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

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Summary Notes


In today's discussion with Dr. Casey Means, we delve into the intricacies of metabolic health, highlighting the crucial role of mitochondria in energy production and overall wellness. Dr. Means underscores the profound impact of lifestyle choices, such as diet, exercise, and sleep, on mitochondrial function and metabolic health. She emphasizes the importance of whole, unprocessed foods, regular movement, and managing psychological stress to support metabolic processes. Additionally, she points out how modern lifestyles, characterized by excessive indoor time and constant exposure to stress-inducing stimuli, can disrupt metabolic balance. Dr. Means advocates for a return to nature and simplicity, aligning our daily habits with our biological needs to foster metabolic resilience and reduce the prevalence of chronic diseases.

Summary Notes

Introduction to Metabolic Health

  • Metabolic health is foundational to overall health and is a primary pathway that drives all other aspects of health.
  • Metabolic dysfunction is at the core of nine out of the ten leading causes of death in the United States.
  • Metabolism involves converting food energy into human energy, powering every chemical reaction in the body.
  • A high percentage of American adults have suboptimal metabolism, leading to various health issues.
  • Specialization in healthcare has led to a focus on symptoms rather than addressing metabolic health as the root cause.

"Metabolism is actually the foundation of all health. It is the core foundational pathway that drives all other aspects of health."

  • This quote emphasizes the importance of metabolism as the central pathway for overall health and well-being.

Mitochondrial Function and Dysfunction

  • Mitochondria are responsible for energy production within cells and are affected by our lifestyle choices.
  • Environmental changes over the past 50-75 years have directly harmed mitochondria, leading to underpowered cells and metabolic dysfunction.
  • Mitochondrial dysfunction is linked to obesity and other metabolic diseases due to the inability to convert energy substrates efficiently.
  • Metabolic health can be improved by focusing on mitochondrial function and addressing environmental factors.

"The mitochondria are the structure within the cells... they are the magical part of the cell that does that conversion process of food breaking down and then converting to energy."

  • This quote explains the role of mitochondria in converting food into usable energy and highlights their significance in metabolic health.

The Trifecta of Metabolic Dysfunction: Mitochondria, Inflammation, and Oxidative Stress

  • Mitochondrial dysfunction, chronic inflammation, and oxidative stress form a trifecta underlying metabolic dysfunction.
  • These factors are interconnected and create conditions such as obesity, diabetes, and other chronic diseases.
  • The cell danger response is initiated by underpowered cells, leading to an immune response that cannot address the root cause.
  • Addressing these three factors is key to reversing metabolic dysfunction and improving health.

"Underpowering in different cell types is going to look like different symptoms... but the core foundational process that is dysfunctional can actually be the same."

  • This quote highlights that while symptoms of metabolic dysfunction may vary across different cell types, the underlying process of dysfunction is often similar.

Solutions for Metabolic Dysfunction

  • Solutions to metabolic dysfunction involve creating more mitochondria, improving their function, and increasing their capacity to process energy substrates.
  • Lifestyle changes such as exercise, nutrition, and managing stress can promote mitochondrial health.
  • Simple habits like walking regularly can significantly impact metabolic health by improving glucose disposal and stimulating muscle contraction.

"What we really want to do to increase our metabolic capacity... it's we need to make more mitochondria. We need to get each mitochondria to be more functional, and we need to have each more functional mitochondria, processing more energy substrates."

  • This quote outlines the primary goals for improving metabolic health, focusing on increasing the number and functionality of mitochondria.

Walking as a Metabolic Health Tool

  • Regular walking, even short walks throughout the day, can have a profound impact on metabolic health.
  • Walking stimulates muscle contraction, which promotes glucose uptake and utilization by the cells.
  • Clinical research supports the benefits of regular walking for reducing blood glucose levels and improving overall metabolic function.

"If walking were a pill, it would be the most impactful pill we've ever had in all of modern medicine."

  • This quote emphasizes the significant health benefits of walking as a simple yet powerful tool for improving metabolic health.

Walking and Anxiety Reduction

  • Walking through space with optic flow reduces anxiety in the brain.
  • There is data supporting the anxiety-reducing effects of walking.

"Walking through space with optic flow has a certain anxiety reduction function in the brain, which there's beautiful data there, in my opinion."

  • This quote explains that walking, particularly with the visual perception of moving through space, has been shown to reduce anxiety, supported by strong scientific data.

Exercise and Mitochondrial Health

  • Different types of exercise affect mitochondrial health in various ways.
  • Endurance and zone two exercises stimulate mitochondrial biogenesis, increasing their number.
  • High-intensity interval training (HIIT) improves mitochondrial fusion.
  • Resistance training leads to muscle hypertrophy and the need for more mitochondria.

