RHR: Beyond Biohacking to Metabolic Mastery, with Dr. Casey Means
In this episode, we discuss:
- Challenging the biohacking and longevity obsession
- Longevity, death, and cellular energy
- Financial incentives in healthcare
- Trusting yourself and listening to your body
- Misalignment of incentives
- Blood markers and practical tips
Show notes:
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Hey everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week I’m really excited to welcome Dr. Casey Means as my guest. She’s a Stanford-trained physician [and] co-founder of Levels, a health tech company with a mission of reversing the world’s metabolic health crisis. If you’ve heard of continuous glucose monitors, or CGMs, Levels is probably already on your radar. But today we’re going to be talking about Casey’s new book called Good Energy. It’s a book about metabolic health and mitochondrial function and the importance of optimizing those for lifelong health and disease prevention and even reversal.
But more than that, Casey has a very holistic view on health and wellness, which I share. So this was a really interesting conversation where we talked about the optimization culture that’s become popular recently, and how that can lead some people astray. [We] also [talked about] how fear-based decision making around longevity can do the same. We talked about the misalignment of incentives in the healthcare, or “sick care,” system, and how that leads to over-prescription of medications and surgery and people focusing on the wrong things. [We spoke about] the relationship between healthcare, food, and education, the importance of connection for health, and some practical take home tips on what labs to focus on and how to think about those labs for people who want to just focus on the most important things for their health and longevity. I really enjoyed this conversation. I think you will too. Let’s dive in.
Chris Kresser: Casey, welcome. It’s such a pleasure to have you.
Casey Means: I’m so happy to be here, Chris. Thank you.
Challenging the Biohacking and Longevity Obsession
Chris Kresser: So let’s just jump right in. There’s something that you and I have both agreed upon for some time. I’ve read other things you’ve written about it, and it’s a drum I’ve been beating for quite a while– this notion that we can make the biggest gains in our health by biohacking. [I’m talking about] high tech devices, tracking every possible marker with every possible device, and really taking things to the limit when it comes to biohacking. What do you think is wrong with that idea?
Casey Means: I’ve been reflecting on this so much because I think there’s so many good things happening with innovation around health and a big interest in it, but I think the deafening noise that we’ve been hearing about is that it’s all about these hacks and these micro optimizations and the protocols and the ritualized mornings and all these things. And I think there’s some fatigue I’m feeling around that and seeing in a lot of people, and I think part of that is because we’re so far off in the United States right now. We are so, so deeply missing the mark on even the basics of health. The reason we’re sick, and the reason Americans are getting sicker every single year in our country, is not because we’re not cold plunging enough. It’s not because we’re not taking the $100 supplement a month. It’s because every pillar of our modern, industrialized, urbanized life is essentially not conducive with optimal cellular health, from the basics like food and sleep and the way we’re moving and our emotional health. So we’re kind of missing the forest for the trees. Less than 28 percent of Americans get the recommended basic amount of physical activity per week and we’re sleeping 25 percent less on average than we were 100 years ago. 74 percent of the calories that Americans are eating are ultra-processed, industrially manufactured food. Our soil is dead. So we’ve kind of got bigger fish to fry when it comes to the health conversation [and] I just don’t want us to get lost in minutia.
I think a big message that I have, and a big message of my book, is [that] a lot of the biggest gains we can have are so much simpler than the conversation that’s most dominant right now would have us believe. I think some of the hyper-specialization [and] protocolization can intimidate people and actually make them feel confused and like they’re spinning. I think we need to get back to basics. [After] going so deep into the research, writing a 400-page book, [and] being in this world of health optimization, the biggest conclusion I think I have is that it’s simpler than we think. And I would just also add on the bigger picture, almost spiritual level, [something about] the dominance of this idea of the longevity conversation has always sat not quite right with me. I’ve thought about that a lot as I’ve been writing this book, Good Energy. And I think it’s because longevity, in a sense, is still an attachment to something way down the road. It’s an avoidance of an outcome that is bad, [or] that we think is bad– death. And it’s sort of still a future attachment to a goal that I think when we actually focus much more on presence. How do we actually, in this moment, focus on metabolic health? How do we channel as much energy through our body? It’s a mindset shift.
I’m not actually striving for a particular end goal of longevity. I’m striving to be able to channel, process, utilize, [and] harness as much energy through my body as possible in this moment. Because when we get grounded in that, I think the longevity will come. But it’s a little bit of a different orientation [from what] I think is focused on now, on honoring this incredible structure of the body and what it can do. It actually changes a little bit of the relationship with the health journey, I think, towards more awe and moment-to-moment presence. So those are some of my thoughts on what’s happening with the conversation right now. Fundamentally, I want to help, just like you, usher in a healthier world. And I think getting back to some of the simple, timeless basics is going to get us the farthest the way there.
