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

welcome to the huberman Lab podcast

where we discuss science and

science-based tools for everyday

[Music]

life I'm Andrew huberman and I'm a

professor of neurobiology and

Opthalmology at Stanford School of

Medicine my guest today is Dr Casey

means Dr Casey means did her

undergraduate degree at Stanford

University and her medical degree at

Stanford University School of Medicine

she is one of the world's foremost

experts in metabolic Health today we

discuss how metabolic function and

dysfunction impacts our health in

particular we discuss mitochondria which

are involved in energy production within

our cells and the various things that we

can each and all do to ensure proper

mitochondrial function which is

essential not just for things like body

composition and physical and mental

energy but also our ability to regulate

hormones blood sugar and much more we

discuss how exercise even simple

exercise like walking as well as sleep

as well as more vigorous exercise and in

particular nutrition including the types

of foods we eat the timing of food

intake and the sources and quality of

those Foods impact are mitochondria and

other aspects of metabolic function we

also discuss how particular

micronutrients within specific foods can

directly impact mitochondrial and

metabolic Health Dr means explains how

mitochondria inflammation and reactive

oxygen species which are the byproducts

of metabolism in our cells can combine

to create conditions of obesity as well

as ways that we can manage those things

or even reverse mitochondrial

inflammation and reactive oxygen species

dysfunction in order to reverse obesity

reverse diabetes and enhance our health

in Myriad Ways by the end of today's

discussion you'll have a clear picture

of the cellular processes that occur in

the brain and body that underly

metabolic disease and metabolic health

and most importantly you'll have a very

clear picture of the actionable items

that we can each and all carry out every

day and every week in order to ensure

metabolic Health proper mitochondrial

function and indeed that can also

body composition and overall feelings of

well-being I would also like to share

that Dr Casey means has a terrific new

book coming out I know it's terrific

because I've read it it is entitled good

energy the surprising connection between

metabolism and Limitless Health if

you're interested in the book we

provided a link to the book in the show

note captions before we begin I'd like

to emphasize that this podcast is

separate from my teaching and research

roles at Stanford it is however part of

my desire and effort to bring zero cost

to Consumer information about science

and science Rel tools to the general

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discussion with Dr Casey means Dr Casey

means welcome Dr Andrew hman thank you

so much for having me really excited to

talk to you today about all things

Health one of the things I love so much

about your work is that you really give

people a sense of agency through

knowledge and actionable tools which is

very near and dear to my mission and my

heart but to kick things off let's talk

about metabolic function and dysfunction

I think most people hear the word

metabolism and they think okay the

burning of energy maybe they think about

ATP maybe they think about calories in

calories out that sort of thing but what

are we talking about when we're talking

about metabolic function and dysfunction

because these are really important

concepts for everyone to understand 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 basil

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 10

leading causes of death in the United

States today it's really quite relevant

to everyone and 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 cell types is going to look

like different symptoms because

underpowering in a asite is going to

look different than underpowering an

ovarian thica cell 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 healthc 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 uh

focusing on those symptoms playing wacl

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

Health Care system as like a Super Subs

specialist as an ENT surgeon is that you

know the more we specialize in health

care we have over a hundred Specialties

now that we've just like invented in the

Health Care System the more we

specialize in health care the sicker

we're actually getting so the more we do

technological innovation in all these

different Specialties the sicker we're

getting and I think what what the real

nugget there that that everyone really

needs to understand is we've bought into

a system where we value

specialization and this is the game in

Western medicine but 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

were focused on the downstream

manifestation of underpowering of cells

the the cell specific symptoms and not

the metabolic function itself so really

our chronic disease 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 overs say it enough it's

urgently needed we know we're not in the

right Paradigm right now when we have a

hundred 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 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

yeah thank you for that I have um

several Reflections and a question uh

first off the the analogy that comes to

mind is an assembly line that's

constructing let's say an automobile and

it sounds like 80 to 90% of the

automobiles that are coming off that

assembly line are not working well tires

aren't on line engines isn't working

well transmission isn't working a bunch

of issues

and no Factory no car manufacturer would

tolerate that nor would the customers

but we're tolerating that in ourselves

it sounds like many people are and then

accepting the fact that then a bunch of

other businesses are going to crop up

like the business that aligns the tires

the business that goes and repairs the

Pistons and and essentially when you

talk about these multi Specialties that

have evolved in the in the medical care

system they provide an opportunity to go

and fix the problems or try and

ameliorate the problems but really what

we need to do to make this analogy uh

much briefer than it otherwise would be

is just to go further up the assembly

line figure out whether or not the

hardware is correct the software is

correct and where the hardware and

software are becoming deficient in this

um in this analogy where we are the

automobile that's essentially coming off

the conveyor broken and the good news is

and I know this because I've read your

book and because I follow your work very

closely the good news is that we each

and all can take matters to some extent

into our own hands collaborate with

healthc care providers yeah and repair

metabolic dysfunction essentially make

us metabolically functional so um the

question therefore is I think most

people when they hear

metabolism they think energy yep and

when we hear energy we think ATP

sometimes but typically people think

about mitochondria right the PowerHouse

of the cell so to speak um so you've

talked about the trifecta or the the big

three mitochondria inflammation and

oxidative stress as three critical

factors underlying metabolic dysfunction

and I'm presuming those are also the

Avenues to address in order to create

metabolic function because ultimately

what we want of course is an optimistic

picture that we can actually take some

control that we have some agency in all

of this which I believe we do so if you

would could you get us all on the same

page about you know what are

mitochondria and what they do why are

they so important then we can turn to

inflammation and oxidative stress yes

absolutely so 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

uh 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 our

cells 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 in 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 periods that totally changes

