Elizabeth Stein 00:00
Hi, everyone. I'm Elizabeth Stein, founder and CEO of Purely Elizabeth. And this is live purely with Elizabeth, featuring candid conversations about how to thrive on your wellness journey.

Casey Means 00:16
This week's guest is Casey Means, a Stanford-trained physician and co-founder of Levels a health technology company with the mission of reversing the world's metabolic health crisis. She trained in head and neck surgery before leaving traditional medicine to devote her life to tackling the root cause of why Americans are sick. She has been featured in The New York Times New Yorker, the Wall Street Journal, Forbes, women's health, and more. Her brand new book Good Energy, their surprising connection between Metabolism and Limitless Out is out now. In this episode, we dive into the 10 trillion dollar healthcare and food industries, and why the systems are broken and making us sick. Casey discusses why metabolic dysfunction is a primary cause of chronic disease. Yes, only 7% of Americans are actually metabolically healthy, and the connection between mitochondria and metabolism, she shares everything you need to know how to optimize your metabolism, including her favorite diet and lifestyle habits are five components of a healthy balanced meal, the biomarkers, we should all be looking forward to seeing if we are metabolically healthy, and so much more. This is an absolute must-listen, and you definitely need to go pick up her book, enjoy.

Casey, welcome to the podcast. It is such an honor to have you on. You're such a brilliant mind in the world of health and wellness conversation today. I can't wait to get started.

Casey Means 02:50
I'm so thrilled to see you and can't wait for this conversation.

Elizabeth Stein 02:54
So on this podcast, I love telling stories of guests who've had this pivotal moment where they've taken the courage to change something in their life. And you really had that moment for you as you were a surgeon and you got the courage to change. So I would love to start with your personal wellness journey what was your way of changing and what really gave you that courage at that moment? Hmm.

Casey Means 03:18
So for me, I had done the very conventional path of becoming a medical doctor, and much of my identity was based on climbing the ranks of this Western medical system, Stanford undergrad, Stanford Medical School, four years of surgical head and neck training residency. And I would say simply put, what happened was four years into my surgical training. So nine years into my medical training, I kind of had this wake-up call where I was looking around at the health of our country and looking at sort of the statistics that we're becoming more and more glaringly obvious, like 75% of the country is overweight or obese. 50% of American adults have pre-diabetes or type 2 diabetes, these preventable lifestyle conditions that didn't really exist 100 years ago in any shape, way, shape, or form as they are today, that are ravaging our human capital. They are actually increasing every year, as we spend more money on trying to treat them. It's a very strange phenomenon, where being a doctor in this system and seeing that the more investment we're putting into these conditions, the increase the rates are of them. So as someone who's always been a person who loves to ask why and to really try and understand the root cause answers of things, I sort of had to step back and say, are we actually attacking the right problem here? Like, is there something fundamental with our healthcare system that we are missing that's causing us to be doing so poorly when it comes to chronic disease in America? And that led me down sort of a series of Pandora's boxes that led me to realize I could not be a surgeon anymore. Because fundamentally, the health care system in America has a very broken foundational business model where it makes more money when patients are sick. And it makes less money when patients are healthy. And that even applies to surgeons. As someone who is finishing my surgical training and going out into the world, I was realizing, as a private practice, surgeon, I will make more money, the more surgeries I do, the more healthy patients I create. And that was totally intolerable to me to really be doing that I had to really shift gear and devote my life to it, is there anything we could be doing to actually keep patients out of the operating room? Is there anything we could be doing, I could be doing as a doctor with my time to help generate foundational health rather than symptom management and more like Whack a Mole medicine that I felt like I was playing where I'm sort of addressing some of these downstream symptoms that are showing up in the head and neck, but not really creating healthy vision. So so that was sort of the journey for me of the wake-up call that made me realize, I got to figure out why we're sick, and how we get better. And I don't think it's really going to happen in the operating room. So shifting gears, quitting my journey as a surgeon and devoting my life to entrepreneurship, to root cause foundational health, metabolic health, writing a book, it was actually pretty much something I felt like I just had to do once I started kind of waking up to the incentives of our system and how they're actually playing into keeping us and our children very, very sick.

Elizabeth Stein 07:00
Yeah, that's incredible. Do you feel like today that some other so many other surgeons or doctors are waking up and doing the same thing, or they're by and large, staying in the system and not waking up to it?

Casey Means 07:13
I mean, I think there are some incredible forces happening where people are starting to realize that we need a different way. I think about some of the doctors who inspired me on my journey, authors who I had read and they're very credentialed and had gone to all these top institutions and yet we're presenting a different way of thinking about health. So I'm thinking about like, Dr. Mark Hyman and Dr. Sara Gottfried, Terry Wahls, David Perlmutter, Dan Dickman, David Sinclair, people who were really inside the system, and then realize there's a different way to look at the body that's focused on true healing, rather than just symptom management. So those people really inspired me. And I think there are a lot more physicians who are feeling very spiritually depleted in their work. You look at the rates of suicide, depression, burnout, and health care. And it's off the charts, it's by far one of the fields that has the highest suicide rate and depression rates. Very sad. A statistic that I talked about in my book is that it'd be basically four full classrooms of graduating medical school classes, so 400 doctors are about 100 students in every Medical School graduating class. 400 doctors are taking their own lives every year. So that's like four medical school classes. And that's much higher than the national average for other professions. And I think about that, and I think there's a spiritual crisis happening for health care providers in our country where they have invested so much time into this education and had the noblest of intentions going into it, then they find themselves in a system that is not making patients healthier, and they have no time to really help patients work on creating holistic, healthy plans. The entire system that they are operating in, is focused on throughput and volume, and more patients just going through the system and having things done to them. And so you've got these great minds who really wanted to help, and they're put into a system with a business designed to grow. And the only way that system grows is by more patients having more things done to them, which is essentially chronic disease management. And so I think that something is happening where it's becoming intolerable to keep doing something that they feel like on some level isn't working. The reason heart disease is the number one killer in the United States. It's not because we don't have enough status. And that's how the system operates though. I do you see more people being curious about another way and you can call it anything alternative medicine, holistic medicine, functional medicine, precision medicine, longevity medicine, it's all the same thing that's basically like what is really the connecting points between a lot of these things that are ravaging the human capital of people in the modern world today? And how do we dig our way out of that with a bit more of a comprehensive lens?

