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

Dr. Andrew Huberman, thank you so much for having me.

Yeah. I think you're exactly right. I think that when we hear the word metabolism, the first thing that comes to most people's minds is my weight. Do I have a fast metabolism or do I have a slow metabolism or something like basal metabolic rate? And I think what's really important for people to realize is that metabolism is actually the foundation of all health. It is the core foundational pathway that drives all other aspects of health. And it's also the core foundational pathway that's truly getting crushed in the modern American world and underlying nine of the ten leading causes of death in the United States today. It's really quite relevant to everyone in the spectrum of metabolic rooted disease is vast and actually really relevant to most Americans, the latest research from American College of Cardiology suggests that 93% of American adults have suboptimal metabolism and we can go into what that means. But fundamentally, when we're talking about metabolism, we're talking about how we convert food energy to human energy. So we take in a astonishing 70 metric tons or so of food in our lifetime. And that is potential energy. It's energy from the environment that's outside of us that through our metabolic pathways gets converted to a currency of energy that can then be used to pay for essentially every chemical reaction inside our body and the bubbling up of all of those chemical reactions is our lives. And so when metabolism is not working properly, it's essentially creating underpowered cells. And like any city or factory or machine not having adequate power will lead to dysfunction. And the reason that the metabolic spectrum of disease is so vast is because we have over 200 cell types in the body and underpowering in different cells types is going to look like different symptoms because underpowering in a astrocyte is going to look different than underpowering in ovarian thiccicella or an endothelial cell. It's going to look different, but the core foundational process that is dysfunctional can actually be the same. And I think The biggest blind spot in Western health care and actually the reason that health outcomes are actually getting worse every year in the United States is because fundamentally we are ignoring metabolic health and metabolic dysfunction. We are laser focused on the downstream symptoms that result from metabolic dysfunction in different cell types And we spend all of our energy focusing on those symptoms, playing whack-a-mal with them, and really ignoring that underlying foundational root cause of metabolic function. And what's so fascinating to me and what I saw in the healthcare system as like a super subspecialist, as an ENT surgeon, is that the more we specialize in healthcare, We have over a hundred specialties now that we've just like invented in the healthcare system. The more we specialize in healthcare, the thicker we're actually getting. So the more we do technological innovation in all these different specialties, the thicker we're getting. And I think what the real nugget there that that everyone really is understanding is we bought into a system where we value specialization. And this is the game in Western medicine. While we've done that, what has happened is we have the worst chronic disease epidemic and the lowest life expectancy of any high-income country in the world. And the reason is because in that specialization, we're focused on the downstream manifestation of underpowering of cells, the cell specific symptoms and not the metabolic function itself. So really our chronic these epidemic in this country. It is a metabolic dysfunction epidemic and underpowering epidemic. And that is the biggest blind spot in health care. And I think a focus on metabolic function. as the center of our health care system. It's a completely new paradigm for health that is urgently and I cannot overstate enough. It's urgently needed. We know we're not in the right paradigm right now when we have 100 isolated specialties and yet 85 to 90% of the conditions in those specialties. If you go to the science and look at the real physiology is metabolic dysfunction. So that's kind of the landscape of what metabolic dysfunction is and how it's kind of creating a big blind spot in the health care system that really represents an outdated way of categorizing disease that unfortunately is killing us. I would say.

Yes, absolutely. the mitochondria or are the structure within the cells we have 40 trillion cells and each cell might have a handful or many thousand mitochondria and they are the magical part of the cell that does that conversion process of food breaking down and then converting to energy to translating it to a currency of energy our body can recognize. And so currently what's happening is that our environment, the environment that ourselves exist in across every single facet of our life over the past 50 to 75 years has changed rapidly. You look at how our food system has changed from whole real food and good soil to industrial food. Our sleep habits have changed. We're sleeping less. It's very fragmented. Our movement patterns have changed. We're sitting 80% of the waking day. Our time in nature has changed. We actually are indoors as Americans 93% of a 24-hour period. So that totally changed our relationship with light. We have 80,000 synthetic toxins in our food water, air, personal care products, home care products. We live a thermonutral existence now with our thermostat. There's no real swings and temperature unless you're intentionally trying to. And then our emotional health is very different. We are very much exposed to low-grade chronic stress triggers, so across food, sleep, movement, emotional health, toxins, light, and temperature. Things are not what they once were. And it's changed in the blink of an eye. I mean, the light bulb was created in 1806. This is like 0.04% of human history that we've even had artificial light. So things have changed. And the unique thing. about all of these changes in our environment is that each one of those pillars, each of those changes in our environment synergistically, directly hurts the mitochondria through different mechanisms. The chronic low-grade stress, the sitting, the ultra-processed nutrient-devoied food, even the blue light at night time. all of it through different core biologic mechanisms synergistically hits this part of the cell the mitochondria. So we have the food coming in, but we're not doing a good job of converting it to an energy form we can use. So we have these underpowered dysfunctional cells because of mitochondrial dysfunction caused by our environment. And, of course, what happens if you've got energy substrate that you can't process, it's going to be stored. And that's, of course, why we have an obesity and overweight epidemic that's affecting close to 80% of American soil. It's just, we talk about obesity like it's the problem. Obesity is one branch of a tree that's rooted in this mitochondrial dysfunction that's caused by our environment. Just to back up a little bit to just sort of share kind of maybe like how I sort of started thinking about that, you know, I had trained as an ENT surgeon and I was at Stanford Medical School and I was so fascinated by this idea of like The way that we're defining the diseases we're treating in like a specialty like ENT is like I saw sinusitis stay in and day out and we'd have these patients on the table that we'd be literally drilling into their skulls to suck out sinus pus and that's like the treatment for sinusitis and the way we diagnose the patients as we say like okay this patient has sinusitis if they have facial pressure Pure lent plus nasal discharge nasal obstruction and low sense of smell. So if they have these symptoms, then they have this disease. But when you actually go to the science and you actually go to the studies of like what is actually happening to create this. What you find is a lot of papers about mitochondrial dysfunction because sinusitis is an chronic inflammatory condition where the cells are essentially sensing some threat and then they mount this immune response that creates swelling and then you get pus build up. But we confuse the dust buildup with the disease, which is actually happening inside the cells. And so you start looking at PubMed as a clinician through a slightly different lens of like what's actually happening in the cells and what you find for almost every chronic disease we're seeing in the US is that you will find a lot of papers on how the mitochondria are dysfunctional, lower ATP generation and a lot of these cell types. And then what does that do in this gets your question about chronic inflammation or oxidative stress? Well, when you've got that dysfunctional mitochondria, let's say in a nasal amucosal tissue, that is a cell that can't do its job. That is a cell that's underpowered and what could be more threatening to the body than a cell that can't do its job. Interestingly, those cells will initiate a whole process, which is called the cell danger response. It's work that's been done by Robert Navio at UCSD. We're basically, they understand the mitochondria is not working properly. This is of course caused by the environment, and they will actually release extra cellular ATP, which is not really supposed to go outside of the cell. And that creates a massive innate immune response saying like, I'm underpowered, I need help. My mitochondria is broken. This is the cell releases ATP outside of the cell. Usually the concentration of ATP is a million times higher inside the cell. So releases it almost as a neurotransmitter, a purigenic neurotransmitter that massively activates the immune system to come and help. But the immune system comes and is like, not much we can do for you here because the problem is not something that the immune system can help with, like, grabbing bacteria and lacing it, or, you know, taking care of some cells and, in fact, with the virus. The problem is outside the body. It's the environment. So you end up getting this tornado of dysfunction of mitochondrial dysfunction caused by the environment leading to the cell danger response, which leads to innate immunity. And then on top of this, you get the oxidative stress, which is the third piece of the trifecta, which is essentially these mitochondria trying so hard to do their work, but they're not working properly. So they create damaging metabolic byproducts, called oxidative stress, free radicals that cause more damage. So this is happening in the nose. It's happening all over the American body because of our environment. So you've got these tornadoes of interrelated physiology of mitochondria dysfunction. chronic inflammation, oxidative stress, which if you start going to the research as a clinician, who's focused on symptoms and confusing those for the disease, and look at what's the pathophysiology of arthritis? What's the pathophysiology of Alzheimer's dementia? What's the pathophysiology of type 2 diabetes? Obesity, fatty liver disease, polycystic covariance, erectile dysfunction, It all traces back to this trifecta that no medication or surgery. You obviously can't operate on oxidative stress. You can operate on the downstream symptoms. So that's the real secret that I really feel like we need to Reorient the healthcare surround since 90% of healthcare costs go towards treating the downstream symptoms of these and for every marginal dollar responding on treating symptoms we're getting the rates are going up because they're doing nothing to actually affect that trifecta but to really make it simple. I like to think of this trifecta of what I call trifecta of that energy. Trifecta underlying metabolic dysfunction of chronic emulation, mitochondrial dysfunction, osteostress, as chronic inflammation is biochemical fear. It's response to a threat. mitochondrial dysfunction is kind of like rolling blackouts. It's not enough power. and the oxidative stress is wildfires. So it's kind of what's funny to me a little bit is like what's happening inside the cell is almost like what's happening like in our society. It's like this is like living in California. It's like blackouts, fire, fear, and that's literally what's happening inside our cell because of the environment. And again, the optimistic news that you alluded to is that we actually have tons of tools and tests that can actually help us understand our level of metabolic health, and even give us hints about inflammation, access, stress, and metoconder dysfunction, and it's very easy to improve if we know what we're actually focused on.

Well, that's the healthcare cost.

Yeah, any country where we've exported the Santa American diet and some of the other norms of Western living are starting to see the same rates of of chronic disease, but like it is worth not menacing words here of all high-income countries in the world. The United States has the worst chronic disease rates and the lowest life expectancy and our life expectancy is going down and we spend about twice as much on health care than the second highest spending country in the world. So we are we are objectively failing and that failure is predicated in our cult of siloing conditions into different, you know, different specialties and not focusing on this root cause. And I want to just be super clear, like, there's a war being fought right now to get us to believe that siloing is the way, because as you alluded to, siloing is profitable. If you can convince doctors and people, that their 10 different symptoms are separate things, then they're going to 10 different specialists office. Meanwhile, 75% of American adults are overweight and no bees, some of the highest in the world. A full 50% of American adults now have pre-diabetes and type 2 diabetes. 50% 30% of teens have pre-diabetes. 40% of Americans have a mental health diagnosis. Cancer is set to reach two million cases this year in 2024, highest ever in recorded history. All timers is going up. Fatty Labor Disease is affecting 40% of adults, 18% of teens, autoimmune diseases, skyrocketing, infertility is going up at huge rates. All these things are going up all at once in the US and yes, in many of the other countries that are eating our diet. And there's no sign of it slowing down. And so that's really If you look at, if you look at the research through this, this different lens, you'll find that all of those diseases trace back to metabolic dysfunction caused by our environment, that no shot, pillar surgery can really address unless we unpack the environmental piece.

