Dr. Mark Hyman:
Coming up on this episode of the Doctor’s Pharmacy,

Dr. George Papanicolaou:
My little mantra is I want to be at the level of fitness that I can do anything I want to do physically at any moment in time.

Dr. Mark Hyman:
Welcome to the Doctor’s pharmacy. I’m Dr. Mark Hyman. That’s pharmacy with an f, a place for conversations a matter. And if you’re a guy out there listening or if you’re a woman who’s got a guy, you’re going to find this conversation fascinating about how to actually look at fitness in middle-aged men in a way that really matters. Things that we don’t typically look at. We’re going to talk about VO two max and body composition, this special episode of Health Bytes with one of my colleagues at the Ultra Wellness Center, great physician, Dr. George Papapa Nicola, who’s a graduate of the Philadelphia College of Osteopathic Medicine. He’s board certified in family medicine and he’s also an I-F-M-C-P Certified Doctor of Functional Medicine certified doctor. He has worked in the health service, the Navajo Reservation, and he’s been working at our practice at Adult Women Center for many years now and is one of our great team there.
And today we dive into the topic of fitness for middle-aged men, particularly talking about what we need to measure and why it’s important, including something called VO two max, which is a measure of your fitness level and your body composition, learning about your muscle mass, which is a critical measure of fitness and your body fat composition. And we’re going to talk about how to fix those things. We’re going to talk about some great cases where we use those measurements to address people’s health, and we’re going to talk about a whole area of fitness and health and aging and what you can do about it. So let’s dive into this conversation with Dr. George Lau, one of my colleagues and friends from the Ultra Wellness Center in Lennox, Massachusetts. Alright, welcome back George to the Doctor’s Pharmacy. Appreciate having you back again,

Dr. George Papanicolaou:
Mark, it’s always a pleasure to be

Dr. Mark Hyman:
Here. Now, for those of you listening may not know George who are just joining the podcast, George is one of my colleagues at Delta UltraWellness Center in Lennox, Massachusetts. We have a practical five physicians, three PAs physician’s assistant, seven nutritionists a great staff, and we take care of people from all over the world with chronic difficult conditions or people who want to just up level and optimize their health and find out how to basically hack the code of biology and understand how their bodies work, how to work with it, and how to up grade your biological software. So that’s what we’re going to talk about today, is how do we upgrade our biological software with a very important drug that has the power to do almost everything you’d want it to do to treat depression, to improve your lifespan, your health span, to reduce inflammation, to optimize your hormones, to balance pretty much everything in your body drug.
And this drug I’m talking about is available at no cost to all of you everywhere on the planet. And it’s called exercise. Now, George, we learn medical school did not learn a heck of a lot about exercise. In fact, we probably learned nothing about exercise except to tell our patients to eat less and exercise more, which is about the most useless piece of advice I’ve ever heard a doctor say. Eat what and how do I exercise and why does it matter and so forth. So today we’re going to get into the science of why it’s important to understand the nature of exercise, what it does to our biology, and particularly how do we measure our fitness level, how do we measure the way our bodies are responding to exercise and why that’s important for overall health. Now we in medicine don’t really think about how to measure someone’s fitness very well.
We have the six minute walk test and we have grip strength and we have sort of certain biometrics we use and certain physiatrists will use it or certain doctors will use it, but it’s kind of marginal. And at the Ultra Wellness Center, we really take a deep dive into every aspect of someone’s health, including their fitness because it plays a role in everything huge from heart disease to diabetes to cancer, to dementia to depression to a DD. I mean, the list goes on and on. So George, you yourself are big exerciser. I’m jealous of your biceps, to be honest with you. He’s got weights in his office, got, I think he’s seeing patients. He’s actually there pumping iron in the back of his office.

