things go in. And then you've got this machine. And if there's a match between what the machine needs and what's going in, you will have health. It's really that simple. But if there's a mismatch or there's things going in that damage the machine, you will have symptoms and disease.

And we are breaking, okay? And we somehow don't make that link that, oh, maybe if the 70 metric tons of stuff I'm putting in my body is a bunch of chemical pesticide-laden, nutrient-depleted crap, I'm not gonna be a great machine. I'm gonna maybe become a little dysfunctional. So were you saying that like 50 years ago, an American would sit down to dinner and,

and they might have steak or chicken on their plate and maybe some spinach or broccoli. And you're saying that that was then. And now an American sitting down and they're looking at their dinner plate and it's what? It's full of toxins. It's full of weird substances that I don't know. It's full of sugar. I actually want to understand what you mean when you say the food is different, that it doesn't contain the information that it used to. Yeah. So sit

Simply put, most of it is ultra-processed, which means the original food was taken and radically transformed to something else, usually stripping it of a lot of its nutrients. And these foods, not only are they sort of this confusing information for our bodies now, but they also are...

covered in chemicals that are known to be harmful to human health. So this is like things like pesticides, artificial sweeteners, artificial colorings, preservatives, et cetera, to essentially increase the quote unquote efficiency for the system by letting them be stored and transported and have longer shelf life.

And what's interesting about the food chemical industry is that it's largely unregulated. And there's very little you have to do to get something improved. You basically have to make a case that it's generally recognized as safe, GRAS. And now, I mean, there was just a paper this year that came out, a landmark paper on this topic of what are called obesogens, which essentially are chemicals in our food that we now know causatively lead to

to obesity. So cause fat storage. These are not carbohydrates. These are not nutritional elements. These are chemicals that we know actually tell the body to store fat. And what are some of these? Pesticides, plastics, things that are around- Plastics in our food? There's a lot of plastic in our food now. Microplastics. I mean, plastics essentially break down into microscopic particles and in our

food supply, water supply. It's really kind of everywhere. But we now know that some of these chemicals actually tell our bodies to hold on to fat. That's why they're now called obesogens. It's actually something recent we've learned about. And so pesticides, many of which are illegal in Europe, but are widely used in the United States, are giving you this

extra dose of obesity promoting potential in your food aside from what the food is. So it's like a double whammy. So growing up, you know, and I'm sure everyone had a family like this in their community. There was always like the weird hippie family where we were jealous of the kids that came to school with the turkey sandwich and the Doritos and the Ho-Hos. And there was always a sad kid that had like, you know,

salmon or grapes cut up or maybe they're like special treat with some cheese. And you're basically saying like the freaky hippie family was right. You know, I think in many ways, yes. I think that, you know, that kid was really set up for more success than everyone around him. Fewer insulin spikes, fewer toxic chemicals hurting his cells, less bad

big swings in his blood sugar, which actually make your days much more stable. One thing about eating so many ultra-refined processed carbohydrates in our diet now, which is now becoming the majority of what we eat, is that when you eat that refined carbohydrate or refined sugar in liquid form or just in a processed carbohydrate form, it immediately turns into sugar in the bloodstream. You digest it and it quickly causes your blood sugar to go up

And something we're knowing about these high blood sugar spikes because of this processed food that so many kids are eating in their lunches, like what you're talking about with the ho-hos and the bread and the Doritos, is that that spike in blood sugar and then that crash afterwards, that can lead you to feel anxious, anxious, anxious.

Brain fog, reduced fact retention, cravings, tired, post-meal crash. So we are now all on this roller coaster of blood sugar because of what is being put on our shelves and what is...

subsidized by the government to be cheap, that is putting us on this roller coaster of subjective experience during our day that if we just can pull ourselves out of and learn how to kind of get off that roller coaster, you actually can have a much more subjectively functional day. So this is aside from all the downstream ramifications of

of how these foods are affecting our long-term health and metabolic health. This is just the rollercoaster you're on 30 minutes or an hour after eating that food. So you see kids bouncing off the walls after a meal and then crashing and being emotional. It's like, we know why this is happening. And then we got to put them on the ADD medication. Exactly. Just to stick on for a minute, the question of why are we so fat? Yeah.

How much of it is just portions? How much of it is that? And then also I'm watching the TV show alone. I'm addicted to it right now. And you're seeing the amount of like movement that's required when a human being is just kind of like an animal left in the woods that needs to fend for himself. And then you look at my lifestyle, which is not that unique anymore. I'm hunched like this, getting a freaky neck cut.

Because I'm behind a computer screen all day and that's the way that I work. How much of it is our sort of sedentary lifestyle, especially among sort of the laptop jockey class? So portions, sedentary lifestyle, how much do those two things fit in?

One interesting thing to know about portions is that if you are eating whole, unprocessed, nutrient-dense foods, you will not overeat. The body has exquisite self-regulatory mechanisms to essentially get you to feel full if you've eaten nutritious food.

Okay. So portions matter, but it's the processing. It's what's been done to the food that is totally changing our satiety cues and making us feel like we need more food. There's actually, I mean, there's hormones like leptin that make you feel full and we can develop leptin resistance because of processed food and because of the interaction with insulin and companies absolutely know this there. I mean,

Processed food companies now literally employ food scientists to figure out how to make you not feel full from their food, and there's things they can put in it to do that. For instance, high fructose corn syrup, which is fructose, is one of these interesting molecules in nature that actually gets you to not realize that you're full.