Elizabeth Stein 10:31
Yeah, well, it's wild. I mean, I think back to when I went to nutrition school, at the Institute for Integrative Nutrition now, almost 20 years ago, and I can't believe I could be that old. But it was the first time hearing about health care and the food system. And that was certainly a big component of what inspired me to start a healthy food brand. But at the same time, you've heard those statistics then which were terrible, and to hear about kids and being sick. And then reading your book, you list these statistics that 40% of kids are going to end up with mental health disorders by the time they're 18. You can also include a lot more after me about these statistics, but it seems as though on the one hand, we've made so many advancements in the health conversation, and the education around this, and yet, the statistics are showing that it's just getting worse. So why?

Casey Means 11:33
Yeah, I mean, one of the big pieces of the why is it that it's not nefarious, I think a lot of people think there's like some evil hand behind all of this that causes all to happen. But something I really realize that one of the biggest issues is that when we originally categorized diseases and sort of started talking about diseases, we didn't have the technology and sort of the ability to understand and image the proteomics and the whole genome sequencing and the metabolomics, and the microbiome and the techniques to understand what's happening inside the cell, the cell signaling pathways, all of that. We didn't have to define depression, dementia, or polycystic ovarian syndrome. So we categorized diseases based on symptom criteria. So based on that, of course, arthritis seems different than Alzheimer's and cancer seems different than infertility. And erectile dysfunction seems different than a heart attack. Of course, because the symptoms are very different. And that's sort of like what we could describe. What's interesting is that now, we have a much different understanding of the physiology of diseases. And we can really see that many of these conditions from infertility to Alzheimer's arthritis to heart disease, on the intracellular level, the invisible level, in many cases, they're almost the same disease that are the same core problems happening inside the cell showing up in different cell types. So of course, the same issue happening in a cell in the ovary is gonna look different than in the brain. But is it different if we classify diseases based on more of that physiologic framework? So we know that there's a whole field of biology called systems biology or network biology, but instead of seeing each disease as the silos based on symptomatic criteria, it looks at the connecting points biologically between diseases like okay, chronic inflammation, maybe it plays in both heart disease and chronic liver disease. So that's a connecting point. So that's really the call, one of the reasons that we got here is that we're practicing an outdated way of looking at the body. And I think the broader way to say that is that we look at the body and diseases as fragmented things. We have a whole culture of separation within medicine. And we need to move towards a framework of connection. The highest level of the thesis that the book is, that everything is connected, and yet we look at the body as if it's upset of isolated parts. And that's not helping us. It's not a nice to have. We actually have to shift the whole foundation. You look at the healthcare system, we now have over 42, medical and surgical subspecialties. The more we specialize in medicine, the sicker we're getting. So there's something about that that's not quite right. And if you look at what is prestigious in our system, it's becoming hyper-specialized. I was an ENT surgeon, ear, nose and throat, head and neck surgeon. For me to become even more prestigious in that field, I would have actually narrowed in on one part of the head and neck, it could have been a rhinologist, an otologist, or a laryngologist. So hyper-specialization is baked into our view. And what that does to patients and doctors is it blinds us to root cause physiology that is connected. And when you wake up to that, and start to see things with your connected goggles, you're like, oh, I actually have to really just hit these individual problems, and a lot of the other stuff will just melt away. I've kind of hit the trunk of the tree, and a lot of the branches will kind of be fixed. And so the journey that I went on, was figuring out what are the core trunks of the trees that are really keeping. And the one that of course, I wrote the book about is metabolic dysfunction. It's this foundational process in our body that's really broken in the Western world, where the way that we actually foundationally power our bodies, is our metabolism. Back to high school biology, the Krebs cycle, and all this crazy, complicated stuff. Metabolism is actually super simple. It's how we convert food energy, which is potential energy that we put into our body, how we convert it through the mitochondria, to human energy, to cellular energy that can power our cells. And the body is kind of this miraculous thing that has 40 trillion cells of 200 different types of cells. And all of those cells need a constant source of energy to do their jobs. And when cells do their jobs well, we don't have symptoms and disease. When cells are dysfunctional, we do have symptoms that disease, like all diseases and symptoms, are fundamentally cellular dysfunction. And so metabolic issues are now based on recent research from the American Journal of Cardiology, 93% of Americans now have a problem with metabolism. 93% of adults. And so when we think about those connecting pieces between diseases, this is the biggest one we have to reorient healthcare towards to help a lot of these chronic issues diminish, and then our prevalence. And the reason we're spending $4 trillion on health care and outcomes are getting worse every year is that we're not focusing on metabolic health really at all. And so that's the call to action for the book is like we both understand our own metabolic health, understand how big of a deal it is in our current disease-riddled country, and then work to understand how to improve it, which is much simpler than we think, and has incredible benefits when we get on top of it.

Elizabeth Stein 17:52
So let's get to the root, there's 93% of us are metabolically unhealthy, which is a very large number, what is wrong? What are those key things that are really contributing to our metabolic health that we can take charge of and ultimately change?