Dr. George Papanicolaou:
Mark, you’re my motivation, mark, you are my motivation though. You are one shit

Dr. Mark Hyman:
Man. I don’t know. I’m doing okay, but I think we have the capacity at any age to maintain or even gain a tremendous amount of fitness. We do. You and I are both in our mid sixties and we’re pretty damn fit. And I dunno if there’s a story, I dunno if you saw it in the news, George, about this guy who was in the seventies or something and he was hanging around some jam or somewhere and he saw a rowing machine or maybe there was one in a garage. And he basically started in his seventies, started rowing on a machine, and now he’s like a world champion in the 90-year-old plus category. And his fitness level measured by something called VO two max, which is what we’re going to get into, actually got better and not only got better but was equivalent to people in their thirties and forties. So what that speaks to is that we see this study kind as we age, but we don’t really know what to do to avert it. And we see this all the time. There are patients who are chatting before about these guys who come into the office and who are our age and look like they’re 20 or 30 years older, right? Yeah. So George, how do you get so into exercise and tell us a little bit about your own sort of background and focus on fitness and health.

Dr. George Papanicolaou:
This is fascinating. We had this conversation a long time ago and it’s more or less how did I get into functional medicine. I used to always wired to think that way. My parents, when I grew up, it was the early sixties and they were smokers and I just had an adversity to that lifestyle from the very beginning. It was just innately in my DNA. And so I was reading, I remember it was a Dr. Mendel’s vitamin book and supplements and way then I was reading that when I was an adolescent. So I was just into that stuff. And then I met my wife when I was 18 and her mother was brilliant. She was a homemaker, stayed at home in Western Pennsylvania, but she would read nutrition action letter back in day.

Dr. Mark Hyman:
Oh yeah, I remember that. Yeah.

Dr. George Papanicolaou:
Nutrition action letter. And she was already talking about the toxins of Teflon and she was already talking about omega threes and she could tell you at the dinner table what vegetables had, how much calcium and magnesium. So

Dr. Mark Hyman:
That’s the whole nutrition part. How about the exercise part?

Dr. George Papanicolaou:
Well, but that was the whole piece of that whole, I was always intrigued by fitness and nutrition, but the fitness piece, I just was always an athlete from the very beginning. I always liked to be athletic. I talked about this many times and I’ve written blogs about it and I have a DHD and exercise is my medicine. It’s actually when I have a DHD patients, whether they’re kids or adults, the first thing I write for them is their exercise prescription because when I exercise, it increases my ability to concentrate. When I exercise, I feel much better, I sleep much better, I’m in a better mood and I’m more able to serve the people around me. So exercise is just my all round drug.

Dr. Mark Hyman:
It’s such an incredible drug. I just got back from Patagonia and I was trekking 10, 15 miles a day up and down mountains and I felt amazing. My nervous system felt great, my energy was great. I had no mood issues, which I usually don’t have, but I just felt more at peace and more everything was like, wow, this is amazing. I mean, literally if I’m using my brain for 10 hours a day, I’m tired. But if I’m using my body, I actually feel better.

Dr. George Papanicolaou:
So one of my internal lines that I speak to myself, my little mantra is I want to be at the level of fitness that I can do anything I want to do physically at any moment in time within reason. That’s right. So let’s say you would call me up to St. George, you got to fly to Patagonia. We’re having this great trek. You’re going to think this is amazing. I get on a plane, I could do it and I can do it. Well, I’m not going to slow anybody down and I’m going to enjoy it and so will the people around me. My goal is always to be at a level of fitness where I can get on my bike and ride 25 or three. That’s right.

Dr. Mark Hyman:
Do whatever you want.

Dr. George Papanicolaou:
Remember, remember that time you and I just got on our bikes and we rode 25 miles. We had a great time. And you were pretty good on the hills, by the way.

Dr. Mark Hyman:
Yeah, yeah. Well George, the truth is we have that capacity. There’s this guy who I love to watch on Instagram and uncle stop who’s a French dude, I don’t understand anything about, it’s all in French, but I want you, he’s like basically goes out, he’s 78 years old on his deck on mountains and somewhere in the mountains of France and he does 25 pull-ups. He’s incredibly ripped and fit. He makes us look like 98 pound weaklings. I mean, this guy is unbelievable and I’m thinking, and he does it in the winter with no clothes on. It’s basically no shirt, some sweatpants. And it just speaks to the fact that our bodies have the capacity, but the problem is we decline as weight. So tell us, George, what starts to happen to men and women as they start to get over 30? What’s the physiological process? We, we don’t think of 30 as old, but it’s actually when the decline starts to happen, that leads to frailty, disability dysfunction and disease, which exercise can completely prevent for the most part.