And the reason for this is interesting because if you are a bear out in the wild who needs to hibernate for a few months in the winter and you come across berries in the fall, you want to eat as many berries as humanly possible in order to

store fat for winter. So fructose is one really interesting kind of molecule that falls outside of this, where if you eat a lot of fructose, it's a feed forward mechanism making you want to eat more. Well, 1970s, we started creating high fructose corn syrup and putting it in almost every

everything. And what a brilliant idea if you're a processed food company to put a substance in there in a ultra refined form, therefore more potent, that makes people feel like they want to eat more. Fructose actually has been shown to make people more

aggressive because if you are that bear and you need to stock up for winter with fat, you need to out-compete other bears for those same berries. And so high fructose consumption has been linked to aggression, violence, antisocial behavior. And of course it's literally in everything that we're eating right now. So portion is important, but what's in the food is what makes us want to eat those big portions. What about sedentary lifestyle? So sedentary lifestyle is a really big piece as well.

Muscle is this fascinating organ in the body that we don't pay enough attention to, which is actually this huge glucose blood sugar sink.

Muscles need, you know, they function well off glucose to basically power the muscles. And we've got tons of muscle all over our body. And if you're using your body even to walk for five minutes, all those muscle cells are just soaking up glucose out of the bloodstream. And the really cool thing about muscle is that you don't need insulin to take up blood sugar. So it's like a freebie where you're just using all this glucose without going down that whole insulin pathway. So, you know, I think that

the more muscle that you have, so like the more resistance training you do, the more muscle you build, the more you're actually getting your body on a more stable metabolic track because you're keeping that blood sugar out of the bloodstream and actually using it. And we've seen, you know, in my company's data, you know, of people who take walks after meals or move after meals, they're able to significantly reduce blood

their glucose elevation, their blood sugar elevation after a meal. You know, we had people actually drink a can of Coke and then the next day drink a can of Coke and just take a brief walk afterwards. And they had like an over 30% reduction in their glucose rise because their muscles are just soaking it up. And if you compound that over a lifetime, that actually makes a really, really big difference. After the break, why Dr. Mean suspects that the government might actually want you to be fat. Stay with us.

Hey guys, Josh Hammer here, the host of America on Trial with Josh Hammer, a podcast for the First Podcast Network. Look, there are a lot of shows out there that are explaining the political news cycle, what's happening on the Hill, the this, the that.

There are no other shows that are cutting straight to the point when it comes to the unprecedented lawfare debilitating and affecting the 2024 presidential election. We do all of that every single day right here on America on Trial with Josh Hammer. Subscribe and download your episodes wherever you get your podcasts. It's America on Trial with Josh Hammer. OK, let's talk a little bit about the institutional failures that are at play here.

You've mentioned a few times the government's role in allowing for or maybe even creating a situation in which the vast majority of Americans are either sick or on the verge of being sick. That sounds or will sound to some people like a conspiracy theory.

Give us the most generous explanation, if you could, about why the American government would allow people to become sick.

Why would it be in the interest for the United States government to have a majority of the population that is so overweight that even when the military is going to recruit people, it cannot find enough fit people to do so? It would seem to me that it would go against the national interest to allow for that. And yet that seems to be what you're suggesting. I want to understand how the government would either be complicit or...

or actively creating a situation where the population is as unhealthy as you're suggesting we are. Right now in the U.S., the two largest industries of private employment are the food service and the hospital staff. In 39 U.S. states, the largest employer is either Walmart, which is the country's biggest food seller, or a hospital system.

So put another way, 78% of U.S. senators represent a state where a food retailer or a hospital is the biggest employer. Okay, so there's not an evil puppet master pulling the strings, but the incentives to keep these systems growing create an invisible hand to keep people eating more food and requiring more care.

Okay. So there's a lot of different organizations that kind of all are around this from the NIH, the FDA, medical schools, medical associations, insurance companies. There's a lot. And, and no, I, I, I know people at every single one of these organizations and they are generally incredibly good, incredibly dedicated people, but they're,

incentives are in invisible hand. I mean, healthcare groups spend three times more on federal lobbying than any other industry. Healthcare spending is growing at double the rate of GDP. These are brilliant businesses.

And by performing costly interventions and by patients not actually just getting healthy, we create what is now becoming a huge percentage of the biggest economy in the world. You know, and then, of course, you've got a medical system which obfuscates the fact that

It's actually pretty simple to reverse all this stuff because in our very reductionist siloed view of health conditions, it seems overwhelming. Oh my God, we've got 15 chronic illnesses to deal with and they all are different and it's so confusing and so hard to manage.

That just feeds right into sort of this disaster situation. If we just kind of all woke up and realized, okay, these are all connected. These are all related to food. We need to change some food incentives. We need to change some healthcare incentives. This is not that complicated. Like 50 years ago, 1% of people had type 2 diabetes. Now it's 13%. We got into this mess very quickly. It's actually quite simple to get out, but not if you've got two of the largest industries in the majority of states running the show.

So rather than talking about the government or lobbies, you know, these faceless organizations, let's be specific. Let's talk about one of them, which is the American Diabetes Association. Why aren't they out there using every resource at their disposal to change the situation? Like in the way that if you go and buy a pack of cigarettes, it'll scare the shit out of you. It says these will kill you. Enjoy, but they're going to kill you. You know, why isn't there sort of an equivalent push to

from an organization that has the explicit mission to get people that have diabetes to be healthy. What is going on there? Explain that for me. You know, interestingly, until 2018, the American Diabetes Association actually advised endocrinologists that type 2 diabetes patients can eat as much sugar and carbs as they want as long as they take their insulin to keep the blood sugar looking more stable.