Casey Means 18:12
Yeah. So what's fascinating about the modern world is that really, so many elements of modernity have hit some of our key lifestyle pillars in a way that uniquely makes them hurt metabolic health. So the ones that are key to understanding are the way that our food, our sleep habits, our movement habits, our relationship with stress, our environmental toxins, and our relationship with light, all have changed profoundly in the past 100 years, we've gone from a whole food diet, from food grown in thriving soil to industrial agriculture, ultra-processed diet, the vast majority of our calories, a huge shift in food. We have no movement. We're now sitting 80% of the time. In a 24-hour period, we sit 80% of the time. 50 years ago, over 70% of the country worked in agriculture, they were on their feet all day. Now we sit 80% of the time, and less than 1% of the country is doing a job like that. Sleep or sleeping 25% less than we were 100 years ago. This is unprecedented. Environmental toxins. There are 80,000 synthetic toxins in our food, water, air homes, and personal care products, that are created by industry in which have virtually zero regulatory oversight, or relationship with light has changed profoundly since the invention of the light bulb. And then, of course, the invention of these screens, the TV and the computers and iPhones. So our bodies are constantly being exposed to light, even though our biology is meant to only be exposed to light for a very specific period of the day and that's deeply impactful on our genetic expression, on our biology. And then I think the last one to mention is just our relationship with stress, we now are in a world in which fear-inducing signals are coming at us 24 hours a day through these devices. And that has an overwhelming impact on how our bodies function. There were always, of course, fears and stresses throughout all of human history. But they used to be, from what we can understand, more acute. They'd be like a threat, and then that would go away, and we'd have a period of calm. Now we feel like we are under siege all the time. And the second we open our phones, the second we go to bed. And so these are the pillars that that I unpack in the book that each in a very interesting and unique way, each of them impacts our mitochondria, these energy-producing batteries and our cell in a different way, and together those factors of modernity are really crushing our mitochondrial health, which means we are essentially becoming underpowered as bodies. And this is showing up as all these different symptoms and diseases that we're facing today and why it makes sense that so many Americans have this issue because it's like it's just our culture and our culture just by default, unless you're doing something weird and different in your day to day life. The default of our culture is to essentially be hurting our mitochondria.

Elizabeth Stein 21:32
So for those who forget science class, let's do a quick refresher on mitochondria.

Casey Means 21:37
Yes, so mitochondria, we have these 40 trillion cells in the body. And inside the cells are these structures called mitochondria. And they are a part of the cell that converts that food energy to ATP. I think of ATP, as like the coin that you use to pay for all the chemical reactions that are happening to your cells. So the mitochondria take these downstream breakdown products of food like glucose and fatty acids, process that, and then spit out this form of energy that we can use. And it's a very sensitive organelle that can be hurt by a lot of these different things in our culture. So that's the refresher on the mitochondria.

Elizabeth Stein 22:25
So when you talk about the mitochondria in the book, you also talk about this bad energy trifecta. And really, the root of what is causing these issues and mitochondrial dysfunction are inflammation and oxidative stress. If you can help describe what each of those are, and how we should be thinking about that, as we're thinking about these factors that are helping or hurting us in our daily lives.

Casey Means 22:52
So this is this kind of gets a little technical here, but we need to realize, like, these sciency words are actually so relevant to a lot of the suffering that we might have in our life, the pain. So it's important to kind of have like a little bit of an understanding of them, because we can fix them, and it will actually really help ourselves be unlocked to do their best work. So the bad energy, good energy in the book is really referring to metabolic health. What does it look like to have your body making energy properly? making good energy meaning high capacity, mitochondria, converting food, energy, cellular energy power, powering ourselves, creating functional cells and organs, leading to better health? Bad energy is when that process is broken. One piece of it is mitochondrial dysfunction, which we just talked about. One result of mitochondrial dysfunction is that you have this little broken machine, like a broken down car that's not working as well, it's going to produce more reactive damaging byproducts when it tries to do the metabolic processes. And that results in what's called oxidative stress. So it's essentially like too many reactive byproducts of metabolism and metabolic processes from a damaged system that then fills the cell with all these damaging reactive molecules that go around and hurt other things in the cell. So there are a lot of synonyms for this. That's called oxidative stress. You might as well hear the word free radicals. Free radicals are those damaging molecules that when your body can't neutralize them fast enough, you get oxidative stress. You might also hear the word reactive oxygen species (ROS). So reactive oxygen species, excess free radicals oxidative stress, that's all kind of one thing that basically means spewing out damaging byproducts that are going to hurt functionality throughout the cell and cause problems. This is one of the reasons why we care about eating antioxidants and making antioxidants in the body because those are actually
the molecules that bind to the reactive free radicals and allow them to not do as much damage. So that's a second. So there's mitochondrial dysfunction, there's oxidative stress, there's chronic inflammation, which is the third piece. Chronic inflammation is when the body's immune system, which is our defense part of the body is essentially always on and never settles down. So there's something in the body that's thinking that there's a problem all the time. The way it's supposed to work is that when there is a real problem, like an infection, or a cut, the immune system is on it, it attacks it, it fights it, and the immune system will basically settle down and go back into the lymph nodes, in the bone marrow and kind of relax. There will always be cells floating around the surveilling, but by and large, the war to kill that bacteria or heal that wound will be done. Unfortunately, for better or worse, the immune system will pick up almost any threat in the body. If anything it perceives is different or not normal, not expecting, it will mount a response. You think about okay, all this ultra-processed food that we're eating, that's foreign to the body. The body doesn't really know what to do with that. It can mount a response to that. The fact that a lot of that food that we're eating is damaging our gut lining. So now the gut lining, which is the barrier between us and everything in our gut is thinner, it's more permeable, we have leaky gut, intestinal permeability. There are all these things coming in from the gut to the bloodstream that aren't supposed to be there, immune system is revved up. Another piece is if you have a cell with malfunctioning mitochondria and lots of oxidative stress, that cell is going to be thinking there's a problem. An underpowered cell, what could be more threatening than that it can't do its work properly? And it's filled with reactive oxygen species, that is going to stimulate the immune system. So the metabolic mitochondrial dysfunction in and of itself is going to stimulate the immune system to actually think that there's a problem. But the issue is that the immune system is then going to basically be fighting against its own cells. And it's gonna be trying to fix an issue that it is not able to fix because the problem is inside the cell, the cell is fundamentally not working properly, and that immune cell can't go out and stop you from eating a doughnut or a soda or get you to go to sleep earlier or get you to manage your chronic stress. It can't do that. And so it's not able to actually fix the problem. So between chronic inflammation, which is going to be basically fighting this battle, and never being able to succeed, and in doing so, it's going to be spewing out inflammatory mediators and creating all this collateral damage, oxidative stress, and mitochondrial function together, it's basically creating this total havoc in our bodies, that are all really linked and routing the same thing, which is just the overwhelm of our bodies from this modern foreign, overtaxing environment that we're living in, that is just really crushing our ability to be metabolically healthy. So those are the three things that we need to think about, our lifestyle and dietary choices through those lenses. How does each choice we make, when we're thinking about what kind of exercise to do or what we should eat or being motivated to sleep more, understanding a bit about how they funnel through these pathways that are damaging so many of us can be extremely motivating because we kind of get why we're doing the work. And we're doing it to ultimately sue those three issues so our bodies can make good energy and be metabolically healthy.

