EFR 735: The Truth About Ozempic and GLP-1 Agonists, How Poor Metabolic Health Causes Chronic Disease, and Why Focusing on Your Mitochondria Daily Can Boost Energy and Increase Your Lifespan with Dr. Casey Means

0:00:00 - Speaker 1 Anybody that wants to kind of have a stronger foundation of blood sugar, blood sugar management, diabetes, the types of it, metabolic flexibility we'll get into that a little bit today, but just the foundational knowledge. Please go back and check that first episode. I'll have it all linked for you in the video notes and show notes. But today I really want to kind of unpack a lot of what's been going on in the world of metabolic health, metabolic disease, you being this chief medical officer and co-founder of Levels, this incredible glucose monitoring company that I'm using right now. That is just empowering people in both education and real life data. So I kind of just have a lot of just what about this, what about this, what about this? And I want to just unpack everything you know about this and take advantage of having an expert on the show.

0:00:49 - Speaker 2 Let's do it. I can't wait.

0:00:51 - Speaker 1 So, someone that has such a strong focus, professionally and personally, on metabolic health and healthy blood sugar management, what does a typical day in the life look like for you? Do you just wake up and go? How do I control my blood sugar? What does it look like?

0:01:11 - Speaker 2 Oh my gosh. Well, I tend to be a little bit more of someone who kind of flows with how I'm feeling. I'm not a rigid protocol person. So I actually I don't have a morning routine, I don't have an evening routine.

0:01:24 - Speaker 1 You, can't say that in 2023. I know, I know. Are you ever going to be a successful entrepreneur? I know.

0:01:31 - Speaker 2 I you know some I mean might even look at my day to day patterns and sort of say it might be chaotic compared to like the ultra protocolized way that we're focusing on wellness. But I go with more like how my body's feeling and what my?

body needs and what I'm being called towards because, well, for a few reasons. One, I think, as I've gotten, you know, more in touch with just sort of, I think, my femininity and sort of the idea of being this like cyclical creature in the world, which I think was really like beaten out of me when I was in like the ultramasculine surgical world for like nine years. You know, medical school and residency, and it was so much about scheduling and like no control over your you know, just same thing every day. Now I'm much more about like how do I feel today, Like what do I need, what is my, what are the stressors that are facing me today versus next week, and like how do I sort of like ebb and flow with that, which has felt really, really good and I think that you know, every day I'm basically just living for my mitochondria.

I would say you know, I think that anyone who listened to your Chris Palmer episode heard a lot about mitochondrial health.

0:02:38 - Speaker 1 It was so amazing and so powerful.

0:02:41 - Speaker 2 But it's really the truth. It's like our mitochondria are the little machines, you know, in our bodies and ourselves that are animating life force, and the more we can support them, the more we can have like a strong life force. And so I'm really thinking about them, as I'm thinking about what I'm doing each day and what they actually need, and one sort of like framing that I feel like again probably has something to do with this, like feminine nature and sort of moving into the phase of life where I might become a mother at some point soon. You know, it's like I think about myself as like I, as this like you know, person, I'm kind of like the parent to every single one of my 37 trillion cells.

And like I am really adopting that role, as like they don't have eyes, they don't have arms, they can't feed themselves, like I am the parent to them and if I can parent them well, like they will do everything for me. Like they will create happiness, they will create mental health, they will create energy, they will create you know, just creativity. And so I take a lot of pride in that of like how can I support their needs? And of course, we know right now like our mitochondria are just absolutely under siege in our modern world.

Every single thing about modern industrial Western life is hurting our mitochondria and unless you are basically like hyper vigilant about how you are protecting yourselves and protecting your mitochondria, you will go down the path of chronic disease and you will have a shorter, more painful life, and that can be really intimidating, cause you're like, okay, am I just spending my life now like protecting myself from the world? And in a sense, yes, but I think this is why every day is a little bit different, because you cannot do it all and you can't become obsessively stressed out and focused on this. You have to do your best and each day I'm kind of called to do different things to support the mitochondria in the cells and so some of the things that we of course like, the vectors that we know we can sort of like pull to improve our cellular health is obviously like our food eating unprocessed, clean, whole food, organic, not covered in pesticides, lots of micronutrients.

We can move our bodies. We can give the stimulus to the body to create more mitochondria to make them work more efficiently to process more glucose. By basically exercising and moving we can manage our stress. We can keep our low grade chronic stress as low as possible and find the psychological freedom to kind of free our bodies from that chronic stress signal that we know crushes the mitochondria. We can sleep well.

Sleep is this amazingly metabolically, you know recharging time, yes. So sleep, exercise, food, stress management. We can avoid environmental toxins that are hurting our mitochondria. We can put the body in cold situations to simulate the mitochondria to make more heat and be more efficient. We can make sure that we're getting sunlight during the day to set up those circadian rhythms, to make sure the mitochondria know what time it is, they know what programs to basically sort of engage in.

So there's all these levers, these vectors, and so ideally you know you focus on all of them every day, but really it's like what can I do today? And so most days I'm really trying to like down the sleep and dial in the movement and dial in the food and avoid the toxins. But it's basically just trying to do like the best I can each day in each of those things, and some days it'll probably be like three or four of them, and some days it'll be seven of them, and some days it'll be zero, because I just don't have, you know, the bandwidth that day. So I kind of am always focused on my mitochondria, but each day looks a little bit different.

0:06:11 - Speaker 1 And Casey, that was so refreshing and honest and, honestly, a little unexpected. Even knowing you personally, you know I would just assume that, oh no, she's got her work cut out for her, she's got this protocol and that protocol and you kind of just eluded to it at the end. You know, I've got a couple of things that I do all the time, or all the time I do none of the things, or it's some kind of combination of that. And I think you know I made a joke earlier about if you don't have a morning routine you're not gonna be successful kind of thing.

I think that's so refreshing to hear right now and necessary, because maybe it's just my little corner of the world, but whenever I pull up Instagram or social media or talk to somebody, it's morning routine, evening routine, morning routine. It's this, these non-negotiables, all the time, and not to cash shade on anybody or that serves you in certain seasons or times of your life, a couple of days of the week, but don't forget that you are also human. Don't forget that you also need, and maybe even should sometimes flex the flexibility muscle more than the hyper vigilant discipline muscle all the time, absolutely.

