The KEY SIGNS You're Not Healthy In Life & How To FIX IT! | Casey Means & Lewis Howes

Dr. Casey Means 0:00 It's not working.

Lewis Howes 0:01 Right.

Dr. Casey Means 0:01 We're getting sicker. Every single year we're getting sicker, we're getting fatter, and we're getting more depressed as a country. And I think the key problem with this is that-

Lewis Howes 0:10 I think you gotta have a dream The School of Greatness. Really? [laughs] Yeah. Please welcome Lewis Howes. You went from, I guess, being a doctor to saying, "Well, how can I help people in a holistic approach to preventing chronic illness and disease?" And, and I'm hearing you say that it starts with metabolic health, is that correct?

Dr. Casey Means 0:26 Yes.

Lewis Howes 0:26 So what is metabolic health then for people, and how can they optimize this?

Dr. Casey Means 0:32 Yeah. So, well, first of all, I think you hit the nail on the head. There is a movement and a tribe of doctors who are sort of waking up-

Lewis Howes 0:40 Mm-hmm

Dr. Casey Means 0:41 ... and realizing that we are missing the elephant in the room of modern American healthcare. And the elephant in the room is that, first of all, the vast majority of things that are killing Americans today are conditions based in our dietary and lifestyle choices over the course of our lifetime, which means that we have huge amount of agency in changing our fate-

Lewis Howes 1:04 Mm

Dr. Casey Means 1:04 ... in terms of these diseases.

Lewis Howes 1:06 How many diseases would you say are caused by food and nutrition alone or our diet?

Dr. Casey Means 1:11 Nine of the 10 leading causes of death in the United States are either not only just caused by food and lifestyle, but are directly attributable to dysfunctional blood sugar or are worsened by-

Lewis Howes 1:23 Wow

Dr. Casey Means 1:23 ... elevated blood sugar.

Lewis Howes 1:24 Really?

Dr. Casey Means 1:24 Nine of the 10.

Lewis Howes 1:25 What's the le- what's the 10th one?

Dr. Casey Means 1:26 [laughs] Well, to go through the ones that we're-

Lewis Howes 1:29 Yes

Dr. Casey Means 1:29 ... like, what we're talking about, so we're looking at things like, um, Alzheimer's dementia, which is now being called, called type three diabetes 'cause it's so related to blood sugar. Heart disease, type two diabetes. Cancer is very much driven by blood sugar. Um, chronic kidney disease, which is very much a problem of the small vessels in the kidney becoming narrowed in part because of metabolic dysfunction and erratic blood sugar control. Um, chronic lower respiratory infections of one of the leading causes of death, and we know that people with unstable elevated blood sugar have much higher mortality even with something like influenza or pneumonia.

Lewis Howes 2:07 Huh.

Dr. Casey Means 2:07 Having high blood sugar actually can get into the fluid of the lung and feed the bacteria that leads to some of these, um, issues. And of course with COVID, we've known now since the very beginning of the pandemic that having metabolic dysfunction diabetes, um, is a key accelerator and driver of mortality, um, and morbidity. There's some odd ones on there too. For instance, suicide is actually on the top 10 list of killers in the United States, and people with, uh, with diabetes or metabolic dysfunction actually have higher risk of suicidality.

Lewis Howes 2:39 Really?

Dr. Casey Means 2:39 So it's all across-

Lewis Howes 2:41 Huh

Dr. Casey Means 2:41 ... uh, the board. Um, and, and so, so what's really fascinating is, is the way in which, um, these, these dietary and lifestyle factors are essentially linking so many of the conditions that are killing Americans today.

Lewis Howes 2:57 Right.

Dr. Casey Means 2:57 And the way we've approached it is we've looked at these as all isolated silos. We think of them as all different things. Like, huh, we wouldn't treat diabetes the same way we treat cancer, um, or kidney disease the same way we treat Alzheimer's. But when we look at these through, um, the root cause approach that you talked about, and sort of the fancy term for this in medicine is systems and network of biology, what is the network between diseases rather than how are they all different?

Lewis Howes 3:22 Mm.

Dr. Casey Means 3:22 When we treat at that level, it's so much more efficient, and we can actually generate good health in the body as opposed to just reacting to symptoms and managing conditions. So I think that's what a lot of doctors are waking up to.

Lewis Howes 3:36 Mm.

Dr. Casey Means 3:36 They're sick and tired of being reactive, practicing sick care, practicing, you know, this end of the line medicine, and they wanna help generate health in people's bodies.

Lewis Howes 3:47 Wow. Interesting.

Dr. Casey Means 3:48 And that's a totally, um, different, different way of, of practicing.

Lewis Howes 3:53 Right. Yeah.

Dr. Casey Means 3:54 So...

Lewis Howes 3:54 That's inspiring. And so what I'm hearing you say is blood sugar management or control is one of the key factors of either being healthy or potentially linking to one of these other, I guess, diseases. Is that right?

Dr. Casey Means 4:07 That's right. Yeah. And, and what it really comes down to, which kinda gets at your question of what is metabolism, um, metabolism is fundamentally the way that we make energy-

Lewis Howes 4:17 Okay

Dr. Casey Means 4:17 ... in the body. So we eat food and, you know, food has, um, you know, fat and glucose in it, and either fat or glucose, glucose is sugar, can be used to convert into a type of energy that our cells can use, which is called ATP. So we take in this substrate, but we have to convert it through our mitochondria in our cells to a form of energy we can use-

Lewis Howes 4:40 Right

Dr. Casey Means 4:40 ... a currency that our body understands and can use. That process of conversion is metabolism, and this is happening in every single one of the 37 trillion cells in our body, and it has to work properly for-

Lewis Howes 4:54 So break, break it down for me then. Fat or glucose, uh, or I guess carbohydrates enters the body through the foods we're eating, right?

Dr. Casey Means 5:02 Yep.

Lewis Howes 5:02 What happens after that? How, how is it processed in the body through the cells, through the mitochondria? How is it processed?

Dr. Casey Means 5:09 Yeah. So looking at carbohydrates, for instance, um, they go into our digestive tract, they're broken down and absorbed into the bloodstream, broken down into simple sugars, um, like glucose and fructose. Um, these go into the bloodstream, and let's say we're talking about glucose, which is blood sugar. This signals to the body, um, particularly in, in, uh, a organ called the pancreas, to release insulin, which is a hormone. That hormone allows you to take that sugar out of the bloodstream through the cell membrane into the cell. Once it's inside the cell, um, it's broken down even further and then goes into the mitochondria, uh, to be go through a chemical processing that then creates ATP, which is this molecule that can be then used to essentially power all the millions of cellular processes that are happening every second. You can't-

Lewis Howes 5:57 So ATP is the power.

Dr. Casey Means 5:59 The power.

Lewis Howes 6:00 Is the fuel?

Dr. Casey Means 6:00 It's the fuel. It's the battery in our body.

Lewis Howes 6:02 Okay. And so the way it's processed is it's- Based on the foods we eat, whether it be fat or sugar that comes through, does that determine how the quality of the energy, or what does that mean within... Is it all equal or the same when it converts in ATP or...?

Dr. Casey Means 6:19 Well, I think the way to think about it is to really focus on the mitochondria.

Lewis Howes 6:22 Okay.

Dr. Casey Means 6:22 This is the energy factory of the cell. This is the powerhouse of the cell. And the thing that people really need to understand is that our diet and our lifestyle in the modern Western world, so past 50 to 100 years, so much of it is actually damaging the mitochondria of our cell and creating problems in that conversion process. So for instance, when we eat too much sugar, okay, and these days the average American-

Lewis Howes 6:48 Is eating a lot of sugar

Dr. Casey Means 6:49 ... like 100 times more than we were like 100 years ago and through the rest of human history.

Lewis Howes 6:53 Yeah.

Dr. Casey Means 6:53 It's like this massive overload of this substrate. What that does is it causes stress on the mitochondria and creates damage. And one analogy I sometimes use is, like imagine you had a factory that was making something like, like cheese. And like all of a sudden you get like 100 times more of like the raw product, like milk, delivered to the factory. Th- the workers would be like, "We don't know where to put this. We can't work." Like, they'd go on strike. There's nowhere to store it.

Lewis Howes 7:19 Mm.

Dr. Casey Means 7:19 There's no refrigerators. It would all go bad. All of a sudden you actually s- produce less cheese even though you have more substrate, you know?

Lewis Howes 7:26 Oh, interesting.

Dr. Casey Means 7:27 And so it's like we are giving so much of the substrate to the body that it's gumming up the system, it's breaking down the factory and creating problems. And the molecular way this is happening is that each time you have these glucose spikes from eating these refined products or added sugars, your body's releasing more of that insulin. It's saying, "Okay, more glucose in the bloodstream, so we have to release more insulin to get it out of the bloodstream." And over time the body sees all this insulin circulating and it's like, "We can't bring more of this into the cell. There's too much."

Lewis Howes 7:58 Wow.

Dr. Casey Means 7:58 And so it actually puts up a block, which is called insulin resistance, which is that cellular process that leads you towards problems like diabetes. And so what's happening now is the body-

Lewis Howes 8:08 And that's why you're storing fat or you're storing other dead cells that you don't need to keep in the body, I guess, right? Or...

Dr. Casey Means 8:13 Right. 'Cause insulin is the signal saying, "Tons of glucose around for energy, so we don't need to burn fat for energy." So insulin is also a block on fat burning. So it's this chemical signal-

Lewis Howes 8:23 Uh-huh

Dr. Casey Means 8:23 ... saying, "Too much glucose around," blocking it from getting into the cell, and also telling the body not to burn fat. So of course, for people who are dealing with, um, trouble losing weight, insulin is the hormone we, or hormone we really, really-

Lewis Howes 8:36 Okay

Dr. Casey Means 8:36 ... need to be, um, thinking about. And so we, we reduce our insulin sensitivity. Um, now we have lots of bl- cir- uh, glucose circulating in the bloodstream, but it's not able to efficiently get into the cell. And, um, and then you've got all these other things that can hurt our mit- our mitochondria. And, and really a mitochondria energy-centric view of health can really help us. Some other things that can hurt the mitochondria are oxidative stress. So I know you talked about this-

Lewis Howes 9:02 Mm-hmm

Dr. Casey Means 9:02 ... a little bit on the podcast with David Perlmutter, but, um, aside from glucose, eating too much fructose, so this comes with like sodas or fruit juice or things that have really high concentration of fructose, it's not gonna actually stimulate insulin in the way that glucose does, but what it does is it goes into the cell and it's converted into something called uric acid.

Lewis Howes 9:21 Mm-hmm.

Dr. Casey Means 9:21 And that uric acid creates oxidative stress, which is sort of this sort of damaging reactive molecule in the mitochondria and creates mitochondrial damage. So now, again, you've got more trouble processing energy in the mitochondria. Environmental toxins are actually a huge problem as well. They can directly damage the machinery or the mitochondria. So we're thinking about things like pesticides and a lot of the fragrances in our personal care products-

Lewis Howes 9:45 Mm

Dr. Casey Means 9:45 ... and a lot of the, the, you know, fragrances and chemicals in our home care products.

Lewis Howes 9:48 Mm-hmm.

Dr. Casey Means 9:49 These things actually go into our bodies, damage our mitochondria, make it difficult to-

Lewis Howes 9:53 Interesting

Dr. Casey Means 9:53 ... produce energy, um, effectively. Chronic stress can damage our mitochondria-

Lewis Howes 9:58 Sure

Dr. Casey Means 9:58 ... through cortisol and through our stress hormones. So it's, it's interesting to think about how all these different aspects of modern life fundamentally feed down into damaging this precious part of our cell that creates energy. And when we have-

Lewis Howes 10:13 The mitochondria

Dr. Casey Means 10:13 ... the mitochondria, and when we have problems creating energy in our body, this can happen in any cell type. Again, 37 trillion cells, you know, dozens of organs in the body. Where this is showing up most prominently in the body is where you're gonna see symptoms. And this is why metabolic dysfunction and blood sugar dysregulation can look like so many different things. It can masquerade as so many different symptoms. And in the conventional system we see those all as separate. But when we think about it as this is actually just where a fundamental core problem is showing up in different cell types, um, and so if you can address that, you can potentially kind of melt a lot of things away. So just as some concrete examples, if metabolic dysfunction is showing up in the blood vessels, well, if it's sort of most prominently showing up in the penis, that could look like erectile dysfunction.

Lewis Howes 11:04 Mm.

Dr. Casey Means 11:05 If it's happening in the heart, it could look like, you know, heart disease.

Lewis Howes 11:08 Wow.

Dr. Casey Means 11:09 Um, if it's happening in the liver, it could look like fatty liver disease. If it's happening in the ovaries, it could look like polycystic ovarian syndrome, which is the leading cause of infertility in the United States-

Lewis Howes 11:18 Wow

Dr. Casey Means 11:18 ... which is a metabolic problem. Um, and if it's happening in the brain, it could look like Alzheimer's dementia. And so it's got all these different faces-

Lewis Howes 11:26 Mm

Dr. Casey Means 11:27 ... but fundamentally is rooted in a core dysfunction in how our body is converting food to energy.

Lewis Howes 11:35 Mm.

Dr. Casey Means 11:35 And, and a lot of that has to do with this chronic overnutrition, overloading ourselves with too much to process, gumming up these systems, um, and then the many other lifestyle factors like toxins, stress, sleep deprivation, um, and sedentary behavior that can also hurt the mitochondria.

Lewis Howes 11:53 Right. So blood sugar management and metabolism management, is that right?

Dr. Casey Means 11:57 Mm-hmm.

Lewis Howes 11:57 So the main things we should be thinking about.

Dr. Casey Means 11:58 Yeah.

Lewis Howes 11:59 How does blood sugar and metabolism work together?

Dr. Casey Means 12:02 Yeah. So, so the way that those sort of things link up is that if your blood sugar is quite erratic, like let's say it's going up and down in big spikes and valleys-

Lewis Howes 12:11 Every day, yeah

Dr. Casey Means 12:11 ... every day.

Lewis Howes 12:11 You're having lots of sugar, you're, yeah, you're just eating poorly-

Dr. Casey Means 12:15 Yeah

Lewis Howes 12:15 ... you're stressed, you're overwhelmed.

Dr. Casey Means 12:16 Yeah. And, and- The majority of foods on the shelves in our grocery stores now have added sugar, like well over 60%. So it's not unusual for an American to be on that blood sugar rollercoaster up, down, up, down, up, down, and that's called glycemic variability.

Lewis Howes 12:32 Mm-hmm.