Longevity, Death, and Cellular Energy
Chris Kresser: Yeah, couldn’t agree more. And there’s a lot to linger on there so I’d love to do that. We can start with the longevity conversation first, and then go back to biohacking and optimization, because I think they’re obviously closely related. Reflecting on what you just said, one way to think about that for me is a fear-based mentality versus a joy-based mentality. Fear-based is, like you said, fearing an outcome, which in this case is death. Which, at least as far as our modern current technology goes now, is an assured outcome for all of us at some point. Yes, that may change, but at least far as we know, we’re all going to die at some point. It seems to me that a lot of the longevity conversation is rooted in a fundamental fear of death, and this is where it does become a spiritual conversation, because I think a lot of people have trouble, understandably, facing that fear. It’s probably the biggest fear that most humans face. And when you orient your life around avoiding an outcome or fear of a particular outcome, that has a very different felt experience than orienting your life around pursuing something that you want or, like you said, really just optimizing for present moment experience. That’s also a deeply spiritual goal, regardless of what form your spirituality takes. I think most people would agree that orienting your life around your present moment experience and how you can enhance that, whether it’s your relationships, your physical health, your emotional health, [or your] psychological health is a worthy goal, and maybe one that is better than orienting around fear.
Casey Means: Yeah, I think that’s beautifully said. So much of my work centers around metabolic health, which, of course, as you know, and I’m sure your audience is aware of at this point, is how we transform food energy to cellular energy, which is, in my mind, the most foundational aspect of health. We have all these trillions and trillions of cells, and they all need power and energy to function. In our modern world right now, maybe upwards of 90 percent of Americans have metabolic dysfunction. There’s this block in how we’re converting energy in our body, which is kind of scary when you think about it. This power, this life force that gives all our cells their animating energy, is being dimmed and what the science is showing us is that this is because there’s a mismatch between this world we’re living in and the realities of this modern world that have changed so much over the last 100 years, across ultra-processing of food and chronic low grade stress with devices and toxins, and our relationship with light, and all these things. It’s all hurting the mitochondria.
We know that to have longevity, you need good metabolic health. Those are pretty much one and the same. But also for every moment in our life to be essentially powered and filled with life force, we need metabolic health. So I think that so much of my framework has shifted from, “Okay, let’s strive for this thing that’s 67 years away,” to “What can I do? What can I cobble together in my life and my environment each day to create compassion for my cells that are struggling so much in this modern world just because of the realities of what we’re around?” As sort of the mother to all my cells, how can I put together a set of experiences, and essentially a culture for my body and my cells, that allows them to do their fundamental process, essentially our cells’ birthright, which is to take energy from outside of us, potential energy, cosmic energy, which is basically food, and food that has literally stored photon energy from the sun in the carbon-carbon bonds of these plants and the animals that eat these plants, and then how can I create the conditions around my cells to create a situation in which my mitochondria and cells can unleash that sun’s energy to fuel my day, my feelings, my synthesis of neurotransmitters to basically let me support my highest purpose today?
So it’s a subtle shift in the way we think about it, but I think it’s powerful. Because if we’re honoring with compassion the needs of the cells and reducing the overwhelm on the cells every single day, like we would care for a baby or like we would care for anything that we love in the world, we will get that long-term outcome. But we’ll do it from a state of honoring and joy, like you said, more so, than from a place of fear or avoidance of an outcome. And I think there’s such an interesting other conversation with, [like] you were talking about, sort of like everyone [and] that assured outcome of death. I’m so fascinated by our Western culture [and] how we’ve almost institutionalized a lack of curiosity about engaging with death in a way that, in many ways, actually distorts our health journey, I think. [If] you look at the West, we really don’t talk about death. Even when people die, we embalm them and we put them in a box, and then we put concrete in the earth. So they’re in a concrete cave, in a box, in formaldehyde. We’re very much fighting this idea that people would go back to nature. On every level, there’s not a lot of curiosity. [If] you look at other cultures, Eastern cultures, indigenous American cultures, Stoics, everyone was talking about death all the time, thinking about life cycles, thinking about these incredible eternal processes that we are a part of and not separate [from]. Being a surgeon and training as a surgeon and thinking about some of this more philosophical component, I’m like, “Wow, our healthcare system actually uses this against people.” We take people’s lack of curiosity, lack of engagement, lack of framework for death, and we use it against them.
In our Western system, it’s not, “How much can we make you thrive?” It’s, “We might do some stuff to keep you alive a little bit longer.” Those are two different things. We don’t focus on prevention, we focus on reactive, whack-a-mole medicine, and we basically have conversations with patients that go a lot like, “This biomarker is off, which means you could die sooner, and I have a pill or a surgery for you to maybe ameliorate some amount of that risk for you.” And of course, a patient who’s sitting there petrified, really thinking about their health journey in that Western framework of like, “Well, I’m this human, and all I have is this life, and I’m going to live, and then I’m going to die, and I have no framework for it. I’m going to take that pill, I’m going to get that surgery.” Not saying that people should never take the pills or get the surgeries, but I think that when we become more empowered and [are] actually facing these realities and the 100 percent certainty of our death and what that means more head on, it actually makes us a more empowered engager with the healthcare system, where we can actually make decisions from not a place of existential grip of fear. We think that we have to be afraid of death, but I think that there’s actually ways to engage with it that can really liberate us and help it be a real teacher for us, and also let us interact with the healthcare system from a place of empowerment rather than petrification.