But I'm hopeful. Exactly.

This is the key question for how we can get healthy. And it's really about creating capacity in the body to turn more potential energy to usable energy as opposed to taking that potential energy and shunting it to a storage form. It's all just like I think about everything visually and I'm like, you got the circular cell from high school biology textbook inside or all the little mitochondria with the squiggly lines inside and it's just like there's excess through those mitochondria. So instead of, you know, after glycolysis and you've got the pyruvate, instead of going through the mitochondria, it's being shut old into something. else. And I mean, this is fundamentally the cause of insulin resistance because when the body senses that the mitochondria can't do that conversion process, the cell basically says, because I can't convert this. I don't have the capacity to convert it to usable energy. I'm going to take the substrates and I need to block them. I mean, you've got to turn them to basically a storage form, which inside the cell could be toxic fats, like ceramides and diosal glycerol. And I'm also going to block the cell from taking any more substrates because I can't do anything with them. That is fundamentally a root of insulin resistance. So the body says, OK, we're going to block the ability of the insulin receptor to transduce its intracellular signaling pathway. We're going to block it. And when that insulin binds, we're not actually going to allow for glucose to come in. So essentially insulin resistance is the cell compensating for the mitochondrial beam broken. and telling the insulin receptor that it's not going to be functional and so you don't get the glute receptors on the cell membrane to allow the glucose to come in. So that's insulin resistance. Again, we talk about that as the problem, but the problem is actually inside the cell leading to that. So that's why just giving someone insulin isn't necessarily an answer. We have to increase mitochondrial capacity to let the flow happen through it to energy, which then trickles up into relieving a lot of these problems. So to answer your question, what we really want to do to increase our metabolic capacity for a first principles perspective, 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. It's really that simple. And the beauty is we can do all of those things. If you actually break down like what those three things mean, it means promoting my topology. through a cycling of old mitochondria to new mitochondria. It means promoting mitochondrial biogenesis. It means increasing the oxidative capacity of our individual mitochondria. It means improving mitochondrial fusion, which is actually when mitochondria come together to form long chains of mitochondria that are more efficient. So there's like a lot of technicalities like what it means to print more mitochondria, have the HP more efficient and have each one do more work. But that's really what we want to do. And that's when it just kind of gets into the simple habits. Like, there's simple things we can do for each of those things for my topology. You know, we can focus on various types of like endurance exercise and high intensity interval exercise. There's compounds like you're all at the knee that promote my topology. When we talk about improving our, you know, octave capacity. This is things like the sprint workouts. We want to build more mitochondria. This is resistance training. Literally. telling the body to make more. So, but first principles, it's how do we get more of these working better, doing more work every day? And then we think about, you know, you look at the date on walking. And it's like, people who walk more than 7,000 steps a day have a 50 to 65% lower chance of dying in 10-year follow-ups. And it's like, yeah, because walking is literally a glucose disposal signal. So you're just simply asking, it's not a great bio-genesis signal, it's not a great, my topology signal, but it's a great disposal. So if you're doing lifestyle habits that do one of those three things, which we can of course go into more, you're improving the cells' capacity to do that conversion process better.

I would say, I mean, at least three, I would say aiming for more than that as good though. So sort of just give a sense of the picture of walking. If walking were a pill, it would be the most impactful pill we've ever had in all of modern medicine. There was a paper in JAMA, a 6300 participants followed for 10 to 11 years. And the people who simply walked 7,000 steps per day compared to less than that had in up to 70% lower risk of all cause mortality in the follow-up period. So not causeality, but it's pretty incredible. They've done follow-up research with slightly different numbers showing, again, though, like many thousands of people in the study followed for about 10 years, 8,000 to 12,000 steps per day was associated with 50 to 65% lower all cause mortality. And this has been played out in many studies showing about a 50% reduction in Alzheimer's. dementia, obesity, type 2 diabetes, depression, cancer, gastric reflux, just all across the board. And I think the key thing is that it's not about the steps. It's about the fact that muscle contraction is medicine. When we contract our muscles, even in a very like low grade way, like walking or doing a couple of air squats, you know, we're activating MPK and we are Essentially, causing that cell to have a stimulus to push glucose channels to the cell membrane. Most of the time, the glucose channels are like in vesicles, in little bags inside the cells. They're not on the cell membrane. So of course, that's going to keep the glucose in your bloodstream, not being processed by the mitochondria. So when we think about steps, it's a proxy metric for just moving more throughout the day. So let's take two people. You have a person who's walking for one to two minutes every 30 minutes throughout the day. Maybe they're exercising at the end of the day or the beginning of the day. Maybe they're not. That person is stimulating glucose channels to be at the membrane all day. Now let's take another person who works out really hard for one hour in the beginning or the end of the day. They feel great about it. They've checked that off their box, but they're sitting in the entire rest of the day. Yes, they have gotten the benefits from the exercise, but for a lot of that day, those glucose channels are inside the cell, not doing the work they could be doing. So I think about these little teeny short walking breaks or push-up breaks or air squat breaks every 30 minutes or so throughout the day. As me, essentially, inside the cell, pushing the glucose channels, the cell membrane to make them constitutionally active. It's totally different physiology and it's so easy. So it's not about the steps. It's about muscle contraction regularly throughout the day. And this has been shown out in actually more clinical research, which has taken, there's been several studies. two that I think are fascinating where they basically took two groups and they said, okay, we're going to have you walk 20 minutes before each meal three times a day 20 minutes after each meal. So that's also three times a day or for like two minutes every 30 minutes throughout the day.

two to three minutes every 30 minutes. Okay. All added up to 60 minutes of walking or light jogging a day. I'm kind of paraphrasing two different studies that showed the same thing. One was jogging, one was walking, but it was basically chunks versus short walks every 30 minutes throughout the waking day. The groups that do the short movement regularly throughout the day, even though the total time is the same across all the groups, have significantly lower 24 our glucose level averages, 24 our insulin level averages. They are metabolically healthier and I believe in the research mechanistically has shown that it's because we're consistently putting This the these channels of the memory and to take up the substrate use the substrate. So this is not in to replace exercise, but I think it's a reframe. I think the concept of exercise is something we're really very wedded to in our Western culture and you look at more like the blue zones and the centenarians and it's like they're kind of moving as built into their everyday life. So we've taken movement out of our everyday life as these knowledge workers as we've been industrialized and then we think that exercise replaces that all day movement. biochemically it does not. So I think a big part of kind of digging ourselves out of this chronic disease mess and creating capacity for mitochondria is finding ways to take a lot of the activities we do now seated and just find a way to do more of them moving standing or walking or if that's tough, you really need to sit at your desk all day, then every 30 minutes, taking two minutes to do some just light movement, flex those muscles, get the glucose channels at the membrane, get the mitochondria. active. And I think another fascinating sad is like our gym memberships in the US have doubled since the year 2000 and obesity has gone up in the same period. So there's some mismatch between our obsession with exercise and our actual outcomes that we're seeing. And I think it's that we have not actually rebuilt constitutive movement into our daily lives.

huge amount, 30, 35% just taking a walk around the block after meal. That's definitely a prescription, I think everyone should do because the research is so strong on it is that building in simply a 10 minute walk around the block or a dance party in the kitchen, moving your muscles for 10 minutes after a meal can drastically reduce your glucose response because you're just bringing all those channels to the membrane, you're taking up the glucose, you're using it. It's a whole different physiology than sitting on the couch after a meal. that's very high impact. It's high leverage if it's after a meal. So highly recommend that. And the levels data and clinical data has shown that out time and time again.

Yeah, so you take sort of each type of exercise. We've got walking, we've got resistance training, we've got high intensity interval training, we've got endurance training, and then we've got sort of more like zone two. So We've got these different flavors of how we get our heart rate up, how we get the blood flowing, what we signal to the cells. And each one actually has a slightly different impact on the mitochondria. When we think about biogenesis, we're thinking mostly endurance exercise and really more of that zone too. And that is really going to be a stimulus inside the cell to print more mitochondria. When we think about improving mitochondrial fusion, high intensity interval training is really, really good for that. 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. So each one has kind of a different impact. And I think this is where, honestly, I think the regular guidelines that we have even by our government, you know, actually make a lot of sense. It's like work every major muscle group three times a week in a resistance type training and then work to get 75. to 150 minutes of moderate to 305 minutes. So 75 minutes of continuous activity or 150 minutes per week of moderate activity. So that actually makes a lot of sense. 80% of Americans are not meeting those very basic guidelines and 20% of Americans don't get any physical activity really at all. Activity for the average American is 3,000 to 4,000 steps per day, which is less than 2 miles. So we are not even close even meeting the basic recommendations that are out there, but I think those are pretty reasonable resistance training two to three times a week, most major muscle groups and working to, you know, get the get the heart rate up moderate level for 100 minutes a week or a strain US for 75 minutes a week. those are going together to be potent stimuli for biogenesis, my topology, mitochondrial fusion for increasing antioxidant enzymes that are going to protect the mitochondria from that oxidative stress. And the one that's just actually not in there in the sort of the basic recommendations for Americans is the walking. And I would just absolutely add to that at least 7,000 steps per day based on what the data is showing, which Honestly, would probably take less than an hour total to do if you break it up throughout the day, it's just a few minutes a day. So that right there are going to be like a big multifaceted set of signals for increasing mitochondrial capacity in different ways.