"Getting heart rate way, way up, breathing hard for some minutes each week, maybe a couple times per week, seems that's a good way to increase mitochondrial function and mitochondrial number."

  • This quote highlights the importance of engaging in exercises that elevate heart rate and breathing to enhance mitochondrial function and quantity.

"When we think about improving mitochondrial fusion, high-intensity interval training is really, really good for that."

  • This quote emphasizes the benefits of HIIT for improving the merging of mitochondria, which is crucial for their function.

"When we think about resistance training, it's like, that's like muscle hypertrophy. We're going to be creating more muscle cells and we need more mitochondria for those."

  • The quote explains that resistance training leads to the growth of muscle cells, which requires an increase in mitochondrial count to meet the energy demands.

Physical Activity Guidelines and Their Impact

  • Government guidelines recommend resistance training 2-3 times a week and 75-150 minutes of cardiovascular exercise.
  • A significant percentage of Americans do not meet these guidelines.
  • Walking is not included in the basic recommendations but is advised based on data supporting its benefits.

"80% of Americans are not meeting those very basic guidelines, and 20% of Americans don't get any physical activity, really at all."

  • This quote reveals the alarming statistic that a vast majority of Americans fall short of meeting the minimum exercise recommendations, which has implications for public health.

"I would just absolutely add to that at least 7000 steps per day based on what the data is showing."

  • The quote suggests adding a daily goal of 7000 steps to the exercise guidelines, which is supported by research and can be achieved with minimal time investment.

Under Desk Treadmills and Health

  • Under desk treadmills are endorsed for improving health by increasing movement during sedentary activities.
  • Studies show that using an under-desk treadmill can positively impact body composition.

"I'm a massive fan of under treadmill desks because genuinely I believe that if we move more of our daily activities that we're doing seated indoors to outdoors moving, it would radically change the health of the United States."

  • The quote advocates for the use of under-desk treadmills as a means to incorporate more movement into daily life, which could significantly improve national health.

"People lost on average, 2.6 pounds of fat and put on 2.2 pounds of lean mass."

  • This quote cites a study where participants using under-desk treadmills saw notable changes in body composition, losing fat and gaining lean muscle.

Physical Activity and Metabolism

  • Non-exercise activity thermogenesis (NEAT) is important for metabolism and combating obesity.
  • Simple movements and muscle contractions throughout the day can have profound health benefits.

"Contracting muscles, contracting muscles. It's medicine."

  • The quote emphasizes the significance of muscle contractions, even from simple movements, as a form of beneficial physical activity for health.

"The data is really good about it. Like, it's basically shows that this is a prime potential intervention for the obesity epidemic."

  • This quote discusses the strong evidence supporting NEAT as a key strategy in addressing the obesity epidemic.

Blood Tests and Metabolic Health

  • Basic blood tests can reveal a lot about metabolic health and are easily accessible.
  • Understanding the results of these tests can indicate mitochondrial dysfunction and guide health improvement strategies.

"Every single person listening, I hope, after this episode, will go to their health record or send their doctor a message and at least get the following test."

  • The quote encourages everyone to obtain basic blood tests to assess their metabolic health.

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

  • This quote suggests that lifestyle changes can quickly improve the biomarkers associated with metabolic health.

Understanding Blood Test Biomarkers

  • Fasting glucose and triglycerides can indicate insulin resistance and mitochondrial dysfunction.
  • Hemoglobin A1c reflects average blood sugar levels and glycation.
  • Blood pressure is linked to insulin resistance and nitric oxide activity, affecting vascular health.

"A patient might go into the doctor and their fasting glucose is 99, one point under what we'd consider the normal range. And their triglycerides are 149, one point under what we'd consider the normal range... this person is definitely metabolically dysfunctional."

  • This quote points out that even if blood test results are within the normal range, they can still signal underlying metabolic issues.

Food and Metabolic Health

  • The quality of food we consume is crucial for metabolic health.
  • Real, unprocessed food from good soil provides the necessary nutrients for cellular function.
  • One's preference for healthy foods can be influenced by consistent consumption of whole foods.

"The root cause of the problem is that we have a toxic food supply that's no longer filled with the molecular information that our body needs to know to be satiated and to function properly."

  • This quote identifies the core issue of the modern diet being the lack of nutrient-rich, unprocessed foods that satisfy the body's needs and support cellular health.

Effects of Ultra-Processed Food Intake

  • A study by Kevin Hall investigated the impact of ultra-processed versus unprocessed food on calorie intake and weight gain.
  • Participants consumed 500 more calories per day on an ultra-processed diet, leading to a 7000 calorie surplus over two weeks.
  • Weight gain was approximately two pounds during the ultra-processed phase, which was subsequently lost during the unprocessed phase.
  • The study illustrates the failure of the ultra-processed food system, evidenced by rising obesity rates, especially among children.
  • Quality of food, nutrient density, and the role of satiety hormones are crucial in natural calorie regulation.