our relationship with light we have

80,000 synthetic toxins in our food

water air personal care products home

care products we live a Thermon neutral

existence now with our thermostats

there's no real swings in temperature

unless you're in intentionally trying to

um and then our emotional health is very

different we are very much exposed to

lowgrade 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' even had artificial light so things

have changed and the the unique thing

about all of these Chang 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 ultr processed nutrient

devoid food even the the blue light at

nighttime 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 a 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 so

wild it's it's just we talk about

obesity like it's the problem obesity is

one branch of a tree that that's rooted

in this

mitochondrial dysfunction that's caused

by our environment and 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 I

had trained as an ENT surgeon and I was

at Stanford Medical School and I I was

so fascinated by this idea of like the

way that we're

defining the diseases we're treating in

these in in like a specialty like ENT is

like I I saw sinusitis day 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 is we say like okay this

patient has

sinusitis if they have facial pressure

purulent pus you know nasal discharge um

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 Chron you know

sinusitis is a 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

buildup but we confuse the the pus

buildup with the disease which is

actually happening inside the cells and

so you start looking at PubMed as a 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

in a lot of these cell types and then

what does that do and this gets your

question about chronic inflammation oxa

of stress well when you've got that

dysfunctional mitochondria let's say in

a nasal mucosal 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 so interestingly

those cells will initiate a whole

process which is called the cell danger

response um it's work that's been done

by Robert navio at uh

UCSD where basically they understand the

mitochondria is not working properly

this is of course caused by the

environment and they will actually

release extracellular 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 purogen

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 a bacteria and licing it

or you know taking care of some cells

infected with a 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 oxa of 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 oxid of

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 mitochondrial

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

type2 diabetes obesity fatter fatty

liver disease polycystic ovarian

syndrome 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 System around since 90% of

health care costs go towards treating

the downstream symptoms of these and for

every marginal dollar we're spending on

treating symptoms we're getting s 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 bad energy

Trifecta underlying metabolic

dysfunction of chronic inflammation

mitochondrial dysfunction oxidative

stress as chronic inflammation is

biochemical fear its response to a

threat mitochondrial dysfunction is kind

of like rolling blackouts it's not

enough power and the oxid of stress is

like 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 uh 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 oxidative

stress and mitochondria dysfunction and

it's very easy easy to improve if we

know what we're actually focused on well

that's reassuring and we're definitely

going to go there um I appreciate the

analogy to living in California I've

lived here my entire life I have been

outside of California but um perhaps the

only thing you left out besides rolling

blackouts fires and what was the other

one fear and fear is high taxes the

taxes the health debt on on the on the

body so in any case not to be too dark

and pessimistic well that's the

healthare cost I maintain great hope and

and still a lot of love for California

you know pretty great it's got It's

Great aspects and it's not so great

aspects and I can say that as a lifelong

California resident um there are other

wonderful places to live a couple of uh

questions first of all about places to

live you've been talking a lot about in

the United States are some of the same

issues with metabolic dysfunction

occurring outside of the United States I

would imagine so y any country where

we've exported the standard American

diet and some of the other Norms of

Western living are starting to see the

same rat

uh of of chronic disease but like it is

worth not mincing 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 abjectly

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 they 10 different

symptoms are separate things then

they're going to 10 different specialist

office office

meanwhile 75% of American adults are

overweight and obese some of the highest

in the world um 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 2 million cases this year in 2024

highest ever in recorded history

Alzheimer's is going up fat liver

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 um 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 that no shot

pill or surgery can really address

unless we unpack the environmental piece

scary picture I'm glad that but hopeful

but hope exactly I'm glad that you are

um creating Solutions and and I should

say and just remind people I said this

in my introduction but you know you're

talking about siloed medical care you're

talking about the kind of standard

medical system but let's not forget

right um I happen to be a faculty at

Stanford you did your medical training

at Stanford are a medical doctor right I

mean you have MD and are highly trained

you were an ENT your nose and throat

doctor so if anyone would be familiar

with the industry and the practice and

the educational system around this it's

you so uh you're not speaking outside

your bwick so before we pivot to

Solutions yeah I know people are eager

to hear Solutions but in order to

understand how to best apply those

Solutions I do think it's worth drilling

into um some of the issues here just a

little bit more you talked about

underpowered cells yeah you've also

alluded to the fact that most people are

consuming enough and probably excess

amounts of caloric energy yes so is it

the lack of mitochondria or

mitochondrial dysfunction that's at the

root of the problem the analogy I come

up with is you've got um a power plant

that can convert incoming power line to

um Power that can be distributed to a

community yeah the community in this

analogy being the organs and cells of

the body yeah there's plenty of

potential

energy but there's something about the

power plant that is inefficient or

dysfunctional they shorts they circuitry

that's just not working such that the

energy that the community can benefit

from the cells and organs of the body is

just not there so it's not a lack of

input it's a lack of conversion and

output and the consequence of this we

see in the form of excess adapost tissue

and all the Downstream effects it's not

just aesthetic it's really all the

downstream effects of visceral fat

subcutaneous fat

Etc what is it that would

improve access to energy and energy

utilization in cells is it simply a

matter of getting the mitochondria to

function better or is it that one can

actually create more mitochondria 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 are all the little