And this is particularly alarming because the ADA is not some front group. They are responsible for the licensing and credentialing doctors who treat diabetes. 40% of the ADA's budget comes from pharmaceutical companies that create diabetes, quote unquote, treatments like insulin.

And they also have received millions from food companies like Coke and like Cadbury chocolates and many, many other processed food companies. And they have licensed their logo to appear on sugar-loaded foods like Snackwell's cookies and Snapple in exchange for donations. That is dark. It's dark, but it's also simple. It's like...

Where is the money, right? Follow the money. Right. Okay, so it's not unique to the American Diabetes Association. There are other institutions that you've mentioned in your writing, like the USDA, like the American Medical Association. Tell us about those because I'm not reading investigations into the kind of things you're telling me about now. The USDA, their mission is

Nowhere does it state it's to improve health. And yet the USDA creates our food pyramid and creates the guidelines that go into what people on public nutrition support like WIC and SNAP can purchase. Of note, the number one line item on SNAP purchases is soda.

So the USDA who makes our food pyramid has a stated mission to, it's like to harness the nation's agricultural abundance to reduce food insecurity and improve nutrition security. It's also charged with ensuring the safety of meat, poultry, and egg products, and to make sure that farmers are okay through like crop insurance and lending and disaster programs. Nowhere in that mission

Does it say anything about human health? And yet they are determining what we eat and what our farm bills go towards subsidizing to make cheap in the country. So flash forward, you are creating the USDA's dietary guidelines for they come out every five years. And the most recent one came out in 2020 for the 2020 to 2025 period. This was released under the Trump administration. And

And they hired a scientific advisory board of PhDs, medical doctors, RDs, you know, registered dietitians to create a report on how they should change it. It was 835 pages. And the team of doctors and physicians said explicitly that the USDA needs to drop the percentage of added sugars in the diet from 10% to 6%.

I mean, just to be clear, the body needs zero grams of added sugar per day to function. But 6%, I'm like, thank you guys, 4% decrease. And actually, if you extrapolate what that 4% means of added sugar, so dropping from 10% to 6%, it represents 20 grams of sugar per person per day, which adds up to 2,400,000,000,000 extra grams of sugar per year consumed in the U.S.,

And what did the USDA do? They rejected. They rejected the recommendation in the 835-page paper by... Why? Well, you look at what was written about this, and their lawyer, a gentleman named Brandon Lipps,

who is the Undersecretary for Food, Nutrition, and Consumer Services, said to the Wall Street Journal that the new evidence is not substantial enough to support changes to quantitative recommendations for added sugar or alcohol. So there we go. So, you know, again, not...

Not a conspiracy theory here, but it's just like this is what's happening. And those recommendations then go into how school lunches are created, how kids are fed, how our farm bills work, et cetera, et cetera. And so it's stuff that does not really make headlines but is actually having a real impact on our lives. To be honest with you, the last time I followed the public health pronouncements of any of these organizations was probably –

the food pyramid, like when I was in seventh grade and it was on a wall. What woke me up to this subject was COVID. It was very clear from early on in the pandemic that the following people were much more likely to get very sick or die from the disease. Overweight people, older people, and people, as you would say, with let's say bad metabolic health.

But that is not the message we heard booming from our public health bureaucracies. And I want to ask you why that is. Like, how do you understand the obfuscation on this subject? Is it simply political correctness? Is it not wanting to be insensitive? You know, in the same way you mentioned that when people go to the doctor's office and they're overweight, the doctor maybe will hesitate to offend them.

Is it just that writ large? What is going on here? There was such a denial of the connection specifically between weight and the disease of COVID that really shocked me. That was obvious to anyone with eyes, but was being denied by the organizations that are supposed to be the protectors of American public health.

Oh, COVID. Yeah. Let's not mince words here. Like we missed a generational opportunity to help people

improve their health in a fundamental way during COVID by using the overwhelming science that underlying metabolic issues like obesity, diabetes, high blood pressure were the factors that created a biologic reality in the body that worsened our outcomes to the virus. And this was monumental amounts of scientific research and not once, not once, not once,

In the past two years, have you heard a public official say that we really need to start working on improving our metabolic health so that we as a country can be more resilient in the face of the virus? Not once.

And, you know, I actually published a paper back in April 2020. So over two years ago at the beginning of the pandemic, it was a review looking at, at that point in the pandemic, which is only about two months, there were already over a hundred papers talking about the relationship between blood sugar and COVID. And I put them together into a review, basically summarizing the mechanisms of how high blood sugar can worsen our response to the virus. These are not correlations, they were causation. So for instance,

If blood sugar gets to above about 180 milligrams per deciliter in the bloodstream, it actually causes immune cells to not move or work properly. They can't literally get to the place in the body they need to get to. Okay? And lots of people are going up above 180 every day just with our standard diet. So that's one thing.

Also, high blood sugar promotes a pro-inflammatory state. And we learned really early on that it's the cytokines, you know, this word that we're hearing all the time, but cytokines now, those are inflammatory molecules. These are what make the end organ damage with COVID. And if you already have high blood sugar, you're already in a pro-inflammatory state, then it's going to, of course, be worse when you get the virus. And there were six other mechanisms, like how blood sugar helps facilitate entry of the virus into the cells that were clear.

And we did nothing, not a single policy to help people manage their blood sugar or even talk about this.

You mentioned early in this conversation that when you were a resident and interacting with patients, that you were wary or maybe even disincentivized or steered away from talking about underlying conditions for fear of being tagged, as you said, ableist, racist, elitist, you know. And to me, it all comes back to like,

There's a hesitancy, and I understand where it comes from. You don't want to blame people for their bad health. Is the COVID response connected to that phenomenon that you noticed when you were in your residency? I think unquestionably. I think it has become problematic for doctors to be very vocal about promoting the idea of individual responsibility.

