May 13, 2024

Dr. Casey Means: Transform Your Health By Improving Metabolism, Hormone & Blood Sugar Regulation | Huberman Lab

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Key Takeaways

“Metabolism is actually the foundation of all health. It is the core foundational pathway that drives all other aspects of health. It’s also the core foundational pathway that’s truly getting crushed in the modern American world.” – Dr. Casey Means
“The biggest blind spot in western healthcare, and actually the reason health outcomes are actually getting worse every year in the United States is because we are ignoring metabolic health and metabolic dysfunction.” – Dr. Casey Means
- If you look at the science, most of the illness is from metabolic dysfunction; instead, we have a system that focuses on the downstream symptoms
We’re confusing symptoms for the disease
Exercise modalities for mitochondrial health: (1) Endurance exercise and HIIT will promote mitophagy; (2) Sprint workouts improve oxidative capacity; (3) Resistance training builds more mitochondria; (4) Walking is a glucose disposal signal
- Build movement into your daily life for improved metabolic health– Shoot for muscle contraction throughout the day instead of exercising for an hour and sitting the rest of the day
- Walk at least 7000 steps per day
- We’re overcomplicating it – the way to improved health is straightforward
Exercise dosing tips: Shoot for resistance training 2-3x per week + 75 minutes of strenuous activity or 150 minutes of moderate activity per week
7 levers to pull for improved health: Food, sleep, emotional health, movement, toxins, relationship with light, relationship with temperature
Eat as much real, unprocessed foods from good soil – start there and follow any dogma you want (e.g., keto, vegan, pescatarian, etc.)
- Five things to strive for in a well-balanced diet: (1) Fiber; (2) Omega-3s; (3) Protein; (4) Probiotics; (5) High antioxidant sources
We’re quick to turn to easy fixes like Ozempic but we’re not addressing the root cause and might be worsening the causes (though symptoms may improve)
Mitochondria are constantly tracking resources and threats and modulating energy accordingly – Take honest stock of the fear triggers in your life and take steps to create a sense of safety in your mind and body no matter what the external world looks like
We need to reconnect with nature, and get creative: Take calls outside, walk during meetings, prep your meals outside, etc.
We can’t change the world around us but we can change how our bodies respond to protect our health

Introduction

Dr. Casey Means, M.D. (@CaseyMeansMD), is a Stanford University trained physician and an expert on metabolic health. She is the author of the book, Good Energy.

In this episode, Andrew Huberman and Casey Means discuss how to leverage nutrition, exercise, and environmental factors to enhance metabolic health by improving mitochondrial function, hormone, and blood sugar regulation.

Host: Andrew Huberman (@hubermanlab)

7:00 – Understanding Metabolic Function & Dysfunction

“Metabolism is actually the foundation of all health. It is the core foundational pathway that drives all other aspects of health. It’s also the core foundational pathway that’s truly getting crushed in the modern American world, underlying 9 of the 10 leading causes of death in the United States today.” – Dr. Casey Means
It’s estimated that as high as 93% of U.S. adults have suboptimal metabolism
Metabolism is how we convert food energy to human energy
- The food we ingest is potential energy that’s converted in our bodies for use in cellular processes
The spectrum of metabolic disease is vast because we have over 200 cell types in the body – underpowering different cell types will look different
“The biggest blind spot in western healthcare, and actually the reason health outcomes are actually getting worse every year in the United States is because we are ignoring metabolic health and metabolic dysfunction.” – Dr. Casey Means
- We are laser-focused in downstream symptoms and the result of metabolic dysfunction in different cell types that we ignore the underlying root cause
“The more we specialize in healthcare, the sicker we’re actually getting.” – Dr. Casey Means
- Siloing is profitable but not better for health outcomes
Broad picture of U.S. healthcare versus other developed nations: (1) We have the worst chronic disease; (2) We have the lowest life expectancy
- Why? Our healthcare system values specialization – instead of looking at the big picture of metabolic health, we look at the downstream symptoms
In the U.S., we spend twice as much on healthcare as the next highest country but our outcomes are worse