I talk about it in the book, but my mother, who died from pancreatic cancer far too soon, had 13 days between her diagnosis and her death, and was totally fearless. She literally was joyful. And I didn’t really know that my mom was going to be that way. You don’t know until you see someone facing that. But the reason why this has come so much more into the way I talk about health and think about longevity is because witnessing a person with, truly, a gun to their head, [knowing] they’re dying rapidly, and seeing fearlessness, nothing has changed my perspective on what it has to be like than seeing that firsthand and actually being with her when she died, [with] her in a state of total peace and gratitude and joy and curiosity. She was very much a present moment type of person. That inspired me to put this all together and share a lot of that in the book, because I think ultimately we want to be the type of people that are not just striving for longevity, but are striving to be the type of person who, when death comes, we can face it with peace and fearlessness. And I think those are two slightly different journeys.
Financial Incentives in Healthcare
Chris Kresser: Absolutely. That’s a rich conversation, and one that we could probably spend the rest of the time talking about. But I’m going to rein in my curiosity, because there’s so many other things I want to talk to you about related to your book. But, yeah, I think we can both agree that it is interesting when you think about how the end informs everything that happens along the way. How we approach death and what our fears and hopes are around that influences the decisions we make decades ahead of that event.
I want to go back to optimization a little bit, because there’s a lot there, of course, to unpack as well. You mentioned 70 percent of the calories Americans consume come from ultra-processed food. I was smiling because it was just 60 percent a few years ago when I wrote my second book and that number just continues to increase all the time. And what was it, 28 percent of Americans get the recommended amount of physical activity? Insomnia and sleep deprivation [are] endemic [in our] culture now. So I think you and I can both agree, and I think even most people who are listening to this would agree, that’s what’s driving the chronic disease epidemic, like you said– not a deficiency of cold plunges or not enough people monitoring their HRV or doing red light therapy, or whatever the case may be. I think what happens, just having worked with lots and lots of patients and trained lots of clinicians who’ve worked with lots of patients, what’s happening is [that] people are so overwhelmed by the modern world now, not enough time, stress, light exposure, all the mismatch factors that we both talk about, that it’s easier to buy a red light therapy device and use it once a day, or to take certain supplements, or to do some of the other biohacking interventions. I’m not saying easy, and I’m not saying cheap, but easier in some way than it is to fundamentally change certain aspects of behavior, like to get to bed two hours earlier or stop using your screen at night before bed or really shift your diet in a consistent way so that you’re eating more nutrient-dense foods and less processed and refined foods. Or make sure you’re getting physical activity on a regular basis. Those are changes that require, I think, more sustained input and effort over time than just buying a new device or doing the latest biohacking trends. So that is the quest, the million dollar, trillion dollar, perhaps, question of, how do we help and support people to do that, to make these more sustained, long-term changes, rather than just the latest biohacking trend?
Casey Means: I think it’s so multifactorial. I think obviously a piece of it is education– just knowing what the factors are that the science is telling us are affecting our health. And a lot of what I think about is some of the financial incentives that actually drive us to be in this place of not wanting to change the big things. Think about if you go into the conventional doctor right now. Even if you have a [gastrointestinal] (GI) autoimmune disorder like Crohn’s disease or inflammatory bowel disease, there are many GI doctors who will not ask you about your diet. And these are GI disorders. If you are going and paying a lot of money and seeing these doctors that have 20 years of experience and they’re not even bringing up food, it undermines the idea that food matters. But then you see independent media and podcasts, and everyone’s talking about food. It’s like, “Who do I trust?” So part of what I think is important to talk about is to help people understand what sort of matrix they’re living in, in terms of the many trillions of dollars of incentives that are in place to make us doubt that the simple things actually matter. We have this very real devil’s bargain between a $4.3 trillion per year healthcare system and a $2 to $4 trillion ultra-processed food system that, together, both make money and together represent over 20 percent of the GDP of the largest economy in the world, that requires to grow more sick patients in the system utilizing more services for a longer period of time for healthcare. That’s just the reality. It makes more money when people are sick and less when they’re healthy. And for food, [they need] more people addicted, voraciously consuming as much of their food as humanly possible. That is, unfortunately, the stark financial reality of both systems that make up a huge part of the global economy. There is no incentive to help people understand how simple it is to be healthy through real food and through taking care of yourself.
Every doctor I know is a really good person. However, what people don’t understand is that these incentives are truly monumental. I mean, far more than our defense budget. They change and manipulate and insidiously insert a bias into every element of the way doctors are trained, the way the news is put out in our country, the way guidelines are written, the way studies and the hierarchy of evidence is evaluated. Everything about those incentives corrupts the way we’re learning medicine. So you get these incredible minds with good intentions going into healthcare, who unfortunately are being taught suboptimal healthcare, and then that trickles down, I think, to consumers and to patients who basically don’t have the powers that be– the doctors, the [United States Food and Drug Administration] (FDA), the [United States Department of Agriculture] (USDA), the [National Institutes of Health] (NIH)– saying what they should be saying, which is, ‘Everyone wake up. All the diseases are connected. And if we eat real, unprocessed, sustainably grown food and sleep and walk 7000 steps a day and lift some weights and get rid of the blue light at night, most of the diseases will go away. You have to start doing this.” I genuinely believe that if all those organizations and all the doctors were screaming that from the rooftops, people would do it. But right now confusion and addiction literally are the business model. That is how we get people spinning and in the washing machine of this big devil’s bargain system.