Elizabeth Stein 28:52
Well, you just mentioned on the education piece and seeing the why. This brings me to Levels. I was a big fan of Levels. It really provided so much information to me, I started eating protein because of Levels, and I started going on my walks after eating, seeing how stress affects my insulin or glucose levels while I was eating. I mean, that was a huge wake-up to see how that truly affects us. So I would love for you to talk a little bit about the connection as we think about glucose and blood sugar, and just the education piece because I think it's so incredible. It's one thing to hear it but when you see those numbers for yourself, it really makes a whole different story.

Casey Means 29:40
Yes. So Levels is the company that I co-founded about five years ago. And what it does is it helps really bring a lot of these concepts we're talking to make them really visible and really real for people. The way it does that is to give people access to the sensor, a continuous glucose monitor. That's been around actually for years and is being used for people with type 2 diabetes. But what we kind of said was, well, this is an amazing device that gives you a constant data stream of a key metabolic biomarker that's changing all the time in response to the way we're living and eating and what we're doing. And we can actually give this to people earlier on, like when they're young and maybe otherwise healthy so they can learn to eat and live and shape their dietary lifestyle choices in a way that hopefully will keep them out of the chronic disease, treadmill and help them understand the principles before they're sick. Why are we waiting to give technology to people once they're sick when they can have it earlier, and maybe stay healthy? So that's the purpose of Levels. It's showing you it's constantly sampling your blood glucose and sending that information to your smartphone. So that you can when you eat a particular food, you can see what's actually happening in your body in real time. If you choose to take a walk after a meal, you can see how that impacts your blood sugar levels. If you eat a meal when you're tired, versus when you're rested, you can see how that impacts it. If you balance your carbohydrates with fiber and protein, is there a different response?

Elizabeth Stein 31:12
That was the biggest thing for me getting protein. I was already eating fiber with it, but adding the protein made a world of a difference.

Casey Means 31:22
Exactly. And I think the thing for people to understand is that if we keep our blood sugar under better control, like more stable, so think less spikes and dips. The average American is just going to be spiking their glucose and crashing their glucose all day, because so much of our diet, is just filled with refined sugars and refined carbohydrates. And so we're on this roller coaster. If you can get off that roller coaster and keep it a bit more like gently rolling hills, not only do we feel so much better day to day, we avoid the crashes. It'll often in our mood more stable and our energy levels are just like the level of fatigue, irritability, all these things. But over the long term, that gentler rolling hills of glucose is sort of a sign that you're not overwhelming your body with so much work to process essentially. Because of all those glucose spikes, you're essentially overtaxing your cells with having to process all of that, which is part of why we're sick is that we're gumming up the system with just so much concentrated, refined raw materials to process and our cells are essentially totally overwhelmed. And therefore producing more of those reactive oxygen species, the free radicals and the mitochondria are pooping out because they're just totally overtaxed. And then you get into that cycle. So that's really where glucose can help you have visibility into what was previously invisible. And we've had to trust a lot of the food marketing and put a lot of the agency outside of ourselves. We listen to our nutrition influencers, and we listen to the doctors, and the doctors have virtually no training and nutrition. And so this is basically allowing people to actually look to their own body for answers and agencies rather than constantly putting that agency outside of that, which is really what the system wants from us. And so really on the biggest picture level, helping people trust themselves and understand their own bodies better in the pursuit of metabolic health.

Elizabeth Stein 33:31
I love that. And it's also that personalization because I think people hear you should be eating keto or paleo, or whatever that it is, and you can see what works truly for your body by seeing those metrics.