And that is because of some social overlays that we've been seeing happening that you talk about a lot on your platform around whether we, by promoting individual responsibility, are essentially shaming people for where they're at and or that we are...

in some way almost discriminating against people who have harder situations in life. And by talking about it even generally, we could be offending or hurting a certain subset of people. So let's just not talk about it at all. Even on social media, it's a guarantee that if I post

something about exercise, there will at least be a couple of comments about how ableist it is for me to talk about exercise. If I post about healthy food, it will talk about how it's out of touch and elitist to talk about healthy food because of course people can't, most people can't access this and it's sort of too, too hard. So there's this social dynamic going on, which is very, very interesting. And I think very disempowering because people

You know, I think many people, even if they are at a disadvantage from a systems perspective, the people I have met in clinic rooms, you know, in my life, many of those people desperately want to help themselves get out of their situation. But it's almost like the system is telling you, and it's often the people who don't have these issues who are telling you not to say that, that it could hurt, that it could hurt someone. So that's one odd dynamic.

you've got another dynamic, which, you know, is that medical education just absolutely does not train a doctor to have the intellectual tools to know how to truly help a patient use diet and lifestyle to improve their conditions. It's not a tool in the toolbox. And

Nearly 80% of medical school budgets are underwritten by the pharmaceutical industry. And many deans of leading medical institutions take over a million dollars per year in payments from pharmaceutical companies.

So you look at this and you think like, of course, the doctors are going to become experts at learning how to prescribe medication. But...

it's a zero sum game in terms of time of what you're learning. If you're learning mostly about how to use pharmaceuticals and when you've got that hammer, everything looks like a nail. And so I think that you got into COVID and it starts becoming obvious from the research literature that if we got our blood sugar down, if we figured out how to be more metabolically healthy, which can only really be done, you can only generate metabolic health through diet and lifestyle. There's no medication that changes, there's medication that manages these conditions, but they do not

create it. And we realized, okay, so we have to create metabolic health to do better in COVID, but no one knows how to do that because we haven't learned it. And that is in part because of the way that medical school is financed. So again, it comes back to incentives. And I think that if some exercise group were funding 80% of medical school education, we'd all be pretty damn good at using exercise as a tool for managing a health condition.

I also think that, you know, thinking about ourselves sort of as consumers, right? We're kind of getting the easy way out. We're kind of getting what we want to. If I go to a psychiatrist or a therapist and I say, I'm feeling a little down. And she says, you know, maybe change your diet, change your exercise, sleep more. And it's like, that's a huge undertaking. Give me the little pill instead. You know, it's a much, much easier solution.

No question. I think there's something really to that. And I think this also mirrors another social trend. This idea of identifying with your chronic illness and how we've started actually feeling like these conditions that we have are a part of who we are.

So if you're starting to be part of this social trend where your condition is something you put in your Twitter bio and it's who you are and you're part of a community and you're part of all these Facebook groups and you go to the meetups and et cetera, it's a form of community, then it's a lot less motivating to want to change it, get out of that. And when it's a part of your identity, it actually seems, I think, there's a lot of perceived difficulty in changing your identity. And so

And so something that I think about a lot is like, how do we like de-identify? Like these conditions are basic cellular dysfunction that we know very basic tools that can help change it and reverse it. Let's keep it really simple and de-personalize this. Because if you make it part of your identity, it is much, much harder to change. And I think that the healthcare system actually has a real interest in

in some way promoting this idea of it being this very difficult thing to change, very much a part of who you are. You hear this in a lot of the language of the healthcare system. It's

Oh, it's runs in your family. Oh, you know, you're, you're a diabetic, not someone with diabetes. You are a diabetic. You know, it's like, that's interesting to talk about someone as an identity of their condition or like, this is mostly genetic, you know? And it's like, oh, most patients aren't able to reverse this. It's like all these things promote this idea of like, yeah, this is really hard. This is really challenging. And of course for

For the doctor, success criteria is a patient who stays on a medication, is in compliant with a medication for the lifetime. That is literally what quality is measured by, of how many patients can you get on medication and keep on a medication. Quality is not considered how many patients can you keep.

reverse the diagnosis. And this actually gets into, I think, a really interesting thing that happened that I think was actually subtly really damaging with the Affordable Care Act. There's this whole talk about value-based care, right? And value is outcomes over cost. You want high value, good outcomes, low cost. So they came up with this whole thing where basically you were going to be reimbursed through Medicare, CMS for quality. Interesting thing happened though. How did they define good outcomes?

They defined good outcomes by medication compliance in large part, not by improved health. Okay? So you actually can go online and pull up this massive Excel spreadsheet of what are called MIPS quality metrics, so merit-based scoring for performance. And you can do it by specialty. And you look in that, and it's fantastic.

fascinating to actually dig into this Excel spreadsheet that you can just find it on a random website online, you know, the CMS website. And you look at what effective clinical care criteria are. And it's things like percentage of patients aged five through 65 with a diagnosis of asthma who were prescribed long-term control medication. That's a direct quote. That is a quality metric. So outcomes is being defined by long-term control

medication adherence, not reversal of asthma, which is an inflammatory condition that undeniably can be improved by medication.

having less inflammation in your body, which can be done through diet and lifestyle. So it's fascinating to me how you can actually twist potentially what look like, oh, we're moving towards value-based care and quality, and it actually feeds directly into the incentives of the industries that are funding the healthcare organization. After the break, what Casey Means thinks about Impossible Burgers. Stay with us. Let's talk about how we change the status quo.