0:07:21 - Speaker 2 Absolutely. Like I actually think rigidity and routine is it's kind of bullshit.

Like I really do feel that way, Like not to, but like I'm really pushing back against it, like what this is going on already, and I mean not to focus too much on the concept of the feminine, but I really I mean when you look at nature, when you look at all natural systems, they are in cycles and they are in you know polarities and you've got light and dark and cold and hot and alkaline and acidic, and you know you've got winter and spring and summer and fall, and you know follicular ovulation, luteal, menstrual, like everything. You know all the lunar cycles, the waves, it's. There is a sort of pattern to things that is not the same every day. And when you try and push biologic systems I mean, think about even HRV, right, we want it to be all over the place, we don't want the metronome Too much. Order in biologic systems is not good and it's not natural. And I think you know trying to artificially restrict the wildness of any biologic form is can seem like you're outsmarting something and you're getting the most efficiency out of it.

But biologic systems are not about order and rigidity, they're about harmony, and harmony is different than order and rigidness. And so harmony is about interdependent, web-like systems that have many different inputs, that all work well together. But it's not necessarily algorithmic or linear. And I think sometimes when we try and solve any complex system like climate or a body or soil or relationships, complex systems are never gonna actually be improved, I think, by linear solutions. They're gonna be solved by solutions that have nudges and multifarious inputs and that nudge it towards harmony. So anyways, that's kind of what I'm thinking about normally in my life is like, how do I nudge myself in lots of different ways but spiritually feel right on that day, towards harmony in my body?

0:09:34 - Speaker 1 I'm already blown. I could just wrap right here, right now, that was so good.

That was so good.

So again I've got a lot of different kind of questions that really the through line I wanna set here for the listener and the viewer is no matter what your walk of life is, no matter what type of nutrition you choose to ingest and digest, whatever form of exercise you do or do not do, whatever maybe you feel is working against you or what you're working on right now, the argument can be made that when we focus on or kind of just look through the lens of better managing my blood sugar, what is blood sugar and what are the cascading positive and potentially extremely detrimental effects when I either honor it or ignore it.

So that's just kind of the tone that I wanna set for the rest of the show for everybody. I've heard you talk recently about some warning signs that we can have that maybe we're ignoring, warning signs that we are not healthy or maybe even just not as healthy as we think we are. This reminds me of a phrase that I say a lot on the show and in life pay attention to the whispers your body gives you before they turn into screams. And I think that's kind of what I'm taking away here when I've heard you talk about this. So what do you mean by that?

0:10:54 - Speaker 2 Yeah, so I think when you look at the diseases and the symptoms that are facing people in the Western world today, specifically the United States, when you look at basically almost every top killer in the US and then most of the sort of like sub lethal symptoms that we're facing that are like really plaguing us and racking up healthcare costs, when you look at all of them and dig into the research, what we're learning more and more now is that so many of them are rooted in metabolic dysfunction. So problems with how the cell fundamentally makes energy, because of what we just talked about earlier, which is that the mitochondria is under siege from all these different elements of modern living ultra process food, sedentary behavior, not sleeping enough, chronic low grade stress, spiritual depletion, environmental toxins, artificial light, thermonutrile existence with no real exposure to cold All these things are hurting our mitochondria. So now we all have metabolic issues. 93% of American adults have metabolic dysfunction and it is the trunk of the tree of almost every major killer and symptom in the US.

Now and this is again what you talked about with Chris Palmer on the brain front, like we're starting to realize I mean, his book is about how you just go through the list of brain disorders, from neuro generative to a neurodevelopmental, to mental health issues, and each one is linked to brain energy, how the brain makes energy. Well, it's true for every cell of the body. And so, really, if you're an American today and you have a health issue, the first place really, of any kind, any symptom, any disease, a first place to start in terms of an empowered place to start, is examine whether that has some metabolic link that you can work on.

And so really, we could name any part of the body, any organ system, and there are conditions that are very common now that are related to metabolic issues, again, how the cells make energy properly and I think the really key thing to realize like well, okay, how could erectile dysfunction and retinopathy and chronic kidney disease and chronic liver disease and depression and osteoarthritis and infertility, polycystic ovarian syndrome and stroke and heart disease and migraine and gout, and how could these all be this like fundamentally, the same thing.

0:13:07 - Speaker 1 How could there be a common?

0:13:08 - Speaker 2 denominator. And there is. There is, and this is very clear and the common link is that in each of these cells, the cell is struggling to make energy. It's like a sputtering machine and it's not doing its work properly, and so then you get cellular dysfunction, which leads to symptoms. The reason they can look like so many different things is because we have dozens and dozens of different cell types in the body, and when different cell types are experiencing an energy problem, it's gonna look like a different symptom. In a liver cell, it could look like fatty liver disease In an ovarian thica cell, it could look like polycystic ovarian syndrome.

In a retinal blood vessel cell, it could look like retinopathy. And so it's a similar process or the same process happening in different cell types, looking like different diseases, and in conventional medicine. What we've done is we said, oh well, they look different, so we'll treat them differently.

We'll treat that downstream manifestation to make that symptom seem better, but because not until very recently we haven't not had the tools to really understand this intracellular process happening. But now that we do, medicine is not caught up essentially to say we're gonna treat at that level, we're gonna treat the underlying metabolic dysfunction, we're still treating the symptoms. And so to kind of get back to your question is like what are some of the warning signs? I would say that it's really interesting because a lot of these sort of like sublethal, like they're not gonna kill you immediately but they're annoying, so let's say like erectile dysfunction, belly fat, pre-diabetes, gout, depression, anxiety, add, like some of these things that they're not there.

0:14:52 - Speaker 1 I have to say real quick I want sorry to interrupt, but I just wanna let the listener know that you're not describing a lot of crazy, wild, outlandish diseases that are just things that people have never heard of or don't know somebody that are dealing with them or, if not, them themselves. So I think it's such an important part to take away immediately is these are very common ailments, chronic diseases, illnesses, things that you have have had or probably know somebody who has right here right now. So we're not talking about anything really that foreign.