Casey Means 33:46
Yeah, it's so fascinating, like, with the concepts like glycemic index, and these scales that we've looked at, you kind of would think, well, if you and I both eat the exact same food that has the same glycemic index, our blood sugar would rise the same amount. But what's fascinating is that just like you said, there's tons of biochemical individuality to it. So you and I could actually eat the exact same food and have totally different metabolic responses to it based on our microbiome composition, how much sleep we got last night, how much we each move today, and what our level of insulin sensitivity is. So knowing actually for yourself, how you're responding can be very helpful because there aren't really generalizations when it comes to biology. I will say there are generalizations in the sense that foods with a lot of refined sugars or carbohydrates tend to spike people a lot more. But if you're really trying to keep the blood sugar more stable so you can really feel better throughout the day, that's where some fine-tuning can be very helpful. But certainly, I talked about this in the book and I don't think it's a necessary thing that everyone needs to run out and get this expensive monitor. We can get so far of the way there with basic first principles thinking about food and, and lifestyle. But for motivation for accountability, for agency, for personalization, it can be a very powerful tool for people on their health and weight loss journey.

Elizabeth Stein 35:16
So let's get into some of those other tools. I think one of the amazing things about the fact that 93% of the population is metabolically unhealthy, definitely needs improvement there. But the good news is that we can reverse those numbers. And as you said earlier, it's not overly complicated. So what are some of those key principles that you like to tell people to start with, like foundationally? If they're hearing this, and it's super complicated and overwhelming, where do we start?

Casey Means 35:46
Yeah, I think step one is understanding a little bit more about your own metabolic health. So actually, just like looking up your lab results from your last physical and really trying to understand where you stand on the metabolic spectrum. Because as I mentioned, 93% of American adults now have biomarkers that suggest metabolic dysfunction. So for people listening, are you certain whether you are in that 93%, or in that 7%, we can make that 7% and grow so much larger with the principles that we'll talk about. But first, you have to know where you stand. And I think an incredible statistic is that 80% of people with pre-diabetes, which now makes up close to 40% of our country, 80% don't know they have it, they don't even know they have it. So we have to know. There are many different levels of testing you can get. There are basic and intermediate. You can go to the sky's the limit with lab testing. But a really empowering thing for people to realize that there are five cheap, easily accessible biomarkers that you can get from your standard primary care doctor that can help you know whether you're kind of on the right track. Those are fasting glucose, triglyceride levels, HDL, waist circumference, and blood pressure. Based on the research that came up with these numbers of percent of Americans who are metabolically essential, to be in that small percentage of metabolically healthy people, what they're looking for is fasting glucose under 100, triglycerides under 150, HDL cholesterol above 40 for men and 50 for women, waist circumference less than 35 inches for women and 40 inches for men, and blood pressure less than 120 over 80. And if all of those are true, and you're not on medication for one of those biomarkers, it's a sign that you're in the right direction. You could of course go deeper with optimal ranges for each of those things. But that's a great start. And that puts you in the minority if those are all true. Then you can go into deeper testing, like fasting insulin levels, CRP, which is an inflammatory marker, and liver function testing, which is a key metabolic organ. But those five alone are very helpful. So everyone should look those up from their last physical or ask their doctor for them on the next physical and just go through the checklist and understand where they stand. So that's step one. Then kind of moving towards where we have the opportunity to intervene? As I mentioned briefly food movement, stress management, sleep, our relationship with toxins, light, with temperature, are the big levers we have the ability to modify, and that all make a difference in metabolism. I do think that food is a place where we just have to start because it's such a big one. We eat over 70 metric tons of food in our lifetime. And in our very recent years, around 60% to 70% of that food that we're eating, that is just literally what our body will be made out of and the food is not only the building block of our body, it's also the instructions for our genes and our metabolic process. 60% to 70% is ultra-processed, industrial, manufactured garbage that's not helping our health. So step one is really just cleaning up the food and realizing how absolutely non-negotiable it is for optimal health, and focusing on minimally processed or unprocessed foods that are as close to the source as possible, ideally with as many organic ingredients as possible. In the book, I outline a very simple, very first principles approach to food that I hope transcends dietary dogma that's just focused on meeting the needs of your mitochondria and cells, which is just trying to get five things into almost every meal and take three things out. The five things that evidence really shows can support our metabolic health are having fiber, healthy protein, omega-3 three fats, probiotics source, and antioxidant sources in our meals, and then keeping out Ultra-processed industrially refined sugars, grains, and seed oils. And when you just go through that list of five things to put in, a challenge I have for you in the book is to read the list of what are the foods in each of those categories, then take 5 to 10 of your favorite fiber sources, your favorite antioxidants sources, your favorite omega three sources, your favorite probiotic sources, your favorite healthy protein sources, and stock your kitchen with them. And then cooking for health really becomes almost like mixing and matching from each of those categories. And the beauty is that if you're vegan, or if you're keto, or if you're paleo, or if you're on a Mediterranean diet, you can do it for all of those because there are plant-based, animal-based sources for all of those. So there are lower-carb and higher-carb versions of each of those. And so just really focusing nutrition through the lens of what my cells need to function at their best? And how do I give myself those things with the food I’m eating, take out the empty calories that don't meet my needs, and therefore, basically push me to have cravings all the time? Because if you're not meeting the needs of your cells, your cells will push you to keep eating until you meet them. And that's part of the reason why our industrial diet filled with refined sugars, grains, and seed oils, is causing us to literally as a country eat ourselves to death because we're eating these calories that aren't meeting the needs of the cells. So that's the foundation of the food principles in the book.

Elizabeth Stein 42:01
One question I wanted to talk about there is seed oil. Certainly a controversial topic. Some people think it's over-talked about, or why is it really so bad? So I would love we're certainly a big proponent of not using seed oils. But I'd love to hear from you on the way, on the overload of omega sixes and why it's so bad.