How do we get to a place where massive numbers of Americans who right now are overweight or pre-diabetic or all of the scary statistics you laid out before, where they are eating better food? It's multifactorial and it's going to take a very concerted effort across a lot of different industries. And I think the first thing is to get the money out of the people writing the guidelines for healthcare.

So you look at the Endocrine Society, which we talked about before, 50% of the people who write the endocrine guidelines have severe conflicts of interest with industry. You look at the USDA's Dietary Guidelines Committee, 95% have significant conflict of interest with food and pharma.

To me, it seems like it should be illegal for an organization that's meant to serve the public health to get funding from a company like Cadbury or Coke. Is there a push for something like that? There's certainly a push, but there's absolutely no universe in which that's a politically good option for anyone running for office. I mean...

I think this is gets to a subsequent point, which is that I, I don't think we're going to really have much progress with our healthcare crisis or decreasing the amount of our GDP that goes to healthcare. If we don't change in some way, the way campaigns can be financed because you know, you're purchasing guidelines, you're purchasing the nutrition research and,

that's basically going into PubMed and becoming the quote-unquote the science. Fun fact, Coke paid, between 2010 and 2015, Coke paid more than $120 million to U.S. universities and research institutions, producing hundreds of studies absolving sugar for its role in the obesity crisis. So you've got industry essentially funding politicians, funding guidelines, funding nutrition research, and funding medical schools, which is physician education. You know, until...

We changed some campaign financing laws. I think this is just... We're just going to get sicker and sicker. Get money out of the people writing the guidelines. And then downstream of that is changing farm bill subsidies. So we right now spend $31 billion promoting entirely disease-promoting foods, most of which go towards...

ultra processing. And we spend a fraction of the pie chart of the farm bill on what are called horticulture, the horticulture carve out, which is like vegetables, fruits, nuts, seeds, like things that are actually like health promoting. It's like, wait, no, no, that's food and commodity crops like sugar and wheat and corn and soy. The USDA is all about that. Then of course, you know,

Food marketing is a huge part of this. We are so many other countries have eliminated food marketing of processed foods to children. We've got marketing from pharmaceutical companies. They make up more than 50% of advertising spend on major news networks comes from people like Pfizer and other pharmaceutical companies. So it's like when you have this thing where a news organization is actually, their budget is coming from Pfizer and

There's no question that that impacts what that network is going to say. And then I think, you know, a big thing here is financing of health care and really shifting the thinking on that. And that starts, I think, with even doctors waking up to the fact that the way we're defining quality is wrong.

We're defining quality based on things like medication adherence and doctors everywhere. All clinicians need to shift the framework to understanding good outcomes as a healthy body, a body that functions properly, not a body that is well medicated. Those are two different things.

things. We didn't learn that in medical school. So things like changing what quality looks like, and if that can become, okay, this person eliminated their asthma, or this person has lower cytokine levels in their bloodstream, or this person has better mitochondrial function and metabolic health and blood sugar, not on medication. If those were our MIPS

QPP, quality metrics, things would change, but they're not going to change until some of those upstream things about financing change. So definitely multifactorial. So those are questions about how the system changes. Let's talk about how individuals can change their lives and get healthier. Huge numbers of Americans say they want to be healthier and they want to lose weight.

And I am one of those people. Like I am the literal picture of the American yo-yo dieter. I think I paid dues for Weight Watchers just as like a personal tax for the past decade of my life. Now I'm on Noom. Then I try, you know, keto for a day and then intermittent fasting for a week. Like I am this person and it kind of works, but you know, it's a struggle, you know? And

Part of it is that you just get so many different messages. Like, here's the secret key. It's this fasting solution. It's going to cost you $500 from Goop. Or you need to exercise more. Or your portion control is way too big. Or eat intuitively. Or stop eating carbs, which for me is kind of a non-starter. So for the person like me who makes a New Year's resolution every freaking year and keeps coming up short...

What should we be doing? Really, like what are the top three or four things that people like me should be doing right now to shed the excess weight and get to better metabolic health? First of all, I will just say like totally hear you, have a ton of empathy because I've been there too. Like I have weighed...

220 pounds twice in my life. Wow. Yeah. And like have lost that weight twice. And so I get it. Like I've been there in healthy ways, you know. But yeah, I was in eighth grade and was...

very large. Do you think that that's like the root cause for you of your passion for this topic? It definitely had an impact on me because at 14, I basically just started reading a ton of books and just made this decision that I was going to change my life. And those experiences really helped me realize that like, okay, circumstances make a big difference. Food is powerful.

And if I don't stay on top of this or vigilant, I will keep slipping, you know? And then I, I went to residency it's, you know, and I basically, I was 26 when I started residency and,

as a surgical resident and I'm working over 80 hours a week and I'm doing life and death surgery type stuff like in the middle of the night. I'm sleeping only about four nights a week because I'm on call all the time. It's just a completely crazy time. And I didn't gain weight again, but my health totally fell apart. I went from this vibrant, amazing, creative, all-star medical student to