0:15:21 - Speaker 2 No, I mean even on the more superficial things. It's like psoriasis, eczema, acne, premature wrinkles, mentioned belly fat. These things are some of the whispers that are telling you that, down the road, if this underlying process of metabolic dysfunction goes unchecked, that whisper could turn into the scream. And what is the scream? Heart disease, type two diabetes, obesity, cancer, fatty liver disease that turns into chronic liver disease, chronic kidney disease or increased risk for dying of a infectious disease like COVID or flu.

Yeah, exactly. So those some of these sort of more like someone might think like well, my acne, how could that be related to future heart disease? It absolutely is, because in many cases, the root of this, one of the strong roots, is metabolic dysfunction, and of course it's not the only root. What I'm saying here is that there are research links to every single condition that's I mentioned so far and a problem in how the cell actually makes energy. And so because I think many people listening to a podcast like this are thinking like, well, what can I do about it?

Like focusing on any metabolic part of what condition or symptom you're facing, on means, there's intervention you can do right, diet, lifestyle, all these things. So, even though it might not be the only positive factor of what's happening, it's one that you can actually do something about. So I think that's really empowering. Yeah, but I think yeah, just to super simply answer your question one of the most common things that I think people could sort of see that would be a harbinger of some metabolic issues is like excess weight. Basically, like if you're having trouble losing weight and that's just kind of been a constant struggle, like that could definitely be a sign that there's some metabolic dysfunction at play.

0:17:15 - Speaker 1 Yeah, I'm glad you said had trouble losing it. I think there's a difference. If we get really honest. I have excess weight and so therefore I blame it on these other things. If you're actively pursuing bettering that situation, your choice is to. I want to lose body. If I want to lose weight but still struggling case in point you know you might be fighting something else other than just willpower. Or am I doing the right diet or not?

0:17:37 - Speaker 2 Right like insulin resistance right.

So, like insulin resistance and metabolic dysfunction kind of are two sides of the same coin, and the physiology of that is that when there's a mitochondrial problem, when the mitochondrial being damaged inside the cell by all these environmental factors, they're not gonna be able to process food to energy well and so they're gonna get basically get backed up. And because they're gonna be blocked in that conversion process, the cell is gonna try and protect itself by becoming insulin resistant, meaning that it's gonna insulins, the hormone that of course lets glucose be taken up out of the bloodstream into the cell. And if the cell cannot process that glucose because of the mitochondria is damaged, it protects itself from being overstuffed with glucose by saying no more is allowed in the cell, so it blocks the insulin signal.

0:18:24 - Speaker 1 You had your chance.

0:18:25 - Speaker 2 You had your chance, you hurt the mitochondria, we're not letting glucose in, and that insulin resistance is often, you know, related to why people are having trouble losing weight. Because insulin is the signal that says there's a lot of glucose around for energy. We don't need to use fat for energy. So either store that glucose as fat, but definitely don't burn that fat. So that's kind of how it's all related to the resistance to weight loss issue.

0:18:48 - Speaker 1 Kind of, while we're on the subject of weight loss, a little bit, maybe a little hot take here, if you'll indulge me right now ozempic semi-glutide, right, you know we're looking. A lot of people are looking at this as a pretty quick fix. It's actually having pretty profound results very quickly for a lot of people, but for a lot of other people it's causing a lot of other problems, which I think we can arguably say is kind of goes hand in hand with a lot of you know medications For something like this, maybe not just specifically ozempic. When we look at a quick fix that solves something like weight loss, reducing body fat, is that also kind of a downstream effect of that helping metabolic health, or are we maybe contributing to another downstream issue with this?

0:19:35 - Speaker 2 With ozempic specifically? Yeah, so this is such an interesting question. So, ozempic and these GLP-1 agonist medications they are profoundly effective at helping people lose weight and people are losing 15, 20% of their body weight very quickly. And there's several things that GLP-1 agonists do. So one thing is that they basically get your pancreas to secrete more insulin that actually even that lower blood sugar levels that's why this has been used traditionally as a type two diabetes medication.

But centrally in the brain, it actually tells the brain that you're full, and so it's not totally clear what the mechanisms of the weight loss are, but it seems to be one of the big ones is that it actually stops your brain from thinking that you are hungry.

0:20:26 - Speaker 1 And so it's Is it suppressed. Ghrelin, increasing leptomores how is that kind of working?

0:20:31 - Speaker 2 The main thing it's acting on is the glucagon pathway, so which and I think that it's essentially inducing a state of starvation because people are eating significantly fewer calories. Now the issue with that is that in a starvation state, the body is not just gonna be losing fat, it's basically gonna be losing a little bit of everything, and so the probably the biggest issue yeah, that we're seeing with those that big is lean muscle mass loss, and so anytime you lose weight, you're gonna lose some fat and some lean muscle, and it's generally thought that about 25% of the total weight loss should be from lean mass, so like muscle, and so that's sort of if you did a dexa scan of people before and after losing weight, it's 25% might be lean muscle.

0:21:28 - Speaker 1 That kind of seems high.

0:21:30 - Speaker 2 Yeah, but if you're in a calorie deficit and your body's kind of like burning through existing resources, it's gonna pull from but with with ozempic it seems to be about 40% is lean mass, so muscle, and so that is very scary because, especially in an aging population where losing muscle is associated with premature mortality, like that's a condition called sarcopenia that's very, very dangerous. And then for people who don't have a lot of lean muscle mass to start with and now you've got a lot of people who are not actually obese using ozempic you're just burning through a lot of this really healthful tissue in the body. I mean, as we all know, like muscle is a miracle organ in the body. It releases myokines that are anti-inflammatory mediators. It is the ultimate glucose sink in the body. It's filled with mitochondria and it's processing all that excess glucose from our diets and it's protecting your frame from injury and sarcopenia and all these things.

0:22:34 - Speaker 1 So it's just so things are bones.