Dr. George Papanicolaou:
As I thought about this, I just want to make this point that my mother-in-law, she’s going to be 92. And when I ask her how she’s doing, she tells me I’m doing well, George, but what’s the alternative? So what’s the alternative to not exercising it’s inactivity And inactivity at any age will cause something called anabolic resistance. Okay, anabolic resistance is the muscles inability to grow in mass or in strength. And so that can we talk about it happening with older adults, but it can happen when you’re younger. And so we want to fight off the anabolic resistance. And the way you do that is through exercise. And so when we think about what we need to be doing, one of the things I think about when we think about chronic disease and aging longevity and mortality is when does it become a problem? Well, it becomes a problem very early on in life.
And as you said, you see a shift between 30, 40, 50 years old and that’s when we really need to be focusing on exercise and what do we need to be focusing on? We need to be focusing on our cardio, respiratory fitness and also making sure that we’re doing some form of resistance training because we know both of those through lots of different studies, randomized clinical trials data, we’ve seen that both aerobic fitness and resistance training and strength training are directly related to decreasing the chronic diseases and chronic conditions that are associated with decrease in our quality of life, in our length of life. We know that. So those are the things that we tend to stop doing, particularly men who are in their bread-winning years, building their careers, they’ll tend to be a little bit more sedentary. And when that happens, you begin to build up that anabolic resistance, you stop making the muscle mass and

Dr. Mark Hyman:
You lose, you start to steadily lose muscle, and

Dr. George Papanicolaou:
When you lose muscle, you lose metabolic ability and you lose this protein of reservoir that will protect you if you become ill as you get older. And it’s very hard to overcome the anabolic resistance. So one of the goals that we have at the Ultra Wellness Center is to work with people very early on in their treatment plans if they’re at that place where they’re well enough to be focusing on fitness and exercise. Sometimes they’re not well and we have to get them to that point, but we want to get them to that point. And what we want to focus on is getting measurements like the VO two max and like a body composition which become their baseline information for where they’re at. And then we can design a program for them to improve their aerobic fitness and then also help them begin to build back that muscle mass if they’ve lost it.

Dr. Mark Hyman:
Yeah, I think this is just a critical point, George, that we don’t realize what happens to us slowly and inexorably as we get older. And we can be the same weight as we were at 25, it’s 55, it’s 65, and actually be twice as fat. You’re metabolically unhealthy even if you’re a normal weight. And there’s actually a word for it. It’s called skinny fat or tophi thin on the outside, fat on the inside or metabolically obese normal weight. And this is a well-recognized medical condition and it’s completely caused by the lack of attention to one of the most important organs in our body, which is muscle and muscle fitness and muscle mass and muscle quality. And all of that is something that’s completely under our control. And if you look at the data, it’s quite striking. You see a steady loss of muscle all the way through life, but it’s totally reversible.
And I saw this in myself, I saw it, and then I was able to completely reverse it and actually have more muscle now than I did when I was 25, which is quite amazing. And I’m like, well, how did that happen? It’s totally possible and it’s totally possible, but it’s something that most people don’t focus on as a thing like, okay, diet, diet, diet. And yeah, I know I need to exercises, go to the gym, I don’t, but maybe they may not be doing the right thing than gym now may not be exercising the right way. And so it’s like anything, if you want, you take a drug or a supplement or whatever, you need to know the right dose and the right quantity, the right frequency and the right, absolutely. So mechanism. So it actually does what you want to do. I think

Dr. George Papanicolaou:
One of the things that we know you mentioned earlier on and we always talk about is what happens in conventional medicine. For years I had a conventional practice. I’ve gone to my conventional doctor for years and they would bring up my weight or my BMI. And I think the point that you just made is that the BMI is just your body mass index. That mask can be anything. It can be fat, it can be muscle, and that’s not really, we’re finding that that’s not really a good measure of your metabolic fitness.