14:20 – Trifecta Of Bad Energy

Trifecta: (1) Mitochondria; (2) Inflammation; (3) Oxidative stress
- These are the 3 factors underlying metabolic dysfunction and avenues to address to create a metabolic function
- Chronic inflammation is biochemical fear – a response to a threat; mitochondrial dysfunction is like rolling blackouts – there’s not enough power; oxidative stress is like wildfires
Mitochondria are the structures within the cells that convert food into energy our body can use
- The environment our cells exist in has changed rapidly – our food has changed, movement patterns shifted, exposure to light has changed, sleep is worse, etc.
- Each change in our environment damages our mitochondrial function in unique ways
- The obesity epidemic is just one symptom of mitochondrial dysfunction
We’re confusing symptoms for the disease: Even in sinusitis, the cells are sensing a threat and the sinus issues are the reaction – it’s a mitochondrial dysfunctional issue; the cells can’t do their job and react accordingly which creates a massive immune response and a cascade of dysfunction
Scary statistics: 75% of American adults are overweight and obese; 50% of American adults have prediabetes and diabetes; 30% of teens have prediabetes; 40% of Americans have a mental health diagnosis; cancer is estimated to reach 2 million cases in 2024; Alzheimer’s is going up, infertility is going up – and there’s no sign of any of it going down

28:00 – Insulin Resistance & Mitochondrial Capacity

The problem is not caloric intake, we are taking in more than enough to supply our cells
We need to create capacity in the body to turn potential energy into usable energy instead of storing
- When the body senses it cannot turn the energy into a useable form, it blocks the metabolic and cellular processes and stores the energy in more toxic forms
Insulin resistance is essentially the cell compensating for the mitochondria being broken and telling the insulin receptor it’s not functional
To increase metabolic capacity: We need to make more mitochondria, get each mitochondrion to be more functional, and get each mitochondrion to process more energy substrates
- How? Exercise!

44:20 – Exercise Tips For Improved Mitochondrial Health

Exercise modalities for mitochondrial health:
- Endurance exercise and HIIT will promote mitophagy and biogenesis
- Sprint workouts improve oxidative capacity
- Resistance training builds more mitochondria
- Walking is a glucose disposal signal – shoot for 7000 steps per day or a few short walks per day
  - “If walking were a pill, it would be the most impactful pill we’ve had in all of modern medicine.” – Dr. Casey Means
  - Walking has been shown to reduce all-cause mortality – it’s not about the steps, muscle contraction is medicine
  - A 10-minute walk before and/or after meals improves glucose response
- Try to take a movement break every 30 minutes throughout the day
The takeaway for exercise is that we want to be moving throughout the day, not just a hard 1-hour exercise than sitting the rest of the day
- We need to build a movement in our daily lives
Exercise dosing tips:
- Work every major muscle group 3x per week through resistance training
- Work to get 75-150 minutes of strenuous to moderate activity
Under-desk treadmills could help you hit your steps and keep the blood flowing throughout the day
- Bonuses: Lose fat, and build muscle while you work
- A slow pace is fine, work on accumulating time; you’ll still hit a lot more steps throughout the day than you otherwise would
Seated calf raises are another way to get in movement while you sit at your desk
- Bonuses: Burn calories, move muscles
Non-Exercise Activity Thermogenesis (NEAT): Movement that is not intentional exercise – think of chores, cleaning, etc.; Give the body stimuli our cells are used to receiving but have been deprived because of modern living
- Our daily lives used to involve much more movement
The simplest solutions are the most effective – the way to improved health is not complicated

58:21 – Blood Tests

7 high priority biomarkers: (1) Fasting glucose (want less than 100); (2) Fasting triglycerides (want less than 150); (3) HDL (above 40 for men or 50 for women); (4) Hemoglobin A1c (less than 5.7); (5) Total cholesterol (less than 3.5:1); (6) Waist circumference (less than 35” for women and 40” for men); (7) Blood pressure (less than 120/80)
- Why? Most American adults have suboptimal metabolism – together, these 7 results give you a good picture of what’s happening in the cell
- These tests should be ordered on a standard physical
Don’t like your results? All of these biomarkers are changeable in 2 months
Triglycerides are a storage form of excess carbohydrates in the blood
The body is always trying to keep things in the right range so it converts things into different substrates – we need to look at the full picture, not a spot check
- Even being on the highest end of normal should be a signal to look deeper
Hemoglobin A1c: A measure of how many hemoglobin molecules have glucose stuck to them; this will eventually cause dysfunction
Why blood pressure? When a cell becomes insulin resistant, insulin rises in the blood – this is a key activator of what dilates and relaxes blood vessels
The secret to getting blood tests: Mentioning there’s been a shift in sleep, lifestyle, bodily feeling is usually a trigger for physicians to approve tests
Tip: You might want to go outside the traditional healthcare system if you’re fighting with your doctor – check out companies like Next Health or Levels and test 4x per year
If you feel good and bloodwork is normal, trust your strategy and keep doing what you’re doing