mitochondria with the squiggly lines

inside and it's just like there's X's

through those mitochondria so instead of

you know after glycolisis and you've got

the pyate instead of going through the

mitochondria it's being shuttled into

something else and I I mean this is

fundamentally the 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 got to turn them to basically a

storage form which inside the cell could

be toxic fats like ceramides and diog

glycerol and I'm also going to block the

cell from taking any more substrates

because can't do anything with them that

is fundamentally a root of insulin

resistance so the body says okay we're

going to block the ability of the

insulin receptor to transduce its

intercellular 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 mitochondria being

broken and telling the insulin receptor

that it it you know that it's not going

to be functional and so you don't get

the glute for you don't get the glute

receptors on the cell membrane to allow

the glucose to come in so that's that's

insulin resistance again we talk about

that as the problem but the problem is

actually inside the cell leading to that

you know so that's why just giving

someone insulin isn't necessarily 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

from a first principal 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 it's really that

simple and the beauty is we can do all

of those things if you actually break

down like what it what those three

things mean it means promoting mitophagy

the recycling of o old mitochondria to

to new mitochondria it means promoting

mitochondrial biogenesis it means

increasing the oxitive 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 technicality to like what it means to

print more mitochondria have them each

be 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 mitophagy

you know we can focus on various types

of like endurance exercise and uh

high-intensity interval exercise there's

compounds like Ethan a that promote

mitophagy um when we talk about

improving our you know oxy of 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 do doing more work

every day and then we think about you

know you look at the data 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 10year 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 biogenesis signal it's not a great

mitophagy 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 cell's capacity to

um do that conversion process better I'd

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huberman there's a lot of great science

and a lot of um great stuff related to

testing and assessment of one's

metabolic Health that we should get into

and will get into but since we touched

on lifestyle and because we've been

talking about the sort of dysfunctional

dark side for a bit maybe we could just

touch on some of the lifestyle factors

that you just mentioned because I do

think it's important that people really

start to feel into their sense of agency

and here we're talking about um things

that are relatively low time investment

certainly don't have much Financial cost

in the sense that they could be done in

gyms and with fancy equipment but they

don't require that um again I I want to

point out that these are not like strict

prescriptives but if you had a magic

wand and because you are interested in

the health of humans um let's talk about

a few of these things that can improve

um glucose disposal um and mitochondrial

function uh mitophagy the removal of of

dead or dysfunctional mitochondria so

they can be replaced um let's talk about

the walking one first you said 7,000

steps a day I don't track my steps um

what are we really talking about there

we talking about taking the stairs and

trying to walk as much as possible maybe

we like if we were going to just give

like a really crude prescription you're

a doctor so you can prescribe things um

what would you tell people to do like

how many short walks per day is is it

like three is it five is um what are we

talking would say up I mean at at least

three I would say aiming for more than

that is good though there's so so to

sort of just give a sense of the picture

of walking if walking were a pill it

would be the most uh impactful pill

we've ever had in all of modern medicine

um there was a paper in jamama uh 6,300

participants followed

for uh 10 to 11 years and the people who

simply walked seven th000 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 causality

but it's it's pretty incredible they've

done follow-up research with slightly

different numbers showing again though

like many thousands of people uh in the

study followed for about 10 years 8,000

to 12,000 steps per day was associated

with 50 to 65% lower uh all cause

mortality and this has been played out

in many many studies showing about a 50%

reduction in Alzheimer's uh 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 lowgrade way like

walking or doing a couple air squats you

know we're activating ampk 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

ins in little bags inside the cells

they're not on the cell membrane so of

course that's going to keep the the

glucose in your 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 1 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 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 constituently active um 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 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 2 minutes every

30 minutes throughout the day so these

are three separate groups either 20

minutes before I either 20 minutes after

or 2 to 3 minutes every 30 minutes 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-hour glucose level averages 24-hour

insulin level averages they are

metabolically healthier and I believe

and the research mechanistically has

shown that it's because we're

constitutively putting this these

channels at the membrane to take up the

substrate use the substrate so this is

not in uh to 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 is 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 but 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 2 minutes to do some just light

movement Flex those muscles get the

glucose channels at the membrane get the

mitochondria active so and I think

another fascinating stat 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 very interesting because I think a

lot of people are now working out so to

speak doing resistance training which I

think is terrific ter used to be such

you know such so restricted to Niche

subculture stuff like bodybuilding

preseason football military Etc and now

it's a more ubiquitous uh for everybody

men women young old that's terrific same

thing with things like yoga and

cardiovascular training I mean I it like

to study the history of exercise culture

and it wasn't

but in the' 60s when you know jogging

was considered kind of like whoa that's

like a really esoteric Niche culture

thing so A lot's changed um I love the

prescriptives you gave because it's just

very straightforward a couple of short

walks um it just makes so much sense um

and I love the visual and I hope people

will really hold it in mind so I'll

reiterate it the the um translocation of

these um energy utilization stores vles

as you call them these little packets

from the center of the cell out to the

cell surface where then they can be Evol

involved excuse me in metabolic

processes and the utilization of energy

in ways that um otherwise they wouldn't

and glucose disposal being a big part of

this so I have heard that a short walk

after a meal will reduce blood glucose

in a way that's really dramatic 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 10minute