I'm a massive fan of under treadmill deaths because genuinely I believe that if we, if we move more of our daily activities that we're doing seated indoors to outdoors moving, it would, it would, it would radically change the health of the United States with real physiology underneath it. So there's actually been research on underdesk standing desks that is pretty interesting. Small studies, but they, You know, took a handful of people I think it was around 10 in a workplace environment. And they had them use under desk treadmills for two and a half hours per day during the work day. So not a lot of very, so speeds for two weeks. And people lost on average 2.6 pounds of fat and put on 2.2 pounds of lean mass in a very short period of time. The study makes a somewhat wild claim that if this were extrapolated to a year, we anticipate that we could see a loss of 44 to 66 pounds, assuming it's linear progression, which is not the case folks. But that's why I'm saying it was a pretty, but that was there in the discussion. But I think that short period is quite interesting. So that's that's pretty significant and that's just for two and a half hours a day. So I think now that they're about $150 on Amazon, these under-dust treadmills, I think for anyone who's a knowledge worker, it's a good thing to have at your house. And the way I use it is like, I basically just force myself to start my day on the treadmill desk and I say to myself, if I don't like it after five minutes, I'll sit down. If I need to sit, but I'll start and just see how it feels and then an hour goes by. And I forgot, and I'm even on it.

I am putting it at such a slow speed. I think I'm usually walking at like one mile per hour. I mean, it's very, very glacially slow. I do put my Laura ring on my second toe when I do this because otherwise it doesn't count my steps because if your hands are at your desk, they, they won't count your steps.

It's all wrong. It's incredible how even at a 1.0, one mile per hour speed after two to three hours, you're easily going to get six, seven, eight thousand steps and then throw in a couple other short walks throughout the day and you're you're getting there easily. So it's just a great way to build back in what modernity took away and that unfortunately is unavoidable that that regular movement for good physiology. So I'm a big fan of them and the data suggests that for a couple hours a day, they can actually have an impact on body composition, which I think is a great, easy, inexpensive thing for people to do. But if you don't want to buy one, like just set those timers and and build in the walks, you know, throughout the day outside,

It's medicine. And I find the concept of neat, just endlessly fascinating, you know, because we kind of come up with this term non-exercise activity thermogenesis. And the data is really good about it. Like it basically shows that this is a prime potential intervention for the obesity epidemic. And it all goes back to the cell. Like it's essentially a stimulus that's telling the body to stay metabolically active as opposed to keeping all those metabolic pathways, you know, dormant during the day. And I think that it just, it is funny though that like we have these acronyms for basically like this is just the way life was a hundred years ago. If you look at like, The 1800s, almost 100% of Americans lived on a farm. Basically, like pre-industrialization, pre-urbanization, most Americans, not 100% but close, lived. They grew some of their own food. They lived either on a farm or had a large garden. Now that number is less than 1%. So like movement was just building to everything we did and you think from there like what has happened like we were outside we were moving our activities of daily living involved movement and if you just take the grocery example then it moved to like okay maybe farmers markets and sort of like you know outdoor open our markets then it's supermarkets then it's you know Now it's literally buying food online with the click of the button. And now some people aren't even doing that. They're literally on the food delivered to them with Uber Eats. So at every level, we've taken away movement from everyday life. And now we have sort of an acronym to like bring it back in. But really it's about just You know, giving the body stimulus stimuli that the cells have been entrained to expect throughout all of human history and building the back end to our modern life. So I think neat. It's incredibly important. And I think it also brings up this point that like is so critical, which is like. I really think our way out of this chronic disease epidemic. And even for people who are listening, don't have a chronic disease, any real chronic symptoms we're dealing with. And just the fact that we're not feeling as good as we could. The way out is pretty simple. It's some of these basic things, like walking more throughout the day, moving more throughout the day, getting outside, eating clean, unpoisoned food. A lot of these things that have the best data are so simple. And I think it's like really important to just always remember like the game and the industry it's all about how complex can we make it like specialization talking about some of my new show but like at the end of the day all the simple habits that we know are healthy like fundamentally improved solar biology and like some of these things like the need like the walking like it's emblematic of the fact that some of the simplest solutions are the ones that are by far the most effective and I think I think the biggest misconception in health care right now is that the way out and the way to get really back to true incredible health is complicated like it's it's really not that complicated we've got to move more you know throughout the day that's one of them and You know, on each pillar that we touched on earlier, food, sleep, all of this, you know, when we talk about the simple habits that we know work, the reason they work is because they all positively impact the mitochondria, they positively impact doxative stress, they positively impact inflammation. So yeah.

That's what comes to mind. You got, you know, you got the big ones. So this, this is key is that 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 and the first seven that I'll mention are very basic and people might take unbridge to them because obviously there's a lot of debate about like what's everyone's favorite lab tests but I think about it is like, what are the basics that everyone should know and then what's like the next tier up that are easy to access in our cheap that will give you a lot more richness, but which you still might have to kind of fight your doctor for. So the first few that you will not have to fight your doctor for and are often free on an annual physical and literally define metabolic syndrome are fasting glucose, fasting triglycerides, HDL cholesterol, hemoglobin A1C, total cholesterol, waste circumference, and blood pressure.

And I will say first about the reason I'm choosing these. It's not, it's not even my own choice, really. It's two reasons. One is that the two studies Over the past five years that have shown us in large populations that the vast majority of American adults are metabolic dysfunctional use those biomarkers. So I think because of that, it's important to know them. And the two studies that I'm referring to are one from UNC in 2018, which showed that based on those biomarkers, 88% of American adults have suboptal metabolism. And then a follow-up study from the Journal of the American College of Cardiology from last year showed that that number has gone to 93.2% of American adults are suboptimal in their metabolism. And these are the metrics that they use in their very basic. If you had to pay out a pocket, they would be less than $100. So let's talk through them. Why they're great is because together they give you kind of like a tapestry of what's actually happening inside the cell if you choose to look at them that way if you read the T leaves of them. are the doctors often. If they see all these lab tests, it'll be an electronic health record. We've all been to this experience. They'll come up on the screen and they'll either be like a green orange or red color next to it. Like it's high, it's low, it's borderline. And the doctor will basically, it's very algorithmic. Oh. You know, you're LDL's high, we need to bring it down. Oh, you're glucose is high, we need to bring it down. Are your blood pressure is high, we need to bring it down. But what I'm inviting people to do is understand a little bit about each test and then read the T leaves of what it's telling us about our mitochondria. So let's start with fast and glucose. So, fast and glucose, when you look at these studies that I'm referring to, they call optimal less than 100. So, to define whether you were in that 88 or 93%, you had to essentially be in their optimal range for all biomarkers, not on medication. So, it's quickly run through what their ranges were. My ranges for optimal are tighter than these, but fast and glucose less than 100. Try glycerides less than 150. HDL above 40 for men or 50 for women. Himalayan 1C less than 5.7%, total cholesterol to HDL ratio less than 3.5 to 1, waste circumference less than 35 inches for men or 40 inches for men and blood pressure less than 120 over 80. If those things were in those ranges and you weren't on medication for blood sugar or blood pressure or whatnot, you were considered optimally metabolic healthy. That's now 6.8% of Americans. All of these biomarkers are easy to change in one to two months, I would say, with simple lifestyle habits.

But so key to understand about the traitors' rights, it's not. We don't want to confuse triglycerides with eating more fat. Triglycerides are a storage form of excess carbohydrates in the blood. So this is why it can tell us something about it. And I know you would, for all of us to talk about this at length, but... And Lane, yeah.

And how it's helping us with that tapestry of understanding the trifecta of bad energy is that if you think about it, let's just go back to that cell and that poor mitochondria that's being absolutely decimated by our environment. And it's capacity is low. Okay. So that might get mitochondria is like I can't process glucose or fatty acids to ATP very well. So I'm in a block. their entry into the cell. So now you've got glucose rising in the bloodstream. So okay, fasting glucose. That was one of our biomarkers. If that's going up, that is a little bit of that tapestry of maybe something's going on inside the cell that's blocking the entry into the cell. So it's rising the bloodstream. Okay, well, where's all that? The body does not want lots of glucose floating around in the bloodstream because it can literally independently cause endothelial dysfunction, which is basically blood vessel problems. It can cause oxidative stress in the bloodstream. It can cause glycation, which is sugar literally just sticking to things. The body doesn't want that glucose high in the bloodstream. So it converts it to triglycerides to be stored in a storage form of energy. That's a key point that I think is helpful to understand is that the body, it's always trying to like kind of keep things in the right range. So it'll convert things. So then try glycerides, a picture in your blood of glucose being high and triglycerides being high is very much should signal to everyone when they look at their labs that there's probably something going on inside the cell that's blocking the cell for me able to use and process. It's a sign of mitochondrial dysfunction and chronic over nutrition. Too much substrate, not enough processing, glucose is going to go up, triglycerides are going to go up. And so then if you kind of squint and read the tea leaves, it's like, huh, I think metabolic dysfunction. And what's fascinating is that the travesty in our healthcare system is that a patient might go into the doctor. And they're fast in glucose as 99, one point under what we'd consider the normal range. And they're triglycerides are 149, one point under what we'd consider the normal range from these things. That doctor might say to that patient, you're totally fine. Both glucose and triglycerides are normal. But that's just really problematic because they're on the upper end of normal for both of those. And so really what that would say to me is someone thinking about the mitochondria is like this person is definitely metabolically dysfunctional. They're on the highest end of normal for both triglycerides and glucose. There's something there's definitely insulin resistance going on here. I would bunch rather see that glucose at 73 and that triglyceride at 50, which to me would say, oh, this solves processing through energy great and things are moving through and we're not backing up in the bloodstream. We're not converting to triglyceride. That's where really optimal ranges get in, but so that's glucose and triglycerides, why if those are starting to creep out bits of sign that something is happening metabolically. And then when we look at some of the other biomarkers, so hemoglobin A1C, is really, so that's a marker that's looking at how many of the hemoglobin molecules that are in the red blood cells that carry oxygen, how many of those hemoglobin molecules have sugar stuck to them, And that's glycation. So you're looking at glycated hemoglobin. And you can imagine that if the concentration of glucose is higher over time, more glucose is going to stick to red blood cells. And that's going to create a higher percentage of glycated hemoglobin. So that's why that lab is represented as a percentage. So less than 5.7 is what we want.