0:22:35 - Speaker 2 Yeah, exactly. So to lose it is disastrous. And then I think the other thing to realize is that, like, if it's just causing people to eat less food but it's not actually getting them to eat healthier food, that's gonna actually fundamentally build a healthier body. Then you're basically taking someone who is eating a bunch of toxins which the American standard American diet is a toxin and you're having them eat a little bit less of a toxin and so, yes, they might lose weight, but are they truly becoming fundamentally healthier? It's really hard to know at this point. When you lose that weight, you will lose some of the very dangerous fat in the body, like the visceral and the intracellular fat. So that's good, Like when you clear out some of that liver fat and the fat around your organs. That is better for metabolic health, but it's complicated because you're also losing muscle mass, and so I don't think the long-term outcome studies on what this is really doing for people in terms of future risk of chronic disease or mortality. We don't know yet, and that is a little bit scary.

We also know that when you come off these medications, the majority of people are gaining back the majority of the weight, so this is and then some. So this is really from the standpoint of the pharmaceutical industry. This drug is just like an absolute cash cow. It's now being approved for kids as young as 12 for overweight and obesity, according to the recent American Academy of Pediatric Guidelines, and they're gonna be on it for life.

0:24:03 - Speaker 1 You know what's so much so this might just be an LA thing. How trendy this is. I see it in a smoothie bar. I go to A smoothie bar now has this little pop-up wellness. I wouldn't even call it a clinic, but just they gotta have somebody there that's authorized to administer this stuff. But I see some agglutide.

0:24:21 - Speaker 2 Really.

0:24:21 - Speaker 1 Get your smoothie, get it was empty, like come on.

0:24:25 - Speaker 2 I've had this experience too. I moved here two months ago and I've probably been asked 20 times like whether, oh, have you tried it? Are you on it? What you should get on it? Like it's great, and I'm like holy moly. When I was living in Bend, oregon, no one was asking about Osempic, but LA.

0:24:40 - Speaker 1 Welcome to LA. Casey, welcome to LA.

0:24:42 - Speaker 2 It's really interesting yeah damn, but I'm very weary of it. I think that the place for it is probably for people who are dealing with morbid obesity and they need help getting started.

0:24:54 - Speaker 1 And help fast.

0:24:55 - Speaker 2 Fast, yeah. And then I think the way that this drug is gonna be most effective is if we can build a whole ecosystem around it where people are getting they're using it as a jumpstart to get some quick progress, to feel better, to feel some energy, to feel like they're in control of their hunger, and then get them in a psychological program to reexamine their relationship with food.

0:25:18 - Speaker 1 Teach them how to Health coaching.

0:25:20 - Speaker 2 Exactly teach them how to go into the grocery store and pick the whole foods and prepare them, start to build a taste for healthy foods and then, of course, start resistance training so that you don't lose as much of the lean muscle. So I hope that some side industry will crop up alongside this trend to basically help people form the whole biologic reality within the ozempic ecosystem that allows them to get off it safely and also build a body that's gonna be metabolically healthy over the long term, because the drug itself is not the magic bullet for metabolic health.

0:25:56 - Speaker 1 Not too much of a tangent, but this reminds me of Mutual Homie. Dr Gabrielle Lyon, I wanna maybe ask her this question she comes back on, I'm sure she has. We're talking muscle centricity here.

0:26:06 - Speaker 2 Yes, she's inspired me, so much, so I'm sure she has a really unique answer to that.

0:26:10 - Speaker 1 I might have to remember that one.

0:26:12 - Speaker 2 Good point.

0:26:13 - Speaker 1 Okay. So someone who has been living it, working in it, spreading the gospel of metabolic health, I'm curious over the last two, three years, since just your last time on the show, has your definition, has your relationship to what metabolic health is and is not? Has that changed? Have you maybe adopted some new absolutes? Let go of some what's been going on in your world, cause you're in it.

0:26:37 - Speaker 2 Yes, it's definitely evolved over time.

I think that there's two or three things that feel most alive for me right now in metabolic health that maybe weren't there three or four years ago.

Like, the definition is the same metabolism is how we make cellular energy from food.

But I think one big piece that feels so much bigger than it did a few years ago maybe, especially after COVID, is the psychological aspect of metabolic health, how much the mind controls metabolism and how our thought patterns and our beliefs and our stress and our personalities, like, actually do impact the way our cells work, cause, you know, our cells hear all of our thoughts and through hormones and neurological signals and cortisol and all these things.

And I think that there's people who are kind of doing everything right in terms of food and getting to sleep and getting the exercise, but if you are fundamentally someone who is living in this constant state of feeling like the world is not a safe place, so living in fear or living with chronic hypervigilance, that is gonna be just a constant grip on the body that is channeling energy towards essentially, threat avoidance or coping as opposed to thriving. And so something that's just become so present for me right now is how for people to be as metabolically healthy as possible and for people to be able to produce the best energy in each of their cells, they need to be fundamentally not living in fear, and that is a different journey for everyone.

For some people, that might be unpacking childhood experiences that have programmed themselves in your subconscious and may be very personal, and for some people it might be the sensationalist media that's surrounding us in the algorithm that's basically just pummeling us with information, saying that the world is not safe, even though in many ways it's actually objectively the safest time in human history to be alive. But most Americans live in fear every single day. When you survey them, and then for others I mean, it could be intergenerational trauma. There's just so. So I think everyone going down this sort of like path of existential inquiry, of like am I living in fear in any way and how do I heal that, unpack it, reframe it? I think there's so much opportunity for mental health care here, maybe even for psychedelic assisted therapy here, but-.

0:29:19 - Speaker 1 It's got my vote.

0:29:21 - Speaker 2 Yeah, but like when you and then I think there's an element here of also just like addressing your relationship with the fear of death as well Like I think that's something that's I've always been very interested in, like Eastern cultures and I studied Eastern poetry in college and Zen, buddhism and things like this and like in most other cultures, in many other cultures, there's such a framework and a curiosity around this concept of death and like we think about life cycles and you know how, you know how like, for instance, like just even the concept of Nirvana is about oneness with everything, throughout eternity and all of time. Like Western world, we've got none of this. Like we don't. We're scared of death. We don't talk about it. We spend a huge percent of our healthcare dollars on the last year of life. We're petrified of anything. I've even talking about it and so you've got this whole culture of people who basically have an existential worry with no coping mechanisms and no framework for it and, of course, spirituality and religion, or you know, at an all time low.