Dr. Casey Means 12:32 And that process of glycemic variability is very damaging to our metabolism through the, through the mechanisms, you know, we spoke about of causing insulin resistance by stressing the body to make too much insulin over and over. But that, those high blood sugar spikes in their own right, um, can cause damage as well. When your blood sugar acutely goes really high, like after eating a Pop-Tart or eating a pastry or something like that, or a big bowl of pasta, that spike can lead to inflammation. It can lead to oxidative stress, um, because of the way that it's overwhelming our systems and creating free radicals. It can also cause a, a process called glycation-

Lewis Howes 13:13 Hmm

Dr. Casey Means 13:13 ... which is where sugar sticks to things in the body. Um, and so if you, if you can imagine, if your concentration of blood sugar is really high, it's kinda gonna just stick to things more-

Lewis Howes 13:23 Right

Dr. Casey Means 13:23 ... like your blood vessels and proteins, and that's not good. That, that, that's like a signal for the body that something's wrong. And so, um, all of these things kind of coalesce to just creating problems. So the more that we can minimize our glycemic variability and go from spikes and valleys to more gentle rolling hills-

Lewis Howes 13:43 Hmm

Dr. Casey Means 13:43 ... the better we are, the better we're going to basically be treating, uh, our cells. And it's not just, um, it's not just the sort of, like, cellular optimization we're trying to do. It's also the way you, you feel. I think a lot of us have had that experience where we have a really high-carb meal, a big dessert, and we feel like we kind of have a crash afterwards. It's like that post-meal crash. We feel lethargic, like we may need to have another cup of coffee or, or even feel jittery after it.

Lewis Howes 14:11 Hmm.

Dr. Casey Means 14:11 Like a big high-carb meal. Um, that's... We really understand how that works. The body sees a huge load of glucose from a high-carb meal. The body then surges out that insulin-

Lewis Howes 14:23 Mm-hmm

Dr. Casey Means 14:23 ... overcompensate, soaks up all that glucose, and you crash. And in that crash state is when we feel fatigue, it's potentially some anxiety, and it's when people usually feel cravings. So by learning-

Lewis Howes 14:36 You want more when you crash

Dr. Casey Means 14:37 ... you want more to bring yourself back up 'cause you've kind of crashed.

Lewis Howes 14:41 So it's just up and down. Up and-

Dr. Casey Means 14:42 And then you're on the vicious cycle

Lewis Howes 14:43 ... yeah.

Dr. Casey Means 14:43 And I think the majority of American bodies are on that cycle 'cause you think about what we eat. It's like breakfast, it's cereal, juice, toast-

Lewis Howes 14:51 Mm

Dr. Casey Means 14:51 ... Pop-Tarts, pastries, you know, sweetened coffee beverages. That's all refined sugar and refined grains. Then you go to lunch, and it's bread, tortillas, wraps, chips, you know, all of that stuff. And then you go to dinner, pasta, potatoes, whatever, and then it's, and then it's dessert. And it's like if you're not... If you're just going along the normal American cultural treadmill of what's normal to eat, you're on a glucose rollercoaster.

Lewis Howes 15:16 Mm-hmm.

Dr. Casey Means 15:16 And that means that your day might be highly labile in terms of the energy, uh, mood, performance, cravings. And so learning just simple ways to, to balance out that glucose rollercoaster can be an amazing life hack and really a superpower for essentially getting your day under better control-

Lewis Howes 15:36 Mm-hmm

Dr. Casey Means 15:36 ... making you feel better in the moment-

Lewis Howes 15:39 Yes

Dr. Casey Means 15:39 ... and of course, creating the cellular conditions to set you up for long-term-

Lewis Howes 15:45 Right

Dr. Casey Means 15:45 ... longevity and health and prevent that whole downstream insulin resistance cascade that we know is related to so many causes of-

Lewis Howes 15:54 Sure

Dr. Casey Means 15:54 ... death in the United States.

Lewis Howes 15:56 So let's, let's speak to people that are listening or watching who maybe have active lifestyles, they like to work out, so they need energy for working out. They're driven, they're passionate in their careers or entrepreneurship. Um, they have a lot of friends and activities they like to go to, so they need energy throughout the day. How can they get the energy, uh, without the glucose rollercoaster happening? What are the best foods to be eating throughout the day? How many times should we be eating? And does it really matter, or does it really depend on each individual's body type?

Dr. Casey Means 16:30 Hmm. Yeah. So I think for the type of person you're describing, the key concept we wanna think about is achieving metabolic flexibility.

Lewis Howes 16:39 Okay.

Dr. Casey Means 16:40 So metabolic flexibility means that we are able to use different forms of energy to make, you know, ATP based on what's available. And what I mean by that is if there's sugar around, we can efficiently burn sugar to make ATP, but if there's not, the body's fine. It's like-

Lewis Howes 16:58 Hmm

Dr. Casey Means 16:58 ... cool, we've got fat to use-

Lewis Howes 17:00 To burn, yeah

Dr. Casey Means 17:00 ... for energy. The average person is not metabolically flexible, and the reason is because they've been on the glucose rollercoaster. Their body is so used to seeing glucose that those pathways are super a- active.

Lewis Howes 17:13 Mm-hmm.

Dr. Casey Means 17:13 Um, and they're constantly on that sort of like craving hit. They want more of it. They haven't really given their... Because glucose is the preferential f- fuel the body will use, it's the first thing it's gonna grab. It's kind of like that easier thing to, um, to use. It will never go and burn fat if there's glucose or it will not burn significant amounts of fat if there's glucose readily avail- available.

Lewis Howes 17:39 Mm-hmm.

Dr. Casey Means 17:39 So something that we can do i- to essentially train our bodies is to give it opportunities to burn fat. So this is where you start thinking about things like time-restricted feast- feeding or fasting or potentially doing a fasted workout where you're actually kind of intentionally keeping your blood sugar levels in the low-normal range, signaling to... And of, and of course, the downstream effect of that it's gonna be insulin will be low. 'Cause if you're not having a glucose spike, then insulin will be low, and that insulin being low takes away that signal to not burn fat. So now your body's like, "Cool. Insulin's low. Glucose is low. I'm gonna tap into my fat stores."

Lewis Howes 18:16 So that's when it starts to burn the fat.

Dr. Casey Means 18:17 Exactly.

Lewis Howes 18:18 Interesting.

Dr. Casey Means 18:18 Exactly. And s-

Lewis Howes 18:19 So if you work out for, in the morning without eating- You're more likely to be burning fat. Is that what I'm hearing you say?

Dr. Casey Means 18:24 That's right. And there's actually a lot of athletes that are using this type of metabolic science to their advan- advantage. There's a, a whole community of endurance athletes now-

Lewis Howes 18:32 Mm-hmm

Dr. Casey Means 18:32 ... that are doing low carb training, and the purpose of that is that they don't wanna be super dependent on glucose during their event, where they're just like every half hour having to take a goo or a bar or an energy drink or something like that and have these big spikes throughout their event. Instead, they've actually trained their bodies to use fat during an endurance workout.

Lewis Howes 18:55 Mm-hmm.

Dr. Casey Means 18:56 And there are literally marathoners now who will run the entire thing fasted-

Lewis Howes 19:02 Really?

Dr. Casey Means 19:02 ... 'cause they can so efficiently burn fat. But that's not, th- th- those pathways have to be kind of worked and developed-

Lewis Howes 19:10 Trained

Dr. Casey Means 19:10 ... to be able to do that.

Lewis Howes 19:11 How do you-

Dr. Casey Means 19:11 And that's metabolic flexibility

Lewis Howes 19:12 ... flexibility. So how do you train metabolic flexibility for yourself?

Dr. Casey Means 19:16 I would say the key thing is to minimize these excessive glucose spikes, to give your body an opportunity to be more in the stable, healthy, low range for more time of the day, to keep insulin in a lower and healthy range so that your body knows to burn fat. One way that you can do this, um, you know, is of course with a continuous glucose monitor. You can, which are becoming popular now, wear it, see what spikes your glucose, modify it, and, and try and get to a more stable range.

Lewis Howes 19:46 Interesting.

Dr. Casey Means 19:47 Or measure your ketones, which a lot of people are doing now. And this is, um, a finger prick device or there are breath monitors. You can also check in your urine. And ketones are a byproduct of fat burning, so if your ketones are super low or zero, it means you're not burning really any fat. And if your ketones are higher, like above .5 or up into the ones and twos, you are proving to yourself that you have got into a state where your glucose and insulin are essentially stable enough that you're burning fat for energy.

Lewis Howes 20:17 Mm-hmm.

Dr. Casey Means 20:18 And so something I like to see if I'm tracking these things is, okay, if I've kept my glucose quite stable and low for a couple days based on the choices I'm making around diet and lifestyle, I start to see ketones rising up, and that to me is proof of metabolic flexibility.

Lewis Howes 20:34 Mm.

Dr. Casey Means 20:34 And I can test things like, okay, if I do the Peloton ride first thing in the morning after not eating, does it increase my ketones later in the day, and start to do some experiments, um, like that. And another thing that people can do is ask their doctor to do a fasting insulin test. Um, it's not a test that's normally done on a regular yearly panel, but it's a really powerful test because, again, if insulin is quite elevated, it's gonna be kind of that block on fat burning. And if insulin is a low and healthy range, it's a signal that your body's probably likely very insulin sensitive.

Lewis Howes 21:07 Yeah.

Dr. Casey Means 21:07 You're not far down that insulin resistance pathway. I like to see it between about two and six.

Lewis Howes 21:12 Mm.

Dr. Casey Means 21:13 And shockingly, the reference range in a lot of labs will say that like anything under 25 is normal, but that would be very, very, very elevated.

Lewis Howes 21:21 Sure.

Dr. Casey Means 21:21 And so you want it to be tight and low to know that you're just giving your body that opportunity to, to burn fat-

Lewis Howes 21:28 Sure

Dr. Casey Means 21:28 ... and to work those different pathways.

Lewis Howes 21:30 So many people are talking about fasting or, or intermittent fasting these days. Is it different for men and women on the ways to fast in order to burn fat, or is it the same for both?

Dr. Casey Means 21:41 You know, I would say it's different for every single person.

Lewis Howes 21:43 Sure.

Dr. Casey Means 21:44 Even, you know, and definitely for, for different genders, but, um, it's, it's different day to day. You know, I think in- intermittent fasting and time restricted feeding is a str- it can be a stress on the body, you know?

Lewis Howes 21:57 Mm-hmm.

Dr. Casey Means 21:57 And so n- I, I tend to think of it as, you know, we've got a certain capacity within the body to manage different stressors, and we know that certain stressors can be helpful in building adaptations in the body to help us improve, so like cold exposure, heat exposure, fasting, um, high intensity interval training.

Lewis Howes 22:16 Mm-hmm.

Dr. Casey Means 22:17 Um, but there's also stressors in our life that are maybe somewhat out of our control, like work stress or family stress or things like that. Um, and we don't wanna overload our body.

Lewis Howes 22:29 Right.

Dr. Casey Means 22:29 And so, you know, if a woman is pot- po- potentially in a part of her cycle, for instance-

Lewis Howes 22:35 Sure

Dr. Casey Means 22:35 ... where her body's also already quite taxed, um-

Lewis Howes 22:39 You wouldn't do it then

Dr. Casey Means 22:39 ... you wouldn't do it then. And on a day that I'm, I don't have as much sleep, on a day that, you know, I might be doing a big podcast [laughs] or something like that-

Lewis Howes 22:47 Right, right

Dr. Casey Means 22:47 ... like today, you know, I'm probably-

Lewis Howes 22:49 You're not fasting

Dr. Casey Means 22:49 ... not gonna add, you know, um... I'm gonna be thinking very deeply about food though, because you also don't wanna be eating a big meal and then crashing, right?

Lewis Howes 22:57 Right.

Dr. Casey Means 22:57 During that time when you have to perform. So it's more about keeping things, keeping things really stable and not-

Lewis Howes 23:02 Mm-hmm

Dr. Casey Means 23:02 ... being highly fluctu- you know, fluctuating. Um, so I think about it more that way. I think that fasting is great if you're otherwise very well resourced, um, with sleep, um, with resilience, psychological resilience, um, not putting your body probably under intense physical stress during that time. I tend to do more like zone two workouts, you know, sort of low intensity during fasts, um, so as not to add too much stress.

Lewis Howes 23:29 Stress to the body, yeah.

Dr. Casey Means 23:30 A- and ultimately too much stress can lead to breakdown.

Lewis Howes 23:33 Really?

Dr. Casey Means 23:33 And so kinda like bringing those things, just thinking of everything in a really holistic picture.

Lewis Howes 23:38 If you stress the body too much, does the blood sugar go up, or what does that do to blood sugar and metabolism?

Dr. Casey Means 23:44 Yeah. Stress is, has a fascinating relation with blood sugar. So psychological or physical stress can both cause blood sugar to acutely go up, even if you're fasted, even in the absence of any glucose.

Lewis Howes 23:57 Really?

Dr. Casey Means 23:58 And the reason for this is that any stress signal to the body will release stress hormones like cortisol and catecholamine, like, um, noradrenaline, epinephrine, things like that. These signal to the body that there's a threat, and the body has trouble interpreting the difference between a physical or a psychological threat. And so it's gonna produce the same stress hormones.

Lewis Howes 24:19 So if there's an event that happens in life, let's call it something we witness or something we see or something we hear or experience- We think of a thing that causes a stress hormone to go to the body. Is that what I'm hearing you say?

Dr. Casey Means 24:33 Yes.

Lewis Howes 24:33 There's a thought that we have associated with the event or the stressful or the thing that we think is stressful.

Dr. Casey Means 24:39 Yes.

Lewis Howes 24:40 And then that causes a stress hormone-

Dr. Casey Means 24:42 Yes

Lewis Howes 24:42 ... to enter the body. Does it go throughout the entire body? Does it go to the heart? What, what happens? And then does it just spike the blood sugar up?

Dr. Casey Means 24:50 No. Exactly. So it, it, it goes to the whole body. And I would say, simply put, in many ways our mind has huge control over our metabolism.

Lewis Howes 24:59 That's what it sounds like.

Dr. Casey Means 25:00 Yes. And-

Lewis Howes 25:00 'Cause we can think a thought and stress ourselves out and have high blood sugar just based on thought alone.

Dr. Casey Means 25:06 You can think your way into metabolic dysfunction, I think. That-

Lewis Howes 25:09 Well, then can you think your way out of it, too?

Dr. Casey Means 25:11 Y- In, in, in some ways you can, and it, it should be a part of our strategy for optimal metabolic health. So the way it works is that, um, these stress hormones, they travel throughout the body, and they actually tell the liver, "We've got a threat. There's a lion chasing us."

Lewis Howes 25:28 Mm.

Dr. Casey Means 25:29 "We need to run. We need to have fuel for our muscles so that we can flee." You know, it's fight or flight.