No sugar stuck to them, causing dysfunction. And because blood cells last for about 9 to 120 days, hemoglobin A1 see is giving us a basically a snapshot of average blood sugar levels over 9 to 120 days. And if that average is higher, again, probably a sign that cells are rejecting glucose from the cell and it's causing rise in the bloodstream. And then Just talking about one other biomarker in that that we talked about, which was blood pressure, people might say, well, how does blood pressure relate to like, what's going on inside the cell, you know, in the mitochondria and whatnot? And a really, the fascinating link is that when that cell becomes insulin resistance, which again is a compensatory mechanism for mitochondrial dysfunction. The insulin is going to rise in the blood because the body's insulin resistance. So the body's going to turn out more insulin to try and overcome the insulin block to drive the sugar into the cells. So insulin levels rise. Well, insulin is one of the key activators of nitric oxide, which is the molecule in the blood that dilates and relaxes blood vessels. And so when we become insulin resistant and we're not responding to that insulin signal, we end up getting less nitric oxide activity. So this is how kind of looking at even these very basic, very cheap biomarkers to the lens of basic cellular physiology. We can start to see, man, my body might be like underpowered. I might have a mitochondrial issue here. So that's a few of those tests that we really want to shoot for.

Yeah, truly. And I think the nice thing about these again, very basic tests and there are so many other tests that I talked about on my book and that you've talked about on your podcast, ApoB, Uric acid, fasting insulin, home IR, HSCRP. liver function test, GTT, all of the other tests that are great that can really tell us more about mitochondrial dysfunction, oxidative stress, chronic inflammation. But the ones I'm mentioning are the ones that you will not have to fight with your doctor about. Everything I just mentioned, like the doctor should order on an annual physical. And it's really about us learning to actually like read the tea leaves of what they're saying and not look at them in this algorithmic way. But like how together, if they're creeping up or if many of them are a little bit high, We need to focus all of our energy on improving mitochondrial capacity, basically. And bring those numbers down, which we can do very, very quickly. Once you start getting the mitochondrial moving through more of those substrates, a lot of them will just naturally come down. Now, in the book, I give scripts to literally talk to your doctor with because you are going to get pushed back. Often, if you asked for a fasting insulin, I would say probably, I mean, even though doctors are waking up a little bit, like maybe 85% of people are going to have their doctors say, they won't order that for them. So I actually think there's a huge benefit. I hate to say it, but like going outside the system. This is where I think innovation has been valuable. There's a lot of amazing companies doing direct to consumer lab testing so you can basically avoid the hassle. And some of them are very affordable. There's a function health is a company that's doing 110 biomarkers including all the key metabolic biomarkers for less than $500 and they'll do it twice a year. So you don't ever have to. And then they do interpretations inside tracker. Next health levels is doing labs. And so There's a lot of this springing up because I think people are sick of fighting with their doctors to get a crumb of information about their health. And it's, it's, we should probably be testing these. I would say three to four times a year. And the beauty is is that like, I think a lot of what keeps people down in the health world is that they're confused about what to do. There's a lot of noise, there's a lot of different strategies. You know do I do you know paleo keto carnivore vegan Mediterranean do I do hit or zone two or eccentric it's like there's so much noise and the beauty with having a plan for understanding your biomarkers regularly is that you can cut through all the noise Try a strategy, see where you stand, retests in a few months, and see if you're moving in the right direction. You don't have to trust your doctor. You don't have to trust me. You don't have to trust anyone. You can literally trust your own labs. And I say to people, like, if your labs are optimal, and the range they just mentioned are not optimal, like you want to actually get to better than all of those. If you want to be optimal, if your key metabolic biomarkers are optimal, If you feel absolutely freaking incredible and you have no symptoms, then you're probably doing the right strategy. Whatever that is, vegan, keto, whatever. And exercise in your lifestyle because that is showing that your cells are fundamentally working properly. So I think that's just a really empowering message. Now there's phenomenal companies that are cropping up to basically help. allow people to do this on their own schedule, which I think is really the future of health, and actually will help lessen, I think, some of the intensity of the diet wars, you know, because it's like people can just say, like, I trust my strategy. I know I'm doing what's right for me, because like, look at all my biomarkers, and I feel great, you know, so.

I think on the highest level, it's about running through what are the science-based things that we know in our environment can lead to metabolic dysfunction. and take on a stock of how those factors are playing out in your life and then choose a few to start moving in at a different direction. So the ones that I think are ones that we can really control and that are we know based on the science or impacting our mitochondrial metabolic health is the food, the sleep, the movement, the emotional health, the toxins, our relationship with light and our relationship with temperature. your journey to optimal metabolic health might be totally different from mine because I might really need to focus on the food and the sleep and the emotional health and you might really need to focus on the toxins and the light and the movement and so it's a lot of it is actually taking stock on where the levers are and your own life where are you crushing it and where is there a lot of room for improvement. So step one is knowing like that those are the things in our environment that we need to basically improve to have to give ourselves the best capacity. And then of course checking your biomarkers to make sure your interventions are working. But food I think is one that is like totally unavoidable of those pillars, those seven pillars. food is one that most of us are getting wrong and that we really actually have to get right to improve our metabolic health for a lot of reasons. I mean, our bodies are basically 100% molecularly made from food and it's so wild.

Like babies are 3D printed from food basically inside a woman's body. It's wild to me. And then what's so cool about the body, what brings me just immense awe every day is that like we have this conception in our Western world that the body is like a thing that we're with throughout our life because we kind of look the same and we like age slowly. So it's like Casey is a thing and Andrew's a thing, but the body is actually a process. The body and there's this amazing Taoist statement. Life is a process, not an entity. I love that.

Yes. And it's so much more hopeful, because if I'm a process, if you're a process, then every day we're eating, we are changing the process. Whereas if you think you're a thing, then there's no hope. Because I'm just I'm Casey, and that's why I am, and I have this disease, you know, and I think so much in our language actually of healthcare. both our Western sort of desperitualized nature, like we don't really have a lot of curiosity with with process, but even like the ideas, the way we talk about disease, I have diabetes, you know, and we don't even talk about diabetes curers, which now a lot of people are curing their diabetes, we call it remission. like it's this thing that's a part of you and I think I just love this idea of like we're evolving every day and food is so important because again we take in 70 metric tons of food in the lifetime two to three pounds per day one metric ton per year on average and that is like the printer ink that's the 3D printer ink to create tomorrow's version of our self which is more likely different than the case of today That's a hopeful message because if we can give the body food, which, you know, I think we, again, our conception of food, I think is very limited, food is the molecular building blocks of the body. It is the cell signaling functional molecules that tell ourselves what to do. They act as transcription factors, epigenetic modifiers, cell signaling pathway, intermediates, and it's also, of course, the substrate to change what the microbiome does and the composition of the microbiome, which is basically a pharmacy inside our bodies to create different molecules that can affect our health. Food is certainly a calorie is a calorie from the concept of thermodynamics. But from the concept of molecular information, it has three massively important parts that are unavoidable for creating cellular health. So I would just say that that is the pillar that we can be happy to drill into. Of like, what do we really do to build as much metabolic health as possible?

Well, just drilling in on two things you just said there. So one thing you said that was interesting was that you're lucky that you like all of those foods. And then the second thing was is it just about not getting excess calories. But I think what's interesting about both of those is that I would argue that the reason you like those foods is because you have given your body enough whole real foods that now everything your biology, neurobiologically, your reward circuitry, your microbiome, your satiety, hormone, threshold, all of these are now basically creating a situation in which you like those foods. And then the caloric thing fits into that because the reason we're eating excess calories, the reason chronic nutrition is happening. And the reason we are quite literally in the United States eating ourselves to death for the first time in human history is because we're not eating real food and we're eating 60 to 75% of our calories of ultra processed nutrient-depleted foods that fundamentally don't give ourselves what they need. And a real premise that I think is so important to realize is that ourselves are brilliant. And if the cells aren't getting what they actually need to function properly, they will drive you to eat until they get their needs met. Unfortunately, because The ultra-processed food is designed to be highly addictive and it's devoid of what this sells actually need for good function. We end up eating ourselves into a grave and now almost 80% of Americans are overweight or obese close to 50% of the country is obese. We literally gloss over this as a culture. It has become so normal and such a sort of amount of time, but I always think about the fact that like There are really no other animal species in the world that have obesity and chronic disease epidemics, and they don't have social media, they don't have experts in a pub med, they don't have the FDA, they don't have the USDA, they don't have any of it, and they have some health that you're out of way to stay at a healthy weight, and to not get heart disease, and it's because they're eating real food that meets the needs of their cells. I think to just boil that down, the root cause of the promise 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. And so, through the complex biology of satiety hormones and neurobiology and microbiome function, we are driven to eat. So, so, so much more. Truly, the jumping off point for anyone on the quest to better health is to eat as much real unprocessed food from good soil as possible and of really of any dietary philosophy they want. Truly, I think if someone's eating real unprocessed food from good soil, who is, you know, plant-based or who is keto, They are going to have such a higher chance of meeting their bodies, actual, fundamental needs. And the good thing about biomarker testing is they can track for themselves if they are having good cellular function with that strategy. There's been studies that have paned this out. We know that the moral to process food you eat, the higher risk of obviously obesity, but also chronic diseases are. But then, of course, there's amazing study from Kevin Hall. Just recently, where he basically locked people up at the NIH, and he for two weeks he had the meat, older process food, and for two weeks he had the meat real food, And people ate 7,000 more calories in the two-week period when they were eating ultra-processed food versus the unprocessed food.