1:16:46 – Environmental Factors & Nutrition To Improve Biomarkers

Take honest stock of your life and what may be impacting your health
7 levers to pull for improved health: Food, sleep, emotional health, movement, toxins, relationship with light, relationship with temperature
- “Of those 7 pillars, food is one that most of us are getting wrong and that we actually have to get right to improve our metabolic health.” – Dr. Casey Means
  - Food is the molecular building block of the body, cell signaler, and substrate to change the microbiome – food is unavoidable for creating cellular health
- On the bright side, you eat everyday – every day is an opportunity to change

1:22:00 – A Deeper Look At Food & Nutritional Habits

We are literally eating ourselves to death in the United States
- 60-75% of our calories come from ultra-processed, nutrient-depleted foods that don’t give our cells what they need – this contributes to overeating because your cells will drive you to eat until they get what they need
- Ultra-processed food is highly addictive and devoid of nutrition
- Ultra-processed food is linked to higher rates of obesity and chronic disease, as well as higher caloric intake
Close to 45% of kids are overweight or obese
Eat real foods that meet the needs of your cells
Start here: Eat as much real, unprocessed foods from good soil – start there and follow any dogma you want (e.g., keto, vegan, pescatarian, etc.)
- Stimulating satiety hormones will optimize our cellular function and curb overeating
- Bad soil also contributes to depleted nutrients in food – sourcing high-quality food is critical
Five things to strive for in a well-balanced diet: (1) Fiber; (2) Omega-3s; (3) Protein; (4) Probiotics; (5) High antioxidant sources

1:32:03 – Ultra Processed Foods & The Brain

The brain can’t map calorie and macronutrient sources – the neural circuits responsible for hunger and satiety are confused when we eat highly processed foods
You will self-regulate hunger on an intuitive level if you eat whole, natural foods
- Our insatiable hunger is mass cellular confusion – the body has never seen these processed foods
Processed food is the ultimate food-based reward; the body can’t predict what the outcome is going to be and it sets off the dopamine system and motivation pathway
- We know what a ribeye steak is and what it’s going to taste like; we don’t know our body’s response to this candy bar versus that candy bar so we seek more
Instead of turning to Ozempic, our bodies can naturally make more GLP-1:
- (1) We can make more cells that make GLP-1: Increase short-chain fatty acid intake AKA fiber, polyphenols from colorful fruits and vegetables, or consume more low-sugar fermented foods;
  - Ginseng may also have some benefit
- (2) We can trigger our cells to make more GLP-1: Eat more thylakoids found in spinach (even just 3.4oz per day), drink green tea, and add curcumin;
- (3) Our cells can inhibit the inactivator of GLP-1: Consume black beans, oregano, swiss chard
Communicate with your cells through food
There’s a conversation about prescribing Ozempic to kids as young as 12 – which is sad considering the changes we can make
- Remember, you have to take Ozempic for life
- No shot can mitigate the assault we’re imposing on our body
- We’re forgetting the quick-fix diet pills we tried in the past – there’s almost no condition that’s fixed with one pill and reduces the rates of the disease

2:00:54 – Leveraging Temperature For Health

Our cells have evolved to adapt to big swings in temperatures
We can use different energetic signals in our environment to improve mitochondrial function
Cold is a tool in our toolbelt that tells the mitochondria to make more heat
- It’s not a supplement for proper nutrition or sleep but is a great supplement
Heat activates heat shock proteins