Lewis Howes 25:34 Mm-hmm.

Dr. Casey Means 25:35 So the liver actually stores about two hours of really quickly accessible glucose in the form of something called-

Lewis Howes 25:41 Ah

Dr. Casey Means 25:41 ... glycogen. It's change of glucose. And it's, it's like our debit account. It's short-term, it's ready to go, but it's only a couple hours worth, okay? So you've got your circulating, and then you've got your stored glucose.

Lewis Howes 25:50 Stored in the liver, like, all the time?

Dr. Casey Means 25:51 All the time, yeah.

Lewis Howes 25:52 Unless you burn it for those two hours, then it's-

Dr. Casey Means 25:54 Exactly. It depletes

Lewis Howes 25:55 ... gone

Dr. Casey Means 25:55 And you deplete your liver glycogen. So that hormone says, "Dump it." So you flood the sh- the bloodstream with blood sugar to feed the muscles. And you can imagine if you are doing a high-intensity interval training workout and go to 90% of your VO2 max in, like, five seconds, that is a stress signal, but you're gonna use that glucose. Your body's actually... So you're gonna see that rapid spike. And it's actually fascinating to see on a continuous glucose monitor.

Lewis Howes 26:20 Mm.

Dr. Casey Means 26:20 Like, I will do a sprint workout or, you know, a CrossFit workout, and it's like within two minutes my glucose is going up. And c- it can look like a big food spike, but the muscles are there using it. And the really cool thing about muscle is that it's one of the only cell types in the body that doesn't need insulin to take up glucose. So it actually can just take it up from the contraction. So it's not like it's really feeding into-

Lewis Howes 26:44 Mm

Dr. Casey Means 26:44 ... that pathway of insulin resistance like we were talking about.

Lewis Howes 26:46 Mm.

Dr. Casey Means 26:46 Like, it's a sink for that glucose. So there's a supply, um, sort of use match, which is good. But when you think about psychological stress, you're literally just like, you're sitting in your chair, you're on your computer, you get an email that's stressful.

Lewis Howes 26:59 And you're like, how are we reacting to it?

Dr. Casey Means 27:01 Your body has that spike, but you're-

Lewis Howes 27:03 Isn't that crazy?

Dr. Casey Means 27:03 ... not moving.

Lewis Howes 27:04 Isn't that crazy?

Dr. Casey Means 27:05 Yeah. You're not using those muscles. It's just sitting there causing damage. And you can think about, like, we're doing this probably 100 times a day in our regular life.

Lewis Howes 27:13 Like we're ruminating on something from the past-

Dr. Casey Means 27:15 Yeah

Lewis Howes 27:15 ... or stressing about something in the future or reacting to, you know, the news or whatever it might be that we can react to. That... How much of the psychological aspect is related to the disease in our life versus just the straight food itself without the psychological, I guess, thoughts that come with it?

Dr. Casey Means 27:37 You know, I think it's so multifactorial. I, I always really say I, I think that food is the foundation.

Lewis Howes 27:43 Mm-hmm.

Dr. Casey Means 27:43 You know, food is the substrate. Food is both what physically builds our bodies, and it's also the molecular information that tells our body how to function. We eat about one metric ton of food per year, two to three pounds per day. This is just straight up-

Lewis Howes 28:03 Mm-hmm

Dr. Casey Means 28:03 ... chemical information that builds our body-

Lewis Howes 28:06 Wow

Dr. Casey Means 28:06 ... and tells our body what to do. You know, we're turning over constantly. The, the body we have today is not the same body we have in a week from a physical-

Lewis Howes 28:13 Mm-hmm

Dr. Casey Means 28:13 ... atomic perspective.

Lewis Howes 28:14 Mm-hmm.

Dr. Casey Means 28:14 We're shape-shifters. We're constantly changing. So food is, it's incredible. It's magical. It's this incredible thing that we're just constantly transmuting into ourselves. And so it's, it's go- we gotta get that right. But while it's necessary, it's not sufficient for optimal health.

Lewis Howes 28:33 Mm-hmm.

Dr. Casey Means 28:33 You've still gotta dial in the other, the other factors. And when I really think about the pillars, I'm thinking about seven things. I'm thinking about food. I'm thinking about stress management, exercise, sleep, our micronutrient status. So not just, like, the macros we're getting, but what are the actual micronutrients, vitamins, minerals, and antioxidants? Our microbiome, how that's doing, and then our exposure to environmental toxins. So yes, while food is the foundation, you've really, you know, gotta get those other d- things dialed in. Any one of those things can shift you off course.

Lewis Howes 29:10 So you said food, stress, exercise, sleep, macronutrients?

Dr. Casey Means 29:13 Micronutrients.

Lewis Howes 29:14 Micronutrients.

Dr. Casey Means 29:15 Which we often overlook.

Lewis Howes 29:17 Okay. What are those?

Dr. Casey Means 29:18 This is all the vitamins, minerals, and antioxidants-

Lewis Howes 29:20 Gotcha

Dr. Casey Means 29:20 ... that come from whole foods. So, like, things we don't often think about, like manganese and selenium and vitamin C and-

Lewis Howes 29:28 Mm-hmm

Dr. Casey Means 29:28 ... um, polyphenols and all, h- you know, trace minerals like chromium, um, that actually... You know, they come from whole foods, and unfortunately because our soils are becoming super depleted now because of our industrial agriculture practices and because of overuse of pesticides that are really hurting our soils, the n- the nutrient composition of our food is declining.

Lewis Howes 29:53 Right.

Dr. Casey Means 29:53 And we're eating less whole foods. But when we think about metabolism and the mitochondria, again, so your mitochondria is filled with all these little enzymes, these little protein enzymes that are essentially doing the work. They are the, they are the, um, factory line that's taking that food and converting it to ATP. And every single one of those amazing little protein machines needs these micronutrients to actually work.

Lewis Howes 30:17 Gotcha.

Dr. Casey Means 30:17 And the way to think about it is they are lock and keys that bind into little pockets of these enzymes and create tiny, tiny structural changes that actually make it work.

Lewis Howes 30:29 Mm.

Dr. Casey Means 30:29 So if we're deficient in selenium or magnesium or manganese or zinc or whatever it is- These aren't working properly, and the majority of Americans are deficient in at least one critical micronutrient-

Lewis Howes 30:41 Right

Dr. Casey Means 30:41 ... 'cause we're just, we're not eating real food.

Lewis Howes 30:43 Right.

Dr. Casey Means 30:43 Um, and because stress can actually deplete a lot of these-

Lewis Howes 30:47 Sure

Dr. Casey Means 30:47 ... chemicals. So, you know, I really think about... I, it all goes back to thinking about those molecular machines that are converting food to energy and what they need to function properly, and micronutrients is, is a big one.

Lewis Howes 31:00 I've also heard, uh, examples of people who, let's say, eat perfectly but still have challenges.

Dr. Casey Means 31:07 Yeah.

Lewis Howes 31:08 Maybe their relationships are off, and they're in a stressful environment in their relationship or their marriage or whatever it might be, or they just react poorly. They worry often to things they see and experience. They're a worrier, and so every time they worry, there's a, I guess a stress hormone is spiking, right? And sending hormones to the body which is spiking blood levels. Is that right?

Dr. Casey Means 31:29 Yeah.

Lewis Howes 31:29 Blood sugar. So it sounds like the psychological side of things is also extremely important to understand, and that every time you're un- you're allowing your body or your mind to ruminate-

Dr. Casey Means 31:41 Mm

Lewis Howes 31:41 ... on a consistent basis, it's sending a signal to the body in a negative way, which is helpful if there's a real-life threat, but not when it's a, on a repeat every day. Is that right?

Dr. Casey Means 31:51 That's exactly right. It's, it's that chronic lo- low-grade stress that can be really damaging, and-

Lewis Howes 31:56 Mm-hmm

Dr. Casey Means 31:56 ... there's... You know, something that's been really fun to experiment with is, you know, there's now heart rate variability monitors-

Lewis Howes 32:03 Huh

Dr. Casey Means 32:03 ... um, like Oura Ring or Whoop or Leaf Therapeutics, and what these do is heart rate variability is a metric that you can track that looks at actually the time between each heartbeat. And oddly enough, we want the time between each heartbeat to actually not be consistent like a metronome.

Lewis Howes 32:20 Hmm.

Dr. Casey Means 32:20 We want it to have some variability.

Lewis Howes 32:21 Really?

Dr. Casey Means 32:22 Yeah, like-

Lewis Howes 32:22 Why?

Dr. Casey Means 32:23 ... maybe .7 seconds and then one point... I'm sorry, .7, yeah, seconds, 1.1 second, .9 seconds. That's variability.

Lewis Howes 32:31 Why do we want that?

Dr. Casey Means 32:32 It really is a symbol of a dynamic system. You know, you want elasticity in the system, and that can sometimes have some ir- irregularity to it. Um, sort of the, the way I kinda think about it is like a stiffer system is gonna be a little bit more, more regular, and there's sort of that... And it's v- these are subtle. You know, it's not like you can feel it in your pulse if you just feel your pulse, but you can pick it up. And so we want more heart rate variability, and usually less, lower heart rate variability is an objective measure of stress. And I've worn these things and been giving a talk on Zoom or something like that, and I'm looking at my, my data afterwards, and my heart rate variability plummeted during the talk, or I'm processing email. My heart rate variability goes down. So using t- and then of course glucose may go up. And so you see these things-

Lewis Howes 33:17 Huh

Dr. Casey Means 33:17 ... happening together, and the immediate thing I think is this is where our tools come in. This is where the deep diaphragmatic breath, where the mindfulness, where having awareness of this happening-

Lewis Howes 33:29 Hmm

Dr. Casey Means 33:29 ... and then there are so many things we can do to modify that stress response, even telling your body, "You're safe," you know?

Lewis Howes 33:37 Sure.

Dr. Casey Means 33:37 "Everything is actually okay," can have a, a huge difference, so really dialing into awareness and then where can I apply the tool. So I would say I take about 100 times more diaphragmatic breaths now than I did a couple years ago because I realized, wow, if this is happening all the time throughout the day without my awareness, that's gonna add up over the next 30, 40, 50 years-

Lewis Howes 33:59 Right

Dr. Casey Means 33:59 ... and have a huge impact. But it, it's not actually just the chronic low-grade stress. There's been a lot of research showing that acute traumatic events, um, like, you know, loss of a loved one or divorce or childhood events, so, um, adverse childhood events which are usually... There's an acronym, ACES. Um, people who have many of these tend to actually have worse metabolic health.

Lewis Howes 34:23 Wow.

Dr. Casey Means 34:23 And this actually may be related to changes in the brain that affect metabolism, so really changing sort of our set point for stress thresholds early on in life. And so, so sometimes we'll have that patient like you talked about who's doing everything right. They're eating really healthy, but they're just really not quite making that progress-

Lewis Howes 34:41 Uh-huh

Dr. Casey Means 34:41 ... towards the gradient they want. And a lot of those patients I'm thinking about what is, like, the deep core wounds and the-

Lewis Howes 34:50 [sighs]

Dr. Casey Means 34:50 ... what's the set point that's causing you to feel that this world is not a safe place, that is causing you to be inherently hypervigilant. Um, and doing that work even on myself has been so positive because I think what you start to unpack as you go down that journey, um, is that your perception of the world and whether it's safe is very much dictated by your lifetime of experience. And, um, I think for those of us who have been on a journey of, like, therapy, and now people are very interested in, of course, how psychedelics can fit into this. And then, you know, other modalities, um, you know, w- long-term meditation, you know, lo-

Lewis Howes 35:28 Hmm

Dr. Casey Means 35:28 ... deep meditation events and things like this that can really unwind some of those kind of amygdala-based-

Lewis Howes 35:35 Right

Dr. Casey Means 35:35 ... fear-based responses in the brain. I think there's huge potential there for that to potentially, like, unlock, um, a new level of health because what it's doing is changing the fundamental way you see the world-

Lewis Howes 35:48 Hmm

Dr. Casey Means 35:48 ... as a place of threat, um, or a place of safety. And unfortunately, I think in our modern world, fear has become a currency that we've used to, to profit in a lot of ways. If we can get people to, to be fearful, we can get them coming back for information that assuages that fear, and we see that with social media. S- we see it with the news. You know, there was that undercover, uh, reporting of, of one of the, uh, CNN executives who, who said, you know, was recorded saying, "If it bleeds, it leads."

Lewis Howes 36:21 Hmm.

Dr. Casey Means 36:21 You know, that we need to get people fearful for them to come back and watch. And what that's doing to our stress hormones, to our brain set point, to our desire to have dopamine stimulation to kind of get some pleasure in the face of all this fear, the way that's affecting our cellular biology is profound. And so, you know, I think- All of this movement that we're seeing right now towards helping people, towards normalizing mental health care-

Lewis Howes 36:47 Mm

Dr. Casey Means 36:47 ... normalizing, you know, psychedelic use is not an end all be all, but I think it's interesting how that's now being talked about as a way to really help-

Lewis Howes 36:54 Sure

Dr. Casey Means 36:54 ... help people unlock some of this chronic, um, you know, fear. I think it's gonna have, you know, but could have positive impacts on the body 'cause if we're living with chronic fear-

Lewis Howes 37:04 Phew

Dr. Casey Means 37:04 ... our bodies are not functioning properly-

Lewis Howes 37:06 Ooh

Dr. Casey Means 37:06 ... and many of us are.

Lewis Howes 37:09 Did you live with chronic fear for a while?

Dr. Casey Means 37:12 I think that the, the healthcare system, the conventional healthcare system unfortunately uses fear as a way to, to control patients in a lot of ways. Um, we... You think about a conversation between a physician and a patient, and it's like, "You know, your cholesterol's a little high. You need to take a statin." And the patient might say, "Well, can I have some time to like, work on diet and lifestyle?" "Well, I mean, it's your choice. I mean, I'd recommend the statin right now 'cause obviously I don't want you to have a heart attack."

Lewis Howes 37:54 Right.

Dr. Casey Means 37:54 "But like, you know, y- sure, if you wanna try diet and lifestyle." Like, that's the type of thing that's happening every day. Like, where this fear of bad outcomes, um, is I think driving very much a pharmaceutical and invasive intervention type of strategy. Um, and I think, I think that that really was unsavory to me because it's very disempowered. It's like, "If I can drive fear in a patient, then I can essentially get them to do what enter- any- whatever intervention-

Lewis Howes 38:27 Wow

Dr. Casey Means 38:27 ... I recommend." And as a surgeon-

Lewis Howes 38:29 Medicines, procedures, anything

Dr. Casey Means 38:31 ... right. Exactly. You know, "Oh, well, if we, if we don't treat this ear infection with antibiotics, then it could travel to the brain and create a brain infection."