I say this tongue in cheek and with such admiration for what he had to do, but I think it's so amusing that we have this totally frank and food toxic food system that's largely ultra-processed. And it took amazing Kevin Hall to basically do an NIH funded study where people, what I say by locked is that they were in patients at the NIH and every had ad lib, you know, unlimited access to food during each of those two week interventions. So it was two weeks of all process food, two weeks of unprocessed or mentally processed food and they could eat whatever they wanted. as much as they wanted in both groups and then they would weigh every single bite that was left on their trays. So they knew exactly exactly how many calories they ate 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 Uh, 500 calories more per day for a total of 7,000 calories more in that two weeks. And they gained about two pounds and then lost two pounds in the unprocessed group, which makes sense, of course, because of pounds about 3500 calories. And so we have to do these kind of crazy studies just to prove what we kind of know is true, which is that this older process, food environment that's cropped up for the past 50 years, is an experiment that has failed. It has failed. You know, close to 45% of kids are overweight or obese now. Like it's not working and that really is the root cause. So I think a lot of food is about quality and how do we actually really meet the needs of the cells that our satiety hormones get secreted and we naturally stop eating because just telling people eat less calories, but eat whatever you want. That just doesn't work. We have to inspire the body to not want to eat excess calories, which we do by stimulating satiety hormones, you know, helping the microbiome, support that process, and then change our award circuitry, which is done with nutrient rich. The most nutrient rich food we can possibly get. And that's why I mentioned the soil, because our food is drastically depleted of nutrients. So when we look at that 70 meter tons of food reading in the lifetime, It's just fascinating. That's the information for our body, what it's going to be built from, how it's going to function. Well, right now, 60 to 75% is ultra-process. So we slash the value because the ultra-processing just like slash is the nutrients. We slash the value of that 70 metric tons. And then we have crappy soil because our industrial agriculture system, which means that the food, in some cases, has 70% less of key micro nutrients in it. So that 70 meter tons, what's actually useful for our body becomes so much smaller. So what we want to do is basically expand the value of that substrate. We're putting in the body, and that means real food on processed from good soil. Meet the needs of the cells. Naturally, don't be hungry, maintain a healthy weight. And, you know, something I talk about is that we could, I mean, we could talk about nutrition, the biochemistry of nutrition all day, but in my review of sort of The biology and the biochemistry, like there's five main things I think we can strive for in our food that can really help meet the needs of ourselves. And when it really comes, there are obviously more things our body needs. But if we strive for these five things, we will ultimately, I think, eat a really healthy diet. And that is fiber omega-3's adequate healthy protein. a good amount of probiotics and high antioxidant sources. And if we build our diet around knowing a few things in each of those categories that we really love and stock our kitchen with it and make our meals, I'm mixing and matching of each of those components. And we get a good amount of those. We will give the body a lot of what it needs to have mitochondrial health, reduced chronic inflammation, reduce oxidative stress.

Yeah, you will self-regulate because the body like every other animal in the world is exquisitely designed to regulate hunger on a very intuitive level. If we eat natural food, it's, you know, it's, I think it's almost ridiculous to talk about calories and isolation because the reason we're eating more calories is because we're eating ultra processed food. And so, but I love what you just said, Andrew about the brain and the polypharmacy. I think that literally is, I've never heard that said. And I think it's like process food is like polypharmacy of food. It is the definition of process food, which I know you talked about with Rob Lustig, the Nova for criteria is literally it's breaking down foods into these constituent parts that were never meant to be separated from each other, like the endosperm of a weak kernel separate from the brand and the, you know, the germ. And then take that and like a little science experiment paired up with all these other individual components and synthetic chemicals that are made in a factory and put them together to create this thing that the body, I truly think our Insatiable hunger, again, we're eating ourselves to death in the United States. That's the reality. Our insatiable hunger and our chronic epidemic fundamentally is a lot of, it's, it's mass cellular confusion. And when you think about what chronic inflammation is, chronic inflammation is biochemical fear. on the cellular level. Well, when you put this stuff into the body that's never seen before, obviously that's going to generate some confusion. And you know, you could trace that back to what that really means with leaky gut and you know, all the sorts of the real physiology of that. There's a wonderful book that is called the End of Cravings by Mark Schatz, or he also wrote the Dorito effect. But he talks a little bit about what you're talking about, which is say, deal that processed food is actually the ultimate sort of food-based variable reward. So in the way that, in things that, I mean, I'm speaking back, expert here, but things that the body can't predict what the outcome is going to be or going to kind of get you in that dopamine motivation pathway. And that's actually what processed food is doing is it's Every time we eat a different, we think we're eating a tortilla, but it's like completely different than all the other weird tortillas, ultra-processed tortillas on the shelf. So every time we eat tortilla and our brain is this incredible prediction machine. And as it's coming towards our mouth, we're predicting what the load is going to be. But we have no idea. Is it a Coke Zero? Is it a Diet Coke? With Aspertame? Is it a regular Coke? It all tastes the same, but the nutrients that our gut are totally different. So we end up actually triggering the motivation pathways because of processed food representing a variable reward. Whereas every time you eat a ribeye, your body's pretty much getting a similar thing each time. And so the prediction matching is going to be more conducive to getting off the motivation treadmill for more, which I think is so fascinating. But I think backing up a little bit, one concept I have for food that really helps me is really thinking about the bodies always trying to help me be satiated and trying to help reduce my cravings. 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 and giving me satiety hormones to basically regulate my hunger and Again, with visuals, I think it's so helpful. I think about these cells lining our small intestine that literally have nutrients sensors like and literal receptors on the cell membrane in the luminal side of the gut that's facing all the food that are just sitting there like waiting to bind with these things in our food that will stimulate the cell to make this a tidy hormone that Poof effortly makes us not hungry, gets rid of that grip of attachment to cravings that all of us are so plagued by. And like, I think, you know, we have this intense conversation happening in society right now about GLP1 analogs, an ozempic, and manjara, and all these things GLP1 agnes. But like, You know, we rarely talk about the fact that like we have nutrient sensing cells of the gut, the else cells of the gut that when stimulated appropriately will make GLP1 and when stimulated the way they want to be, will secrete hordes of GLP1 for us. And so how do we actually think about just literally giving the body what it needs to stimulate the study hormones and the process who's aren't giving us those things? You know, the things that are gonna stimulate those cells Well, the things that will, I mean, this is kind of fascinating if you don't mind going down a little road. No, please. Yeah, please. With the GLP one conversation, I feel like so missing from the conversation is the idea that like from a first principles perspective, there's three ways our body could make more GLP one. We make more cells that make it, else cells with the gut. Each of those cells makes more GLP1, and, importantly, we can also inhibit the inactivator of GLP1, which is an enzyme called DPP4. So GLP1 actually gets rapidly degraded by DPP4 in the body. So if we can figure out how to inhibit DPP4, we can raise our GLP1 levels.

It's an enzyme that breaks down GLP1. You said that and I missed it. It's so fascinating. And so how often have you seen in the headlines? Oh, here's some strategies to inhibit your DPP for never because OZEMPIC is, you know, on track to be the highest grossing med in human history and just like we talked on the beginning of the episode. The whole industry, this four trillion dollar health care industry, is desperate for us to not understand how to do the things that drugs could do for us. So when we look at those three first principles approaches of how do we make more else else get them to produce more GLP one from each L cell and then inhibit the breakdown to the inhibition of DPP four. For the first one, we know that short chain fatty acids, which of course are the byproduct of microbial fermentation of fiber in the diet, stimulates the differentiation of more else cells in the gut. So more short chain fatty acids, more else cells.

Eat more fiber. Eat more fiber.

Yeah. Yeah. That's going to be like the highest sugar of the fermented foods, which people often go to. And often costly soda.

That's such a great point, which is that ultimately we want the short-term fatty acids, which is the medicine that the microbiome are making for us through the microbial fermentation process. And we can basically do that in three ways. One is we can eat more fiber, which is prebiotics. We can also eat more polyphenols because we're now learning that the microbiome actually processes. They ferment polyphenols from our which is basically you'll find those in colorful fruits and vegetables, spices, teas, cocoa things like that. So fermentation of polyphenols and fiber to short-chain fatty acids, which then we absorb. And then, like you just said, in a fermented food, the bacteria in that food will be making short-chain fatty acids by fermenting the food in there. And then if we drink that, we're getting the short-chain fatty acids directly. So that's the kimchi, sour, crowd, Greek yogurt, kavas, which I'm obsessed with, which is like low sugar, kombucha. It's like made with fermenting beats, basically. That's good stuff. It's such good stuff. Uh, me so noto. So that's one. That has been shown to differentiate more else else in the gut. We also know that people with type 2 diabetes have much fewer else else in the gut. And it's hard to know what the causality is there. But I think a safe assumption is like if we keep our blood sugar under better control and sort of stay out of that diabetic range, it probably lends itself. I don't know what the chicken and the egg is there, but blood sugar stability, more else, all different. And then actually ginseng. has been shown to improve as else all different variations. So that's just sort of one set of things. And I don't think the dose on ginseng has been settled, but very high antioxidant component plant. When we look at actually stimulating more GLP1, you've talked about your remate, I think, having like a mild effect on GLP1, but there's actually a lot of other things in the literature. Protein, of course, very potently stimulates these nutrient receptor cells and specifically like valine and glutamine seem to have a potent stimulatory effect on GLP1, so you're gonna find that in like meat and turkey and eggs and things like that.

Antioxidants, lowering blood sugar, ginseng. So those are kind of the L-cell ones. The actual secretion of more GLP1 The one of the most potent ones and the study that looks at this like the bar graphs are very clearly statistically significant. Lots of asterisk is actually thylacoids. So I look like. Tell me more about thylacoids are so fascinating. Thylacoids are actually a structure in plants. that are part of the chloroplasts. So, you know, chloroplasts, and this also is fascinating as chloroplasts are basically the plant version of mitochondria, essentially. And phylloquids are a molecule in the chloroplasts. And there's actually been research that shows that when you eat about 100 grams of spinach, which gives you five grams of straight phylicoid over 12 weeks daily, it led to a significant increase in GLP1. And again, I don't remember the exact, it was two or threefold higher secretion. So this is in part, so that's a direct cemetery effect of the LSELs. And so this equates to 3.5 ounces of spinach a day, which is like nothing. So just getting those green. I think I actually, I don't think it actually, it might have set in the methods, but I would imagine raw because you want to get those undenatured thylacoids in the gut. So just kind of another, and actually thylacoids do a lot of other interesting stuff. They inhibit lipase in the gut. And so actually help more fat get down to the distal small bowel and promote satiety. So this is one of the reasons why you talk about, oh, the people who eat all these healthy foods and greens, they're less hungry. It's like, it's biochemistry. Like, there's stuff happening in there that is making the hunger signals go down through things like inhibiting lipase, you know, improving GLP one secretion. So other things for GLP one secretion, the thylacorrids, also fibers been shown, specific amino acids, so high protein foods, things that involve a lot of valine and glutamine, green tea, and specifically the allagic, the ECGC that is one of the compounds in green tea. That's been shown to stimulate GLP one. So there's several things that are all in that like whole food, you know, basically things you would associate with the healthy diet, but we actually know they stimulate GLP1. So, you know, those are all things I try to include in my diet, and the last one is inhibition of DPP4. And that one, there's just actually, when you look at the research, there's some kind of random foods that tend to inhibit DPP4. Black beans, Mexican oregano, other forms of oregano, rosemary, guava, and I wrote this one down because it's a word I hadn't seen very much before. I started digging into this, but mirasatan, which is found in berries, cranberries, and peppers, and Swiss chard. So all that is to say, ultimately, many of us are gripped by cravings, and the idea of have, you know, just sort of not being constantly driven to eat more, which I would argue that about 80% of Americans are feels really hard to overcome, but a lot of it is literally just communicating to yourselves in a clear way through food. to help you be satiated. And the science can show us how to do this and a lot of it comes down to eating. Essentially, what you were talking about, how you eat omnivorous, protein, healthy sources with nutrient density and lots of colorful fruits, vegetables, spices, herbs, things like that.