2:07:20 – Fasting

Our metabolic health is better if we compress eating to our chronobiology
- If you eat all your calories in 6 hours versus 12 hour period, you initiate a different milieu in the body and allow the body to clear insulin
- Melatonin affects transiently impairing our insulin sensitivity
Note, a study that recently came out about intermittent fasting increasing cardiovascular events is problematic – only the abstract was released, it wasn’t peer-reviewed, and it may actually never see the light of day
- The methods were also poor, it was recall-based which usually doesn’t bode well
Most Americans eat 11 times over a 15-hour period – this is stressful for the body; the body needs time for insulin and glucose to come down
- The average American body is rarely if ever, tapping into fat stores for energy because there’s always glucose around
The goal is to create metabolic flexibility, the ability of the body to use glucose first then fat stores when glucose is depleted
Tip: Ease into compressing your eating window and see how your body responds

2:17:03 – Continuous Glucose Monitors (CGM) & Awareness

CGMs are helpful in learning about what foods and food orders impact your glucose
- Exercise and heat also affect glucose
- Including dietary fat can help blunt glucose response
Adding fat and fiber to meals lowers glucose response
- Fat slows gastric emptying and digestive process
- Fiber creates a mesh blocking some of the glucose in meals
- Tip: Try adding either chia seeds, flax seeds, or hemp seeds to your meals
The purpose of a CGM is curiosity: Learn which foods and activities are helping or hurting your blood glucose
- Keeping blood sugar throughout your lifetime is one of the best things you can do for your health
- A CGM gives you the data and trends over time instead of relying on the doctor once per year
- Insulin should peak about 45 minutes after a meal and come down after about 90 minutes – any longer and this may signal insulin resistance
Glycemic variability (swings in blood glucose) is correlated to poorer biomarkers across the board; this underlying dysfunction won’t show up on a standard point-in-time test
- Lowering the extent of spikes and crashes can help manage craving and energy
Dawn effect: How high glucose rises right when you wake up in the morning
- The cortisol response getting you to wake up may spike glucose – this could be related to poor sleep, insulin resistance, stress
- Truncated sleep affects daytime glucose regulation
Future wearables: Lactate tracker, over-the-counter CGMs, alcohol effect tracker, etc.

2:37:39 – Mindset & Our Relationship With Fear And Control

“Our relationship with fear and control is probably the most underrecognized thing that is impacting the metabolic health crisis, disease epidemic.” – Dr. Casey Means
Loneliness impacts mitochondrial function
Stress causes our blood sugar to go up (this is where a CGM gets interesting)
The mitochondria are constantly tracking resources and threats and modulating energy accordingly
- When a cell or mitochondria are getting the message that there is a threat, they are going to change their response toward threat response instead of thriving
- Our phones are forcing us to engage with the fears and threats of millions of people around the world – this is unnatural
Our phones are constantly giving a fear signal
Western society is afraid of death: We’ve designed our healthcare system to keep people alive, regardless of quality of life
We spend 93% of our time in cars or indoors! Go out in nature
Tip: Take honest stock of the fear triggers in your life and create a sense of safety in your mind and body no matter what the external world looks like
- Go outside, speak to a therapist, etc.
- It serves consumerism to be trapped in your house, in your head because you’ll spend any amount of money to feel better – get outside

Articles

Metabolic features of the cell danger response (Mitochondrion)
Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study (JAMA Network Open)
Association of Daily Step Patterns With Mortality in US Adults (JAMA Network Open)
The Acute Effects of Interrupting Prolonged Sitting Time in Adults with Standing and Light-Intensity Walking on Biomarkers of Cardiometabolic Health in Adults: A Systematic Review and Meta-analysis (Sports Medicine)
The energy expenditure of using a “walk-and-work” desk for office workers with obesity (British Journal of Sports Medicine)
A potent physiological method to magnify and sustain soleus oxidative metabolism improves glucose and lipid regulation (iScience)
A role for brown adipose tissue in diet-induced thermogenesis (Nature)
2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines (Journal of the American College of Cardiology)
Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake (Cell Metabolism)
Decreasing human body temperature in the United States since the Industrial Revolution (eLife)
Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes (Cell Metabolism)
Effect of meal timing and glycaemic index on glucose control and insulin secretion in healthy volunteers (British Journal of Nutrition)
Glucotypes reveal new patterns of glucose dysregulation (PLOS Biology)
Personalized Nutrition by Prediction of Glycemic Responses (Cell)
Digital health application integrating wearable data and behavioral patterns improves metabolic health (npj Digital Medicine)
Rapid and reversible control of human metabolism by individual sleep states (Cell Reports)

Other Resources

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blood sugar, fitness, health, hormone health, life, nutrition, popular
Notes By Maryann