Lewis Howes 38:40 Oh, man.

Dr. Casey Means 38:40 And it's like most ear infections resolve on their own without antibiotics, and overuse of antibiotics is causing huge, huge problems with our gut, which then leads to mental health issues and metabolic problems. And it's like, but if people are scared of the potential, you know, outcome that may be very rare, then of course you can kinda get them to do stuff. And, and I think that, I don't think that doctors are intentionally doing this. I think we have an incentive system in Western healthcare-

Lewis Howes 39:06 Mm

Dr. Casey Means 39:06 ... that really drives people towards intervention. Um, but I think that, you know, I, I also think that with COVID we saw this happen where, you know, this fear of, you know, anyone, you know, being harmed from COVID or, you know, that we, we, you know, kind of got people to do anything and everything. And, and we're kind of losing this, um, we're losing kind of that rational sense of, of the risk that is inherent in living. You know, we get in the car every day, and like, there is risk involved in that.

Lewis Howes 39:40 Sure.

Dr. Casey Means 39:40 But we choose to do it. And I think that, um, you know, there's just a lot of, a lot of sort of fear-based thinking that happens in the healthcare system that unfortunately disempowers patients and pushes them to do interventions more quickly, when I think that, um, there is so much opportunity to help coach them with diet and lifestyle, which takes longer-

Lewis Howes 40:01 Right

Dr. Casey Means 40:01 ... it's harder, um, but ultimately it generates health rather than just putting a Band-Aid on disease. There's no medication that actually generates health. Only diet and lifestyle strategies generate health.

Lewis Howes 40:14 Wow.

Dr. Casey Means 40:14 And so that should obviously be the foundation of our, of our medical system, but unfortunately we're not very well trained as physicians to, um, know that information or to coach on it. Um, but yeah, to answer your question, I think a large part of my personal journey has been trying to overcome fear. Um, one of the-

Lewis Howes 40:31 Really, personal fear

Dr. Casey Means 40:32 ... personal fear. I, I think one of the biggest examples of this is my, my mom just passed away-

Lewis Howes 40:37 Mm

Dr. Casey Means 40:37 ... and about a year ago, um, from cancer. And just as any normal person, I spent my life fearing my parents' mortality. Like, it's like, "Oh, this is gonna be d- horrible and devastating." And, and I think a lot of people worry about premature loss of a parent. And, you know, I think going through that experience and it actually being a very beautiful, transformational experience, um, seeing... It was a very, it was sort of a surprise and, um, she had-

Lewis Howes 41:06 Mm

Dr. Casey Means 41:06 ... two weeks between her diagnosis and her death. And-

Lewis Howes 41:08 Oh, man

Dr. Casey Means 41:09 ... we had this beautiful time together as a family.

Lewis Howes 41:11 Wow.

Dr. Casey Means 41:11 She was actually very much on the same page about sort of holistic health as me and, and knew in her heart that she was dying very rapidly. Um, she chose to stay at home, be with the family.

Lewis Howes 41:24 Mm.

Dr. Casey Means 41:25 We were all together, had this spectacular two weeks.

Lewis Howes 41:29 Mm.

Dr. Casey Means 41:29 The hospital system, through every possible medium, was trying to pull her into the system. You know, uh, it was pancreatic cancer, so it's like, "You need a liver stint. You need a liver biopsy. You need a blood transfusion. You need to be- start chemo immediately." And the reality was she knew, "I'm dying, like, right now." She ended up dying in two weeks. None of the interventions would have helped. We wouldn't even had a, um, you know-

Lewis Howes 41:52 Would have lasted maybe a few more months or a few more weeks maybe. You don't know.

Dr. Casey Means 41:55 I actually don't think at all. I think that, um-

Lewis Howes 41:58 Might've caused more stress and more-

Dr. Casey Means 41:59 Well, and it was COVID, so she would have been in the hospital-

Lewis Howes 42:02 Right

Dr. Casey Means 42:02 ... and we could have not visited her.

Lewis Howes 42:03 Oh, that'd be tough.

Dr. Casey Means 42:04 So-

Lewis Howes 42:05 Yeah

Dr. Casey Means 42:05 ... anyways, that experience of seeing her approach, um, seeing her pure joy in the face. She was just, ended her last two weeks very joyfully, was very at peace.

Lewis Howes 42:17 Mm, that's nice.

Dr. Casey Means 42:17 Um, we had that time together. Um, she was not just, like, locked in the hospital doing interventions that would not have helped very much. I realized, oh, something I've been fearing my entire life happened-

Lewis Howes 42:31 Phew

Dr. Casey Means 42:31 ... was the most transformational growth experience I've ever had. I still feel way more connected to my mom than I ever could have imagined.

Lewis Howes 42:39 Mm-hmm.

Dr. Casey Means 42:40 No one can tell you, "Oh, you, you're gonna still feel connected," until you maybe experience that. And it kinda made me realize-

Lewis Howes 42:46 Wow

Dr. Casey Means 42:46 ... fear is kinda not useful. [laughs]

Lewis Howes 42:49 Right.

Dr. Casey Means 42:49 Um, so I think that something like that, and I, I think it probably lots of people have their own examples, just kinda makes you realize the futility of living in, in fear. And, you know, what does it do? It damages your body. It doesn't really change the outcome. A little bit of healthy fear is useful, of course. Like, you don't wanna cross the street without looking. Um, but- The, the idea that, um, we should be fearful all the time, like, uh, that's gonna protect us, is such a, a fallacy. So turning to stoic philosophers, turning to, you know, some sort of Eastern texts, uh, Buddhist and Taoist texts, like sort of looking into traditions that have thought this way has been a really useful-

Lewis Howes 43:26 Yeah

Dr. Casey Means 43:26 ... part of my journey, and I think needs to be a part of how the healthcare system reforms, because we weaponize fear of death as a way to control patients-

Lewis Howes 43:36 Yeah

Dr. Casey Means 43:36 ... into doing anything we want. And I think fundamentally overcoming your fear of mortality, which is the, the, the only thing we can be certain of in this world, um, and really approaching that with a sense of awe and a sense of curiosity-

Lewis Howes 43:54 Mm

Dr. Casey Means 43:54 ... and a sense of what can this teach us about how to live, I think is an absolute foundational part of what we need to do as individuals, but also the healthcare system.

Lewis Howes 44:03 Yeah.

Dr. Casey Means 44:03 Because otherwise, we're just using fear as this thing, fear of death as this thing to just wrangle people into as many interventions-

Lewis Howes 44:11 Mm

Dr. Casey Means 44:12 ... and, um, and as pharmaceuticals as possible with the-

Lewis Howes 44:15 Yeah

Dr. Casey Means 44:15 ... with the off chance that people think it's gonna somewhat reduce their chance of mortality.

Lewis Howes 44:21 So what I, what I heard you saying there was that there's no medicine that can actually make you healthier. Is that correct? Or that, that could actually solve the issue on the medicine itself?

Dr. Casey Means 44:32 The vast majority of all medications, I probably wouldn't say all on a record [laughs]

Lewis Howes 44:37 Okay, yes

Dr. Casey Means 44:37 ... but I would say the vast majority-

Lewis Howes 44:39 Most

Dr. Casey Means 44:39 ... do not generate health in the body. They manage-

Lewis Howes 44:43 They-

Dr. Casey Means 44:43 ... symptoms

Lewis Howes 44:43 ... they don't cure the, the, the-

Dr. Casey Means 44:44 No

Lewis Howes 44:45 ... the disease or whatever

Dr. Casey Means 44:45 If you take away a diabetes medication from someone, their diabetes is not gone. It's right back there where it was.

Lewis Howes 44:52 Mm. Mm-hmm.

Dr. Casey Means 44:53 Um, whereas if you get someone to really foundationally improve their cellular function, which can only be done through consistent dietary and lifestyle habits-

Lewis Howes 45:04 Mm-hmm

Dr. Casey Means 45:05 ... um, they can truly reverse their disease.

Lewis Howes 45:07 Right.

Dr. Casey Means 45:07 But there's no medication that reverses diabetes. There's no medication that reverses heart disease. There's no medication that reverses Alzheimer's dementia. Um-

Lewis Howes 45:16 They just kinda manage the symptoms, is that what-

Dr. Casey Means 45:18 They manage the symptoms, you know, and maybe-

Lewis Howes 45:20 Maybe some relief, a little here and there

Dr. Casey Means 45:22 ... relief, um-

Lewis Howes 45:24 Huh

Dr. Casey Means 45:24 ... you know, life extension for some of them. Um, but, but they do not create health. And what health is, health is optimal cellular functioning. We are just a big, you know, bag of cells, and each cell needs to be functioning properly for us to have health. What is a symptom? What is disease? That is cellular dysfunction happening on the individual level, happening in a s- you know, if that's happening in mass, that might be tissue dysfunction. If that's happening, uh, you know, in a bigger way, it's organ dysfunction, and that's when we see symptoms of disease. So we have to really zoom in on what's happening in the cell.

Lewis Howes 46:04 Mm.

Dr. Casey Means 46:04 And what is a c- a cell is being, getting its information from what you're eating, what it's being built from, which is your food, um, what stress hormones it's seeing binding to its little cell membrane, um, you know, what's happening with your hormones-

Lewis Howes 46:19 Mm-hmm

Dr. Casey Means 46:19 ... which of course is dictated by stress and by sleep and by exercise and by food. It's this super complex milieu that can only be optimized by the choices that we're making every day, day in and day out consistently. Even by the sunlight we're exposing ourselves to in the morning, and, um, you know, Andrew Huberman talks about this-

Lewis Howes 46:36 Mm

Dr. Casey Means 46:36 ... all the time, but literally the consistent exposure of sunlight first thing in the morning is chemical information to your body through the sunlight's energy to tell your cells how to function. You can't put that in a pill.

Lewis Howes 46:48 Wow. [laughs]

Dr. Casey Means 46:48 You know, it has to happen through these millions of years of evolutionary evolved processes. And so, yes, like-

Lewis Howes 46:54 Wow

Dr. Casey Means 46:54 ... medications can't, with their, you know, one pathway that they might be intervening on, truly generate foundational cellular health, which is what we need to achieve.

Lewis Howes 47:06 They don't, they don't bring, uh, wholeness back to the cell.

Dr. Casey Means 47:09 Yeah.

Lewis Howes 47:10 I guess there's what? Some creams or something that might help you heal a cut or something like that, but we're talking about, like a chronic illness medication, right? There's...

Dr. Casey Means 47:19 Yeah, but even if you think about a cut, you know, I mean, a cut is like, it seems so simple, but it's actually so complex. It's like for a cut, if, if you think about people with disease, like diabetes for instance, one of, one of the reasons that people with type 2 diabetes die is because of chronic wounds. They have wounds that won't heal.

Lewis Howes 47:37 Interesting.

Dr. Casey Means 47:38 Oh, yeah, and I mean, that's-

Lewis Howes 47:39 Are they internal wounds or external wounds?

Dr. Casey Means 47:40 External wounds. People can get, um-

Lewis Howes 47:43 Wow

Dr. Casey Means 47:43 ... something that happens with people with diabetes is they often have nerve damage, um, because of the way the blood sugar's affecting the nerves, so then their feet become numb, and then they might get a cut on their foot. They don't feel it, and then that-

Lewis Howes 47:53 Mm

Dr. Casey Means 47:53 ... festers, and because of their high blood sugar, their immune cells don't work, so they can't heal the wound. Um, and so-

Lewis Howes 48:00 And then they die from the wound

Dr. Casey Means 48:01 ... and then they get a huge systemic infection that might lead-

Lewis Howes 48:04 Wow

Dr. Casey Means 48:04 ... to death or an amputation. So the, the majority of lower limb amputations are caused by diabetes-

Lewis Howes 48:10 Come on, really?

Dr. Casey Means 48:10 ... diabetic ulcers that are like wounds. Um-

Lewis Howes 48:13 How many people have type 2 diabetes in the US? Do we know the number?

Dr. Casey Means 48:16 Oh, yeah. Well, there's 128 million Americans with prediabetes or type 2 diabetes.

Lewis Howes 48:22 Come on.

Dr. Casey Means 48:22 And of those, 30 million have full-on type 2 diabetes.

Lewis Howes 48:26 30 million out of what? 300 and, what is that? 300 something million people?

Dr. Casey Means 48:29 Yeah, it's about 13% of the population now.

Lewis Howes 48:31 Has type 2 diabetes.

Dr. Casey Means 48:32 Yeah, and it was less than 1% in the '50s and '60s.

Lewis Howes 48:37 And prediabetic, you're saying 100 million.

Dr. Casey Means 48:39 Yep.

Lewis Howes 48:40 What does pre-

Dr. Casey Means 48:40 Around that

Lewis Howes 48:40 ... what does prediabetic mean? Who is, who is someone who might be prediabetic?

Dr. Casey Means 48:45 Well, it actually can be quite surprising. [laughs] There are lots of young, healthy people walking around who look otherwise fit who have prediabetes and don't know it. 90% of people with prediabetes do not know that they have it.

Lewis Howes 48:59 How do you know if you have it?

Dr. Casey Means 49:00 Well, the easiest way to do it is through a blood test.

Lewis Howes 49:02 Okay.

Dr. Casey Means 49:02 Um, so you basically get a fasting blood sugar test from your doctor.

Lewis Howes 49:06 Uh-huh.

Dr. Casey Means 49:06 And if it's between 100 and 125 milligrams per deciliter of fasting glucose, um, that's considered prediabetes.

Lewis Howes 49:13 100 to 125.

Dr. Casey Means 49:14 100 to 125.

Lewis Howes 49:14 Where do you wanna be at? What's a healthy range?

Dr. Casey Means 49:16 So what's considered normal is 100 or below.

Lewis Howes 49:19 100 or below.

Dr. Casey Means 49:20 But I would say that that is way too lenient of a range.

Lewis Howes 49:23 Mm-hmm.

Dr. Casey Means 49:23 Because what we've figured out is that people in the low end of normal are much less likely to develop long-term problems with, like heart disease, stroke, or diabetes. So even if you're in the high normal range and your doctor says to you Oh, your, your fasting blood sugar is 97. You're great. You're normal

Lewis Howes 49:40 That's very close to 100.

Dr. Casey Means 49:41 You should see that as a huge red flag.

Lewis Howes 49:44 Wow.

Dr. Casey Means 49:44 You are metabolically dysfunctional if that's the case.

Lewis Howes 49:48 Wow.

Dr. Casey Means 49:48 Um, and so really where you wanna shoot for is about 70 to 85 milligrams per deciliter.