Casey Means 42:25
Yeah, there are three main reasons why seed oils are highly, highly problematic for our health. And the first is that the number one source of fat in our diets now is soybean oil. It's seed oils. Literally, we're just crowding out healthy calories and foods that could be actually supporting our health. The seed oils aren't doing anything for our health. So it's just wasting a lot of the fat that we could be eating that actually could serve healthy biological processes. And putting in this garbage that is essentially made from in factories through leaching and chemical extraction of oils, hexane, and dewaxing. It's just an ultra-industrial unnatural process, these foods were never part of our food system for 1000s and 1000s of years. And they're crowding out healthy whole foods, forms of fats that can really support our well-being. Two is what you mentioned, which is the omega-6 fat content. These seed oils tend to have a very high ratio of omega-six fats compared to omega-three fats. The problem with omega-6 fats is that they are incorporated into our cell membranes, and they tend to be pro-inflammatory. And the reason for that is that when the immune cells are floating around, and essentially are making the determination whether to settle down and reduce the chronic inflammation, or keep the inflammation going, they will snip fats, the immune cells will snip fats in the cell membrane and manufacture different immune chemicals. Some will resolve inflammation, pro-resolving mediators. That's what happens when they snip omega-3 three fats. When they snip omega-six fats, they manufacture chemicals that keep the inflammatory response going. So you can imagine if you're loading the diet with omega-six fats, you have a skewed ratio in the body of those fats. There's going to be a more a higher likelihood of immune cells manufacturing the pro-chronic inflammation mediators as opposed to the resolving mediators. This is just like math. It's like let's load the body with more of the stuff that can be turned into the downstream byproducts that are anti-inflammatory. But the third piece that the people just don't talk about, which is also so important is that omega six fats and omega three fats compete for the same enzymes. Enzymes are like little protein machines in the body that can do chemical reactions. The omega-three fats and Omega six fats compete for the same enzymes to go through a conversion process that ultimately makes them have their most bioactive activity. To give an example of this, if you eat chia seeds, hemp seeds, and flax seeds, you're taking in an upstream Omega three fat called alpha-linolenic acid. That alpha-linoleic acid actually has to be converted through a several-step process to EPA and DHA, which are downstream omega threes, which have amazing anti-inflammatory and structural properties. But to get there, to do that process, to make the most useful, you require several steps with these enzymes called long aces and desaturate aces. Omega six fats also use those enzymes to basically be converted. So if you're overloading the body with omega-6 fats, you're blocking the ability of the body to take the ALA and turn to EPA and DHA. So even if you're eating a lot of plant-based, it's not doing anything much. ALA has its own purposes, too. But you're you're gonna be blocking the flow to EPA and DHA. And that's one that no one talks about. When I think about reading every label and never eating soybean oil, corn oil, vegetable oil, canola oil, etc. It's not just the omega sixes. It's also that I know I'm literally gumming up the machinery that could help me take the helpful stuff I need. I'm spending all this money on chia seeds and hemp seeds, and I want to get the most value out of them. And instead, I'm gumming up that system, that's a big piece of it as well.

Elizabeth Stein 46:50
Wow. What do you think about for you, you can certainly control what you're consuming at home. And it's much easier to control that. But when you go out to dinner, I guess is probably the biggest offender. What do you think about that?

Casey Means 47:07
Yeah, the reality is, that I've moved throughout my life to eating the vast majority of my meals at home. And really just shaping my life a lot around the ability to cook more. So it's a priority, it's a choice. For instance, in the past in my 20s, I gained a lot of knowledge, I associated with new restaurants and the novelty of eating out with like fun and enjoyment. And that would be a special experience with friends. And now, because of so much of this learning, I find it really wonderful to have people over to eat at my house, or if I'm going to someone else's house, really try to graciously offer what can I bring, that would be helpful. And so and then bring something really healthy, that they're going to love and that's, that fits it supports everyone's health. And so I'd say I cook, I probably eat 90% of my meals from stuff that I make at home as you build a healthy community, too, which is a huge priority in my life. People you're around want to eat healthy, too. And then if I'm eating out, I will often suggest meeting at a place that I know uses really good oils and that cares. Although it's just really hard to find truly healthy restaurants out there. I would say even some of the healthier restaurants still are using sugar and seed oils and stuff like that. But you can try. I live in LA and Erawan is a huge healthy grocery store. But they still use seed oils and so it's tough. I will ask about oils, I certainly won't order things on the menu that I think will have a lot of sugar. Like if I order chicken breast with vegetables, I can be pretty sure it doesn't have a lot of sugar. But after all that, then I just let it go. Because if I'm at him with someone, I haven't chosen the restaurant and I'm with friends, I just don't worry about it as part of distress and you need to have joy. And at that point, it's like okay, so this is the 5% of the time when I'm going to be burdening my body with some of this stuff. And that's okay because I spend a lot of time trying to build capacity in my body so it can handle things like this. But the reality is I try to really prioritize keeping it to a minimum. If I'm flying on an airplane, I'll either fast or I'll bring my own food. I'm not putting myself in positions where I'm going to have to depend on processed food. But when it does happen, I embrace it and enjoy it because eating under stress is also not good for metabolic health.

Elizabeth Stein 49:50
All right, well, we're gonna move into some rapid-fire Q&A Three things that you're currently loving. It could be anything. A product, a show, a book.