And so I just think that's also a journey that people need to go down Like, and the key nugget there is if your body is living in any type of fear. It's going to be diverting resources from thriving and making energy effectively. So that's a personal journey that everyone needs to go down, and loneliness, I think, is also a big part of this. We've seen loneliness with COVID parallel so much with the even more increase in metabolic diseases, and there was a great paper that came out last year. Dr Molly Molloof was the lead author on this.

I'm basically like the metabolic pathways downstream of loneliness, and so loneliness is a primitive fear signal, because if you are perceived yourself as lonely and we know that social media is not cure loneliness it actually in many ways things will feel more separate. It actually activates a lot of the stress physiology that ultimately hurts our mitochondria. So community building, fearlessness, existential inquiry all of that is a part of the metabolic journey in a way that the research is just showing more and more strongly. So that's one thing I think. A second piece is actually just like so simple, but it boils down to like walking more. I think it's so funny.

It's like it's just like so simple, but I'm like it's overwhelming in the re and I just wrote a book that I just it's coming out next year but like digging through like hundreds and hundreds of papers about exercise, it's like one of the only things I feel like I can say with like complete confidence is like you need to walk more if you can, and the reason for this is really quite interesting.

So I actually think the concept of exercise may be like screwing us Really. Yeah, I mean, we exercise is a fairly modern concept in the way that we think about it, like seeking out hard work intentionally to take the place of general physical activity.

Exactly Throughout human history, we were just moving all day, and a body that is moving all day, even in a low grade way and using functional movements like lifting and squatting and a lot of the things that we just had to do to live throughout most of human history. That body is experiencing completely different physiology than a body that is mostly sedentary during the day but then exercises for one hour Interesting, so think about this Every time you stimulate your muscles, even if you just stand up or take a five minute walk, what that's literally doing is sending a signal to your muscle cells to translocate glucose receptors from inside the cell to the cell membrane.

0:33:13 - Speaker 1 Just as simple as going from seated to standing.

0:33:15 - Speaker 2 Yes, you're moving Glute 4 channels to the membrane, which is gonna clear glucose out of the bloodstream without insulin. You can actually clear glucose without insulin just by activating the muscles. And so you can imagine two different bodies one that's sitting all day and that's just like never happening, and then of course you get a huge spurt of it in the hour and that's fantastic and that's gonna improve insulin sensitivity to all the good things. Versus the body that maybe still works out but is getting up every 20 minutes or so for like a minute or two and stimulating the muscles in some low grade way. That body is going to have more glucose channels on its membranes all day as opposed to the other body that's been sitting. So I think a lot now about that visual in my mind of like I'm not standing up because my Apple watch is telling me to or because I know that like I need to get my 10,000 steps.

I'm doing it too physically, as the parent of my cells encourage those sweet little glucose channels to come to the membrane and do what they need to do for me to make my life better, which is clear glucose from my bloodstream, so it's not sitting there sticking to things and causing glycation and causing inflammation and causing oxygen. You know it's like so simple.

I want to be a body that brings glucose channels to the membrane all day. That means I have to get up and move my body, even if it's like for two seconds every. You know, and the studies on this are so interesting, Like you take three groups of people and there's been a couple of studies that are like generally the same as this and you say, okay, we're going to have you walk for 20 minutes before each meal, 20 minutes after each meal, or one chunk of 60 minutes, so all three of them walk 60 minutes over the course of the day but like different, different amounts.

Or you can take people into different groups and say like, okay, we're going to have you walk one minute walk or jog like one minute and 40 seconds every 30 minutes, or in one chunk. That's basically equal to all those one minute and 40. And in each of in all of these studies, the ones that do it more frequently, as opposed to the chunk, have lower 24 hour glucose and insulin levels. So it's like to get more bang for your buck. Basically spread out the time that you're moving throughout the day more than just one chunk. Now there are, of course, like caveats to this, like there are that this is more like the low grade activity that's just constantly stimulating our bodies to metabolically act.

0:35:46 - Speaker 1 Just general movement. General movement. We're not talking about tabatas, you know, every 20 minutes.

0:35:50 - Speaker 2 Exactly. This is just stimulating the muscle groups to do what they're supposed to do. There's, of course, other types of exercise that are metabolically advantageous, like resistance training and like high intensity interval training, that do different stimuli for our physiology, and we should absolutely be doing those. But I think the core message that I'm that I'm focusing on here is that we, our bodies, are meant to move to have the optimal physiology that, like is our birth Right, and if we don't stimulate that through these gentle actions regularly, we are going to have dysfunctional physiology. So that has been very motivating to me to pursue these like glucose disposal activities throughout the day, and it doesn't necessarily have to be walking. It could be air squats every half hour, it could be gardening in the middle of the day, you know, or just taking a lap inside your house.

0:36:42 - Speaker 1 You know, lap inside your house.

0:36:43 - Speaker 2 There's this concept of non exercise activities, thermogenesis, like neat yeah, which the research on it is amazing. It's like people can lose a lot of weight just by like in lists long intense low intensity steady state training. Yeah.

0:36:56 - Speaker 1 Coupled with neat yeah Is like the secret sauce to happiness. But also body composition, losing weight Absolutely that, like nobody's talking about.

0:37:07 - Speaker 2 It is key. It is key and so neat is basically any activity that is not actual exercise that you're doing during the day that activates your muscle groups and is moving. So it's like it's even cooking in your kitchen and walking around. It's gardening, it's taking your trash out, it's walking from the car to the store, it's fidgeting your leg under your table, it's walking on a treadmill desk, it's taking a walk after dinner, it's walking your dog and even it's not like official exercise. And this is truly, I think, a gateway to good, to good metabolic health. So I think a big part of our role is to figure out how to include like neat and basically movement in, build it into every part of our day.