Dr. Mark Hyman:
It says what you’re saying is the thing that everybody talks about with relation to obesity, which is body mass index is kind of a poor measurement for what’s really going on under the hood that you can be, for example, Shaquille O’Neal or a bodybuilder and have an extremely high body mass index. So you have like 35 and maybe that’s considered severely obese, but actually you’re just solid muscle. Or you could be a body mass of 22, which is perfectly normal, a body mass index of 22 and be metabolically obese and diabetic because you have no muscle and you’re eating tons of crappy food, but you’re gained the weight. And so it’s sort of an inaccurate measurement. Absolutely. I want to talk to you about how do we actually measure this At the Ultra Wellness Center, we do a number of different measurements that can quantify your level of fitness and your level of muscle and your level of fat and quality of it.
We can even look at mitochondrial function, which is a critical aspect of your health. So we look at things that most physicians and practices don’t do as a way of creating a customized personalized set of recommendations to optimize your health. And of course, it’s not just around exercise, it’s around everything. We look at your nutrition, we look at your hormones, we look at your immune system, we look at your gut, we look at toxin levels. So we look at all of it as it affects all of it, but today we’re just talking about this whole issue of fitness and why we need to think more carefully and nuanced about it. So let’s talk about how do we measure the two most important aspects of fitness, which is basically your cardiovascular fitness and your muscle fitness. Yes. So let’s talk about cardiovascular fitness first. How do we measure that? So

Dr. George Papanicolaou:
Cardiovascular fitness is measured using something called your VO two max. And essentially that’s basically the maximum amount of oxygen you can deliver to your cells during your maximal amount of activity. And so that can be done in a lab and you do a V two max. You’re going to get on a bike, you’re get on a treadmill and they’re going to put a mask on you which is going to then be able to measure your oxygen utilization. So you’ll start exercising and then you’ll increase your exercise until you put your max amount of activity or exhaustion. And then they’ve been measuring your O2 metabolism the entire time. And then they’ll be able to then determine the maximum amount of oxygen uptake in utilization, and that will be your VO two max.

Dr. Mark Hyman:
So essentially that’s measuring how much oxygen you breathe in and how much carbon dioxide you breathe out, which is an indirect measure of your metabolic rate. And it determines how many calories you can burn a minute, how much oxygen you can burn ’em in. So basically your metabolism, because I have a slow metabolism, well, they might be right because if you have a low VO two max, you’re burning far less calories per minute because the rate limiting step of burning calories by the way, is how much oxygen you can process per minute. That’s called the VO two max. The volume of oxygen,

Dr. George Papanicolaou:
It’s

Dr. Mark Hyman:
In liters per minute,

Dr. George Papanicolaou:
It’s m mls per minute per kilogram.

Dr. Mark Hyman:
So it’s basically how much oxygen can you utilize. And so a guy like Lance Armstrong who wins the tour to France can maybe have a much higher utilization. His VO two max may be 90, whereas the average guy who’s like a diabetic might be 15 and someone who’s fit might be 45. My watch says I’m 46 and I’m superior. I don’t know at this age, but I used to be 55, 55 V two max when actually measured last time. I don’t, my watch is accurate, but it’s really a critical measurement.

Dr. George Papanicolaou:
I think V two

Dr. Mark Hyman:
Max for everything for longevity. If you look at the longevity trajectory, it’s probably the thing that is most correlated with longevity.

Dr. George Papanicolaou:
So talking about VO two max and body composition and muscle mass are two of my favorite things to talk about with my patient because they’re correlated to so many things, both of them. There’s a vast amount of data for both your cardio respiratory fitness, which is measured by your VO two max and your muscle mass and muscle strength to the top 10 leading causes of death in the United States, also to the 35 chronic conditions that lead to them. And two of the chronic conditions that are listed at near the top are sarcopenia, which is loss of muscle mass and decrease in your cardio respiratory fitness or your aerobic fitness,

Dr. Mark Hyman:
Which are two things that traditional doctors never look at or measure,