I think that, to me, a little bit of rebellious energy, and revolutionary energy, like your podcast title, a little bit of that defiance energy, by people knowing how they are a pawn in a very, very big game. In fact, doctors are pawns in a very, very big game. Knowing some of that, and sort of speaking it clearly, I think that can really help people feel some of that motivation to double down on the basics as a form of resistance [against] being taken advantage of by these systems. I think, for me, that’s one approach that, at least through the work I’m doing and my book, seems to be really resonating with a lot of people– that we are being suckered on every level, and it’s basically to line the pockets of a couple really big industries, and we can opt out of [it] at any time, and focusing on the basics is the ultimate form of empowerment.
Trusting Yourself and Listening to Your Body
Chris Kresser: We’re speaking the same language. I’m sure you know my last book, Unconventional Medicine, was largely on this topic. And what I’ve found is that, in talking with a lot of people since I published that book, some people are scared to chart their own course. I would say even a lot of people. And it’s somewhat generational. I think older generations in particular, were raised to really revere doctors. There’s the white coat syndrome that we talk about in medicine, where, and I’ve seen this play out in people in my parents’ generation, for example, who are afraid to question their doctors, or afraid to go against their doctor’s advice. You talk about [that] in your book– don’t trust doctors, don’t trust the science, don’t trust me, trust yourself, which I agree with wholeheartedly. And I think for some people, that’s difficult, because they were not raised to trust themselves, especially when it comes to their own healthcare. They were raised to trust doctors and other external authorities. And as you pointed out, those external authorities are failing us for various reasons. Almost always, I think, in the case of doctors, it’s not because of any ill will or malicious intent. It’s that they’re as much victims of the system as everybody else is. Even if they mean well, if you’re a primary care doctor seeing 25 or 30 patients a day, and you have a panel of 2500 patients, and your average appointment time is 10 to 12 minutes if you’re lucky, your hands are pretty tied. I mean, how many conversations are you going to be able to have with people about how are you eating, how are you sleeping, what’s your physical activity like, etc?
So there’s this big systemic problem. But let’s focus, because this is one of your things that you talk about in the book, on trusting yourself. How do you do that? If you’re a person who has no medical training, no science background, you’re intimidated by this sort of thing, and you have a sense that you’re not getting the full story from your doctor. You want to do something different, but you’re afraid. What would you say to that person?
Casey Means: So I think, well, two things. I think biggest picture, like this is, my favorite chapter of the book is chapter nine, which is called ‘Fearlessness: The Highest Level of Good Energy’, because it gets at what you’re talking about. People, I think, are afraid. We live in a culture that is disempowering and that makes us question our sanity when we have questions about our health, which I think is devastating. Of course, if you can disempower people to think that they’re quacks or sort of uppity if they’re questioning their doctor or questioning systems, if you can create that culture, then you get a lot of people who are really dependent and don’t want to be shunned from the tribe, so they fall in line and listen to everyone and listen to the systems, and that’s super profitable. So in that chapter, I think that examining some of those limiting beliefs head on is really a big part of the process. But fundamentally, when I think about trusting yourselves, I say, “Don’t trust your doctor, don’t trust influencers, don’t trust the science. Trust yourself.” I’m not saying that we should not go to the doctor and not take the doctor’s recommendations. I’m saying we shouldn’t take them as gospel without also tuning in to what our own bodies are telling us.
And the really beautiful thing about the time that we’re living right now is that I think there’s two amazing ways that we can all listen to our bodies. One is very analog and old school, and one is more high tech, but together, they can give us a lot of empowerment if we know how to use these tools well. The analog one is just sitting down and listening to your symptoms and your own bodies. Symptoms are a gift. I’m not the first person to have said that, but it’s so, so true. And that is a huge frame shift for a lot of people, because our culture has told us that symptoms are something that are intolerable and need to be squashed. When you walk into a CVS or a Walgreens, it’s hundreds of pills and bottles with the express purpose of hammering out your symptom when it crops up, so much so that the aisles are actually categorized by symptom type, like headache, rash, acid reflux. Headache, here’s an Advil, rash, here’s cortisone cream, [gastroesophageal reflux disease] (GERD), here’s an antacid. The idea that we get so brainwashed [with], from when we’re two years old walking into CVS with our parents, is if I have a symptom, it needs to be eliminated.