Lewis Howes 49:52 And can people get a test that they can order and do this themselves, or do you have to go-

Dr. Casey Means 49:56 For sure

Lewis Howes 49:57 ... what are these? Where are they-

Dr. Casey Means 49:57 You can actually buy it at CVS or at the pharmacy. You just-

Lewis Howes 50:00 What's it called?

Dr. Casey Means 50:00 ... prick your finger. Um-

Lewis Howes 50:02 Or what are these called?

Dr. Casey Means 50:02 One drop... They're called glucometers. Um, so-

Lewis Howes 50:05 Glucometers

Dr. Casey Means 50:05 ... you can just... They're, like, literally $20 on Amazon. There's Keto Mojo. Um-

Lewis Howes 50:10 You just prick your, your finger, and then it'll tell you right away or in a few minutes?

Dr. Casey Means 50:13 In five seconds, yeah.

Lewis Howes 50:14 So then it just tells you what your level's at

Dr. Casey Means 50:16 What it is

Lewis Howes 50:16 ... how interesting

Dr. Casey Means 50:17 And it's cool to check it actually, um, day to day, like, for a few weeks because one thing you'll find is that let's say you have one poor night of sleep. Like, let's say had a big work thing due and you got six hours instead of eight hours, your blood sugar in the morning might be 10 points higher.

Lewis Howes 50:31 Come on.

Dr. Casey Means 50:32 Oh, for sure. Yeah.

Lewis Howes 50:33 [laughs]

Dr. Casey Means 50:34 Or let's say you had a really late meal the night before. Your blood sugar might be higher the next morning. So what it starts putting together for you is-

Lewis Howes 50:40 Mm

Dr. Casey Means 50:41 ... this is very dynamic, and if I did these activities day after day, year after year for my whole life-

Lewis Howes 50:47 It builds

Dr. Casey Means 50:47 ... I'm building. So figure out what allows you to be in that 70 to 85 range.

Lewis Howes 50:53 Wow

Dr. Casey Means 50:53 Maybe it's, like, a really awesome workout in the middle of the day prior and getting to bed a little bit earlier and getting morning sunlight exposure and doing some deep breathing in the morning, and all of a sudden you're like, "Oh, cool. My blood sugar-

Lewis Howes 51:03 So good

Dr. Casey Means 51:03 ... is 72 [laughs] milligrams-

Lewis Howes 51:05 Yeah

Dr. Casey Means 51:05 ... per deciliter," you know? Or fasting for f- you know, 16 hours or something like that. But figuring out-

Lewis Howes 51:10 Whoa

Dr. Casey Means 51:10 ... what works for you to stay in that low range and then dial it in for as many days of the week as possible, um, as you can. The other really interesting thing about fasting blood sugar as a test is that, you know, the body, like we were talking about with the insulin resistance, it's very adaptable. And when the body starts becoming insulin resistant, so it's saying, "We're seeing too much glucose around. We're producing... Like, we're gonna create an insulin block," what the body does is it's like, "Well, we've gotta get this glucose out of the bloodstream," so it starts producing more insulin. So your, your insulin levels will actually start rising as you become insulin resistant to push more of that glucose into the cells. And so a study in The Lancet, a big medical journey- sh- journal, showed that you can actually keep your blood sugar levels normal for, like, 13 years-

Lewis Howes 52:01 Wow

Dr. Casey Means 52:01 ... prior to them elevating, and all the while insulin is rising, but it's compensating to keep glucose-

Lewis Howes 52:08 Wow

Dr. Casey Means 52:08 ... low. Unfortunately, because we don't check fasting insulin in this country, we're missing that window where people are clearly becoming insulin resistant, but their glucose still looks normal in their yearly check. So to just make this concrete, you and I could both go to the primary care doctor and have a fasting glucose of 80 milligrams per deciliter, and so the doctor says to both of us, "You're both in perfect health." If I'm really insulin resistant because I'm on that glucose rollercoaster and I'm getting poor sleep and I'm chronically stressed and not managing it and I have childhood trauma-

Lewis Howes 52:41 Right

Dr. Casey Means 52:41 ... that I haven't addressed, blah, blah, blah, all that stuff, I could be at 80, but I'm doing that by my insulin being elevated to, like, 35 or 40, and your insulin might be two. So your body's not working hard at all to keep your insulin at 80, and my body is having to produce so much insulin. So I am clearly on the path towards metabolic disease, diabetes, and all the associated conditions, heart disease, stroke, cancer, Alzheimer's, dementia-

Lewis Howes 53:05 Wow

Dr. Casey Means 53:05 ... fatty liver disease, gout, infertility, erectile dysfunction, blah, blah, blah, blah. And you're in the clear, but our doctor tells us that we're the same.

Lewis Howes 53:13 Huh.

Dr. Casey Means 53:14 So, uh, this is why I recommend that every patient ask their doctor for a fasting insulin check because you, you have a sense of what's actually happening under the hood, and if you're in that early range... And of course, this is talking about people who are in the normal range. That's not, that's not even including the 128 million Americans who actually have a diagnosis of prediabetes. So this is, like-

Lewis Howes 53:32 Geez

Dr. Casey Means 53:32 ... people in the normal who still may be on the route to problems. So it's now becoming like the majority of the country is dealing-

Lewis Howes 53:41 Wow

Dr. Casey Means 53:42 ... with a fundamental problem-

Lewis Howes 53:44 True

Dr. Casey Means 53:45 ... in how they make energy in the body, which is a core process that allows every cell to function, so.

Lewis Howes 53:51 And you're saying there's seven factors to this, but what would you say are the main couple? Is it food and lack of exercise, or what?

Dr. Casey Means 53:59 I would say the four, like, most important pillars are food, um, sleep deprivation-

Lewis Howes 54:06 Sleep

Dr. Casey Means 54:06 ... and interruption in sleep, you know, just the beeping and the buzzing and, um, the blue light late at night, um, that interrupts our sleep quality-

Lewis Howes 54:13 Mm-hmm

Dr. Casey Means 54:14 ... the chronic low-grade stress and the fear that so many people are dealing with, and then the sedentary behavior, the fact that most Americans are sitting more than eight hours a day.

Lewis Howes 54:24 Yeah.

Dr. Casey Means 54:24 And that is just... Sitting creates inflammation in the body. It create-

Lewis Howes 54:29 Oh

Dr. Casey Means 54:29 ... it, it keeps that glucose in your bloodstream and not going into the muscles. Um, and, and the exercise one I think a really empowering, um, just a tip for people. It doesn't have to be, like, go out and, you know, run five miles or do a high-intensity interval training workout or do a CrossFit workout. It literally is as simple as walking, maybe walk 15 minutes after a meal, especially if a high-carb meal. And even walking for two minutes every half hour has been shown to statistically significantly reduce insulin and glucose levels-

Lewis Howes 55:02 Really?

Dr. Casey Means 55:02 ... throughout the day. It's actually the study was a minute and 40 seconds. So it was looking at for people who just walked for 30 minutes in one chunk of the day but otherwise sat during the day versus people who walked for 30 minutes but broke it up into one minute and 40 seconds every 30 minutes throughout the waking day.

Lewis Howes 55:18 Huh.

Dr. Casey Means 55:19 Those people that moved more frequently but the same quantity, um, had much lower glucose and insulin. And I think the reason-

Lewis Howes 55:26 Hmm

Dr. Casey Means 55:26 ... is because- If you think about sitting all day and then walking for 30 minutes, you've basically just, like, been atrophying your muscles all day.

Lewis Howes 55:34 Sure.

Dr. Casey Means 55:34 Like, you're just this, like, you know, blob sitting there-

Lewis Howes 55:37 [laughs]

Dr. Casey Means 55:37 ... versus-

Lewis Howes 55:38 The continuous of it, like, constantly.

Dr. Casey Means 55:40 Yeah, and again, thinking back to the cells, you're activating these pathways.

Lewis Howes 55:44 Uh-huh.

Dr. Casey Means 55:44 It's all just information to the cell. Activate the pathways, get them moving, you know, get the glu- clear the glucose every 30 minutes, you know?

Lewis Howes 55:50 Wow.

Dr. Casey Means 55:51 And so it's not like this is a lot of stuff you have to do.

Lewis Howes 55:54 Yeah.

Dr. Casey Means 55:54 A simple walk makes a big difference. But I think one of the, from looking at all this literature, one of the biggest takeaways I've realized is that moving more frequently, even-

Lewis Howes 56:02 Is key

Dr. Casey Means 56:03 ... if it's low intensity, is key. It can't just be that one chunk.

Lewis Howes 56:06 Yeah. And maybe if you're in an office or something or you're, you're not walking or have the ability to walk, maybe you could do some air squats or push-ups-

Dr. Casey Means 56:12 100%

Lewis Howes 56:12 ... or just anything where you're moving your body.

Dr. Casey Means 56:14 Yeah.

Lewis Howes 56:15 Some split squats, whatever it might be. Um-

Dr. Casey Means 56:17 Yeah

Lewis Howes 56:17 ... just body weight stuff.

Dr. Casey Means 56:18 For a minute.

Lewis Howes 56:19 Yeah.

Dr. Casey Means 56:19 A minute 40 seconds. Do, do 30 squats.

Lewis Howes 56:21 Lift your knees up in the air or something.

Dr. Casey Means 56:22 Exactly.

Lewis Howes 56:22 Yeah, whatever.

Dr. Casey Means 56:23 Yeah, exactly. I love that.

Lewis Howes 56:25 That's interesting.

Dr. Casey Means 56:25 Yeah.

Lewis Howes 56:25 Some high knees, yeah.

Dr. Casey Means 56:26 Yeah.

Lewis Howes 56:27 Wow, this is fascinating. So 13%, is that what you said, has type 2 diabetes in the US?

Dr. Casey Means 56:32 Yeah. Mm-hmm.

Lewis Howes 56:34 Is type 2 diabetes reversible?

Dr. Casey Means 56:38 Absolutely. Yeah. I mean-

Lewis Howes 56:39 But, but beyond that, it's not reversible. Is that right?

Dr. Casey Means 56:42 Well, type 2 diabetes is sort of the... That's like, once you get into that range of type 2 diabetes, of course there's a spectrum of how, how bad it is.

Lewis Howes 56:50 Okay.

Dr. Casey Means 56:50 Right? And it's always easier to reverse these things earlier on.

Lewis Howes 56:54 Right. It's actually-

Dr. Casey Means 56:54 But-

Lewis Howes 56:54 ... diabetes is the fo- there's another... There's not a type 3 or type 4?

Dr. Casey Means 56:57 No.

Lewis Howes 56:57 Okay.

Dr. Casey Means 56:58 No. Type 2 diabetes, so basically-

Lewis Howes 57:00 What does that mean when you have type 2 diabetes?

Dr. Casey Means 57:02 So it means, based on our criteria, it just means you meet a particular threshold of blood sugar levels. So if your, if your-

Lewis Howes 57:09 Mm

Dr. Casey Means 57:09 ... first thing in the morning fasting blood sugar, your, you know, you go to the doctor, they take your blood, if it's below 100, um, non-diabetic. 100 to 125-

Lewis Howes 57:18 Pre-diabetic

Dr. Casey Means 57:18 ... pre-diabetes. 126 or above, type 2 diabetes.

Lewis Howes 57:21 Wow. And you can reverse that, the earlier you catch it, back to the pre-diabetic or to the 100 to 125, and then hopefully below that-

Dr. Casey Means 57:29 Yeah

Lewis Howes 57:29 ... with nutrition and lifestyle.

Dr. Casey Means 57:31 Absolutely. Yeah, and there's actually been studies showing, I mean, Virta Health, um, Sarah Hallstedt, she's an amazing... Th- this company is showing reversal of type 2 diabetes with a, um, low carb, high fat diet and coaching. I mean, it's, it's not even an exercise intervention. It's just diet, and they showed that in 12 weeks they could actually-

Lewis Howes 57:50 Coaching, what type of coaching?

Dr. Casey Means 57:51 Just a nutritional coaching.

Lewis Howes 57:52 Yeah, just-

Dr. Casey Means 57:52 Like with a doctor

Lewis Howes 57:53 ... "Hey, are you doing this every day?"

Dr. Casey Means 57:54 Exactly.

Lewis Howes 57:54 And, like, just checking accountability.

Dr. Casey Means 57:56 Exactly. They're not even including exercise. Like, it's that simple. Um, and they are showing amazing reversal of diabetes, to the extent where the American Diabetes Association, they did not actually recognize reversal of diabetes as something that's possible until this past year. They're actually calling it remission, uh, which I think is a funny term. Like, it's, it's basically reversal. I mean, you're-

Lewis Howes 58:19 Right

Dr. Casey Means 58:19 ... changing cellular function. You're becoming more insulin sensitive. You're lowering your circulating glucose levels. And you know, the reason why you want to get on top of this early though is because the longer you have diabetes, again, coming back to the mitochondria, the more damage you're doing to those cellular structures. So you want-

Lewis Howes 58:36 It's harder and harder to reverse it

Dr. Casey Means 58:38 ... it's harder. It's harder.

Lewis Howes 58:38 How big of a business is type 2 diabetes in the US alone?

Dr. Casey Means 58:42 Oh.

Lewis Howes 58:43 A year.

Dr. Casey Means 58:43 Incalculable. Um, so if-

Lewis Howes 58:46 How much money is spent on the management of type 2 diabetes?

Dr. Casey Means 58:50 You'll see lots of different numbers, usually somewhere between, like, 200 and 600 billion. But-

Lewis Howes 58:56 200 to 600 billion?

Dr. Casey Means 58:58 Yeah. [laughs]

Lewis Howes 58:58 Just for type 2 diabetes.

Dr. Casey Means 58:59 Well, our healthcare costs are $4 trillion per year, about 17% of our GDP. We spend more than, of course, any other country in the entire world.

Lewis Howes 59:08 70% you said? How much?

Dr. Casey Means 59:10 17.

Lewis Howes 59:11 17%.

Dr. Casey Means 59:11 17%, yeah, yeah, yeah.

Lewis Howes 59:12 Okay, I was gonna say. 17.

Dr. Casey Means 59:13 17%. Um, $4 trillion.

Lewis Howes 59:15 $4 trillion is healthcare in the USA.

Dr. Casey Means 59:16 Yeah.

Lewis Howes 59:17 What is Canada?

Dr. Casey Means 59:18 I don't know.

Lewis Howes 59:19 Okay, gotcha.

Dr. Casey Means 59:19 But if you look at the curve, it's, like, all these little dots down in the lower left corner, and then there's, like, the US up here in terms of cost. And-

Lewis Howes 59:27 200 to 600 billion of that is in the type 2 diabetes management.

Dr. Casey Means 59:31 Metabolic management.

Lewis Howes 59:32 Management.

Dr. Casey Means 59:32 Yeah.