OZEMBIC is the commercial name, and we're going to go vegan. Yeah.

Right. Yeah.

I think there were over 20 million prescrips in the United States last year. Is it expensive? It's $20,000 per year. Does insurance cover it typically right now insurance is covering it for indications, but there is a all out assault from the pharmaceutical industry to essentially classify obesity as a genetic disease and a chronic disease in order to be able to feed this medication more into the insurance pathway and essentially get more taxpayer dollars to pay for this medication. And it is extremely expensive and it's on track to be the highest-grossing medication in human history because it's now being recommended for people with obesity, type GDIBDs, and then the American Academy of Piatrics recently has talked about giving this to children as young as 12. as part of the first line for overweight. And, you know, I think really it's such a travesty based on the conversation we've had because what OZEMPIC does not do in any way shape or form is impact the toxic environment that we're living in that's hurting our mitochondria. Losing weight is different than improving mitochondrial function. And mitochondrial function is the root cause of basically every chronic illness and symptom that's torturing American lives today. And so in many ways it represents like the ultimate bandade for an environment that is not changing. And when you think about what we could do with $20,000 per year, And it's a weekly injection. So people would say, well, her person, like, oh, it's, and it's a medication that is intended to be taken for life because when people come off this medication, many people are gaining back all of the weight or even more weight afterwards. And then there's been conversations. Peter, it tears weighted on this about loss and lean mass, you know, part of the weight loss is disproportionately muscle. And so there's a lot of concerns about it. above and beyond its ability to lower the number on the scale that we should all be very alert to because the reality is is that the 40 trillion cells in our body are in an environment in the Western world right now that is not conducive to core biologic functioning, and there is obviously no shot that can mitigate the multi-front assault on our biology that ultimately generates a body that's immensely profitable for those hundred specialties of healthcare. So we're living in this matrix and this game of, you know, a devil's bargain between a four trillion dollar healthcare and pharmaceutical industry and a six trillion dollar process food industry that all want us to think that, you know, the answer is found in a shot and we don't need to change anything about our lifestyle, but of course, you know, these simple habits that we're talking about eating real food, moving, walking, et cetera, getting out in the sunlight, rapidly can increase our mitochondrial capacity and, you know, are just the most disruptive thing that we can do. You know, in our culture today is is learn about metabolic health and improve it and It's just interesting to see what's happening in the media with sort of the assaults against these empowering habits and very in favor of a medication like OZEMPIC and then when you trace, you know, unfortunately incentives there a huge percentage of these outlets that cover, you know, OZEMPIC is a miracle drug. Their bills are paid by Pharma, 60% of mainstream media advertising budget is Pharma and so, you know, I just, I just say that because I think It's a scandal that we give so much airtime to these medications and not to simple metabolic habits that can make us feel, you know, so incredible and really change our core biology.

I think we have to look at history here. I mean, first of all, there have been other weight loss medications throughout history that you've talked about in the podcast. Like the fenfen and then there was another one. I think even before that that made people their temperature go up that you can. Yeah.

Look it up.

It just hasn't. And I think that I'm not just going to lump, it's a different mechanism. So I don't want to lump it in with past weight loss drugs. However, if you look at the trends throughout history, the medicalization and Pharmacology towards chronic issues has been an object failure. I cannot, I don't know of, and I'm sure people can correct in the comments, but of a single chronic condition for which the explosion of the pill to treat and manage that condition has lessened the rates of that condition. The more SSRIs you prescribe, the more depression we have. The more metformin we prescribe, the more tied to diabetes rates are going up. The more ozempec is being prescribed. OBC is going up. You know, this is on Wall Street. They're not This is on track to be a blockbuster drug and they're not assuming the rates of obesity are going to go down. That wouldn't actually make sense for the business model. I mean, these are being talked about at the JP Morgan healthcare conferences. Do you think they're thinking that this is going to plummet? No, like there are, I can't think of very many chronic conditions for which the explosion of the medication has reduced the frequency of the disease. That's really something to think about. And the reason is because of exactly what we started this conversation with. They're not actually truly impacting or healing the root cause physiology. In some cases, they're worsening that root cause physiology, like they are inducing oxidative stress. They may help with the symptomatic management. Um, but not actually reducing that trifecta that we talked about in the beginning. And so why do we have reason to believe that medicalizing obesity and not actually getting at the root cause, which has to be impacted by multimodal gentle nudges in our daily life habits and environment that that's actually going to reduce the rates of the condition.

So no one has basically described this better than you. I feel like on your platform, but I think about it very, very simply. Throughout human history, humans have really in so many different parts of the world been exposed to hugely fluctuating temperatures. Like if you look at the Sahara Desert or like a regular day in Colorado, it's like, you can go from, let's talk about the Sahara Desert. You can go from 30 degrees to 110 degrees in the span of one day. And like even the concept of indoors is like a relatively, new concept in human history for walls, you know, insulation, then central heating and cooling. That's like the last 50 75 years in most homes. And so this idea Our cells have evolved to respond to big swings and temperature that very recently, we have totally pulled away. And I think that when I think about the mitochondria and increasing their capacity, I'm thinking about, well, how do I use different energetic signals in my environment to essentially get the mitochondria to do better work? And we can think about all the different types of energies that were exposed to solar energy, thermal energy, acoustic energy, mechanical energy, you know, food energy. Like there's that's basically what our environment is, right? And thermal energy is a big one of those. 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. And so, that's kind of the framing that I use for it. And like, you know, this data's hard to know if it's totally accurate, but like, our population is cooling. And some of, I think it was a data Stanford actually that was showing that like our temperature has gone down like 2% or something like that in the last 100 years. And that fundamentally is mitochondria not working as well as they should research has shown we're making less ATP and a lot of ourselves and that's you know function of mitochondrial dysfunction. One fun fact I don't know if you knew this but the body makes about 88 pounds of ATP per day for like the average American so we're constantly making it constantly recycling it in this like you know like basically make it use it, make it so fast that, like, we essentially don't change our weight, but it's kind of, and of course, as it's being broken down, HP to ADP, we release heat. And so, I just think of cold as, like, one of the tools in our tool belt to talk to the mitochondria to say, make more heat. And, you know, world in which our mitochondria under siege, I think it's a valuable, often very inexpensive one, that can we use. Of course, it does not supplement. or replace food, sleep, exercise. But I think it can be a very valuable tool to stimulate that signal, to basically make more heat. And we know, of course, it can help. And the data is mixed, but like increase brown fat, which is like mitochondrial dense fat, and have it do more work and whatnot. So ultimately, brown fat is mitochondrial dense fat, and we want to help promote that. So that's all used cold. And then on the heat side, You know, just fascinating how that's kind of acting to help metabolic health through the activation of the heat-talk protein, some of which have, you know, the ability to upregulate antioxidant defense systems and quell some of that wildfire that we talked about that can hurt our mitochondria. So, I put them lesser on my list, but, you know, because we just can't, we can't avoid the food and, you know, the sleep and the movement, but I think it's a great tool that we can use.

The way I conceptualize the idea of fasting, obviously this is one where we need more words, right? Because the word fasting is so limited. There's so many different parts of this. skipping breakfast for me would be that or or skipping dinner sometimes I'll skip breakfast right I think that some of the most interesting data that I've seen has been about if we reasonably compress our eating into daytime hours during the part of the diurnal cycle when we are supposed to be eating so essentially matching our chronobiology with our behavior which, you know, we are diurnal organisms, so we kind of need to respect that. Like when we do that and we compress it in a moderate way, our metabolic health is better. And so some of the studies that have looked at this one that was interesting was, and I think very hopeful for people, is that if you take all the food, all the calories that you're gonna eat and eat them in a six-hour window versus a 12-hour window, totally same amount of calories exact same food. This is a controlled experiment. People who eat the same amount of calories in a six-hour period are gonna have much lower, statistically significantly lower glucose, 24-hour glucose in insulin levels compared to people who just space it out over the course of a 12-hour period. And it makes sense because if you're spacing that food out over the course of 12 hours, that is a different biochemical, no you and your body throughout the day. It's kind of similar to the walking. It's like you are then stimulating insulin several more times. You are exposing the bloodstream to insulin and glucose just more throughout the day. and giving the bloodstream less of an opportunity to just sort of be clear from that glucose and that insulin. And so compressing our eating windows seems to be helpful for metabolic health. And it's a bang for your buck, right? Like you can eat the same amount of food. You just have to eat in a sort of period of time. So for people who want to eat a lot, maybe just consider compressing it into daytime hours, six to eight hour window.