I was dealing with anxiety and depression. I had cystic acne all over my jawline. I got chronic pain in my neck. My left hand went numb. I had IBS. I could, you know, literally my gut function was a disaster. And it was just to be in the operating room and feel like your gut is just about to explode 15 hours a day. And I mean, just thinking about like, wow, my gut can't

do what it's supposed to do right now. And so that all that happened. And then it was fascinating because halfway through residency, you do a six month research block where you're not seeing patients, you're working a nine to five job in a lab. It's like, everything's under control again, no life and death situations, no emergency tracheotomies in the middle of the night, which I was doing all the time, you know, um, within one month of being back on my shit with,

exercise, sleep, less stress, cooking my own food, actually seeing the light of day during daytime because I was in the hospital from 6 a.m. to like 9 p.m. every day, not seeing the sunlight, you know, controlling, buying my food at the farmer's market, not eating cafeteria food. Every single symptom went away in one month. Anxiety, mood, acne, IBS, neck pain disappeared. So I'm like,

Okay. Like this all is happening while I'm having these observations around the healthcare system being, you know, poorly incentivized. And I think having that intellectual plus personal experience together really solidified things for me and just realized that like,

why aren't we talking? If sleeping more could help me this much, why have I never spoken to a patient in my entire career about their sleep? And then you go on PubMed and you look at sleep and chronic disease and it's like thousands and thousands and thousands of paper. They're not in the guidelines, of course, because the sleep industry isn't funding our guidelines. But it's like I couldn't just be part of that charade. And then I think one of the biggest things that evangelized me was

was, you know, just last year, you know, my mom essentially died very suddenly of metabolic disease. And it was fascinating to me to look back at her history when she had me in her late 30s

I was 11 pounds, nine ounces. So I was what was called a fetal macrosomic baby, meaning big body over 8.5 or so pounds is called fetal macrosomia. And it's so funny in America because we actually like celebrate big babies. We're like, oh, it's like, it was like a bragging right when I was a kid. I was like, oh yeah, I was 11 pounds, nine ounces. And it's like, there is so much research about how that portends metabolic issues in the mom, but also metabolic issues in the baby. And of course I went on to have metabolic issues. I was 220 pounds in eighth grade.

And she then, so that, so no one mentioned that to her. Maybe this means you have insulin. And of course you think about insulin. We talked about how it's a growth hormone. Well, if insulin is high, then,

It grows cancer. It grows fat cells. It grows babies. Okay. So no one mentioned to her that maybe she had some insulin issues, some blood sugar issues, whatever. Flash forward. She develops a lot of the standard American diseases, hypertension, high cholesterol, blood sugar issues. Again, multiple different specialists, different medications. No one's sort of talking to her about what to do. And then she actually got really on top of things and kind of was reading a lot. And, and, and, but I think it was honestly just too late. She ultimately, uh,

developed abdominal pain, got a CT scan, had widely metastatic pancreatic cancer and died two weeks later, you know, pancreatic cancer, you know, it is, the risk factors for it are blood sugar issues, obesity, smoking, you know, all the things that lead to metabolic issues. So it's really a cancer that's directly driven by metabolism. So I looked back at that situation and I'm like, no one, no one looked at her as a person and put together a

All these clues and this journey. And, you know, they got exactly what they wanted from her. She went to a bunch of different specialists. She had two weeks of insane healthcare costs at the end of her life. She was on tons of, you know, medications and her for between age like 50 to 72 when she died, you know, and she,

Had she at age 40, when she had me, uh, learned that she had insulin resistance and learned how to fix it at that time, none of, none of that would have happened. So anyways, that's a total tangent, but you know, it's just, it's those type of stories, both in myself, my mother, people around me, you know, that really just, how do we serve these, you know, people to actually be empowered to understand how to help themselves and not just be part of this treadmill, um,

towards chronic illness that essentially all of us are on if we're not being extremely vigilant about our day-to-day choices and educating ourselves about them. So I guess at that point, we can now go into what some of those things are, but happy to talk. Yeah. I was going to say, as someone who has...

radically shifted her own personal behavior in the past, what are the three or four things that those of us who want to be in better health should be doing right now, even if they go against some of the messaging that we're hearing from mainstream culture? The biggest one by far is to eat real, unprocessed, clean food. If people do that,

90% of the issues will go away. And what I mean by that is food that looks like it was in its original form, you know, vegetables that have not been gone to a factory and ground into flowers and dried and mixed with corn and turned into a chip, like an actual cooked vegetable that doesn't have a

Whole food fats as opposed to just tons and tons of refined ultra-processed seed oils. So like you can get fat from avocados and olives and coconut and meat and eggs and whole food forms of fat surrounded by, you know, all the things they're meant to be with in nature. But most of the fat we're eating today is industrialized, ultra-processed, easily oxidizable seed oils.

that are really bad molecular information for our body. So eating just whole, real, unprocessed, clean food as much as possible, which means avoiding things that come out of bags and boxes and packages and that have more than a couple ingredients. And there's caveats to this. Like for instance, like,

One of my favorite snacks is flackers, which are like flax crackers. I mean, these are literally, they're in a bag. They have a label, right? They have a few ingredients, but it's literally organic flax seeds, apple cider vinegar, and spices. So it's not like don't eat any packaged foods, but like make sure it has a couple ingredients. Is a good rule of thumb to...

I don't know if this was a Michael Pollan line or someone else, but just to stick to the periphery of the grocery store. In other words, don't go to the aisles in the middle with what I think of as the fun stuff. I got to train myself to not think of that as the fun stuff, but go to the produce department, go to the fish and meat department. And that's basically it.

That's right. Yeah. And I think what's a really fun thing to note is that if you do that for a few months, you will, your brain will change to love those foods. We know that. And your gut will actually, your microbiome population will change and they will literally produce byproducts that make you like the food more. So you are investing. I'm kind of like, just try to just like

I'm joking, but like with this healthy, unprocessed whole foods for like a few months, knowing that it's an investment in changing the reward circuitry in your brain, your satiety and hunger hormones, your microbiome to actually have you genuinely love the food, which is why nutrition people are so annoying. Like myself, it's like, oh my God, I love it.