Lewis Howes 59:33 Holy cow.

Dr. Casey Means 59:34 And [laughs] on top of this, our life expectancy is going down. So what's, what's ironic about the American healthcare system-

Lewis Howes 59:44 Yeah

Dr. Casey Means 59:44 ... and for three years our life expectancy has been going down.

Lewis Howes 59:46 Mm-hmm.

Dr. Casey Means 59:46 You would, you would think, right? Like, like, this is, this is sort of what perplexes me about physicians right now, is that, you know, you're... As, as a physician, you're really, like, a steward of the system. Like, you are the person sort of calling the shots-

Lewis Howes 1:00:00 Yes

Dr. Casey Means 1:00:00 ... and doing the treatment. You look at this system, and okay, every single year we're increasing healthcare costs. Every single year it's an increasing part of our GDP. We're now spending $4 trillion on healthcare. We're literally throwing money at it, and outcomes are getting worse every single-

Lewis Howes 1:00:16 Mm

Dr. Casey Means 1:00:16 ... year.

Lewis Howes 1:00:17 Wow.

Dr. Casey Means 1:00:17 If, if you're not stopping and thinking, "What is going on?" what are you doing with your time? You know, it's like, it's not working.

Lewis Howes 1:00:27 Right.

Dr. Casey Means 1:00:27 We're getting sicker. Every single year we're getting sicker, we're getting fatter, and we're getting more depressed as a country, and just throwing money at it. And I think the key problem with this is that, you know, the modern American healthcare system has produced miracles, literally. We have-

Lewis Howes 1:00:43 Yeah

Dr. Casey Means 1:00:43 ... uh, uh, 100 years ago versus today, if you transported someone from 1900 to today and they looked at what's, you know, life expectancy and infant mortality and, and what happens when we get an acute illness, they would, they would be shocked. It's unbelievable. But that's because we are very good at managing acute illnesses. So if you have an infection, you know, something like childbirth, if you break your arm, if you're in a car accident, we can manage these things.

Lewis Howes 1:01:06 Whereas before we weren't good at that-

Dr. Casey Means 1:01:08 No

Lewis Howes 1:01:08 ... and so people would die or have massive complications with those.

Dr. Casey Means 1:01:11 Absolutely, yeah.

Lewis Howes 1:01:12 Right.

Dr. Casey Means 1:01:13 And so that's great. Like, if, like, we can manage that. But chronic disease is where we are abjectly failing.

Lewis Howes 1:01:19 We're bad.

Dr. Casey Means 1:01:19 And chronic diseases are 90% of our healthcare costs. They are the things that are killing Americans. And they are based in diet and lifestyle. And those are the things that we are doing, having w- this is w- worse outcomes the more money we spend.

Lewis Howes 1:01:34 So 90% Of the 4 trillion, is that what it is?

Dr. Casey Means 1:01:37 Goes towards chronic disease management

Lewis Howes 1:01:38 ... chronic diseases, which is what else besides type 2 diabetes is in- included in that?

Dr. Casey Means 1:01:43 These are the diseases that are, like, long-term, are considered to be, um, develop over time, and are generally rooted in diet and lifestyle

Lewis Howes 1:01:51 Like heart disease.

Dr. Casey Means 1:01:52 Heart disease, Alzheimer's, dementia, chronic respiratory illnesses, chronic kidney disease, chronic liver disease. Um, you know, th- there's, like, depression, anxiety, chronic pain-

Lewis Howes 1:02:04 Interesting

Dr. Casey Means 1:02:05 ... chronic fatigue syndrome, gout. They're things that don't just, like, come and go like a cold or-

Lewis Howes 1:02:10 It's not overnight, yeah

Dr. Casey Means 1:02:11 ... come and go and-

Lewis Howes 1:02:12 So 90% of these, of the money is going towards chronic disease and illness.

Dr. Casey Means 1:02:17 That's right.

Lewis Howes 1:02:18 And what I'm hearing you say is chronic disease and illness can be prevented with nutrition and lifestyle.

Dr. Casey Means 1:02:24 Or reversed.

Lewis Howes 1:02:25 Or reversed.

Dr. Casey Means 1:02:25 I- in many cases. Of course, not all.

Lewis Howes 1:02:28 Most, most of the cases, I'm assuming. A lot of the cases, right?

Dr. Casey Means 1:02:30 I think a huge-

Lewis Howes 1:02:31 80%, I don't know

Dr. Casey Means 1:02:31 ... burden of that disease could be prevented or reversed. Obviously, there's gonna be cancers that-

Lewis Howes 1:02:36 Sure

Dr. Casey Means 1:02:36 ... you can't reverse with diet and lifestyle, but a lot of the cancer we're-

Lewis Howes 1:02:39 Could've been prevented

Dr. Casey Means 1:02:40 ... seeing today could likely be prevented. Um, but we're not trained on how to do that effectively as physicians or any practitioner.

Lewis Howes 1:02:48 How much money could we save if we just invested in the prevention and the, the lifestyle and nutrition training and coaching versus just spending money on these things that are masking and not solving the problem?

Dr. Casey Means 1:02:59 I think trillions of dollars.

Lewis Howes 1:03:00 Wow.

Dr. Casey Means 1:03:01 Yeah, and the funny thing is is that, you know, what taxpayers don't realize is that they're paying for this, like-

Lewis Howes 1:03:07 Oh, man

Dr. Casey Means 1:03:07 ... four times over.

Lewis Howes 1:03:08 It's crazy.

Dr. Casey Means 1:03:08 We are paying taxpayer money to, of course, fund, you know, healthcare, Medicare, Medicaid, all these things. We are then going to the doctor and paying our co-pays. We're paying our insurance premiums. We're paying for that service. We are also paying taxpayer money for the farm bills and for the food subsidies that are making all the disease-promoting foods cheaper for-

Lewis Howes 1:03:32 Ugh

Dr. Casey Means 1:03:32 ... Americans.

Lewis Howes 1:03:33 Yeah.

Dr. Casey Means 1:03:33 So we spend $31 billion on our farm bills, which directly subsidize the foods that cause disease, making them artificially cheaper.

Lewis Howes 1:03:42 Jeez.

Dr. Casey Means 1:03:42 So this is corn, sugar, soy, wheat, um, and other foods like that. Does not go towards the vegetables and the fruits-

Lewis Howes 1:03:50 Right

Dr. Casey Means 1:03:50 ... which are actually part of a separate very small horticulture bill, which is, like, not even... It, like, a, a fraction.

Lewis Howes 1:03:56 Like 10 million or something. Yeah.

Dr. Casey Means 1:03:58 It, it's-

Lewis Howes 1:03:58 So small. [laughs]

Dr. Casey Means 1:03:58 It's, it's a, it's a tiny little amount. So they're paying for those that then make us sick, and then, of course, we're paying for the environmental damage of those terrible farming practices of the foods that make us sick that are then ruining our topsoil and creating horrible runoff in our rivers and oceans. So literally, like, you walk into the store and you grab, you know-

Lewis Howes 1:04:21 Mm

Dr. Casey Means 1:04:21 ... Skittles, um, or you grab Wonder Bread, and I think what people don't realize is that if that had a real price tag on it, it would be, like, $150.

Lewis Howes 1:04:32 Wow.

Dr. Casey Means 1:04:32 You know, 'cause it's the healthcare cost. It's the cost of the food.

Lewis Howes 1:04:35 Psh.

Dr. Casey Means 1:04:35 It's the cost of the taxpayer money for healthcare for others. It's the cost of the environmental damage, and it's the cost of the farm bills. We're paying all that.

Lewis Howes 1:04:43 That's crazy.

Dr. Casey Means 1:04:43 And yet it's $3.

Lewis Howes 1:04:46 Yeah. Yeah, what I think what's cool, what you're, you're doing and a lot of other of your peers are doing, is trying to give people information and access to take back control of their own health and prevent a lot of these things from happening by just making better choices every day. Having the information and the education of what makes you sick and what keeps you healthy, uh, with all these different factors you talked about, and also just staying on track with it, you know, staying on track, uh, consistently to, to prevent and stay healthy as long as possible. The challenge is there's so much temptation in the world. There's so much temptation and so much available-

Dr. Casey Means 1:05:24 Mm-hmm

Lewis Howes 1:05:24 ... at all the times to make poor choices.

Dr. Casey Means 1:05:27 Yeah.

Lewis Howes 1:05:27 Whether it becomes nutrition, diet, sugar, all these different things, processed foods, it's, it's very challenging for a lot of people, even myself, which I consider a healthy person, active. I just ran a marathon three days ago for my first marathon.

Dr. Casey Means 1:05:39 Congratulations.

Lewis Howes 1:05:40 And, thank you. But I still feel like, oh, but I still... I'm not in the best shape that I could be in, right, 'cause of the nutritional aspect. I can go months of eating super clean and healthy, and then other months where I'm like, "I feel great. Let me just have some sugar every day now." Um, so it's the, it's the accountability. It's the structure. It's the, the a- uh, accessibility to so much processed foods where I think is challenging for a lot of people, and I think that's what's one of the hardest things is just the discipline it takes.

Dr. Casey Means 1:06:11 Yeah.

Lewis Howes 1:06:11 The personal discipline.

Dr. Casey Means 1:06:13 Yeah.

Lewis Howes 1:06:13 So how do you manage it personally? Knowing all this information, do you still eat a lot of sugar, or are you kinda like cut sugar out of your life now?

Dr. Casey Means 1:06:21 Yeah. Well, first of all, I think the points you made are so important. Like-

Lewis Howes 1:06:25 Mm-hmm

Dr. Casey Means 1:06:25 ... it is hard, and, and that's why, that is why I'm excited about technology that helps people eat better because, like, like continuous glucose monitoring and, of course, what we've started with Levels is because it's not like I wanna walk around and see everyone being a cyborg with technology on their arm. I'm actually a very, like, crunchy granola person. I'm not the most tech-savvy person, and, like, I wanna just, like, be in the backcountry unplugged.

Lewis Howes 1:06:51 Yes.

Dr. Casey Means 1:06:51 You know? Like, that is my ideal. However, the cards are stacked against us so monumentally in the way we's- we've talked about. The past 50 to 100 years, the human body has had to be bombarded with all these external signals-

Lewis Howes 1:07:06 Mm-hmm

Dr. Casey Means 1:07:06 ... that it's never had to deal with in, you know, the tens of thousands, hundreds of thousands-

Lewis Howes 1:07:11 Right

Dr. Casey Means 1:07:11 ... of years of evolution, and it's breaking our bodies. We have broken bodies by and large in America, as evidenced by the fact that six in 10 American adults have at least one chronic disease.

Lewis Howes 1:07:21 Jeez.

Dr. Casey Means 1:07:21 We're, we've, we're breaking. And so w- those cards are sort of stacked against us. Of course, there's governmental factors. There's all this stuff. There's food marketing. Our school lunches for kids are-

Lewis Howes 1:07:32 Yes, everything

Dr. Casey Means 1:07:32 ... awful. And so- In the face of that modern reality, tools to empower ourselves to make decisions, um, that are better, I think are very important. Um, and ideally, you know, you could use these tools to gain awareness, to gain learning, to gain knowledge of how to eat and live in a way that keeps your blood sugar more stable, that keeps your metabolic health on point, and then maybe you don't have to use it anymore.

Lewis Howes 1:07:58 Right. Right.

Dr. Casey Means 1:07:58 You know? Maybe it's just a window.

Lewis Howes 1:07:59 You learn about it.

Dr. Casey Means 1:08:00 Yeah.

Lewis Howes 1:08:00 Yeah, exactly.

Dr. Casey Means 1:08:01 You know, I'm not wearing one right now.

Lewis Howes 1:08:02 Mm-hmm.

Dr. Casey Means 1:08:02 I've been at this for three years, and I can go months now without wearing one. I mean, it can be very helpful for accountability at this point, but-

Lewis Howes 1:08:09 But you know what works and what doesn't work now

Dr. Casey Means 1:08:11 ... I know what works

Lewis Howes 1:08:11 ... yeah.

Dr. Casey Means 1:08:12 Yes, and it's a nuanced balance. And so that's what I'm so excited about is empowerment. I think that is the key word.

Lewis Howes 1:08:19 Yes.

Dr. Casey Means 1:08:19 Um, because your doctor might say to you, um, "Oatmeal's... You've got high cholesterol, so eat oatmeal."

Lewis Howes 1:08:25 Mm-hmm.

Dr. Casey Means 1:08:25 Like, "This is a heart healthy whole grain thing."

Lewis Howes 1:08:27 But that might be not bad for you.

Dr. Casey Means 1:08:29 Well, put your blood, put a blood sugar monitor on, you know, on your arm and, and eat the oatmeal and see what happens. And maybe for you, your blood sugar stays quite stable and you don't have a big spike. But for me, because I've tested this, one serving of Quaker rolled oats caused me an 80-point glucose rise and crash, which is about four times higher than the highest I want to go. I want to go up, like, 20 points-

Lewis Howes 1:08:53 Wow

Dr. Casey Means 1:08:53 ... after a meal.

Lewis Howes 1:08:54 You want to stay, like, here, not here, right?

Dr. Casey Means 1:08:56 Exactly.

Lewis Howes 1:08:56 Yeah.

Dr. Casey Means 1:08:57 So for my body, terrible metabolic choice. For yours, maybe it's okay.

Lewis Howes 1:09:01 Maybe worse.

Dr. Casey Means 1:09:01 But the fact that the doctor's saying it sort of works for everyone, that's where we can kind of get into trouble, 'cause every single body is different. We are so biochemically individual, and what works for you and me might be very different in terms of what causes a blood glucose spike.

Lewis Howes 1:09:15 Wow.

Dr. Casey Means 1:09:15 And it can also be different day to day.

Lewis Howes 1:09:18 Sure.

Dr. Casey Means 1:09:18 If, like, again, if I'm sleep-deprived, it might hit me a lot harder than on the day that I'm not. So knowing what those variables are can be really useful information. So-

Lewis Howes 1:09:28 Wow

Dr. Casey Means 1:09:29 ... for me, like, when I started wearing, um, continuous glucose monitors when we started Levels, I was almost 100% plant-based, and what I learned super quickly was that there-

Lewis Howes 1:09:40 Before the monitor you were plant-based?

Dr. Casey Means 1:09:42 And I'm still, like-

Lewis Howes 1:09:43 Yeah

Dr. Casey Means 1:09:43 ... 93% plant-based.

Lewis Howes 1:09:45 Sure.