And to me that is so dark, because it’s a form of disembodying. It’s a form of telling our bodies, through both a chemical and also through our mindset, that it’s doing something wrong, when in fact symptoms are fundamentally the way our bodies are expressing that their needs are not getting met. And the Functional Medicine paradigm that was so revolutionary to me when I learned it was this very obvious statement that symptoms can’t arise out of thin air. They have to arise out of cellular dysfunction, because we’re made of cells. We’re entirely made of cells. So to be not feeling well, something needs to be dysfunctional in the system. If that’s the case, then we need to run through the list of what could be creating dysfunction. What are the modifiable things that could be creating dysfunction? Which is a short list. It’s like, how’s my food been? How’s my hydration been? How’s my sleep been? How’s my emotional health been? How’s my stress been? How’s my movement been? How’s my relationship with toxins been? How’s my relationship with light been? What medications have I been taking? Run through the list. And every time I have a symptom, if I run through the basic list, I can figure out 10 things that are ways that I have not been supporting the needs of my cells. Maybe I’ve been eating at restaurants too much and eating some seed oils because I’ve been kind of lax on my diet, or I haven’t been sleeping because I’ve been traveling, or I’ve been on social media too much, and I’m stressed out whatever it is.
So number one is listening to symptoms, seeing them as a gift, understanding they are a sign of your body not getting its needs met or being overwhelmed with too much that it cannot handle, and then going down the road to compassionately help change the environment for ourselves and see what happens with the symptoms. Basically curiosity, versus this sort of like terrorism towards our body of squashing anything that crops up. I’ll say one more thing about that, too. In our world, where many people profit off of our attention in our distraction industrial complex of social media and marketing and news and all of this stuff we are part of, I think the disembodiment from ourselves and listening to our bodies and symptoms is also that we are so freaking busy and we’ve bought into this busyness culture that we virtually cannot hear our bodies. I got so sick in my surgical residency because I was working 80 to 100 hours a week, constantly under stress, and all these things were arising in my body that I just did not stop to listen to. Then I got very, very sick with eight or nine separate symptoms and it took a long way to peel back. I could have saved so much time by just setting the boundaries in my life to listen when they were starting to talk, before they became blaring warning signs– [irritable bowel syndrome] (IBS), depression, severe acne, chronic pain, a lot of stuff that was not fun to deal with. And it was mostly because I was so busy and bought into that being a way of, in our culture, being valuable. The busier you are, the more valuable you are, which is a sick, distorted Western concept. Then you don’t listen to your symptoms. So slowing down is one of the ways we do this, which, of course, there’s some fears around that for many people that we need to examine.
The second piece of how to trust your body is technological, and I’ll just say briefly [that] we have tools now, basic tools like lab testing, going to the doctor’s office and getting lab tests or doing direct-to-consumer lab testing, and also the wearables that can give us some input on, essentially, a realistic perspective of what the inputs and the outputs are on some of our basic physiology. I think with the labs, if we know how to interpret five to 10 of the basic key fundamental health biomarkers and track them [and] choose to understand them, which I think anyone above a fifth grade education level can understand some of the basic biomarkers like glucose and triglycerides and hemoglobin A1C, it’s not rocket science. [But] understand them, take ownership of them, track them every three to four months, and maybe use a couple select wearables, not as a way to punish yourself but as a way to stay realistic about your lifestyle, together that can help you really understand [whether your] health journey [is] working for [you] or not. If you can track triglycerides, fasting glucose, hemoglobin A1C, there’s a couple others that I think are very valuable, every four months, and they stay in the optimal range or are moving towards the optimal range, you can cut through all that marketing noise and all the crazy confusion in the health space and say very confidently on your own two feet, “My choices are working for me,” or “My choices are not working for me and I had to make changes.” And I think that’s incredibly empowering in a system that literally profits off of our confusion. Get your baseline. Make some changes that focus on improving core foundational health. Recheck in three months. If they’re not getting better, you need to tweak a little bit and keep iterating on that for years. Ultimately, I think that helps us be an incredibly empowered patient who can, like we talked about in the beginning, trust ourselves.
Discover why chasing longevity might miss the point. Learn to optimize your health through metabolic mastery. This episode is essential for understanding the foundations of health with simple, effective lifestyle changes. #chriskresser #HealthOptimization #MetabolicHealth
Misalignment of Incentives
Chris Kresser: Let’s talk a little bit more about misalignment of incentives and how that relates to everything we’ve discussed so far. I think a lot of my longer term listeners will understand [this] from previous conversations, but [like] you said earlier, knowledge is power. In some sense it’s helpful to have a little bit of revolutionary mentality here. That might be too strong of a word, but if you understand how all the forces are combining to work against your best interests, then you might be more likely to advocate for yourself than if you think that the system is working in your favor. And I use the term “the system” very intentionally, because again, I think a lot of people like their primary care doctor. And sometimes what I’ve seen stand in the way of people waking up to this is that they think, “My doctor is a good person. They wouldn’t do anything that would be against my interests.” And again, I think if you’re looking at things on an individual basis, that’s true, but if you look at how all the incentives are aligned, that doctor is part of a system that is, by definition, working against your best interests. Even despite their best intentions, one person’s not going to be able to overcome that very successfully, at least if they’re part of that model.
So let’s talk a little bit about how those incentives are misaligned. The way I think about it is [that] we have exactly the healthcare (or sick care, depending on how you want to refer to it) system that you would expect us to have, given the way the incentives are aligned, or misaligned. There’s that Charlie Munger saying, “Show me the incentive, and I’ll show you the outcome.” That’s basically the whole story of our disease management system.