Dr. George Papanicolaou:
Look at or treat. And they’re highly correlated because if you look at the traditional markers of cardiovascular disease, which are going to be hyperlipidemia, hypertension, and inflammation, if you look at the markers of metabolic disease, which are going to be insulin resistance, obesity, inflammation, inflammation again, basically what happens is that they lead to atherosclerotic vascular disease,

Dr. Mark Hyman:
Meaning coordinating the arteries, clogged arties in

Dr. George Papanicolaou:
Your brain, which means your heart, your body, which you’re going to be getting less blood flow to your muscles. And if there’s less blood flow to your muscles, there’s going to be less what oxygen delivery. And then what happens is now if you’re not aerobically fit, then you’re getting less oxygen to your muscles, then your muscles stop growing. And so then that leads to some of that loss of muscle mass. So your aerobic fitness and your ability to maintain your muscle mass and strength are very much correlated, interconnected. And they’re interconnected. And that’s why we have to pay so much attention to them. Because going back to it, I want to emphasize it one more time. Both of them, through vast amounts of data since 1950, have been highly correlated to chronic disease, decrease health span and increase in mortality. Yeah. That’s why we got to focus on

Dr. Mark Hyman:
I really agree, and I want to sort of bring it back to the kind of gee sites for a minute.

Dr. George Papanicolaou:
Yeah, I want to go there too because

Dr. Mark Hyman:
When I wrote my book Young Forever, I talked about one of the key hallmarks of aging, which not my deficient, is sort of the scientists who come together and say, what, as we get older, what are the hallmarks? What are the criteria? What are the phenomena we see as we get older? And one of the things we see is a dysfunction and a decline in our mitochondria. Absolutely. Now, as medical school, we learn about mitochondria in first year medicine and the biochemistry and the kreb cycle, and then we’re basically all told to forget about it. It has no relevance for clinical medicine. And so most physicians have no clue how to diagnose problems with mitochondria or to actually treat them. And yet mitochondrial function is critical to almost everyone in the chronic disease, whether it’s diabetes, have decline, mitochondrial function, autism, heart disease, I mean, you name it, it’s there. It’s mitochondrial disease, and yet we learn nothing about it. And so we actually now have a window into how to look at mitochondria through things like VO two, accessing body composition. Some of the other tests we do at the Ultra Wellness Center are like organic acids, mitochondrial swabs, which we can look at your actual mitochondrial function. So there’s a lot of ways we can diagnose what’s going on, and then we have really clear ways to treat it through diet and lifestyle exercise, which we’re going to get more into and very supplementation. So

Dr. George Papanicolaou:
Getting back to the VO two max, I know we want to go into the weeds on that. We could spend the whole day just talking about VO two max. You brought the mitochondrial piece. Well, the whole point of getting oxygen to the cell is to get it into the mitochondria to produce energy. And so when you talk about the Krebs cycle, there’s not a day that goes by that I’m not looking at the Kreb cycle at least 10 times. There’s not a day that goes by that I’m not looking at the four respiratory changes of the mitochondria because we do that testing in our office and people are shocked like, wow, what are you talking to me about? Well, I’m talking about the most important thing to your health. You’re mitochondria. I’m really working out well, right? And why? There’s a host of various reasons.
We’re going to focus on exercise piece today, but we know there’s a nutritional piece and we know there’s some other pieces to that including genetics. Just to go back to our athletes, an Olympic cross country skier or a Tour de France winter, they’re born with VO two maxes, like eighty five ninety, you and I we’re born 40 to 60. We might be able to give it a little higher through training, which we’ll talk about later. But there is a genetic piece to all of this, but you can train it. And it’s really important to know that VO two max, it declines with age just as muscle mass does. And again, both declines are associated with decrease in health span and decrease in longevity and increased mortality. So the whole point, what I want to hopefully we really get to our listeners today and our viewers, is that you have to at a very early age begin to incorporate exercise into your lifestyle. Because if you come to meet age 50 and you are metabolically imbalanced or you’re obese or you already have metabolic syndrome and you’re not an exerciser, it would be easier for me to get you off a crack
Than to get you to start exercising. It’s an extraordinarily difficult habit to begin late in life,