Dr. Casey Means 1:09:45 But, like, I'll eat a little bit of really thoughtfully sourced animal protein now. But what it did for me was make me realize that within my plant-based diet, there were certain foods that were causing really big spikes and how I could modify plant foods and balance them-

Lewis Howes 1:10:00 Hmm

Dr. Casey Means 1:10:00 ... with adding fat, protein, and fiber to my carbohydrates to keep the spikes much-

Lewis Howes 1:10:05 Interesting

Dr. Casey Means 1:10:05 ... less. So it's-

Lewis Howes 1:10:07 'Cause you can be plant-based and be unhealthy.

Dr. Casey Means 1:10:09 Absolutely.

Lewis Howes 1:10:09 [laughs] Yeah.

Dr. Casey Means 1:10:10 Oh, my gosh. You can be-

Lewis Howes 1:10:11 You can have a sugar all day long and be spiking left and right still

Dr. Casey Means 1:10:13 ... you can just be, you know, trashing your health that way.

Lewis Howes 1:10:16 Yeah.

Dr. Casey Means 1:10:16 And I think that one of the things I'm most excited about with this personal biofeedback data about nutrition is that I think it's gonna pull the rug out from diet wars and from all these really-

Lewis Howes 1:10:27 So show the proof. "Here's the evidence."

Dr. Casey Means 1:10:28 Yeah. [laughs]

Lewis Howes 1:10:29 Yeah.

Dr. Casey Means 1:10:29 'Cause, like, I can look... You know, some- someone who's carnivore, and this has happened, can, can be ripping on vegans on social media. And if I can come out and say, "Here are my blood sugar curves, they're flat. Uh, my insulin is three, my cholesterol is X, Y, Z. My inflammation markers are this, my vitamin D is this, and my omega-3 levels are this," like, how can you fight with me?

Lewis Howes 1:10:52 Right.

Dr. Casey Means 1:10:52 Like, this is working-

Lewis Howes 1:10:53 This is healthy

Dr. Casey Means 1:10:53 ... for me.

Lewis Howes 1:10:54 Yeah, yeah, yeah.

Dr. Casey Means 1:10:54 And it might actually look identical-

Lewis Howes 1:10:57 Hmm

Dr. Casey Means 1:10:57 ... to their lab work because the body is such a complex system. There are many different redundant pathways to kinda getting to the same outcomes. But the key is you have to be so thoughtful-

Lewis Howes 1:11:08 Sure. Sure

Dr. Casey Means 1:11:09 ... about how you're doing it. The, the run-of-the-mill vegan diet is probably not going to be great for people.

Lewis Howes 1:11:14 Yeah, the processed sugar, yeah.

Dr. Casey Means 1:11:14 Neither is the run-of-the-mill carnivore diet.

Lewis Howes 1:11:16 Exactly.

Dr. Casey Means 1:11:17 You know? And so just having insight into that, but I think it's, again, it's like the proof is in the pudding.

Lewis Howes 1:11:21 Mm-hmm.

Dr. Casey Means 1:11:21 And, um, and that's where I'm, I'm excited to see, like, more data helping to quell some of the debate-

Lewis Howes 1:11:28 Yes. Smart

Dr. Casey Means 1:11:28 ... of what's better, 'cause each body's different and, um, you know.

Lewis Howes 1:11:33 That's interesting. So tell me about Levels then. What is... What are you guys doing at Levels with this con- Is it called constant glucose monitor, is that what it's called?

Dr. Casey Means 1:11:42 Continuous glucose monitoring.

Lewis Howes 1:11:43 Continuous.

Dr. Casey Means 1:11:43 Yeah, CGM.

Lewis Howes 1:11:44 Where you put on, you essentially put on a, a monitor in your skin, right? For two weeks-

Dr. Casey Means 1:11:49 Yeah

Lewis Howes 1:11:49 ... is that what it is? And then it monitors your blood levels for 24/7 for two weeks.

Dr. Casey Means 1:11:55 Yeah.

Lewis Howes 1:11:55 Anything you consume or don't consume, it ma- it tells you what's happening. You have an app that shows you and tracks it.

Dr. Casey Means 1:12:01 Right. Yeah.

Lewis Howes 1:12:02 So why is this essential for someone to be curious about and to be- potentially want to try this out?

Dr. Casey Means 1:12:09 Yeah. The reason why it's something that I think is relevant to pretty much everyone is because of the rates of what we're seeing in our country. Like, if you're just living your life, standard American diet, more likely than not, you're going to end up with a metabolic disease. That's just now common reality. And so having some information to both see what the trajectory is over time, have a real sense of ownership over what's going on metabolically in your body, I think that's really empowering. Like right now, you kind of get crumbs of information from your doctor once a year. But imagine if, like, you know, you could really have ownership over that foundational aspect of your health. So that's one thing is just, like, the awareness. And then the, the bigger piece is to have this closed loop biofeedback on everything you're eating-

Lewis Howes 1:12:53 Mm-hmm

Dr. Casey Means 1:12:53 ... and everything you're doing to, to keep glucose more stable. 'Cause we want to get off that-

Lewis Howes 1:12:58 Yeah

Dr. Casey Means 1:12:59 ... those ups and down swings, not only to improve our day-to-day functioning and the subjective experience of our days, the energy, the mood, the cravings, um, the fatigue, um, but also to set us up for, like, the long-term avoidance of sort of the, the glucose-related met- um, metabolic diseases. And so that's really the reason to use it. And what I love about it is, like, just like with the oatmeal example, try a food, see what happens. The cool thing is, like, even if you do spike, it doesn't necessarily mean you have to get rid of that food forever. It means that you can potentially modify it and work with it. So let's take the oatmeal example, for instance.

Lewis Howes 1:13:36 Mm-hmm.

Dr. Casey Means 1:13:36 If you love oatmeal, like you're just like, "I do not want to live without oatmeal," that's fine. One thing we've seen in our data set, so we've had about close to 25,000 people go through our program. We have over 50 million glucose data points, so we have a lot of information here. People who eat, like, rolled oats, like instant oats, which are fairly processed, spike higher than people who eat less processed forms of oats, like steel-cut oats or-

Lewis Howes 1:13:58 Mm

Dr. Casey Means 1:13:59 ... groats-

Lewis Howes 1:13:59 Mm-hmm

Dr. Casey Means 1:13:59 ... which are kinda like a chewy, very whole food form of, of oats. So eat one of the less processed ones potentially, or add fat, protein, and fiber to that carb. The carb alone, if you're eating what I call, like, a naked carb, essentially a meal that's just, like, dominant carb-

Lewis Howes 1:14:16 All carbs. Yeah

Dr. Casey Means 1:14:17 ... yeah.

Lewis Howes 1:14:17 No fat, protein.

Dr. Casey Means 1:14:18 Yeah, like two bananas or oatmeal or Skittles. Like, you think about some candies, like Skittles are basically just, like, sugar. Whereas, like, a Snickers bar actually has-

Lewis Howes 1:14:29 It's got some peanut butter

Dr. Casey Means 1:14:29 ... peanut butter and-

Lewis Howes 1:14:30 And chocolate. Yeah, and nuts

Dr. Casey Means 1:14:31 ... nuts and chocolate. And crazily enough, Skittles have an over 80-point glucose spike in our data set, and Snickers is, like, 35 or something.

Lewis Howes 1:14:40 Mm.

Dr. Casey Means 1:14:40 So it's, like, half, and because Skittles are more of a naked carb. Um, and so-

Lewis Howes 1:14:45 Hmm

Dr. Casey Means 1:14:45 ... Skittles are actually the highest spiking food in our entire data set.

Lewis Howes 1:14:48 Come on.

Dr. Casey Means 1:14:48 Which, yeah, number one.

Lewis Howes 1:14:49 Just a straight sugar ball.

Dr. Casey Means 1:14:50 Straight sugar ball. Skittles, candy corn, Milk Duds, it's like they're all-

Lewis Howes 1:14:54 Oh my gosh

Dr. Casey Means 1:14:54 ... very similar.

Lewis Howes 1:14:55 Oh, Milk Duds. So good.

Dr. Casey Means 1:14:55 Um, jelly beans.

Lewis Howes 1:14:56 Yeah. It's like sugar coated on sugar-

Dr. Casey Means 1:14:58 Exactly [laughs]

Lewis Howes 1:14:58 ... with more sugar. It's crazy.

Dr. Casey Means 1:15:00 So, um, so yeah. So you want to avoid that naked carb situation. So-

Lewis Howes 1:15:05 Hmm

Dr. Casey Means 1:15:05 ... I see oatmeal with chia seeds, which has tons of fiber and protein, a little bit of almond butter, which has fat, protein, and fiber. Add a few maybe low glycemic berries, like a couple blueberries or raspberries or whatever, which have a, a good amount of fiber and antioxidants. Um, maybe some flax seeds on top, which is gonna be fiber and fat. Mix it all together and, like, you're gonna probably absorb the glucose slower. It's gonna slow digestion. The fiber can actually block the amount of glucose that gets-

Lewis Howes 1:15:32 Hmm

Dr. Casey Means 1:15:32 ... into the bloodstream. The fiber also has the effect of feeding the microbiome, which has downstream positive effects on metabolic health.

Lewis Howes 1:15:39 Wow.

Dr. Casey Means 1:15:39 So it's like keep the oatmeal, but modify it. And if you're not wedded to oatmeal, then start experimenting with other breakfasts.

Lewis Howes 1:15:47 Wow.

Dr. Casey Means 1:15:47 So for me, I'm like, I couldn't care less about oatmeal. So if I, I saw that it spiked me and I, I think I never ate it again. I'm like, "I don't even like this. I just thought it was healthy."

Lewis Howes 1:15:56 Right.

Dr. Casey Means 1:15:56 So, like-

Lewis Howes 1:15:57 You cut it out of your system

Dr. Casey Means 1:15:57 ... for me, that's gone. Um-

Lewis Howes 1:15:59 Hmm

Dr. Casey Means 1:15:59 ... and if you look in our data set at what some of the best scoring breakfasts are, we see things logged like eggs and avocado, eggs and greens. Um-

Lewis Howes 1:16:09 Hmm

Dr. Casey Means 1:16:09 ... we see frittata. We see, um, chia pudding. Um, we see, um-

Lewis Howes 1:16:17 Hmm

Dr. Casey Means 1:16:17 ... actually one that we see is, like, green... Some, some... There's a particular smoothie that we actually see logged a lot. It's called the Fab Four Smoothie.

Lewis Howes 1:16:25 Yeah, by, um-

Dr. Casey Means 1:16:25 It's popularized by Kelly LeVeque.

Lewis Howes 1:16:26 Yeah, she's great.

Dr. Casey Means 1:16:27 She's amazing and she... It basically is a really well-balanced smoothie that's low sugar, high protein and fiber and healthy fats, and there's some vegetables in there as well. And a lot of our community logs that, and so it's actually got a very low glucose spike. So-

Lewis Howes 1:16:41 Hmm

Dr. Casey Means 1:16:41 ... what you can see from all, from this amazing data set is that there's all these options that have, like, less than 20-point glucose spike. Um, so choose those-

Lewis Howes 1:16:50 Choose those options

Dr. Casey Means 1:16:51 ... as opposed to, you know-

Lewis Howes 1:16:52 Interesting. So someone signs up for this, I guess there's a waiting list right now, but when they... What does it do for them? Does it coach them on the foods to eat? Does it tell them, oh, you know, "You just ate this and it's not good for your system right now. Add this to it if you wanna keep eating it." It kinda coaches you for those two weeks, or what's it do?

Dr. Casey Means 1:17:10 Yeah. It does everything that you just said, basically.

Lewis Howes 1:17:12 Hmm.

Dr. Casey Means 1:17:13 So the, the... So a Levels member will actually use it for a full month to start.

Lewis Howes 1:17:18 Mm-hmm.

Dr. Casey Means 1:17:18 Um, so it's, the sensors are on the arm for two weeks. So the first month of Levels is two sensors. So you put one on for two weeks, you peel it off, you put a new one on, and so it's 28 days total. And throughout that process, it's doing exactly what you're saying. You log your food, you take a photo of it, um, and then you get a score for each of those meals. So the score is essentially a 1 to 10, zone score is what it's called, that tells you about the glucose impact of that meal. So you're shooting for 10s. Um-

Lewis Howes 1:17:43 Hmm

Dr. Casey Means 1:17:43 ... and 1 is, like, lower. So-

Lewis Howes 1:17:45 Interesting

Dr. Casey Means 1:17:45 ... for example, I could eat sushi, which of course has white rice, and sometimes the white rice has sugar actually added to it. Um, and for me, like, sushi usually scores, like, a 2 or a 3. Like, I have a very, very high spike. Um-

Lewis Howes 1:17:59 And you want it to be a 1. So it's-

Dr. Casey Means 1:18:00 You want it to be a 10.

Lewis Howes 1:18:01 10, okay.

Dr. Casey Means 1:18:01 You want it to be a 10. So that's, like, a pretty... Like, that would look like a big, sharp spike-

Lewis Howes 1:18:04 Gotcha

Dr. Casey Means 1:18:04 ... and crash.

Lewis Howes 1:18:05 Gotcha.

Dr. Casey Means 1:18:05 So what I learned, and what the types of things that we talk about in the Levels app is, like, okay, well, based on what other people have logged, if you log sashimi, you're probably gonna score, like, a 10.

Lewis Howes 1:18:15 Right.

Dr. Casey Means 1:18:15 A 9 or a 10, 'cause that's of course just, like, straight fish. People are now logging cauliflower rice sushi, which is kinda interesting, which has, like, almost no glucose spike.

Lewis Howes 1:18:24 Wow.

Dr. Casey Means 1:18:24 And there's actually restaurants offering this now.

Lewis Howes 1:18:26 Huh.

Dr. Casey Means 1:18:27 Or, I mean, I think, like me, there are some people who just don't wanna give up sushi. Like, that's not like oatmeal.

Lewis Howes 1:18:32 Yeah, yeah. [laughs]

Dr. Casey Means 1:18:32 Like, for me, I'm like, "I'm not giving up sushi."

Lewis Howes 1:18:34 [laughs]

Dr. Casey Means 1:18:35 So then there's other things it'll suggest, like for instance, add, preload your meal with, before the sushi, have a salad with protein and fat. 'Cause there's been research that's shown that if you eat, like, again, fiber, fat, and protein before carbohydrate, if you sequence the meal differently, you actually have a lower glucose response. So you can eat the exact-

Lewis Howes 1:18:55 Interesting

Dr. Casey Means 1:18:55 ... same sushi, but if there's some other stuff in your stomach first, um, you, there's-

Lewis Howes 1:18:59 It's processing it a different way

Dr. Casey Means 1:19:00 ... it's processing it differently.

Lewis Howes 1:19:01 Wow.

Dr. Casey Means 1:19:01 And it's changing the hormonal response to the food.

Lewis Howes 1:19:04 Wow. Interesting.