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 whenever I

go to a city like New York when I am

forced to walk more I I always just feel

so much better we also know that the

optic flow that one experiences with

walking has some interesting effects on

the lyic pathways and quieting of some

of the anxiety and stress related

Pathways um this links up with things

like EMDR although there are factors

that are separate from EMDR basically

moving through space um not outer space

but walking through space with optic

flow has a certain um anxiety reduction

function in the brain which they

beautiful data there in my opinion um

okay so that touches on walking you did

mention higher intensity exercise so

let's um keep it within the

cardiovascular realm for now so um

getting heart rate way way up you know

getting breathing hard for you know some

minutes um each week maybe a couple

times per week um seems that's a good

way to increase mitochondrial function

and mitochondrial number is that right

yeah so you take sort of each 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 uh 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 like a

slightly different impact on the

mitochondria when we think about

biogenesis we're thinking mostly like

endurance exercise and really um more of

that zone two and like that is really

going to be a stim 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

distance type training and then work to

get 75 to 150 minutes of moderate

activity so 75 minutes of strenuous

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 to even 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 uh

for 150 minutes a week or strenuous for

75 minutes a week those are going

together to be potent stimuli for

biogenesis mitophagy mitochondrial

Fusion for increasing antioxidant

enzymes that are going to

protect the mitochondria from that oxa

of stress um and the one that's just

actually not in there in the 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

the data is showing which honestly would

probably take less than an hour total to

do if you 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

terrific what what are your thoughts on

um under the desk treadmilling I I don't

own one of these but and I try and get

walks and I definitely do my three

resistance training exra uh sessions per

week different muscle groups on

different days so it ends up being each

muscle group is hit directly once and

indirectly a second time but I like to

do a long hike once on the weekend a run

in the middle of the week that's 30

maybe 35 minutes and then some V2 Max

really short workout 12 minutes total

where basically I'm just going for um

you know the feeling that my uh heart is

going to jump out of my chest and I'm

going to get going to die from gasem of

a but luckily thus far I haven't died

nonetheless um the total time commitment

isn't that great but I find that I'm at

a desk a lot and I have a standing desk

is it wise to get a treadmill to

treadmill under the desk seems like it

would be one of the best things one

could do I'm a massive fan of under

treadmill desks 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 desk that

is pretty interesting small studies but

they you know took a handful of people I

think it was around 10 um in a workplace

environment and they had them use under

desk treadmills for two and a half hours

uh per day during the workday so not a

lot at very so speeds for uh two weeks

and people lost on average 2.6 lb of fat

and put on 2.2 lbs of lean mass wild 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 assuming it's

line near progression exactly which is

not which is not the case folks but I

that's why I'm saying it was it was a

pretty but that was there in the

discussion and but I think that short

period is quite interesting um 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 underd 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 5

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've

forgotten I'm even on it is that right

so you're able to work without thinking

about having to to um to treadmill 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 aura ring on my second

toe when I do this because otherwise it

doesn't count my steps because if your

hands are your desk they uh they it

won't count your steps because the AA

Rings measuring hand accelerometry yeah

but um it it 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 8,000 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 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 a have an impact on body

composition which I think is is a great

easy inexpensive thing for people to do

but if you if you don't want to buy one

like just set those timers and uh and

build in the walks you know throughout

the day outside terrific yeah I'm a I'm

a fan of getting walks when I can I also

I wonder your thoughts on there was a

study not sure if you're familiar with

it um published at the University of

Houston where they looked at what they

called Solus push-ups um which all the

gym goers are going to roll their eyes

um imagine sitting down and raise

pressing your toe against the ground and

raising your heel so kind of like seated

calf raay but no weight right under the

desk and this study had some remarkable

claims and conclusions um which included

as I recall that the activation of this

muscle the Solus which makes up about 1%

of the body's total musculature um

involved caused rather a

disproportionate use of blood glucose so

it mobilized blood glucose in a good way

um and the idea was if people would it's

not just bouncing your knee but would

actively push their toes against the

ground and raise their heels as they

were seated and doing work that somehow

there would be a positive effect on

metabolism and blood glucose utilization

I talked a little bit about this on

social media and a few other podcasts

and and it was interesting to see that

sort of attacks that I got like people

really didn't like the idea um that this

was any different than so-called neat

non-exercise and um activated

thermogenesis so it's known that people

that fidget a lot or or move around a

lot burn a lot of calories this actually

goes back to some really beautiful work

um several decades or more ago from

Rothwell and stock who talked about like

the fact that animals and people who

fidget a lot burn a lot of energy they

tend to be thinner they tend to have

lower adapost tissue stores um and it's

because they're just burning a lot more

calories and this is actually what um

people who suffer from anorexia which is

by the way the most deadly of the

psychiatric condition so it's um we're

talking about true anorexia are

encouraged not to do because um they

either do it spontaneously or they learn

that it's a very efficient way to burn

calories and that's not what they need

but many people do need to burn more

calories so um bounce in the knee that

thing that drives everybody crazy if

you're not the one doing it um Solus

push-ups uh what are your thoughts about

this in that study we don't have to pick

it apart in detail but I thought it was

kind of interesting it's all coming back

to just moving the body as much as

possible during the day Contracting

muscles Contracting mus Contracting

muscles it's medicine and I I find the

concept of neat just endlessly

fascinating you know because we we kind

of come up with this term non-exercise

activity thermogenesis and the data is

really good about it like it's basically

shows that this is a a prime potential

intervention for the Obesity epidemic

and it all goes back to the cell like

it's a 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 um 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 buil into