Absolutely. And the methods were very poor in that study. It was a recall based study. I think for two days of recall of people's diets, which is notoriously very bad in terms of accuracy. So yeah, and I think I'm not in any way suggesting that a six hour window is the optimal window. I'm just sharing the data that suggests that compressing the window uh, seems to have a favorable effect. And I certainly don't do six hours. But I think when you look at what the average American is doing, which is the average American has 11 eating events per day. And 50% of Americans eat over a 15 hour window per day. I can recall those because I remember when I was writing the book, I was like, That's a long time, 15 hours with 11 events, and every time you're doing that, you're going to be stimulating this glucose rise in the bloodstream, exposing the blood vessels, that glucose, you're going to be turning on all the pathways with insulin to basically store it, or, you know, and it's so it's strained for the body. 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. It gives our body an opportunity to have space to use accessible glucose and then convert into using stored fat, but be, and that ultimately is metabolic flexibility, the ability for the body, giving the body opportunities to use glucose, but then have times when there's not high glucose and insulin around to actually get into the fat stores. And I think one of the reasons why We have such a massive overweight no obesity, you know, rates in the country is because with the way the culture of eating right now, 11 eating events today, eating over the course of 15 hours per day, I would imagine the average American body is rarely if ever. tapping in to their fat stores for energy in a meaningful way, because we always have glucose available to the body. If you think about, again, the stats about ultra-processed food, about 70% of the items on the shelves and the grocery store ultra-processed food, and those ultra-processed foods are built on refined added sugars and refined added grains. So we've very, really give the body the opportunity to rest and move into fat burning. And that's where compressed in the eating window, can be valuable. Obviously, people have talked about this before, but fasting can be a stress for the body, especially if your body is not used to using fat for energy. And so it's something to ease into and go slow. But I think if you're slowing down enough to really hear what your body's signal are saying, you can kind of know whether I think you're fasting is working for you or not. I can tell if I've got too many other things going on, I haven't slept well, a lot of stress. I can tell that fasting's kind of making me jittery and not feel good. Versus if I'm really, if I have good capacity, I can feel that it's actually making me feel really incredible. And so tune in with your body, obviously. And you know, you can check your biomarkers. If you have a CGM on, you can see what's happening in your glucose. If you have a ketone monitor, you can see what's happening in your ketones and really actually track, which I think makes fasting, actually, even more fun. I'll mention one other piece of data that I think is actually really kind of fun as well with timing of eating. There was a study that looked at people who ate the exact same meal at 9.30 a.m. or 8.30 p.m. So basically after dark, essentially in the part of the diurnal phase when we probably shouldn't be eating versus early in the morning, 930. And the glucose and insulin responses for the same meal at 830 p.m. were significantly higher than when eating at 930 a.m. and so again, bang for your buck. It appears that eating In that earlier part of the day when we're active and our chronobiology is set up for metabolism and activity, we have a lower glucose and insulin response. There's also some evidence that melatonin, which is secreted as we get closer to sleep, has somewhat of an effect on impairing our insulin sensitivity transiently. And so we may actually just be not absorbing the glucose from those meals effectively later at night. So I tend to kind of move a little bit more A little bit more low carb. I would say throughout the day based on that data and what I've seen on my continuous glucose monitor, basically just higher spikes for the same meal later in the day. So why not just kind of move it up earlier?

Oh, good.

It does make sense, but also the heat can affect the accuracy of the sensor itself.

Well, I mean, a lot of the things that you just naturally learned are the things that have been shown in data. And like you said, some of this data, it's like small studies, small groups of people, but for instance, adding fat and fiber to meals has a significant and repeatable. impact in populations on lowering glucose response. That probably in some part due to slowing gastric emptying and actually slowing the digestive process. So the rise in the bloodstream is going to slow down and then fiber both for that reason, but also because fiber can in a sense create like a mesh sort of blocking the absorption of some of the glucose that's in the meal. So literally kind of actually preventing you from absorbing all of the carbs. And we've actually seen that in the levels data set that the more fiber people include with their meals. We see essentially a direct relationship with lowering of their glucose excursions, which is really exciting because fiber is something that you can add to meals very easily. I put basil seeds, chia seeds, hemp seeds, flax seeds on a lot of my food at this point because it's essentially a little bit of fat. a lot of fiber and it's kind of just helps you kind of get more from your meal. So what you can learn. So I think step one, the way I think about a glucose monitor, first of all, say the purpose of the glucose monitor is not to have to game the system and get flat glucose. The purpose of the glucose monitor is curiosity. It's to start to understand how It's essentially an MRI for how all of our different dietary and lifestyle strategies are creating this readout of glucose in our body, which I think can be really interesting. And in a world where so many cards are stacked against us with that in lifestyle and where there's a lot of confusion about what's right for us. That can be like very helpful and actually reducing the confusion and the cognitive load of our choices. We know that keeping your blood sugar through the course of a lifetime in a low and healthy range. So I don't mean up and down spikes during the day, but keeping your blood sugar healthy throughout the course of your lifetime is probably the best thing we can do for longevity, staying insulin sensitive, staying out of the diabetic range. And so one thing the glucose monitor does for us is just give us more awareness and agency into like what the trends of our glucose are. over time as opposed to a literally one data point snapshot once a year in the doctor's office, which is what the majority of us are used to. I really love the idea that people who are able to wear glucose monitors every now and again, maybe once a year, maybe more than once a year. They know what their glucose is. And so they're never going to walk into a doctor's office and have a bomb dropped on them about pre-diabetes or type 2 diabetes because you have the data, which is ultimately I hope the world that we can move towards for a lot of biomarkers. So you can see trends over time, which I think is very valuable. One thing that's fascinating in terms of early prediction of metabolic disease is that you can see how long it takes your glucose to come down after a meal. In a normal healthy insulin sensitive body, even if the glucose goes way up, it should come way down very quickly, because the insulin is binding to insulin receptors, and the glucose is getting taken up, and it'll lower.

It should be down by two hours, but from what I've actually seen in our like most insulin sensitive people, and also in research that looks at young healthy populations, you should basically be spiking and coming down spike about 45 minutes and come down hour and a half, 90 minutes to two hours. But if this is after sorry after last bite after last bite although it's hard to kind of exactly know but yeah meal is over i would say about forty five minutes to go up to the peak and then start coming down very quickly now if you start to see that glucose is going up and then trailing very slowly back down to normal maybe taking more than two hours three hours That is going to be one of those early indicators of potential insulin resistance. Your body's not clearing the glucose, but that's not a metric that we use in standard practice. at all. And I've actually seen myself very insulin sensitive. My insulin is like 2.5 and you know, if I don't sleep and I am stressed and I have been sitting, my glucose will take way longer to come down. I have become transantly insulin resistant. So I think that's just fascinating to see that. So looking what that ultimately, the metric that we call that is area under the curve. you want a low area under the curve, AUC, after we go spike. So you want a spike and come down quickly. That's going to be, if you shade the area under the curve, it's a small amount. If you go up and then trail off for two to three hours, that's going to be a lot of shading under that curve. And high AUC is associated with inslimers, it's basically another thing that you can see is essentially glycemic variability. And glycemic variability, GV, is a metric of house spiky. Your curves are. Facing paper out of Michael Schneider's lab at Stanford in 2018, called glucotypes reveal new patterns of glucosis regulation. Totally landmark study, but basically they put congenitors glucose monitors on non-diabetic individuals who by standard criteria of diabetes do not have diabetes. 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, 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. When you correlate those different patterns of glycemic variability in non-diabetic people, you find that the spike here they are, the worse their biomarkers are, metabolically across the board, insulin, triglycerides, et cetera. So basically they're showing signs through very ability. of underlying dysfunction that you would never know from a standard test. Those are the people who I imagine are probably going to go on to develop diseases. And yet, based on standard criteria, their doctors telling them that they're fine, that they're all the same. So he also showed in that study that non-diabetic individuals when you have a CGM on are going into the diabetic range and the pre-diabetic range a fairly significant amount and we would never know that if you weren't um if you weren't actually tracking like a movie of the glucose so that's so glissimic variability um area into the curve those are two things another really interesting thing you can know from a CGM is Don effect so Don effect is basically a term in the literature for how high your glucose rises right when you wake up in the morning. I don't know if you noticed this when you were wearing a CGM, but some people noticed that the second day wake up, their glucose jumps up, 5, 10, 20, 30 points. What's happening here is that the cortisol awakening response to actually get you to wake up and got it of bed, that cortisol can cause you to dump a bunch of glucose from your liver, because it's basically saying stress hormone cortisol, we got to get up, we need glucose to fuel the muscles, let's dump a little glucose. So it's normal, but what the research shows is that magnitude of dawn effect is correlated with insulin resistance. So the more the dawn effect you're getting, I think it can signal maybe the more stress you're under, the more cortisol you have floating around, how big your cortisol awakening response is, but also if you imagine if you're dumping all that glucose from your liver and your cells aren't taking it up well, because your insulin resistant, that that response, that dawn effect is going to be higher. So I don't have the numbers right in front of me, but typically I would want to see a dawn effect. I think of like less than 10 points. So you wake up and you may very well see a rise. This is absence of any food yet. And you do not want to see that going up 20, 30, 40 points. Some people see a little bump again with caffeine in the morning because it's more cortisol. And so that's another thing that standard stuff would never tell you. So those are kind of some of the looking at early predictors and metabolic dysfunction. More of the fun stuff is actually just figuring out how is food affecting your body. And this is where people really enjoy it. And like figure out, like, oh my god, this food that I thought was healthy is actually Not, you know, serving me and actually a lot of people I think were trying to make healthy choices. My boyfriend like he when we started dating, he started using levels his healthy snack. He worked in Venice would be to go to moon juice and get oh gosh, I don't want to throw moon juice under the bus here, but But he would get this green juice that was sweetened with dates and it was like nine dollars and this is like the healthy choice. And he saw the second he put on levels that it was causing a huge spike like 50, 60, 70 points and then he was crashing. he was actually trying to make a good decision. So now he's swapped his snacks out for more like, you know, grass fed cheese and some flax crackers and maybe like a venison stick or something. Like grabbing goes stuff that isn't spiking his glucose, but I think it can help people figure out like which foods are doing what I want them to do and which maybe aren't. And same thing happened for so many of our members with oatmeal. Unfortunately, oatmeal instant oatmeal is one of the biggest spikers in our data set. for breakfast and a lot of people are making that choice because they think it's heart healthy. In many people, it's actually causing a big glucose excursion and crash. And then in some other people, it's not. And so it's really helping with what are the sneaky spikers? And then where's the biochemical individuality? And there was a phenomenal paper out of Israel that from from Sal about seven years ago called personalized nutrition by prediction of glycemic responses. It made big waves. But it basically showed that you and I could eat the same handful of blueberries and have totally different glycemic responses. So the idea of glycemic index as like a certain amount of food with a certain amount of glucose causes a certain glucose rise, it kind of debunked that. And that matters because repeated sustained glycemic variability over time is not good for our health. We want to choose the foods or balance the foods that are going to keep us relatively more stable. So that's very helpful just understanding your personal response to food. And then what are the lifestyle strategies you can use sleeping better, walking after meals, more resistance training, cold plunging, breath work that can actually serve to modulate the food environment to actually reduce the glucose spikes. And people find that all of those things can positively impact glucose spikes, especially the walks after the meals. But it's been fascinating to see a lot of women, especially like menopausal women in our community who find that their glucose patterns are getting worse because estrogen's dropping. And that's going to, you know, really. take a hit on insulin sensitivity, they start resistance training, glucose comes kind of right back down. So because of the monitor, they can feel more confident in the intervention they've chose to do to help with metabolism, that kind of creates a virtuous cycle. So those are some of the big things. Those are big. Can I mention one more? I just, I could obviously talk about this all day. I think it's fascinating, but this is just one more that I think it's fascinating, because this is a paper in nature from last year that talked about, and this meant actually be one of the most valuable things to people, which is that, again, talking about cravings, we all want to get off the craving grip. 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 and the reason for that is because a big spike leads to a lot of insulin secretion and then you soak up all the glucose and sometimes you can actually go below your baseline. So a small spike usually won't lead to a crash, but a big spike often will. That's called reactive hypoglycemia, post-prandial hypoglycemia. A lot of people think they're dealing with hypoglycemia when in fact what they're really dealing with is that they're spiking their glucose too high and then they're crashing. And the paper showed that the extent of post meal dips, the crash after the spike was predictive of 24-hour energy intake and cravings for carbohydrates. And this makes sense. If you crash low, that is a signal to your body. We have to get our glucose back up, and it will drive you to eat high energy foods, carbohydrate rich foods and cravings. So one of the best things we can do to I believe from my personal experience from members experience and with some data to support this is that one of the adjuncts we can use to monitor our to manage our cravings is actually to like lower the the extent of our spikes so that we crash less and so that was a fascinating study looking at CGM data.