Casey Means: That is such a great quote [and it] pretty much sums it up. I wish I included that in the book. That’s so good. It’s really kind of the thesis. At the highest, highest level, I think the incentive that is important for people to recognize is that the healthcare system, as it stands right now, makes more money when patients are sick and it makes less money when patients are healthy. It is a business, and it’s a business designed to grow. So even though there are really good people in the system, that is the ultimate business model for hospitals and for clinics. [The] volume of procedures, of patient visits, [and the] speed of seeing people is ultimately what’s going to generate more revenue. Getting surgery for heart disease and atherosclerosis and heart blockage is going to be far more profitable for a hospital than a series of five or six intensive nutrition consultations or prescribing a medical diet which could reverse heart disease. The surgery does not reverse heart disease. The surgery where they crack your chest open and might put you on bypass and reroute [the] blood in your heart is a plumbing operation that may bill hundreds of thousands of dollars. But the nutrition, even though that is not incentivized, can actually reverse heart disease. So that’s kind of incredible when you think about [how] the incentives change what we focus on.
I think there’s been efforts to change that. With the Affordable Care Act and Obamacare a few years ago, there was [a] program that got put forward which was basically value-based care. Essentially, we are going to pay doctors more money if they have higher value care, and the value equation is better outcomes over lower cost. So this would ideally feed towards what I just talked about with nutrition coaching for someone with heart disease, because that is much, much lower cost but may have better outcomes. So that would be high on the value curve. And then you’d get doctors being reimbursed more by Centers for Medicaid services. So that sounds amazing on face value. Unfortunately, programs like this can still get corrupted by the influence of the pharmaceutical industry and other forces that profit from sick Americans. The way that got corrupted, and I tell this just as an illustrative example of how things even on face value that can be good can still kind of go wrong when the incentives are poor, was they had a program called [Munich Information Center for Protein Sequences] (MIPS) database. Basically it was hundreds of different quality metrics that different doctors could report on. Different specialties had different metrics they could report on, and if you could report on meeting these criteria, you were eligible for potentially more value-based reimbursement. But [if] you actually dig into this huge Excel spreadsheet that’s online to see what the criteria were, the way they defined good outcomes with doctors’ care and patients was, in many cases, how many patients in a doctor’s panel were on long-term, chronic medication therapy. In my mind, I would think about good outcomes for a patient as a patient who actually heals, a patient who gets better, a patient whose cells are functioning properly. But by this criteria, it was how many patients are medicated over the long-term. You get a situation in which a doctor can basically say that they’re practicing high value care by having all their patients medically compliant with medication, which is not a bad thing, but we could do so much better. Imagine if that doctor had been incentivized by those outcomes metrics to, hey, we’re going to pay you way more if this patient loses their diagnosis. The doctor would be scrambling to think about how to do that, and it would lead them to things like diet, lifestyle, sleep, stress management– the things that actually nudge the cells towards truly better function, which most medications don’t do.
So, fundamentally, I think at the high level, it’s a lot of those sorts of true financial incentives. Doctors bill based on RVUs, relative value units. The more RVUs they bill, which means the more patients they see and the more things they do, the more likely they’re going to get promoted, [and] the more likely their salary is going to be higher. That’s the reality. There’s other levels to it too, which I think are really interesting. One is, we wonder, “Well, why is all the crappy food so cheap?” And I know you think about this all the time with your passion for regenerative agriculture, but it’s incredible that our taxpayers are truly, literally paying for the subsidies that go into making these garbage foods that are making us so ill through our taxpayer funding of the farm bills. These farm bills are going towards almost exclusively commodity crops that get turned into ultra-processed foods. Corn, soy, [and] wheat that go into high fructose corn syrup and ultra-processed grains that are the backbone of ultra-processed food and fast food that are making us sick. So we’re not only paying for the farm bills that make the garbage food cheaper, we’re then paying the health care costs of Americans who are getting sick because of it. And of course the environmental devastation from these foods being grown with industrial agriculture practices.
Then you’ve got this whole other side of the issue, which is conflicts of interest in some of our largest federal agencies that control things like the USDA guidelines and what goes into our school lunch program. I think most people don’t realize that the USDA controls the school lunch program, which serves 3 billion meals to children per year. That is more meals than many fast food companies combined. The school lunch program is [basically] the largest fast food business in the country, federally funded. And the foods that are served are, ultimately, in part determined by what goes into the USDA guidelines for America. Well, the USDA guidelines for America from 2020 to 2025, 95 percent of people on the panel that made those guidelines were being paid by the processed food industry. Direct conflicts of interest. This is published. This is clearly reported. So there’s a huge interest misalignment and conflict of interest with the people making the food guidelines, and in the past few years, there’s been huge deals brokered between Kraft, Heinz, and the USDA school lunch program that’s making our kids in America sick. Kids are getting so sick in America right now.