everything we did and 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 air 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

into 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 like the way out is pretty

simple like it's it's some of these

basic things like walking more

throughout the day moving more

throughout the day getting outside you

know eating clean unpoisoned food the

the 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 the minutia but like at the end

of the day all the simple habits that we

know are healthy like fundamentally

improve cellular biology and like some

of these things like the neat like the

walking like it's emblematic of the fact

that um some of the simplest Solutions

are the ones that are by far the most

effective and I think I think the

biggest misconception in healthcare

right now is that the way out and the

way to get really back to to True

incredible health is complicated like

it's it's really not that complicated we

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 know work the reason

they work is because they all positively

impact the mitochondria they positively

impact oxy of stress they positively

impact inflammation so yeah I love it I

love Simple Solutions that hit multiple

cellular Pathways that can make

everybody healthier I'd like to just

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tracker.com huberman I'd like to talk

about assessment blood tests in

particular um I remember in college I

was just very curious about blood

testing and I had read a little bit

about it but it was really hard to

access um I actually went to the Student

Health Center and said you know can I

just get um like my lipids measured some

hormone stuff measured I was in great

health I just want to do that and

they're like no like what's the issue

you know why why why would you do that

now it's very easy to find places that

will do blood tests but there is some

cost often um and nowadays thanks to

your efforts your innovative and

Engineering efforts and the efforts of

others there are ways to measure what's

in your blood blood glucose in

particular um with continuous monitoring

and with um snapshot monitoring so um

let's talk about blood tests what what

do you think are um the three to five

things that basically everybody if they

can should know about what circulating

in their blood I'm I'm imagining LDL HDL

this kind of thing I guess apob is a big

uh favorite of our our friend Peter AA

um fasting blood glucose continuous

blood glucose postmeal Etc just kind of

evaluating how exercise food Etc impacts

blood glucose and then I'll leave the

other categories open because my my

point here is not to answer the question

for that's what comes to mind you've got

you know you've 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 umage to them because

obviously there's a lot of debate about

like what's everyone's favorite lab test

but I think about it as like what are

the basics that everyone should know and

then what's like the next tier up that

are easy to access and are cheap that'll

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 okay

sorry I hate to interrupt and my

audience hates it even more but I'm

going to just could you just explain

what each of those is and what it what

it corresponds to yes great thank you

and and I will say first of all the

reason I'm choosing these it's not it's

not even my own choice really it's it's

two reasons one is that the two studies

over the past 5 years that have shown Us

in large populations that the vast

majority of American adults are

metabolically 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 UNCC in 2018 which showed that

based on those biomarkers 88% of

American adults are have suboptimal

metabolism and then a follow-up study

from the Journal of the American College

of Cardiology from last year show that

that number has gone to

93.2% of American adults are suboptimal

in their metabolism and these are the

metrics that they used and they're very

basic if you had to pay out of 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

Tea 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 through this experiment experience

they'll come up on the screen and there

will 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 your LDL is high we need to bring

it down oh your glucose is high we need

to bring it down oh 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 Tea Leaves of what

it's telling us about our mitochondria

so let's start with fasting glucose so f

fting 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 the their their

optimal range for all biomarkers not on

medication so I'll quickly run through

what their ranges were my ranges for

optimal are tighter than these but

fasting glucose less than 100

triglycerides less than 150 HDL above 40

for men or 50 for women hemog glob1 C

less than

5.7% total cholesterol to HDL ratio less

than 3.5 to 1 waist circumference less

than 35 in for women or 40 in 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 or blood pressure or whatnot

you were considered optimally

metabolically healthy that's now 6.8% of

Americans um

all of these biomarkers are easy to

change in one to two months I would say

with simple lifestyle habits could you

remind us what hemoglobin A1c is I think

most people are familiar with HDL

cholesterol being the quote unquote good

cholesterol and LDL being the bad

cholesterol and as I say that I know I'm

going to get dog piled oh totally but

I'm not sure that I adhere to that I'm

not sure I don't adhere to that I'm not

sure about a lot of things but I am sure

that most people think of them that way

um so just as a yeah to stay functional

here we we'll frame it that way for now

with with the caveat that that might not

be the whole story isn't the whole story

but um triglycerides fat in the blood

fatty stuff but so key to understand

about the triglycerides it's not PE 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 and I know you and you

and Rob lusting talked about this at

length but LAN

yeah I mean one of the things that's

really tricky gosh is that the the

language around nutrition and health is

complicated because people hear the word

fat they think body fat but then they

also think the macronutrient fat we just

need more words to better parse totally

the reality in biology we call the two

major groups of of people lumpers and

Splitters lumpers like to lump

everything together it oversimplifies

and complicates Splitters like to split

everything give a name for everything

individual name for everything it

complicates and so there's a middle

ground right there's a there's a land of

reasonable people and nomenclature and

unfortunately that does not exist on the

internet nor does it exist in any one

specific subfield of medicine or science

I mean so much of the confusion out in

the world is because of a lack of

adequate language right in order to

explain okay so um the triglycerides are

a reflection of excess carbohydrate

intake 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 Poe mitochondria that's being

absolutely decimated by our environment

uh and its capacity is low okay so that

mitochondria is like I can't process

glucose or fatty acids to ATP very well

so I'm going to 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

enviral markers 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 this 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 we 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 triglycerides 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 in