And now they're all the latest gen of each of them are all Bluetooth now. So no more scanning, which is kind of nice. And the answer is yes, there are several different analytes that we're going to be able to track. And Abbott, which is one of the three main manufacturers of CGMs, has announced that they have a new product called the Lingo, which is going to actually be able to measure ketones, lactate, and alcohol, continuously, which is pretty interesting from like a metabolic, comprehensive metabolic standpoint, different sensors for each, not all, in one, so I think we'll have to like, poke a dot ourselves if we're tracking all those things. And then Dexcom, which is the other main company that makes CGMs, has just announced they're coming out with an over-the-counter, non-percription version of a CDM. CGM called the Stella later this year. So there's exciting things happening in the industry, and I really do think continuous monitoring. It's going to expand to a lot of other things that you're talking about hormones, et cetera. And I mean, it really needs to. I think that You know, snapshots of dynamic system are just never going to really be able to give us a full picture on what's going on and what we really want to be able to do to dig our way out of this healthcare crisis. I think is is empowerment individually and understanding how this rapidly changing environment is affecting our own biology. So we can make the targeted choices to hopefully change the environment to be more conducive to cellular health and continuous monitoring is a closed loop by a feedback that can that can help us with that. decision making and essentially predict failure of the system rather than wait for failure of the system before we do something about it. So yeah, I think lots coming down the pipeline. Yeah.

Yeah. So I think that mindset and more broadly than mindset, I think psychology and our relationships specifically with fear and control, I think they're probably the most under-recognized thing. that is impacting the metabolic health crisis, the chronic disease epidemic, there has been data that's looked into this. We know that there's study showing that loneliness impacts mitochondrial function and that loneliness is a risk factor and stress is a risk factor in these things and something really fascinating actually with the CGM data is that many people who wear a CGM, I don't know if you saw this, but when you feel stressed, it actually has a diabetic effect. It literally causes our blood sugar to go up when we feel stress and that can be a fascinating unlock for people to realize I kind of feel like I'm okay right now but my body is telling me something different. It's telling me that biochemically I'm actually releasing energy stores from my liver glucose to fight some threat that you know I wasn't really aware of so there's there's we definitely understand there's this link here but But it's certainly not made its way into clinical practice. So the way I think about it is that what we know about the cells and especially the mitochondria is that the mitochondria are more than the powerhouse of the cell. They actually are a part of the cell that is constantly tracking resources and threats and are basically modulating energy resources based on that. And the threats can be anything. They can be a virus. They can be, and this is all coordinated through this thing called the cell danger response. It can be a virus. It can be a toxin in the environment. It can be lack of micronutrients for the electron transport chain that it needs to do its function. It can also be psychological threats. Because, of course, our psychological milieu translates through nerves and hormones and neurotransmitters and our microbiome to affect our cellular biology throughout our whole body. Our cells here, every single thought that we're thinking through biochemistry. And when a cell and a mitochondria are getting the message that there is a threat or something to be afraid of, they are going to change metabolic function towards defense alarm, threat response, and away from repair, homeostasis, building essentially thriving. So, and I think what's really maybe the most unnatural thing about our modern world, you know, the food, of course, is unnatural. 70% is ultra processed, but we also have this device in our hands. literally with us all the time streaming fear inducing media into our brains and eyeballs every waking moment of the day if we let it. So we're glued to our screens and our devices and Right now, essentially, the traumas and fears of eight billion people all over an entire globe are now ours to process and ourselves and our mitochondria. There is no escaping it. They are going to respond to that. And so 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. And this can come down to every person's journey will be different for this because the things that cause a sense of threat or fear for any two people are going to be different. And I think some of the main categories is one. on resolved childhood trauma, like something that I think is getting a lot more talked about these days, but like what's embedded in our nervous system, these limiting beliefs and memories that are really wired, that create a sense of hypervigilance and us sort of all the time. What's coming in through our devices, our phones, our computers, the media that we're exposed to that's constantly giving a fierce signal. And I think on a broader level, a big Western one that we don't talk about is literally like existential feel of fear of mortality. We have a very desperatulized, very uniquely death-fearing culture. Like you look at other cultures, Eastern indigenous, the Stoics. They all had intense curiosity about death. We talk about the cycles of life. There's this real engagement with it that we are so afraid of in the in the Western system to the extent that our entire healthcare system actually I think you know we've built it around like we're not gonna we're we're not gonna help you thrive we're just gonna do whatever we can to make sure you don't die like that's it's built in everywhere and so we've got the devices we've got the childhood trauma we've got the fear of mortality we have a very poor system of mental health care in the culture. And I think that through all these things, Americans are getting crushed, mindset and psychology wise. And that is a big, big trigger of our mitochondria, essentially diverting resources towards defense threat and alarm, rather than homeostasis building repair. So again, it comes back to taking really honest stock of what are the true fear triggers in our lives across those and others, and creating a sense of safety in our minds and bodies, no matter what the external world looks like, which may mean putting boundaries up to the media, doing the therapy, doing the different modalities. What I believe, and I talk about in the book, getting back to the question about nature, is one of the best things that we can do is actually literally just go outside. And I, it sounds so simple, but one of the most astonishing stats I literally found in researching this entire book was that the average American is spending 93.7% of their time indoors. And wild. 93.7. That's in a car or in a building. So We are locked in these cages staring at fear inducing media and our mitochondria are like. What? Like what? I don't know where to channel my energy. It's just, it's short circuiting, I think. So many things happen when we go outside. As you know, I mean, even what the vision system is doing to our anxiety levels, we are getting sunlight, which, of course, for, for, you know, complex reasons is very helpful for our metabolic health separately in trains are, you know, chronobiology and, you know, light, light from the sun is an incredible regulator of our mitochondrial function. But it also, it's our best teacher, you know, when we're out in nature and we really look at how beautiful the world is and the cycles of nature, we see the cycles of, you know, the seasons and we see the awe of the sun and the trees and just all this alchemy that's happening outside of us, we see, you know, spring to summer to fall to winter, we see the tides moving in and out. Everything's in phases and I think When we reflect and meditate on all the cycles and the polarities in nature, night and day, cold and hot, new moon, you know, quarter moon, full moon, you know, all these things, it's actually It entrances on a subconscious and conscious level that there is a fundamental harmony and pattern to the world we're living in that is bigger than us and that is fundamentally good and beautiful. And we are locked inside of the four walls of our house. I think we get very scared. We get very controllable. And the system wants it that way, because when we are scared and when we are existentially afraid, we will literally do anything, we will buy anything, do anything, watch anything that will in some way ameliorate that pain that we're feeling. And we will take any pill, we'll get any surgery, anything that makes us feel like we're controlling this seemingly out-of-control situation. And that's what drives us into all the dopamine loops, you know, the social media, the processed food, the porn, the gambling, the alcohol, all of it. It's all to ameliorate, I think, ultimately fear. And I think, yeah, I think by actually really just spending a lot more time trying to get that 93.7% down to like 50% spend as much time as you can outside. We know that people who spend more time outside are metabolically healthier. And I think it's for pleotropic reasons, but I think one of it is that it is the ultimate convincing of abundance and fundamental abundance in our world and of awe, which I think is really the antidote to fear. And that has a profoundly soothing effect on our psychology and the sense of scarcity that drives a lot of the decisions that actually make us unhealthy. It's fundamentally rooted in in scarcity. And I think also when we realize we are part of nature. Again, going back to that Taoist statement, we're a process, not an entity. Realizing like, you know, all the trees around us, and when we take that walk, even in a city, we see all the trees, all those plants, all those leaves are making the oxygen that process that literally let us do oxidative phosphorylation. And that sun, and that leaf on the tree, the sun's energy is literally being stored in the carbon carbon bonds that the plants are generating in photosynthesis that ultimately All metabolism is is unlocking the potential energy stored from the sun to create the human energy that lets us love and move and live and think and do all the things we love to do. And then it just becomes so obvious, like, of course we have to eat real food. And of course we have to not poison our soil with pesticides. And of course we have to like, care about the environment and we have to get outside and move and we have to be in the sunlight during the day because we are the environment. We are a process that's constantly in dynamic conversation with it and I think a lot of people will find that their health gets a lot better if they spend radically more time outdoors and I think a lot of people might say Like, can't, I work on a computer and I'm like, you know, Rome is burning. Like, we're sick as hell right now. We need to get creative. Like, move your computer outside, take a walking meeting, open your mail outdoors, chop your vegetables on your balcony at your apartment. Like we have to find a way to connect back with our source, understand that the world is abundant and harmonious, re-entrenched the belief in our connection with nature, and then let all of our dietary and lifestyle strategies stem from that sense of gratitude and awe, and that will lead us right where we need to go, which is a really, I think, joyful experience of our health journey that's rooted fundamentally in connection rather than us being siloed from all of this, which going back to being in the conversation, that's fundamentally what's wrong with the health care system. It's silos, and we have siloed ourselves from all of the life-giving things that are environment. And that has ultimately led us to be very, very, very sick. And we've just, I think we gotta go back outside. So that's one of the things. But there's many other things we can do to change those. Our relationship with fear, but. We can't change the world as a whole, but we can change what happens inside our body in terms of how we respond to it. And for our mitochondria's sake, we have to. We have to create a sense of safety in our bodies for our mitochondria to do the work we need them to do for health.