Casey Means 50:04
Oh my gosh, I love this question so much. There are so many things I love. The first thing that comes to mind is I've been reading this wonderful book called Autobiography of a Yogi, which is kind of like a spiritual book about Hindu spiritual principles by this thought leader who came over from India in the 1920s called Paramahansa Yogananda. I grew up religious and then moved away from the church. And it's kind of one of the first schools of thought that feels like a very non-dogmatic, but very empowering, spiritual tradition that's not about rules. It's more about just connecting with your true nature as an incredible spiritual being, you know. And so I was introduced to this by this wonderful woman who you may know, Kimberly Schneider, who's written several books. She wrote a book about Yogananda called You Are More Than You Think You Are. It's been the first and it's gotten me to really actually meditate every single day. And that's been a wonderful thing. So highly recommend that. And actually, a fun fact, Steve Jobs when he died, at his funeral, every single person at the funeral got a copy of that book because it was so meaningful to him. So a great jumpstart for feeling empowered, meditating more, and diving into more spirituality, and things like that. The second thing I'm loving, I'm just going to choose a few random things. I was given a waist suitcase for Christmas by my boyfriend, and I read Peter Thiel’s Zero to One, this book about creating consumer products and wanting to have a 10x better solution than other things on the market, which I think is Purely Elizabeth, a solution to granola. But I'm like, oh, this suitcase is 10x better than every suitcase I've ever had before. And it's literally worth a little bit more money. It's just a suitcase. But it's so much better. And then another thing I've loved recently is I've been taking WeNatal, which is a prenatal multivitamin for both men and women. My partner takes it and I take it. And it is just like the highest integrity brand, really thoughtful sourcing, really thoughtful, sustainable packaging. And it's I've always had trouble staying on top of vitamins, but I trust this brand so much. And it makes me feel so good after I take it that I'm actually religiously taking it. And I'm really noticing a difference and how I feel. We love WeNatal. Those are the three that came to mind today.

Elizabeth Stein 52:45
Love it. Well, I just started taking their Omega Three.

Casey Means 52:48
Yes, I take that too.

Elizabeth Stein 52:49
And it's beautiful packaging.

Casey Means 52:50
Yeah, it is so beautiful.

Elizabeth Stein 52:51
Three favorite good energy habits.

Casey Means 53:03
Okay. I think my favorite good energy habit from the entire book is the power of walking. It sounds so basic, but a lot of friends have asked me like, what's the craziest thing you learned while writing this 400-page book about health? And I'm like, honestly, this sounds so boring. But some of the most powerful research I saw in the entire writing of the book was the power of walking. And there's literally research from top journals like the Journal of American Medical Association, that shows that if you take 1000s of people and follow them for over 10 years, people who just walked more than 7000 steps a day have a 50% lower risk of dying than people who are walking less than that. So even not even getting to 10,000 just 7000 says the average Americans walking 3500 to 4000 steps today. So we're like, we're literally just not moving like where these miraculous bipedal organisms and we don't walk. And the reason it's important, from a good energy standpoint is that every time we move our muscles, even in low-grade ways like walking, we push glucose channels to the cell membrane, to basically take up glucose out of the bloodstream and process it. So if you're sitting all day, but then you just work out for an hour at the end of the day or the beginning of the day, but you're sitting the rest of the day, by and large, your body is keeping those glucose channels inside the cell. And you're not kind of getting that constant metabolic activity versus if you just are moving more throughout the day, steps is a proxy metric. It's not about the steps it's about just moving more throughout the day. You are changing your whole fundamental biology to push these glucose channels through the cell membrane all throughout the day. So I think the real concept there that I talked about in the book is that almost our obsession with the exercise of the culture is like part of the problem with why we're sick because we think that exercise is a substitute for just moving throughout the day. But the human body to work properly needs to be in motion all day. Not moving constantly, but always finding ways to get up and move around, which means taking stock of everything we do in our modern world, and figuring out ways to make more of those activities, standing or moving. So that could mean instead of catching up with your kids, or your partner on the couch, at the end of the day, throw a football outside, just converting activities. So that's one. The second good energy habit that was fascinating to me, was a concept called social jetlag, which I did not know about before writing the book, but it was very resonant for me because it's about sleep. What I learned was that three aspects of sleep are actually super important for metabolic health, we think about quantity seven, or eight hours. We also think about quality more now that we all have our sleep wearables and that's more like deep sleep and REM and all that. But consistency is just as important. Consistency means that you're going to bed and waking up at fairly similar times. And that's the one that I've always been bad at. But giving myself kind of a free pass, I'm like, well, I sleep eight hours, just my bedtime jumps around a lot. So social jetlag is this concept where if you're working a standard Monday through Friday, and you have Saturday and Sunday off, which obviously isn't the case for everyone, but you take your work days and your leisure days, and you look at the midpoint of sleep. So if I go to bed at 10, and wake up at 6 on the weekdays, my midpoint is 2 am. Four hours from 10 am, four hours till 6 am. My midpoint is 2 am. If on the weekends, I sleep from 12 to eight, my midpoint is 4 am. So 2 am and 4 am are the two midpoints. And that represents two hours of social jetlag. Research has shown that if you have two or more hours of social jetlag in your weeks, it confers double the risk of metabolic syndrome, obesity, and diabetes. So consistency actually makes a difference, even if you are getting enough sleep. So that has really motivated me to prioritize my bedtime which just sounds kind of obvious, but it's like I think we're kind of in a culture or like, we eat whenever we want, we go to sleep whenever we want. The body is desperately trying to know what time it is so that biology can be optimal for that time. And we're really just confusing the body by looking at blue light late at night, not looking at the sunshine during the daylight hours, eating at erratic times, and going to bed at erratic times. So those are the things we need to clean up to basically help and train our circadian biology to do its best work. The third one I will mention is actually about mindful eating and focusing on mealtime behaviors. There have been studies that have shown that when we eat slower, we actually drastically decrease our risk of diabetes and obesity, metabolic issues. The data is pretty crazy, people who eat the fastest have a four times higher risk of developing metabolic diseases. I am a notoriously fast eater in medical school and surgical training. It was just drilled into me, I just am walking and shoving food. You know how it is. And that's just our culture. So realizing how important it was, has helped me find the motivation to make that a priority. Now I live with my partner. And so we really prioritize sitting down to as many meals as possible, putting our phones down. I'm not religious, like I don't practice an organized religion, but like we do say a grace, like a gratitude moment for the food, which, slows us down and puts us I think more in that relaxed rest and digest state realize what we're actually doing at the table, which is we're taking in matter from the environment to build our bodies and help generate health and energy. It's beautiful and we just have forgotten our culture, how miraculous this is. Then we sit and we talk. My attempt to really eat as slowly as possible, also gets me to try and prioritize meaningful conversation because that gets me to stop eating fast. And so it's a trickle down of knowing the research and then kind of reshaping mealtime behaviors. So eating slower, eating more with other people, and in a sense of gratitude, are all of those things associated with real better health in the data. So that was fun to learn about for the book.