inside the cell that's blocking the cell

from being able to use and process it's

a sign of mitochondrial dysfunction and

chronic overnutrition too much substrate

not enough processing glucose is going

to go up Tri are going to go up and so

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

healthare system is that a patient might

go into the

doctor and their fasting glucose is 99

one point under what we'd consider the

normal range and their triglycerides are

149 one point under what we'd consider

the normal range 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 as 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 much rather see that

glucose at 703 and that triglyceride at

50 which to me would say oh this cell's

processing through energy great and

things are moving through and we're not

backing up in the bloodstream we're not

converting to triglycerides so that's

where really optimal ranges get in but

but so that's so that's glucose and

triglycerides why if those are starting

to creep up it's a 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 you want those cells

nice and smooth and slippery smooth no

sugar stuck to them causing dysfunction

um and because blood cells last for

about 9 to 120 days hemoglobin A1c 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

to 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

resistant 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 through the

lens of basic cellular physiology we can

start to see man my body might be like

underpowered I might I might have a

mitochondrial issue here so that's a few

of those tests that we really want to

shoot for terrific and um thanks for

bringing up blood pressure again it's

sort of um comes across to many people

as old school right but when AO was here

um one of the several times he was here

he he really pushed on blood pressure is

such such a key metric right I mean

obviously if blood pressure is high

you're getting less nitric oxide through

for whatever means here uh vessels and

capillaries are constricted um cells

aren't able to use the energy that's

coming in there's excess energy there's

buildup of metabolic waste there's all

this stuff and now we can start to see

the picture yeah it's trying to emerge

and as you mentioned um briefly these

markers can be put into healthy range or

maybe even fantastic range in a very

short period of time so we'll talk about

um how to go about that um in terms of

getting a basic blood test is you're a

physician what's the secret code um I'll

give away one that um

a former guest who's also an MD shared

which is oftentimes if you ask your

physician for a blood test they will say

well unless there's a particular need or

you're um struggling with something they

won't give it to you but if you have a

shift from Baseline in a symptom or in a

number that can help all the Physicians

are going to come after me now with I

guess with stethoscopes um uh I'm

willing to Stand My Ground

um if you want a blood test it's often

useful to mention that there's 's been

some Market shift um you want to be

honest right but some Market shift in

sleep in lifestyle in how you feel

standing up sitting down I'm not trying

to you know lace people's minds with

ideas to to uh create narratives here

but um oftentimes where Physicians are

resistant they'll be more amendable if

they understand that hey like

something's changing and the patient

saying something's changing it actually

would be irresponsible of them to not

give the blood test so there you go um

Bring It On MDS so yeah truly and I

think the nice thing about the again

very basic tests and there are so many

other tests that I talked about in my

book and that you've talked about on

your podcast apob uric acid fasting

insulin hom IR hscrp liver function test

ggt all these 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 like the the the everything I just

mentioned like the doctor should order

on an annual physical and it's really

about us learning to act 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 like we need to focus

all of our energy on improving

mitochondrial capacity basically and and

bring those numbers down which we can do

very very quickly once you start getting

the mitochondria 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

push back often if you ask 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 like amazing companies doing

direct to Consumer lab testing so you

can basically avoid the hassle and some

of them are very affordable there's um

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 um insid tracker uh 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 a

crumb of information about their health

and it's it's it's we should probably be

testing these I would say three to four

times a year um 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 2 or Ecentric 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

re retest in a few months and see if

you're moving in the right direction s

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 I I say to people

like if your labs are optimal and the

ranges I just mentioned are not optimal

like we you want to actually get to

better than all of those if you want to

be optim if your 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

like and and exercise and your lifestyle

because that is showing that your cells

are fundamentally working properly so I

think that's just a really empowering

message and 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 cuz like look

at all my biomarkers and I feel great

you know so yeah what used to be the

before and after um you know pre-diet

exercise post- diet exercise um photos

on social media are now starting to also

include numbers which is kind of

interesting I mean obviously these

aren't randomized control trials but

it's cool to see people posting their

numbers yeah of things that are

not just related to Aesthetics but are

um or body weight but are related to

health metrics yeah uh it's it's it's

fun I think it it speaks to um a more

scientific or at least a more

quantitative approach to things and I

think it's inspiring for people um

thanks for putting those scripts in the

book that people can refer to um let's

say that um I go in for these blood

tests I do the basic 7 and I find that

my fasting glucose is a little high my

triglycerides are a little high my LDL

is a little high um maybe a few other

things are okay so I'm kind of in the

you know not in the Red Zone but I'm in

the like I should probably pay attention

to these things what are some of the

things that one can do in order to try

and move those needles in the right

direction um I know we talked about

walking in movement before what are a

few others and maybe we could start to

touch into Nutrition a little bit and

then we'll pivot to um insulin and blood

glucose 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 honest stock of how

those factors are playing out in your

life and then choose a few to start

moving in a different direction so the

ones that I think are ones that we can

really control um and that are we know

based on the science are impacting our

mitochondrial and metabolic health is

the food the Sleep the movement the

emotional health the toxins our

relationship with light and our

relationship with temperature and 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 in 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 thing

those are the things in our environment

that we need to to basically improve to

have to give our CS the best capacity

and then of course checking your

biomarkers to make sure your

interventions are working but 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 that's