So I would say, big picture, it’s incentives. It’s a lot of conflicts of interest. And I think it’s, frankly, a big issue with how a lot of our federal institutions and academic institutions are accepting money from private industries that have a vested interest in more sick patients. When I was at Stanford Medical School, they accepted a 3 million [dollar] grant from Pfizer to help redesign our curriculum. I just can’t imagine it wouldn’t have some impact on how we learn about pharmaceuticals. I can’t say for certain, but for sure if you’re getting $3 million from a pharmaceutical company, you’re not going to be telling every student that we should eliminate as many medications as humanly possible. Also, a huge amount of the [budgets for the] American Academy of Pediatrics, the American Diabetes Association, the FDA, and the NIH, 40 to 70 percent [of] some of these [are] coming from pharmaceutical companies and processed food companies. I think one thing that could really change things for the better would be if a federally funded organization or an academic institution is taking federal funding, and therefore should have the best interest of taxpayers in mind, they should probably not be allowed to accept so much money from industry.
We could go on and on, but there’s [stuff] at every level. I mean, 10 percent of the food assistance program, the largest food assistance program in America, SNAP, which is what helps low income families on food stamps, 10 percent is going straight to soda. We allow that. That’s crazy. That’s a direct, basically, money laundering of taxpayer money to Coca Cola and Pepsi. That’s crazy.
I think the last one I would mention, [and] we talk about all these in the book because I think it’s all just very fascinating, [is] mainstream media. The people who give us the news. 60 percent of their budget comes from [the pharmaceutical industry]. I think some people are under the illusion that, as the people watching TV, we’re the customer, but actually the advertisers are the customer. So that’s going to have an impact on the sheer news that we’re getting about what’s happening in our country and about health. This, of course, played out [during] COVID, where there was virtually not a single second on mainstream media about how Americans could improve their immune resilience or stay healthy through natural means. It was just essentially years of exclusive talk about pharmaceutical interventions, which of course had their place, but at the expense of talking about any natural habits. So there’s seven, eight, nine, 10 different factors there that are the rottenness of our system, that largely comes down to money creating a culture in which, again, doing the basic, simple habits seems almost like, “Why would we even talk about this? This is so much more complex than simple things could possibly impact. It’s so much bigger than that.” But in fact, the reality is that almost all our chronic diseases and symptoms are fundamentally rooted in metabolic dysfunction, and metabolic dysfunction can be easily understood and changed with simple habits. So we’re kind of living in a bizarro world right now, and I think the more of us talking about this and kind of blowing it up, the better. Because it’s tough to see what’s happening to so many Americans with their health right now across the lifespan.
Chris Kresser: Yeah, yeah. Another one of my favorite quotes that’s relevant here is from Upton Sinclair. He said, “It’s difficult to get someone to understand something when their salary is dependent on them not understanding it.” And going to your point about the sponsorship of Stanford and all the medical research that’s sponsored by big pharma, there have actually been studies done that have shown that influences the results. You probably didn’t really need to do those studies because it’s just common sense if you understand human nature, but we have those studies, and those studies have shown that research that’s sponsored by a particular interest is more likely to come to a conclusion that’s in favor of that interest. Don’t bite the hand that feeds you, right? It’s a pretty basic human principle.
Blood Markers and Practical Tips
Chris Kresser: So let’s finish up by talking about some practical take home tips from your book. This is something we can kind of focus in on a little bit, which I’m a big believer in as well, which is the basic blood markers that are most important for assessing metabolic health and mitochondrial function. And again, we’re not talking about anything crazy or esoteric. We’re talking about markers that are readily available [and] that your primary care doctor should be able to order. You can even order [them] yourself now through direct labs and things like that. And, with ChatGPT and other large language models, they’re not foolproof and I don’t recommend using them without any kind of other input or verification, but they can be helpful. If you’re someone who has zero training and zero understanding of this stuff, there are lots of ways that you can get help, even on your own, [with] understanding how to interpret these lab tests. And as time goes on, and when I [say] time goes on, I’m talking about in the months to come, there’s going to be more and more of these kinds of AI-based tools that can help with basic education and information about these tests. Not to replace a doctor, but to really give people some understanding of these tests, if you’re totally new to them.
Casey Means: Yeah, absolutely. For me, I think about lab testing in a basic, medium, and intense version. And I think that for everyone, the basics can get us a lot of the way there. Like you said, these are [ones] you can get from your primary care doctor. They’re super cheap, often covered by insurance, and they’re like our check engine light. Is there a problem? The ones that I consider in the basic category are essentially what make up the criteria for metabolic syndrome on the clinical level– things like fasting glucose, triglyceride, HDL cholesterol, hemoglobin A1C, waist circumference, and blood pressure. Altogether, those would be like 50 bucks probably out of pocket, and your doctor will be totally fine ordering them for you. Unfortunately, the way that doctors interpret these results is very algorithmic. If glucose is high, you need Metformin. If blood pressure is high, you need an ACE inhibitor. If your triglycerides are high, or if they do end up checking LDL, then you need a statin. It’s very, very algorithmic when, in fact, the way I would invite people to look at these tests and to understand them is really reading the tea leaves of what they’re saying about how our cells are working and how they’re processing energy properly.