0:37:46 - Speaker 1 Yeah.

0:37:47 - Speaker 2 Which of course is free and it's simple and it's not hard, but of course, of course, this is why no one's talking about it, because it doesn't make anyone any money.

It's not the sexiest, it's not, but like the US, the US population spends more on any country in the world, of course, on fitness memberships. We spend more than any country in the world on weight loss modalities and we're the fattest country in the world. So more and more and more focus on exercise doesn't actually seem to be helping us. So I think there's this other, other world that we need to be exploring. That really gets back to the basics like move more throughout the day.

0:38:31 - Speaker 1 If I could give a blanket statement to the entire world, for how would I wrap up the best health advice, regardless of who the person is or what they're struggling with or what they're trying to improve? Focus on sleep, take a walk, yep, and maybe drink some. Drink some better water.

0:38:47 - Speaker 2 I would, and I would also just add like don't eat processed food.

0:38:50 - Speaker 1 Yeah, yeah, there we go, Of course, of course, yeah yeah, so.

But I'm glad we're talking about exercise because I would love to have you kind of unpack what is going on with our blood sugar when we exercise. I don't think a lot of people really know the spike that happens, the changes in our blood sugar that's happening when we're doing a good thing. We're adding you stress to the body, because I think when people hear blood sugar spike or worried about our blood sugar dropping or going, just changes, yeah, we can change that or control that with. You know nutrition and other things, but what's going on differently with exercise and blood sugar?

0:39:27 - Speaker 2 So yeah, so what you're getting at is so fascinating. So if people are wearing continuous glucose monitor, they often will find that when they do intense exercise so like powerlifting or high intensity interval training they actually see a big spike on their blood sugar levels, even if they haven't eaten anything. And people are like, oh my gosh, I thought I'm not supposed to spike Like what is going on? And what's happening here is that when you push your body quite hard in a workout, it actually stimulates stress hormones like cortisol, catecholamines, and that actually signals the liver like, hey, there is something stressful going on that we probably are going to have to run away from.

0:40:03 - Speaker 1 I was pulling up mine. You're pulling up yours. Did you have a spike? Yeah, I'm wearing my levels. Everybody, I'm looking at my exercise log is a 121.

0:40:11 - Speaker 2 Okay, so nothing crazy during my workout.

0:40:14 - Speaker 1 Wow, what were you doing? True, crazy. I was lower body day, so lifting, lifting, strength training, yeah.

0:40:21 - Speaker 2 So that makes a ton of sense. It was hard. You're pushing like probably to your max. You're going to see that with that type of workout or with a cardio activity where you're going above your 70% VO2 max. So basically, like once my heart rate's getting up to about 160 beats per minute with either a run or elliptical or Peloton or whatever, that's when I get the spike. And the reason is cause it's basically stressing my body enough for that stress physiology to be stimulating my liver to dump glucose from that is stored in the liver. We have this like short term storage bank of energy in the liver for moments like that when we need that energy. So it goes into the bloodstream to feed the muscles and so we might see a little spike there. The reason it's I don't believe it's a problem like a food spike is because you have a sink that's like going to use it up. You're using the muscle which is then going to process it to energy, and so it's being fed into a system where it's actually being used.

0:41:22 - Speaker 1 It's when instead of just roaming free, causing havoc and the rest of our body and all of our other systems.

0:41:26 - Speaker 2 Exactly. And because muscle doesn't need insulin to take up glucose, you're not necessarily going to be stimulating that big, that big insulin spike that food is doing so.

It's very, very different physiology and we know that lifting and high intensity interval training, both of which can cause your glucose to spike, both are associated with better insulin sensitivity and lower glucose levels. So overall it's just not one to worry about. And if someone's taking more of like a gentle walk, that's when they'll see their glucose going down generally on their glucose monitor, because it's not a stress signal to the body. You're not, the liver's not going to be producing excess glucose, and so in that case you're actually just it's sponging it up out of the bloodstream.

0:42:11 - Speaker 1 So, gentle, we don't need it readily available for use. Yeah, yeah, love it. All right. What are the kind of goodies we got going? You're just a wealth of knowledge, and just so we are, so I appreciate this so much. Okay, so we've been talking a lot about energy. Yes, now I think we can look at it as how do we create better, more efficient energy? How do we make cleaner energy? Maybe through our nutrition, or kind of go the other route of focusing on the things inside of our bodies that create energy that you know, take energy to create energy, but also innately create it.

Is it more about creating better energy or channeling more energy into the right places, basically fueling ourselves or getting ourselves to create more fuel?

0:42:55 - Speaker 2 Oh my gosh, this is such a nuanced and great question. The answer is it is both. So the the fuel. The way I would position this is that there's two things going on when we're creating energy in the body. One is you are putting an energy substrate in the body, so like a raw material to make energy, and that's like our macronutrients from food, so like carbohydrates, fat predominantly and then that's going into the body and you know you need it to be processed then by our energy making machinery, like our mitochondria, to turn it into energy and food, when properly selected, can support can support both of those processes. So you want to choose, you know foods that have you know like. Actually, can I back up?

0:43:50 - Speaker 1 and make sure I frame it properly.

0:43:52 - Speaker 2 Sorry, Um. So let me just think for one second. Um, I'll just start from the beginning of the question.

0:44:04 - Speaker 1 Please yeah.