It's so good. It's like, it's not just being annoying. Like people actually do change their perception of these things, which I think is actually quite empowering. And there's fMRI studies to actually show this. So eating real food is number one.

The second piece would be movement, for sure. The more you move the body, the more you're just soaking up these damaging metabolic things like excess glucose from the bloodstream. You're using it. You're converting fuel to energy as opposed to converting fuel to fat. And there's really interesting research that actually shows that it's better to move more throughout the day than to just have one workout at the end of the day. So for people listening, even...

setting a little timer for every 30 minutes and doing 15 air squats or walking around your house for two minutes will actually lower insulin glucose levels more than the one activity. And it makes sense. Like if you're constitutively activating these pathways throughout the body, even for short periods, you are a active body as opposed to a sedentary body that has a spurt of activity. And so just

My chief of staff and I will often, if we're working on Zoom together, just after we conclude a point, we'll just get up and do a few air squats together on Zoom. It's fun, and it's not hard. And then the third thing was,

would be sleep, I would say. We're sleeping like on average, like a couple hours less per day than we were historically. And sleep is this magical time when our body actually clears out a lot of the damaging stuff that builds up in the body that causes cellular dysfunction, clears it out, does some of that processing. Our growth hormone is secreted. A lot of hormones actually get secreted at night.

And we also have a lot of genetic pathways in the body that are called like clock genes, meaning that they're activated at different times. So if we restrict sleep or if we...

are sleeping in really erratic times, we actually, that's information to the body that something's wrong. Like what, what's up? Why is this happening? You know, and it changes our genetic expression. So by being more regular and consistent about sleep and getting enough sleep, we're just setting up our hormones, our genetic expression, all these things. And we're cleaning out the trash of what builds up in the body all day. All of which is of course good for our brain and bodies. And so those would be like, I think the three biggest pillars of,

Other things, so on my sort of list of the big things, which is really like seven big ones, it would be the food, the movement, the sleep, the stress management. So just making sure that you're figuring out ways to cope with stress. Light exposure is another one. We wanna make sure that we're getting sunlight in the morning, dark at night. Again, that feeds into our genetic expression of these clock genes. Environmental toxins, avoidance.

avoid them, eat as much organic food as you can. Try to avoid packaged foods are essentially concentrators of pesticides. Cereal has some of the highest pesticide concentration of any food, like 15 times more than what is the acceptable limit for the body. So like avoid processed foods and try and do organic if you can support the microbiome, of course. Um, so not using

excess unnecessary antibiotics that kill the microbiome, not using excess painkillers like Advil, which actually really damages the microbiome, supporting the microbiome with fiber and colorful foods that help it thrive. And so those are some of the big ones, environmental toxins, light exposure, microbiome support, managing stress, getting good sleep, moving and food. And you don't have to do all of them all the time, but those are the levers that

that translate into functional physiology in the body and have unequivocal evidence base around them. So you leave the path that you're on. You decide, I don't want to be a part of this. At first, you didn't have a plan.

But now you very much have a plan. You co-founded this health startup, just how I know about you, called Levels, that's raised something like $50 million already from some of the most premier venture capitalists in places like Silicon Valley. I read somewhere that Levels had a waiting list of more than 200,000 people. So for people who haven't heard of it, what is Levels? What are you building? And how does it solve the problems we've been talking about in this conversation?

Simply put, Levels shows you as an individual exactly how food affects your health in real time. So this allows you to have, for the first time, closed-loop biofeedback on what you're putting in your mouth...

and how it's affecting your body. Closing that feedback loop from what used to be a really open system where you like would eat a bunch of stuff and then not know what your cholesterol or your glucose or whatever was for like a year from now to a immediate system. And we do this by giving people a sensor that's called a continuous glucose monitor that they wear on their arm and it's running a lab test

about every 10 minutes, 24 hours a day, sending that information to your smartphone and showing you exactly how your body's responding in terms of blood sugar to everything you're doing, what you're eating, but not only what you're eating, what your exercise is doing, what sleep deprivation did to your glucose, et cetera, how stress is affecting your glucose. So closing the loop and our mission at levels is lofty. It's to reverse the metabolic disease epidemic.

which we talked about affects 93% of Americans. And it's by empowering individuals to understand their own health data and how their choices are affecting their health in real time. It's kind of like the ethos of like the whole earth catalog and that kind of 60s counterculture phenomenon of, like I said before, like the hippie things that are now

clearly were correct, but marrying them with some of the most sort of leading edge technology. Yeah. And like, I'm a hippie in some ways. Like I want to be in the back country backpacking. I like barely know how to use my iPhone. Like I don't want to be strapped to a sensor my whole life. It's not, it wasn't my goal to be this like bionic person who has a sensor on. However, we are up against monumental challenges that are new and

that are intentional and that are keeping us ignorant and in the dark about our own bodies and which serves industry that does not have our best interest as its goal or business model. Therefore, what gets me up in the morning is the idea of subverting that whole process and giving information directly to people that lets them understand this key aspect of their health, this trunk of the tree,

of so many pain points they're dealing with and manage it, learn about it, own it, have agency around it. And just to, just to back up, like I'm not saying that managing your glucose, keeping it more stable throughout the day, getting rid of that roller coaster is the only thing you need to do to have optimal health right now. It is the only continuous biosensor that is available on the market. And it's, as we've talked about in this episode, it's an incredible biomarker for understanding how things are, um,

going in the body because as blood sugar becomes more erratic, we know that's a big problem. But I'm certainly not suggesting that this is like the only biomarker we need to care about in American healthcare. But it's a really important one and it's one we have access to. So what my company does is give people access to this technology that was formerly totally

not something they would be able to access. It used to only be available for people with severe diabetes to manage their condition. And our premise is that if you can give this to people 40 years earlier on the start of this trajectory, help people learn themselves how to eat properly. It's not about dogma or telling people exactly what to eat. It's about people learning what to eat based on their own feedback, how their own individual body responds to food because everyone responds differently.