"And literally just giving people this ultra-processed food, which is devoid of what our bodies need and therefore will drive people to eat more, they ate 500 calories more per day for a total of 7000 calories more in that two weeks."

  • This quote emphasizes that ultra-processed foods lack essential nutrients, leading to increased calorie consumption and weight gain.

Nutrient Depletion in Modern Diets

  • Modern diets are predominantly ultra-processed, lacking in essential nutrients.
  • Industrial agriculture has led to nutrient-depleted soils, further reducing the nutritional value of food.
  • The combination of ultra-processed foods and poor soil quality significantly diminishes the utility of food for bodily functions.
  • Strategies for improving diet quality include focusing on fiber, omega-3s, healthy proteins, probiotics, and high-antioxidant foods.

"Right now, 60% to 75% is ultra-processed. So we slash the value because the ultra processing, just like, slashes the nutrients, we slash the value of that 70 metric tons."

  • The quote highlights the significant proportion of ultra-processed foods in modern diets and their negative impact on nutrient availability.

The Role of the Brain in Dietary Choices

  • The brain's hypothalamic circuitry drives hunger and satiety by seeking out amino acids and micronutrients.
  • Highly processed foods confuse these neural circuits due to their lack of clear nutritional profiles.
  • The comparison between the effects of a balanced diet and highly processed foods on the brain's reward circuitry.

"The neural circuits responsible for hunger and satiety would get immensely confused by what's in a highly processed food."

  • This quote explains how highly processed foods disrupt the brain's ability to regulate hunger and satiety due to their unclear nutritional content.

Cellular Confusion and Chronic Inflammation from Processed Foods

  • Processed foods contribute to cellular confusion and chronic inflammation, which is a form of biochemical fear at the cellular level.
  • The body's inability to recognize and properly respond to the unnatural components of processed foods leads to adverse health outcomes.
  • Chronic diseases and insatiable hunger in the US are partially attributed to this cellular confusion.

"Our insatiable hunger and our chronic disease epidemic fundamentally is a lot of it's mass cellular confusion."

  • This quote suggests that the widespread health issues in the US are partly due to the body's inability to understand and process the components of ultra-processed foods.

Satiety Hormones and Nutrient Sensing in Dietary Regulation

  • The body contains nutrient-sensing cells that regulate hunger through the secretion of satiety hormones.
  • Proper stimulation of these cells with the right nutrients can naturally reduce cravings and regulate appetite.
  • The conversation around GLP-1 analogs like Ozempic overlooks the body's natural ability to produce GLP-1 when stimulated by appropriate nutrients.

"I literally just have to give the body what it needs. I have to stimulate the body in a way that it will serve me in giving me satiety hormones to basically regulate my hunger."

  • The quote emphasizes the importance of providing the body with the nutrients it needs to naturally regulate hunger through the secretion of satiety hormones.

Strategies to Increase GLP-1 Naturally

  • Increasing the number of L cells that produce GLP-1, stimulating more GLP-1 production, and inhibiting the breakdown of GLP-1 are strategies for enhancing natural GLP-1 levels.
  • Dietary components like short-chain fatty acids, polyphenols, amino acids, green tea, and curcumin can stimulate GLP-1 production.
  • Foods like black beans, oregano, rosemary, and certain berries can inhibit the breakdown of GLP-1, prolonging its effects.

"There's three ways our body could make more glp one. We make more cells that make it l cells of the gut. Each of those cells makes more glp one. And importantly, we can also inhibit the inactivator of glp one, which is an enzyme called dpp four."

  • This quote outlines the three primary ways to increase the body's natural production of GLP-1, which can help manage cravings and regulate appetite.

The Role of Temperature in Mitochondrial Health

  • Exposure to varying temperatures has historically been a norm, but modern lifestyles have reduced these fluctuations.
  • Cold exposure signals the mitochondria to produce more heat, which can improve their function and increase brown fat.
  • Heat exposure activates heat shock proteins that may enhance antioxidant defenses and support metabolic health.

"We can speak to our mitochondria with the language of thermal energy and say, hey, it's cold outside, we need you to print more of yourselves or work harder such that we can create heat inside the body to respond to this stimulus."

  • This quote explains how exposure to cold temperatures can act as a signal to mitochondria to increase their activity and improve metabolic health.

Intermittent Fasting and Metabolic Health

  • Compressing the eating window to align with the body's natural diurnal cycle can improve metabolic health.
  • Eating the same amount of calories in a shorter time frame, such as six hours, can lead to lower glucose and insulin levels compared to spreading intake over twelve hours.
  • Time-restricted feeding is a practical approach to enhancing metabolic health without reducing calorie intake.