For instance, if there is a problem with how our bodies are converting food to energy and we are having trouble taking food substrates out of the bloodstream into the cell and turning them into cellular energy, things are going to get backed up, and that’s going to look like fasting glucose going up in the bloodstream. Blood sugar is essentially being rejected from the cell because the mitochondria is so bogged down, and the cell is probably filled with problematic, toxic fats, and so the glucose is essentially left in the bloodstream. So, okay, if fasting blood sugar is going up, that’s a clear sign that there’s actually some problem inside the cell that’s going on. Then that glucose has to kind of go somewhere. We don’t want hugely high glucose levels, so a lot of that’s going to get converted to triglycerides. So if your fasting glucose is high and your triglycerides are high, those are two signs that there’s actually a backup at the level inside the cell, probably caused by the way our environment’s negatively impacting our mitochondria that can’t do its work.
Then you look at something like a hemoglobin A1C and it’s like, okay, well, that’s average glucose levels. And again, that tells us that if the glucose levels are higher for a long period of time, that’s sticking to hemoglobin [and] our hemoglobin A1C is going up. [It’s] another sign that somewhere inside the cell, we’re not actually converting energetic substrates like glucose to human energy. That’s a problem. How do we increase mitochondrial capacity?
Then you look at blood pressure, another one of the biomarkers. Well, what’s that telling us? People see these all in vacuums as separate things, but they’re actually all saying the same thing. When that glucose is rejected from the cell, the body responds with high insulin levels to try and drive glucose into the cells, that insulin is gonna block some of the chemicals in the bloodstream like nitric oxide that let our blood vessels dilate, so blood pressure goes up. All of these basic metabolic biomarkers [trace back] to, “Is my mitochondria doing its job properly or not?” And the way to actually hit all of them is [figuring out] how we build mitochondrial capacity through our daily choices, which gets into all the pillars we’ve talked about– the food, the sleep, the movement, the resistance training, removing toxins, all these things that are hurting our mitochondria. It’s just a different framework for looking at our labs that’s, I think, more empowering. It’s not just, “This is up, must bring down.” It’s like, “Let’s think about this holistically.” I recommend people getting [those tests done] every three to four months while they’re making changes to really see [whether] we [are] increasing mitochondrial capacity and bringing these numbers down or not. The standard ranges for those basic biomarkers, to be considered by the medical system metabolically healthy, although I argue we need slightly stricter ranges, is a fasting glucose less than 100, triglyceride less than 150, hemoglobin A1C less than 5.7 percent, HDL above 40 for men or 50 for women, blood pressure less than 120 over 80, and waist circumference less than 35 inches for women or 40 inches for men. If all those are true, [if] you’re in that criteria for all of those, you are part of a 6.8 percent of Americans who meet [the] criteria for being in the normal range for all of those. [It’s a] very small percentage of Americans. But the great news is that all of them can change in the course of [a few months]. I’ve seen every one of those biomarkers change a lot in one to two months for people who have made intensive lifestyle changes. So, that’s kind of the basics.
If we get into the more medium tier, your doctor may weirdly fight you about getting some of these tests. That’s when I’m looking at fasting insulin, [C-reactive protein] (CRP), which is an inflammatory marker, vitamin D, uric acid, liver function tests like [aspartate aminotransferase] (AST) and [alanine transaminase] (ALT) and [gamma-glutamyl transferase] (GGT), getting a richer, more comprehensive picture of our cellular health. And then, of course, the sky’s the limit with micronutrient testing and hormone testing and all sorts of stuff. But that basic and medium tier can give you astronomical information about foundationally how your body’s doing and is not very expensive. I would also add probably ApoB into there as well, which is a great cholesterol marker. But if you can commit to learning a bit about those, which [there are] so many resources out there do that [with]– my books, your books, others books in our space– we can have a much better grip on where we are on the spectrum of health or disease.
Chris Kresser: I love that. Very simple. And of course, [I] agree that these markers are signposts and indicators of what’s happening, not instructions for what medication to take, which is pretty much how they’re interpreted in the conventional medical paradigm. Like you said earlier, there are warning signs. There are yellow lights on the dashboard if they’re out of range, of course, or they’re a green light on the dashboard if things are going well overall.
This has been an amazing conversation, Casey. [I] really appreciate your work. Your book is Good Energy: The Surprising Connection Between Metabolism and Limitless Health. [I] highly recommend it. There’s so much good stuff in here for people who want to optimize their health but also want to optimize their life and live a good life– be happy, well adjusted, connected to themselves and others, and really pull that all together in a holistic way. Tell people where they can learn more about your book and also your work in general, if they’d like to stay connected to you.
Casey Means: Thanks, Chris. So, my website is kind of the hub of everything I do, and that’s CaseyMeans.com. All my social links are there. On Instagram I’m @DrCaseysKitchen, and I have a weekly or a biweekly newsletter called Good Energy Living, which is just tons and tons of information about being healthy and my latest thinking on things. And the book is everywhere books are sold– Amazon, Barnes and Noble, small bookstores, Bookshop.org, all over the place. [I] encourage people to check it out if they’re feeling like they need a jump start on their health journey.
Chris Kresser: Fantastic. Thanks everyone for listening. Keep sending your questions to ChrisKresser.com/PodcastQuestion, and we’ll see you next time.
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