Elizabeth Stein 1:00:09
I love those. Those are some great habits to pick up. Okay, three of your favorite good energy pantry staples or fridge staples.

Casey Means 1:00:20
Okay, I would say the number one that comes to mind is Zen basil seeds. These are fancy chia seeds basically. So compared to chia seeds, they can be used interchangeably. They have more omega threes, more fiber, more antioxidants, more vitamins and minerals. They are slightly more expensive, but they have more of all that stuff. So I love them as a major fiber source for me. I also fill my pantry with them, wild-caught canned fish. So I always have sardines, salmon, and tuna. And a lot of days if I don't have leftovers or something, it's kind of the perfect meal. I'll do a can of wild planet salmon with primal kitchens, avocado oil, mayo, a can full of wild brine sauerkraut, and a little squirt of organic sriracha from Yellowbird, and mix it all up. It’s basically like a weird tuna salad. Put it on flax crackers with avocado. Like I love Flackers which is gonna be my third one. And that gives you protein, omega threes, probiotics antioxidants, and fiber and doesn't spike my glucose even one point. That's a wild planet and then I do I have to shout out to Flackers because I love crunchy things. And I love crackers and I love snacks. But all of the standard brands are gonna have refined seed oils and refined grains, Flackers, the only ingredients are organic flax seeds, apple cider vinegar, and sea salt. They have nine grams of fiber per serving, which is almost equivalent to what the average American is getting for fiber and a whole day. If I have two servings of slackers, I'm getting more than the average. I get 12 bags shipped to my house from Amazon per month because we literally go through them so fast in our house. Then, of course, I love my Keto granola from Purely Elizabeth. We have the peanut butter one, we have the coconut almond, we have all of it. So those are also on our Amazon auto-delivery as well.

Elizabeth Stein 1:02:49
And lastly, what is your number one non-negotiable to thrive on your wellness journey?

Casey Means 1:02:57
Oh, my personal non-negotiable to be totally honest, is not eating ultra-processed food. Ultra-processed food is the root of our chronic disease epidemic because it's so interconnected with so many other aspects of that energy. It's decimating our soil which is creating an environmental habit. It's what's interlinked with environmental toxins because everything's in plastic and covered in pesticides. It's interlinked with the fact that we're indoors all day because we're not actually out in our gardens and we're not seeing the sunlight and we're obsessed with our computers which means that we're not actually moving. Ultra-processed food is, in my mind, really a central factor of the whole problem. And of course, ultra-processed food drives a multi-trillion dollar food industry that's designed to keep us addicted, which then fuels the $4 trillion dollar healthcare industry that manages “the problems that arise from it”. So you could put any Ultra-processed food in front of me and I wouldn't touch it because I think it's evil in a way and it's not even a craving for me. So that's a non-negotiable. I see it as a weapon of mass destruction that is for our health our bodies and our future. So that's kind of the one that gets me most amped up but in a new non-negotiable for me that's actually been one only the last, I would say it's been about 110 days or so but I listened to a Rich Roll podcast right at the start of the year and it just finally was the thing that got me to totally stop. I was never drinking heavily but I stopped drinking alcohol completely for dry January and it was so positive that I've kept going so I'm sort of on my non-drinking journey and it has been profoundly impactful even though I wasn't drinking that much before, but one thing I've noticed is just a lot more creativity and also better sleep. And so that's one that we'll see. We’ll do a part two sometime. I'm not anti alcohol. But I have just been fascinated with how it's been positive even though it was moderate before. So yeah.

Elizabeth Stein 1:05:25
I love that. Well, Casey, thank you so much for being on the podcast. I think, as you said, in part two, I could go on and talk to you for hours after this. But where can everybody find you and the new book that's coming out?

Casey Means 1:05:37
Well, the book comes out on May 14, and it's everywhere. It's on Barnes and Noble, Amazon, and independent booksellers. If people want a signed copy, they can get that through a bookstore called DIESEL in LA. You can google DIESEL bookstore in LA. And then for me, personally, I am at caseymeans.com. I'm on Instagram, @drcaseyskitchen. And I have a newsletter called Good Energy Living. I really pour my heart and soul into that every week. So if you want more information on sort of the extension of the book into real-world week-to-week stuff, that's a great place to get more practical information. So yeah.

Elizabeth Stein 1:06:25
Amazing. Thank you so much for being here. Thanks so much for joining me and living purely with Elizabeth. I hope you feel inspired to thrive on your wellness journey. If you enjoy today's episode, don't forget to rate subscribe, and review. You can follow us on Instagram at purely underscore Elizabeth to catch up on all the latest. See you next Wednesday on the podcast.