"People who eat the same amount of calories in a six hour period are going to have much lower, statistically significantly lower glucose, 24 hours glucose and insulin levels compared to people who just space it out over the course of a twelve hour period."

  • This quote indicates that time-restricted feeding can have a positive impact on blood glucose and insulin levels, even when total calorie intake remains the same.

Optimal Eating Window

  • Compressing the eating window has favorable metabolic effects.
  • The average American has 11 eating events and eats over a 15-hour window daily.
  • Frequent eating stimulates glucose rise, exposing blood vessels to glucose and activating insulin pathways.
  • Allowing insulin and glucose levels to drop enhances metabolic flexibility.
  • Metabolic flexibility is the ability to use glucose and then switch to fat stores for energy.
  • High rates of overweight and obesity in the U.S. may be due to constant glucose availability, preventing fat store utilization.
  • Compressing the eating window can help the body rest and transition to fat burning.
  • Fasting should be eased into and monitored for individual response.
  • Continuous glucose monitoring (CGM) can make fasting more engaging.
  • Eating earlier in the day results in lower glucose and insulin responses compared to eating the same meal at night.
  • Melatonin secretion at night may impair insulin sensitivity.

"And so I think giving the body times intentionally to allow insulin to come down and to allow glucose to come down, what that does is it generates metabolic flexibility."

This quote emphasizes the importance of allowing insulin and glucose levels to fall to enhance the body’s ability to switch between using glucose and stored fat for energy.

Impact of Diet and Lifestyle on Blood Glucose

  • Resistance training can help replenish glycogen and reduce carbohydrate cravings.
  • Quality of food intake is crucial for managing blood glucose.
  • CGM use reveals surprising foods that spike blood sugar levels.
  • Food order can affect blood glucose stability.
  • Sauna use may cause blood sugar spikes, potentially due to dehydration or sensor accuracy issues.
  • Including fat and fiber in meals can blunt blood glucose spikes.
  • Lifestyle adjustments based on CGM data can improve overall metabolic health.

"And then across time, I also found that I love hot sauna. I go so hot with the sauna that I've been accused by Rogan and other people. I'm gonna turn myself into a brisket. But after the sauna, my blood sugar spikes, presumably because I'm a bit dehydrated and it's the concentration of blood glucose. Is that possible? Does that make sense?"

This quote discusses how sauna use can potentially lead to an increase in blood glucose levels, which could be due to dehydration affecting the concentration of glucose in the blood.

Insights from Continuous Glucose Monitoring

  • CGM provides a detailed picture of glucose trends over time.
  • CGM can predict early signs of metabolic disease by measuring glucose decline post-meal.
  • Area under the curve (AUC) after a glucose spike should be low for optimal health.
  • Glycemic variability (GV) is an indicator of metabolic health, with lower variability being preferable.
  • Dawn effect refers to the rise in glucose upon waking, which is influenced by cortisol.
  • Continuous monitoring can reveal individual responses to food and lifestyle factors.
  • CGM can guide interventions for improving insulin sensitivity and metabolic health.

"And he showed that on a CGM, a continuous glucose monitor, you have these low variability people that are pretty much flat throughout the day with little teeny rolling hills after their meals. You have moderately spiky people, and then you have very spiky people who are going up, down, up, down, up, down, up, down."

This quote explains how CGM can reveal different patterns of glycemic variability among individuals, with lower variability being associated with better metabolic biomarkers.

Relationship Between Diet, Cravings, and Metabolic Health

  • CGM data shows that high-carb meals can cause significant glucose spikes and crashes.
  • The extent of post-meal glucose dips is predictive of subsequent energy intake and carbohydrate cravings.
  • Managing glucose spikes can help control cravings and improve metabolic health.

"This paper in nature showed that essentially, when people spike their glucose with high carb, high starchy foods, they'll often have a big crash afterwards."

This quote highlights a study that found a correlation between glucose spikes from high-carb meals and subsequent crashes, which can influence cravings and overall energy intake.

Mindset and Connection to Nature

  • Mindset and psychology, particularly related to fear and control, are critical factors in metabolic health.
  • Stress and loneliness impact metabolic function and can trigger diabetogenic effects.
  • Mitochondria respond to psychological threats by altering energy resource management.
  • Modern life, with constant exposure to fear-inducing media, affects cellular function.
  • Spending time in nature can help establish a sense of safety and abundance.
  • Nature provides a fundamental understanding of life's harmonious cycles.
  • Reconnecting with nature is essential for health and can reduce the time spent indoors.
  • Embracing nature can lead to a healthier relationship with food and lifestyle choices.

"And I think a big part of the metabolic health conversation is how do we create a sense of safety in our bodies, no matter what is happening outside of our bodies?"

This quote addresses the importance of establishing a sense of internal safety and stability to support metabolic health, despite external stressors.

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