0:44:07 - Speaker 2 So that's such a great and nuanced question chase, and when I think about food and making energy from food, I'm I'm thinking about two things. I'm thinking about food having both the substrate that turns into energy, so like the glucose and the fat that ultimately is going to be converted to ATP, to energy in the cell. But I'm also thinking about all these other components of the food that are going to actually support the machinery that makes energy from those macronutrients. So when you think about, like the mitochondria, converting fat or glucose to energy, the mitochondria requires like 10 or more micronutrients as cofactors to let its machinery basically work. So like, for instance, you know you've got these five protein complexes at the final stages of ATP production, which need things like coenzyme Q10 and several B vitamins. Vitamin C is required, magnesium is required All these micronutrients. Well, where do we get those? We get them from food, and so you need to be making sure that you're getting all these healthful micronutrients from your food. But then also think about feeding the microbiome. Our microbiome takes polyphenols, which are plant chemicals, and also fiber, which comes from plants, and turns both of those into postbiotic products. It converts them and do short chain fatty acids and literally thousands of different chemicals that get. Then it gets absorbed by in, you know, through our gut, into our bloodstream, and many of those are metabolic regulators that basically impact that whole metabolic process. So you're using your diet to feed the microbiome, you're using it to create a good concentration of micronutrients for metabolic mitochondrial processes. You're also, you know, of course, like the Omega three fatty acids in the food that you're eating is going to build the cell membranes which all these glucose receptor, the glucose channels and insulin receptors sit in. And you want highly fluid, dynamic cell membranes, which, of course, is related to what types of fat you're eating, your diet and the and the ratio of Omega threes and Omega sixes in your diet.

So you've got all these elements of food that are supporting the machinery. And then you've got the elements of food that are actually the fuel, the fuel that's going to convert into energy, and that's the glucose, okay, and the fat predominantly. And when we think about the quality of those fuels, you know it's kind of funny. It's like the glucose molecule from a beautiful piece of organic, you know, the glucose or the, let's say, fructose. The fructose or we'll stick with glucose Like the glucose in a natural, organic food or a candy bar. That molecule of glucose is exactly the same. It's the same structure. The issue is that when it's in the ultra processed form that the candy bar or whatever it is the cookie, it's so concentrated and there's so much of it and it's been ultra processed, so you're gonna absorb it really fast.

0:47:14 - Speaker 1 It's not with the all the goodies and the fruit.

0:47:16 - Speaker 2 It's not with all the other stuff that's gonna support all the metabolic machinery and it's just loading into your bloodstream and it's going to overwhelm the machinery with so much substrate to process and not have the other healthful stuff in it that supports the machinery. So you overload the machinery with processed food and you don't give it the other supporting materials to let the machinery work. That's why ultra processed food is so bad, because it hits you on both sides. It's too much fuel and under nourishing the machinery to process it. With whole foods and unprocessed foods, first of all, you're getting all those extra like beautiful micronutrients and antioxidants and polyphenols and omega-3s and all of it In this beautiful package that's gonna support all the machinery. And whole foods trigger our satiety mechanisms so exquisitely that we tend to not overeat when we eat unprocessed food.

0:48:08 - Speaker 1 Wow, that's a fascinating point.

0:48:09 - Speaker 2 Yeah, you don't. There's just so much complexity and nuance to food that we will never be able to artificially engineer. There's tens of thousands of chemicals, of natural chemicals, in every bite of natural food and the way those are interacting with our hormones and our satiety cues and our brains and our reward circuitry and our microbiome. It's a symphony.

0:48:32 - Speaker 1 It's a beautiful symphony. I can see you in harmony right here. It's a symphony that makes us not overeat.

0:48:36 - Speaker 2 Like people who eat unprocessed whole foods from good soil, meaning that it's like as nutrient rich as possible tend to not be overweight or obese, and so, and that this is also why, when you look at traditional cultures who eat so many different macronutrient ratios and so many different patterns of diets, like across the blue zones and across many different cultures, but none of them have I'm talking about like historical traditional cultures obesity didn't really exist. And again, it's because natural whole foods in their natural state tend to really exquisitely trigger our satiety cues. So you're not gonna overload the body with too much of this hyper concentrated fuel that overwhelms all the metabolic machinery and you're giving it all the supporting materials to basically do the symphony it needs to do. So that's kind of how I think about the fuel conversation.

0:49:26 - Speaker 1 Beautiful, beautiful. So well said and I can't believe it. I blinked and it's been an hour. I wanna get to one other question before my final question, and I know when talking with you ahead of time, it was kind of a special area in your heart about. We kind of talked about soil and regenerative pastures and regenerative farming. I think this is becoming a lot more popular, at least it's becoming more popular for me and it makes sense to me. But how? By focusing on how and where and when we grow our food, how is that actually improving our metabolic health?

0:50:02 - Speaker 2 Yes, this is such an important topic and it has a lot to do with what we just talked about, because the quality of the food that's in front of you is 100% directly dependent on the soil that it was grown in. If soil is healthy and thriving, the food is gonna have more micronutrients, more antioxidants, more polyphenols, more omega-3s. Research has shown this, like if the soil is healthy, the food is gonna have more of these really helpful properties, and so it's actually really funny as people say, like oh well, farmers market food or organic food, it's like more expensive and it's like if we were actually pricing like price per nutrient, I think it'd be a very different equation, because if you're getting significantly more like omega-3s, for instance, from wild caught fish versus fish that's been grown in farms, and you're actually paying, you're paying per molecule of omega-3, like huh, maybe the wild caught fish actually isn't as expensive as we thought.

Great little mindset shift there I would love if we could start to like really more quantitatively figure that out. But similar. The same goes for animals that are grown eating plants that were grown in good soil. They're gonna, of course, concentrate a lot of these nutrients and have more of much higher levels of omega-3s. And we typically think about polyphenols as only being present in plants, but if you actually take pasture-raised, fully grass-fed cows, their milk contains polyphenols so, but we wouldn't really know that from conventional cows because they're not eating polyphenol-rich foods. So it's just so fascinating. So soil directly dictates the quality of our food, and what I mean by healthy soil is soil is supposed to be full of life. There are literally billions of microorganisms in every tablespoon of soil, from bacteria to fungi to nematodes, and all of them are working together to basically do all these like miraculous processes of various cycles of nutrient exchange and putting nitrogen into the soil, or basically helping 3D print carbon into soil and basically root systems.

The root systems are the 3D printing of carbon underground, like that's what roots are, and but that can only be done if the soil is healthy and biodiverse and porous. And so, unfortunately, because of our industrial farming practices monocrop agriculture, spraying pesticides on everything, industrializing agriculture, using these crazy machines that agitate the soil just in such an aggressive way this is tilling it's all, killing the microbiome of the soil and the microbial diversity and the biodiversity of soil, and in doing so is making our food much less nutrient-rich. So now most soil on these industrial farms has no life in it. It's actually turned to dirt. So soil is a living organism. Dirt is dead.