so wild it's so wild every time I think

about that I kind of like blows my mind

like babies are 3D printed from food

basically inside a woman's body it's

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 is a thing but the body is

actually a process the body and there's

this amazing dos statement like life is

a process not an entity I love that

no I'm sorry to interrupt I'm just I I

always you know wish that if people

could understand that um with Biology

and health understanding the nouns and

the names is important but it's verbs

it's verbs verbs verbs if you understand

that things are processes or processes

depending on who you are and where you

live in the world um it all becomes so

much more tractable yes and it's so much

more hopeful because if I'm a process if

you're a process then every every day

we're eating we are changing the process

whereas if you think you're a thing then

there's no hope cuz I'm just I'm Casey

and that's who I am and I have this

disease you know and I think so much in

our language actually of healthc

care both are Western sort of despir

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 I I

and and we don't even talk about

diabetes cures 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 oursel which is molecularly different

than the Casey of today that's a hopeful

message because if we can give the body

food which you know I think we again our

our conception of food I think is very

limited um food is the molecular

building blocks of the body it is the

cell signaling functional molecules that

tell our cells what to do they act as

transcription factors epigenetic

modifiers um cell signaling pathway

intermediates and it's also of course

the substrate to change what the

microbiome does and the composition of

the M microbiome which is basically a

pharmacy inside our bodies to create

different molecules that can affect our

health so 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

drill be happy to drill into of like

what do we really do to

you know build build as much metabolic

Health as possible yeah I want to focus

now if you're willing on food not just

macronutrients proteins fats and

carbohydrates not just calories although

that as well but things like timing

things like fasting um and

micronutrients which I think is a a

highly underexplored topic so with

respect to food um gosh I feel like

we've all been exposed to pretty much

every variation of you know it's it's

all calories in calories out and by the

way I believe in the laws of

thermodynamics um so yes total caloric

load matters total energy expenditure

matters without question within the

framework of not consuming excess

calories there's a lot to explore

however um I can just say for myself for

what it's worth I'm not very hungry

until 11:00 a.m. noon or 1 I'm okay not

eating until then and just you know

water electrolyt and caffeine does me

just fine I can exercise Etc but once I

start eating I I really enjoy eating and

I mostly like the proteins I like Meat

and Fish and eggs and I like cheese and

vegetables and carbohydrates and fruit

and all of it I like all the stuff and I

I tend to like single or few ingredient

Foods I just naturally do so I've been

lucky in that way but I know a lot of

people like sandwiches processed foods

things that are combinations of

ingredients what do we know about about

kind of uh I don't want to say optimal

but if one we're going to explore

different ways of eating for sake of

adjusting these biomarkers in the right

direction and improving metabolic health

is there kind of a a generic jumping off

point would most people for instance be

wise to um cut back on the total number

of sugars or the the total amount of

sugar rather and perhaps reduce the

amount of carbohydrate and replace it

with some lean quality protein I mean

are there generalizations that we can

make or is it really all just about not

getting excessive calories and trying to

get those calories from the most

nutrient-rich sources 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 in 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 our cells what

they need and a real premise that I

think is so important to realize is that

our cells 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 the cells 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 in such a short

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 they don't have PubMed they

don't have the FDA they don't have the

USDA they don't have any of it and they

have somehow figured out a 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 and so I think to just boil that

down the root cause of the problem is

that we have a toxic food supply that's

no longer filled with the molecular

information that our body needs to know

to be satiated and to function properly

and so through the complex biology of

satiety hormones and neurobiology and

microbiome function we are driven to eat

so so so much more so 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 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 body's 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 panned this out you

know we we know that the mor Ultra

process food you eat the higher risk of

obviously obesity but also chronic

diseases are but then of course there's

an amazing study from Kevin Hall just

recently where he basically locked

people up at the NIH and he for two

weeks he had them eat Ultra processed

food and for two weeks he had them eat

real food and people ate 7,000 more

calories in the two week period uh when

they were eating Ultra processed food

versus the unprocessed food they were

locked at the NIH I've been to NIH quite

a bit um I don't it's it's great for a

day job or a day visit I don't know that

I want to be locked there that sounds

like a that sounds like the Stanford

Prison prisoner experiment I say this

tongue and Chic and with such admiration

for what he had to do but I think it's

so amusing that you know we have this

totally Franken food toxic food system

that's that's largely Ultra processed

and it took amazing Kevin Hall to

basically do an NIH you know funded

study where people what I say by locked

is that they were impatience at the NIH

and every had ad Li you know unlimited

access to food during each of those two

week interventions so it was two weeks

of ultra processed food two weeks of

unprocessed or minely 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

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 a pound is 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

Ultra processed food environment that's

cropped up over 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 uh the root

cause so I think a lot of food is about

quality and how do we actually really

meet the needs of of the cells so that

our satiety hormones get secreted and we

naturally stop eating because just

telling people eat less calories but eat

whatever you want that's 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

reward 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 dep depleted of nutrients so

when we look at that 70 metric tons of

food we're eating in the lifetime it's

just fasting you that's 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 processed so we slash the value

because the ultr processing just like

slashes the nutrients we slash the value

of that 70 metric tons and then we have

crappy soil because our industrial

agriculture system which means the the

food in some cases has 70% less of key

micronutrients in it so that 70 metric

tons what's actually useful for our body

becomes so much smaller so what we want

to do is basically expand and the value

of that substrate we're putting in the

body and that means real food

unprocessed from good soil meet the

needs of the cells naturally don't be

hungry maintain a healthy weight um 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 our cells and 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-3s 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 a 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