Dr. Casey Means 1:19:04 Or it will say, "Take... You're going up. Your glucose is going up. Take a 10 to 15-minute walk right now."

Lewis Howes 1:19:10 No way. And it'll bring it back down?

Dr. Casey Means 1:19:11 Oh, yeah, for sure. I mean, it can definitely bring it-

Lewis Howes 1:19:13 Does it just tell you, like, it, live data, is it like, "Okay, you need to add this," or, "You need to go walk," or?

Dr. Casey Means 1:19:18 It's telling you, um, in pretty close succession.

Lewis Howes 1:19:21 Wow.

Dr. Casey Means 1:19:21 Yeah. And, and helping you-

Lewis Howes 1:19:23 'Cause if it sees a spike, it's gonna say, "When you're in this range, go take a walk or add this or-

Dr. Casey Means 1:19:27 Yeah

Lewis Howes 1:19:28 ... eliminate that."

Dr. Casey Means 1:19:28 Yeah. And actually, if you have a spike and you haven't logged anything, like, we'll say to you, um, "Hey," like, "what happened here? What did you do?"

Lewis Howes 1:19:35 Oh, interesting.

Dr. Casey Means 1:19:36 And some people will see spikes if they're exercising, like we talked about, 'cause of the stress response. Usually, if someone's going above about 70 to 80% of their max heart rate, they're gonna see a spike-

Lewis Howes 1:19:46 When they're exercising

Dr. Casey Means 1:19:46 ... 'cause that's the stress response type thing. And we can... People will be able to exclude that from their scores, 'cause we know it's not a food-induced spike. It's not like a, the same as sort of a- A potentially damaging-

Lewis Howes 1:19:58 Sure

Dr. Casey Means 1:19:58 ... food-induced spike. So-

Lewis Howes 1:19:59 This is fascinating.

Dr. Casey Means 1:20:00 Yeah.

Lewis Howes 1:20:01 'Cause it gives you information on your body.

Dr. Casey Means 1:20:02 Yeah, and then we'll give the people tons of swap options. Like for instance, if they log a tortilla, like let's say they log tacos and they have a really big spike, we have a ton of content on like, "Here's 10 other tortilla alternatives that we don't know don't spike as much." So for instance, like-

Lewis Howes 1:20:18 Hmm

Dr. Casey Means 1:20:18 ... jicama tortillas-

Lewis Howes 1:20:19 Mm-hmm

Dr. Casey Means 1:20:19 ... from Trader Joe's. There's now... There's keto tortillas. Like, I just got to LA yesterday. First stop, Erewhon.

Lewis Howes 1:20:25 Of course.

Dr. Casey Means 1:20:26 Got their almond flour keto tort- I'm like-

Lewis Howes 1:20:27 Yeah

Dr. Casey Means 1:20:28 ... in love with them.

Lewis Howes 1:20:28 You spent $70 on those? Yeah. [laughs]

Dr. Casey Means 1:20:30 Oh, yeah. My... They are like, you know, $40 a piece.

Lewis Howes 1:20:32 They're so good. Yeah. [laughs]

Dr. Casey Means 1:20:32 But I love those tacos. Butter lettuce is great. Um-

Lewis Howes 1:20:36 Mm-hmm

Dr. Casey Means 1:20:36 ... you know, so there's different- d- different options.

Lewis Howes 1:20:39 Sure.

Dr. Casey Means 1:20:39 So we'll give people those resources, give them Costco shopping lists, give them-

Lewis Howes 1:20:42 Hmm. That's pretty cool

Dr. Casey Means 1:20:43 ... Whole Foods shopping lists. Yeah.

Lewis Howes 1:20:44 Okay, now I'm excited to try this.

Dr. Casey Means 1:20:45 Okay. [laughs]

Lewis Howes 1:20:46 Um, what do people need to do if they wanna get on the wait list or, or sign up-

Dr. Casey Means 1:20:50 Yeah

Lewis Howes 1:20:50 ... to be part of this?

Dr. Casey Means 1:20:51 So they just go to levelshealth.com and put your email address in, and you'll be in the loop about, about the wait list and getting off it.

Lewis Howes 1:20:58 'Cause you're kind of, like, rolling it out, like, every few months to new people, right?

Dr. Casey Means 1:21:01 Yeah.

Lewis Howes 1:21:02 Okay, cool.

Dr. Casey Means 1:21:02 Exactly. Yeah, and then that'll also sign people up for the newsletter, which has just, like, a ton of amazing information about a lot of the stuff we talked about today and a lot more tips. And, you know, there's... Certainly people don't need a continuous glucose monitor-

Lewis Howes 1:21:13 Right

Dr. Casey Means 1:21:13 ... to apply these metabolic health strategies. You know, you can, you can learn from what people in the program have learned and apply that to yourself, and so we, we try and put as much of that on the blog as possible-

Lewis Howes 1:21:23 That's interesting

Dr. Casey Means 1:21:23 ... so that people can learn. Um-

Lewis Howes 1:21:26 This is fascinating stuff. And are you on social media a lot yourself, too?

Dr. Casey Means 1:21:30 I'm on social media at Dr. Casey's Kitchen.

Lewis Howes 1:21:32 Okay.

Dr. Casey Means 1:21:32 So D-R Casey's Kitchen. Um, and then Levels is at Levels. Um-

Lewis Howes 1:21:37 Okay, cool

Dr. Casey Means 1:21:37 ... and we post a lot of experiments that our members are doing.

Lewis Howes 1:21:40 Hmm. That's cool.

Dr. Casey Means 1:21:41 Yeah, and so get some, get some fun ideas for people to try.

Lewis Howes 1:21:44 How many people are using it at one time, do you know? 'Cause you said 25,000 people-

Dr. Casey Means 1:21:48 Yeah

Lewis Howes 1:21:48 ... have done it over the last couple years, but how many people are on it right now? Do you know?

Dr. Casey Means 1:21:52 Oof. It's a good question.

Lewis Howes 1:21:52 Is it hundreds? Is it 1,000?

Dr. Casey Means 1:21:54 Oh, I'd say a, a couple thousand.

Lewis Howes 1:21:55 Okay.

Dr. Casey Means 1:21:55 Yeah. I'm not... I don't know the exact number for sure, but around that.

Lewis Howes 1:21:58 That's so interesting.

Dr. Casey Means 1:21:59 Yeah.

Lewis Howes 1:22:00 Really cool stuff. I've heard a lot of great things about it, so I'm gonna have to try it myself. Um, and I guess it'd be wearing a patch for a couple weeks, right? For a month, but it'll be cool-

Dr. Casey Means 1:22:08 Yeah

Lewis Howes 1:22:08 ... to get a re- to see the, uh, the research on myself. Um, really cool. So go, guys, go to levelshealth.com. Check it out. Dr. Casey's Kitchen if you wanna see more about, uh, Casey as well. What else should we be thinking about, or how else can we be a support to you or, or Levels?

Dr. Casey Means 1:22:25 Oh my gosh. Well, I think the best thing you're doing is just having these fabulous people on your podcast. You've had so many wonderful people in the Levels community on, and I think just spreading the word about holistic-

Lewis Howes 1:22:35 Yeah

Dr. Casey Means 1:22:35 ... health and metabolic health. I mean, it's amazing how, I think, podcasts like yours and, you know, Andrew Huberman, David Sinclair-

Lewis Howes 1:22:43 Hmm

Dr. Casey Means 1:22:43 ... Dr. Perlmutter's podcast, like, Mark Hyman's podcast, Drew Pruitt. Like, these things are becoming the thing that people look to to figure out how to actually create health in their lives-

Lewis Howes 1:22:53 Yeah

Dr. Casey Means 1:22:53 ... 'cause they're not necessarily getting it from their doctor. And so I think it's a really exciting time that we're in. I'm very grateful for, like, for the work that you do.

Lewis Howes 1:23:00 That's cool.

Dr. Casey Means 1:23:00 Yeah.

Lewis Howes 1:23:00 I appreciate it, Casey. All right, this is a question I ask everyone at the end called three truths. I think you know what's coming. Um, imagine it's the last day on Earth for you, and you've lived an incredible life, done everything you wanna do. But for whatever reason, you've gotta take all of your work with you to the next place. So no one has access to this in- conversation or your blogs or content or anything you've ever done. But you get to share three lessons you've learned from life with the world, and that's all we have left to, to kinda be remembered by you. What would you say are those three lessons or three truths?

Dr. Casey Means 1:23:31 Hmm. I think one of the biggest ones for me in terms of what brings joy and satisfaction to my life is to focus on the little things and just true awe in all the amazing things going around us. I think if you just step back for, like, one second, you know, and look at what's going around us, we're in this incredible cosmic journey.

Lewis Howes 1:23:53 Mm-hmm.

Dr. Casey Means 1:23:53 You know, we're hurling through space.

Lewis Howes 1:23:56 [laughs]

Dr. Casey Means 1:23:56 We're made of tr- trillions of cells, innumerable atoms. We're, we're constantly, you know... It's like every time we eat, we're literally taking in matter from the universe and converting into our body and, like, shifting our shape every day. It's just, it's at... You know, we're part of this incredible just continuum of, of, of energy and matter and, like, you know... I think it's just so awe-inspiring, so just, like, step back. Look at the awe, you know, the fact that the sun is shining and telling your brain, you know, what to do. It's fascinating.

Lewis Howes 1:24:27 Yeah.

Dr. Casey Means 1:24:27 So I, I think, like, focus on the little things and just having a sense of awe and reverence for everything around you, like, brings me just such intense joy every single day.

Lewis Howes 1:24:36 Yeah.

Dr. Casey Means 1:24:36 And can help elevate you from some of the day-to-day stresses. Um, so awe. Live with awe and focus on the little things, and of course, that loops into being in the present moment 'cause you have to stop and pause-

Lewis Howes 1:24:47 Mm-hmm

Dr. Casey Means 1:24:47 ... to see things. Um, I think the second thing would be really f- we talked about this a little bit earlier, but, like, really focus on death. You know, examine it. Think about it. Be curious about it. I think, you know, one of my favorite quotes, Steve Jobs talked about death as life's greatest invention, and I think that's so true. When we overcome our fear of mortality and have a good relationship with, with death and see it as not an end but a, a part of the process that's very natural, um, think about the, the way that energy cycles through generations and we're a part of that, um, I think it's incredibly liberating. Like, you know, and again, getting back to the question of fear, like, if you can not be fearful of death, like, you have a lot of power-

Lewis Howes 1:25:36 Yes

Dr. Casey Means 1:25:36 ... um, to make your own decisions and not be controlled by external forces.

Lewis Howes 1:25:39 Right.

Dr. Casey Means 1:25:40 And so, um, there's a lot we can learn from it. So I would say on a practical level, like, yeah, read some of the stoics. Read some of the, you know, Buddhist or Zen thinkers. Um, you know, read some Mary Oliver poetry. You know, there's people who are grappling with this, and it can really make life, I think, more joyful-

Lewis Howes 1:25:57 Hmm

Dr. Casey Means 1:25:57 ... um, ironically. Uh-

Lewis Howes 1:26:00 Right

Dr. Casey Means 1:26:00 ... and then I think the third thing would be just never stop asking why. Um- And really, if anything is conventional wisdom or is being kind of spouted by the large majority-

Lewis Howes 1:26:17 Mm

Dr. Casey Means 1:26:17 ... in a loud way or anyone's having to be coerced to believe something is true or manipulated or, like ask why.

Lewis Howes 1:26:25 Mm-hmm.

Dr. Casey Means 1:26:26 Um, and think about the bigger picture. When you keep asking why, it just makes life so much fun. So for me, like looking at the healthcare system and being like, "We're spending more money. People are getting sicker. Why?"

Lewis Howes 1:26:35 Why?

Dr. Casey Means 1:26:36 That was the best question of my life, and led me to leave the surgical world, get into functional medicine, ultimately start Levels, and realize this incredible world of metabolic health and how things are connected-

Lewis Howes 1:26:50 Mm-hmm

Dr. Casey Means 1:26:50 ... rather than how things are separate. And I think that I just, you know, hope that doing that at every stage, um, will continue to just open up whole worlds of new opportunity.

Lewis Howes 1:27:03 Mm.

Dr. Casey Means 1:27:03 So I would say ask why and challenge conventional wisdom-

Lewis Howes 1:27:07 That's-

Dr. Casey Means 1:27:07 ... and think for yourself.

Lewis Howes 1:27:08 That's beautiful. One of the reasons I keep asking questions on this show. After nine years, I'm still curious and I wanna learn more, so I think those are great. Um, I wanna acknowledge you, Casey, for taking a, for asking why many years ago and taking a shift in your career and your mission from being, I guess, in the practice of surgeries and, and prescriptions now into prevention and reversal of these, I guess, diseases for people, and really helping people shift their thinking from having personal power, personal knowledge and information on their health. So I acknowledge you for taking the shift. It's a big change, I guess, for... It, it probably feels like a big change for a lot of people in the medical world to think differently than what they've been taught for so long.

Dr. Casey Means 1:27:51 Mm.

Lewis Howes 1:27:51 So I acknowledge you for seeing things and allowing yourself to reinvent an identity that you once held onto probably for a long time, and shifted into a different part of your identity. So I really acknowledge you for the process and, uh, all the great information you're giving people with Levels. It's really inspiring to see what you guys are building, so-

Dr. Casey Means 1:28:10 Thank you

Lewis Howes 1:28:10 ... congrats on that as well. Final question, Casey, what's your definition of greatness?

Dr. Casey Means 1:28:14 Mm. My definition of greatness is being able to achieve and embody sort of thriving in this world, and to be able to enact your purpose. And fundamentally, um, you know, be able to go out there and really, uh, really live your purpose and shine your personal light, that really requires us being healthy.

Lewis Howes 1:28:38 Mm-hmm.

Dr. Casey Means 1:28:39 And so that is what drives me as a physician and as a health tech op- entrepreneur, is if we can help create more function in people's bodies, they can go out and share their light, which is, you know, their greatness. Um, make their minds healthy, help make their bodies healthy, help empower them to take control of their health. And, and so that's really just, um, how I think about, how I think about greatness.

Lewis Howes 1:28:58 Mm.

Dr. Casey Means 1:28:58 Being able to shine our light and embody our purpose.

Lewis Howes 1:29:01 Love it. Casey, thanks so much.

Dr. Casey Means 1:29:02 Good to see you.

Lewis Howes 1:29:02 Appreciate it.

Dr. Casey Means 1:29:03 Yeah, the two fastest ways to not recover from trauma are to compare yourself to others and to minimize your pain. It sounds crazy, but the mo- A- a- and I, you know, believe me, I went through [laughs] I could tell, uh, just horrible experiences of going through kind of this, this