And what happens when you grow your food from something that's dead? You create food that is crappy. And then what happens? Health suffers, and you know it's just, I think about like.

Soil is ultimately where, like all life comes from, that sustains human life, and if we kill it, we're obviously hurting ourselves. And there's just so much hubris to think that we could outsmart these cycles that we barely understand. And I think anytime you squeeze or try and optimize or over-engineer any of the things in the universe that generate life, you only hurt yourself and we're basically we've done this to women, we've done this to soil and what happens? The world gets screwed, basically. So it comes back to harmony. Like it may seem, you know, more chaotic to have a farm that has 15 different plants growing on it at one time and it's like, oh, we should just clear this all out and create one big square of corn, just go with corn, right, right, cause then it's like we need this exact. It's like everything's so easy. We just like have one machine that gets all the corn at one time.

But what happens is then you just totally ruin the harmony of the system, and you need that harmony for sustainability, for long-term health of the system, and so I think there's just a lot of reckoning happening with realizing that our role as humans is to support and give protection and safety to these ecosystems, like our food systems, and then let them do their work Like they will produce everything. If we just protect them and support them and give them clean inputs, it's when we squeeze them and try and make them more efficient and actually break their cycle, say, it needs to be summer, all four seasons, we're not gonna have downtime, we're just gonna keep pushing and pushing and pushing. It will say no, and that's what's happening, and so really, practically speaking, what it comes down to is trying to is trying to get your food from the healthiest soil as you possibly can. Another thing to remember is that so much of our microbiome is actually seeded from the food that we eat, and there's bacteria on everything that we eat, and we want bacteria.

0:55:36 - Speaker 1 Which is a good thing, by the way, it's a good thing, yeah.

0:55:38 - Speaker 2 And the healthier the soil that you're getting your food from, the more you're gonna be just constantly exposing yourself to various bacteria that can support our health. And so I mean I would say, if you can like, try and find a farmer's market. Talk to the farmers, ask how the food has grown, whether they use, what kind of pesticides they use.

0:55:57 - Speaker 1 Try your hand at growing your own. Try your hand at growing your own.

0:56:00 - Speaker 2 Yeah, you can grow a lot of food in a tiny raised bed in your backyard or on a little deck in an apartment.

0:56:06 - Speaker 1 Have you seen lettuce grow? I have a lettuce grow.

0:56:08 - Speaker 2 I love it, love it, yeah. Yeah. If you can't do that, try maybe to get a CSA box Community Sponsored Agriculture. They'll either ship it to your home or drop it off. If you can't do any of that and really get to meet farmers or talk to farmers or grow your own food, organic is the next best option Because, even though organic doesn't necessarily organic is the absence of toxic chemicals on the food, so toxic synthetic pesticides, which is good, because then it's not necessarily like really killing that microbial diversity in the soil with these harsh chemicals. But the reason organic is sort of one step lower than really buying your food from a soil-focused farmer is that organic isn't about maximal biodiversity in the soil. It's about getting rid of toxic things but not about cultivating biodiversity.

0:57:05 - Speaker 1 Intriguing.

0:57:06 - Speaker 2 And so that's why it's really about finding food that's grown in the healthiest living soil, that soil that is just like beautiful and you pick it up and it smells sweet and it's amazing. And then, of course, conventional is sort of the lowest option that we'd want, which is food that's been grown in dirt, essentially lifeless, biodiversity depleted soil that's covered in pesticides, that has usually been transported long ways across the country or the world to get to you and, in doing so, losing a lot of its precious nutritional value.

0:57:41 - Speaker 1 Okay, so I don't know where this hour went. I'm just over here again reminding myself Chase, you're hosting a podcast. I'm just soaking it all up. I'm soaking it all up. Everything that you talk about and the way that you present the information is one of the things that I love most about you and the work that you're doing. The whole team at Levels is hey, here is information, foundational science, but also here's real life and here's how we can get back to real life and how we can help promote more life from literally the ground up. So, thank you.

0:58:10 - Speaker 2 Thank you, thank you.

0:58:12 - Speaker 1 I feel like you've kind of hit it on the head there the last little bit. But taking all of what we just talked about, what you just shared with us, and putting on the lens of moving forward in life, Maybe the person listening right now is finally gonna they're gonna grow their own food or they're gonna make a choice to empower their metabolic health. They're gonna do something. They're gonna do something today to move them forward, to keep moving them forward, Ever forward. How do you interpret that here today?

0:58:36 - Speaker 2 What does that mean to you At this moment in my life? Ever forward to me means one-ness, becoming as much a part of the universal system around me as I can. So that means many things. It means getting back in touch with some of the things we're talking about. My place is a biodiverse ecosystem around me of food and other people and community and just integration and not separation.

I think that is where biology really thrives. And yeah, I mean I wanna be integrated with people, I wanna be integrated with the soil, I wanna be integrated with seasons and cycles and I think we need to get back to that and then sort of away from our isolationist mindset for total health. And I think the second piece of that is just that sense of, I think like it kind of links to like ego death. It's like really like oneness with everything in terms of realizing that we're just totally and utterly connected with every other piece of energy in the universe and like that journey. The more psychological side of connection and oneness is that path to psychological freedom that we also know is so important for good human health, Because when we have that freedom and that fearlessness, our body can really focus on thriving.

1:00:03 - Speaker 1 Preach, preach. Yes, that's so important and it's home for me because it's definitely been a big area of my focus the last couple of years as well. So there's never a right or wrong answer. So I appreciate everyone's interpretation and I'm curious I have to go back and listen to the first time you're on the show what your answer was then and get a little compare.

1:00:22 - Speaker 2 Yeah.

1:00:23 - Speaker 1 Okay, so we're gonna have your information and everywhere that you are and spreading the good word down in the show notes and video notes. So again, thank you so much for your time spreading the good word and reminding us we have dominion over our life at the cellular level.