reduce chronic inflammation reduce oxy

of stress it's interesting for me to

take a step back from nutrition as it's

typically presented and think about the

brain the hypothalamic circuitry that

drives hunger and satiety and things

like that and to map that on to what

I've heard and I I believe to be true

based on my view of the literature which

is that we are largely meaning these

circuits in the brain make us largely

amino acid foraging machines because we

need those amino acids in order to carry

out metabolic processes and reconstruct

any tissues that need repair and and

Recovery not just from exercise but just

daily turnover um removal of waste Etc

um so we're foraging for amino

acids unconsciously we're foraging for

micronutrients and of course we need

macronutrients we need enough energy

from proteins fats and carbohydrates or

some either combination of the three I

feel like I'm sort of in the dying

category of omnivores right I'm neither

you know I'm not meat-based and I'm not

uh plant-based I'm omnivores I think

most people are omnivores actually but

uh omnivores aren't discussed quite as

quite as much as um the other categories

at least not on social media but that

you know we're we think of ourselves as

getting hungry and wanting to eat um and

I think eating the foods some of them I

listed off before like Meat and Fish and

eggs and vegetables and fruits and some

I do like starches like you know rice

oatmeal some pastas some sourdough

Breads and things I love butter who

doesn't love butter um of course none of

that stuff in excess olive oil but if

one looks at kind of that um

Buffet of of options you realize you can

get some high quality amino acids you

can get some high quality lipids you um

probably want to get more of them from

olive oil than from butter but you can

get the micronutrients you need provided

those food sources are healthy now

contrast that with a highly processed

diet or even a minimally processed diet

and you can get the taste you can get

the macronutrients you can get the

calories but you don't meaning the brain

doesn't really have a sense of it can't

directly map taste calories

micronutrients on um onto one another

and so you can imagine that the neural

circuits and here I'm it's a little bit

of hypothesizing SL conjecture but that

the neural circuits responsible for

hunger and satiety

would get immensely confused by what's

in a highly processed food right a

Snickers bar if you like sweets tastes

pretty good but it's unclear what's in

it except sugar except some you know

it's got a certain Snickers bar taste

right but if the circuits of the brain

are really trying to drive us to get

amino acids and

micronutrients um for bodily health and

repair well then highly processed and

even moderately processed food has just

got be pure confusion I'm sorry to go

long here but it reminds me of the of an

idea I had once where like imagine if

you took a pill that in greatly

increased the level of dopamine

norepinephrine acetylcholine and

serotonin all at once that's

polypharmacology and it might make you

feel a certain way maybe good maybe bad

and then afterwards you'd probably have

a bit of a crash from as the drug wore

off no doubt you would but let's say you

wanted more of that feeling you wouldn't

really know what to go look for because

you don't know what what was in it

because it's poly pharmacology so I feel

like Pro highly processed food is

polypharmacology whereas when you are

eating foods that create a more pure

experience of micronutrients amino acid

content calories and taste those four

things map to one another that

intuitively we can start to understand

oh I like this food and it's good for me

and this is enough of it right I don't

know anyone who of reasonable size that

that eats like four ribeye steaks you

know they eat one I me I'm sure there's

some freaks out there that do that but

you know one you know even small piece

of quality meat is very satiating yeah

you will self-regulate because the body

like every other animal in the world is

exquisitly 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 poly

faracy I think that literally is it's

I've never heard that said and I think

it's like processed food is like poly

Pharmacy of food it is the definition of

processed food which I know you talked

about with Rob lusting the Nova four

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 wheat

kernel separate from the brand and the

you know the germ um and then take that

and like a little science experiment

pair it 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 I 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 disease 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 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 but um there's a

wonderful book that is called the end of

Cravings by Mark shatzer he also wrote

the Dorito effect but he talks a little

bit what you're talking about which is

ideal that processed food is actually

the ultimate sort of food um based

variable reward so in the way that it in

like things that I mean I'm speaking the

expert here but things that the body

can't predict what the outcome is going

to be are 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 ver we think we're eating a

tortilla but it's like completely

different than all the other weird

tortilla Ultra process 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

Aspartame is it 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 process

food representing a variable reward

whereas every time you eat a ribeye your

body is pretty much getting a similar

thing each time and so the

prediction um matching is going to be

more conducive to uh getting off the

motivation treadmill for more which I

think is so fascinating um but I think

backing up a little bit one one concept

I have for food that really helps me is

really thinking about the body's 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 in 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 nutrient 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 the satiety

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 gp1

analoges and OIC and mjara and all these

things gp1 Agonist but like you know we

rarely talk about the fact that like we

have nutrient sensing cells of the gut

the L 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 society hormones

and the processed foods aren't giving us

those things you know the things that

are goingon to um stimulate those

cells well well the things that will I

mean this is kind of fascinating if you

don't mind going down a little road

talking yeah please with the gp1

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 gp1 we make more cells that make it

l cells of the gut each of those cells

makes more glp1 and importantly we can

also inhibit the inactivator of gp1

which is an enzyme called dpp4 so gp1

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 what is dpp4

it's an enzyme that breaks down

gp1 said that and I missed I apologize

so fascinating and so how often have you

seen in the headlines oh here's some

strategies to inhibit your dpp4 never

because OIC is is you know on track to

be the highest grossing Med in human

history and just like we talked about in