I mean, ideally, people wouldn't have to wear these forever because they'd learn these principles and would be able to kind of move on. Although I will say I've been wearing one for three years and I'm still learning a ton. I do think in the world in which we are systemically disempowered to essentially be dumb about our own bodies, I really love the idea of moving into a more empowered world.

individually educated system where we also move past food marketing. I think this technology has the potential to make food marketing obsolete and also to create some really interesting class action lawsuits. Because if you start seeing that what's on a box, like this is heart healthy. Oh, these honey nut Cheerios are heart healthy. And then you start seeing that hundreds of thousands of people are having an 80 point glucose response to that food, which is huge.

that's going to create some new conversations. And could we move to a post-marketing food world where you're actually, the marketing comes from within. Who cares what the Instagram influencer says about what's healthy or not? You can just be like, actually, I have all the data right here. I'm good. This is working for me. Thanks so much for your really strong, violent opinion about whatnot. But my physiology is good. So thank you so, so much. That's what's happening. And

anyone who wants to attack me about what I say about food or this or that and what I'm doing, it's like, here's all my data. The conversation's over, you know? And so I think each person being able to do them for themselves could be a really interesting change the whole influencer landscape and the food wars and the food dogma, which I'm very excited about. You up for a quick lightning round? Sure. Okay. This is yay or nay. Keto. Yay or nay.

Yay, but not for the reasons that people think. Fasting. Intermittent fasting. Absolutely. Amazing for the human body. Most bodies, yeah. Calorie counting. Nay. Alcohol.

oh, this is so hard because it's yay or nay. But I mean, if it's just a yay or nay, then nay. You know, it's cytotoxic. It hurts our bodies. But like there's some interesting epidemiologic data about what very small amounts of alcohol can do that are potentially not problematic. But it depends on what lens you look at it. Keep it very, very minimal. Veganism.

Definitely can't go with a yay or nay because there are 5,000 different versions of veganisms and some are hard nays and some are probably yays for particular bodies. Seed oils. Seed oils, hell nay. Yeah. Disgusting. If you want to really like lose your lunch, Google a YouTube video on how canola oil is made.

Impossible meat and other plant-based meats. Hardnay. Disgusting, full of processed garbage and seed oils, a food scandal of our time. A few more questions. If you could delete one food from the universe, what would it be? High fructose corn syrup. What is the unhealthiest thing in your life that you cannot bring yourself to give up?

I think going to bed late, I get an amazing amount of creative energy at night and I sometimes run with it and I'll stay up till 4am. I think every paper or article I've ever published in my entire life has been written between midnight and 4am. So that is few and far between. It's terrible for health, but like it's when the universe kind of flows through me in the most effective way. And I'm just like, fuck it. Like I'll stay up late every once in a while. Yeah.

What's something that you do personally or believe deeply that isn't supported by data or medical research? There's some subtext in that question that I think is worth addressing, which is that you have to remember that

there's so much science out there that you're not seeing because it's not in our guidelines. And because a lot of groups have said what science is and is not. And so like, there are things I do like use lavender essential oil to manage if I'm stressed. And a lot of doctors would be like, that's pseudoscience. There's like many scientific papers that show that the compound in lavender has anti-anxiolytic effects, but like,

The average doctor would be like, that's not evidence-based because it's not in the guidelines, but we've kind of talked about guidelines. But I would say, you know, stuff like that, practicing gratitude, sleeping on a temperature, an eight-sleep mattress that changes the temperature and helps me sleep better. I think the science is a lot wider than we think. What did you have for breakfast? I'm still fasting, actually, because it's 1227 here. So I'll either fast until lunch or...

I will eat generally like a low glycemic nutrient rich breakfast. So I'll do chia pudding, which has tons of fiber and protein with some berries. I'll do maybe some pasture raised eggs with some smoked salmon, frittata with tons of vegetables. Or if I wait till lunch, I'll just eat like a nice big salad with...

you know, a sugar-free dressing that I make usually Dijon balsamic olive oil and, uh, you know, some sardines and tons and tons of vegetables or something like that. So, you know, interestingly in our levels of data, breakfast food is some of the most horrendous food that we see. Like standard American breakfast cereals are some of our highest spikers in the entire data set. So if people are listening, it's like switch to a savory breakfast, watch your day improve. So, so, so, so much.

Dr. Casey Means, I would say it's clear that you ate your Wheaties today, given the level of energy brought to this conversation, but I'm sure Wheaties are terrible for us. So instead, I'll just say thank you so much for this enlightening conversation. I really appreciate it. Thank you. Thanks to Dr. Casey Means for coming on and making the time. You can check out her work, her company's work at levelshealth.com.

Did you learn something from this show? Did you find your assumptions challenged? Did you hear things that you disagreed with, things that pissed you off, things that made you stand up and cheer? I hope so, at least to some of those things. So share this with people in your community and have an honest conversation about this subject with your friends. And if you want to support our work, please visit commonsense.news and become a subscriber today. See you soon.