Dr. Mark Hyman:
But you can and you to by the way, and

Dr. George Papanicolaou:
You have to, it’s not an option. And the Ultra Wellness Center where all the doctors are versed in this, all of the PAs are versed in this. We work with nutritionists and we work with exercise physiologists to help you get over any barriers that may exist for you. And that’s why people come and we get, and since you published your last book forever, young, young, young Forever,

Dr. Mark Hyman:
Bob Dylan, that was Forever

Dr. George Papanicolaou:
Young, fre, you’re so much into rock and roll than I am. But needless to say, we’ve been getting a lot more patience and clients that want to really focus on their longevity. And I’ll spend, so this is something I spend a lot of time reading about, thinking about, and then finding ways to reduce the barriers for my patients. So with the VO two max, getting back to that, we get that measured. We either have people get that done local to their environment, or there’s are some places near Ultra Wellness Center that we can have ’em get their VO two max measured. And for many people, it’s brand new information, but it then becomes a really great marker for them because we can then give them a fitness program that’s designed specifically to improve your oxygen delivery and oxygen utilization, which will then improve your VO two max and give you that cardio respiratory health that you’re going to need as you age.

Dr. Mark Hyman:
And by the way, the side effect is you feel much better. Oh my gosh, you have more energy. Oh gosh, when you burn more calories sitting down, doing nothing. And the reason I like it, I get to eat more. I mean, I like to eat, but when you increase your VO two max, you basically just burn more calories sitting down, doing nothing. It’s

Dr. George Papanicolaou:
A vital sign in my way of thinking for my patients. I don’t want to see them in the room unless they’ve had a VO two max and they’ve had their body mass composition done because those are two, to me, those are vital signs that if I don’t know them, I can’t give you everything that you need to be

Dr. Mark Hyman:
Healthy. Yeah, I don’t know if there’s good data on this, but I think your VO two max is probably as important or if not more important than measuring your blood pressure or your cholesterol or your blood sugar. It’s that important. And we don’t look at it in

Dr. George Papanicolaou:
Medicine. Well, they’re highly correlated. I mean, V two max is correlated to your lip levels and also blood pressure. So there are some studies that make that

Dr. Mark Hyman:
Correlation, and I don’t want people to feel listening to that. They can’t start late in life because there’s this guy I read about who was a French dude who decided he was a post office worker and retired at 65 and he was going to take up cycling and at 105, he could cycle basically a 14 minute mile, which is really fast. And his VO two max was that of a 30-year-old, and he decided, I think at 103 or something that he wanted to improve his VO two max. So he basically got on a training program to improve his VO two max, even at 103 years old, you can absolutely. So George, take us through, we basically measure it through a lab, essentially a cardiometabolic lab with a cardiometabolic cart that measure your oxygen and carbon dioxide exchange, and you get a number, and there are other sort of surrogate ways you can do it through various watches, and I don’t know how calculations, but basically it’s a really important number to know we get your number.
Okay. The average person that I see who’s not that healthy is maybe their twenties, even teens. It should be kind of typically as you get older it gets lower, but typically in your thirties, it’s in the thirties, it starts to go down. When I was 45, mine was 55. So it’s possible to keep it high at any age. So when you start to see these people and you do this testing, what is the sort of strategy then around cardiometabolic fitness? And soon, we’re going to get into body composition in a minute, but I want you to stay tuned for that because it’s a really important conversation. And I think it’s again, one of those unmeasured vital signs, which is muscle. You talked about sarcopenia, which is a condition that is correlated with almost every feature of aging. And in fact, it’s probably the reason we age so much and yet we don’t ever measure it or talk about it in medicine either is big gaps.
And again, this is what we’ve been doing in my practice for 30 years at Kenya Ranch before and then here at the Ultra Wellness Center. And so how do you approach someone who comes to your office and maybe you can tell us a story of a patient who has measured the otax, it’s low, and what do you find in those patients? What do you do for them? How do you tell them to increase their VO two max? What’s the scientific method essentially for increasing scientifically your VO two max and your metabolism and your mitochondria and your fitness level?

Dr. George Papanicolaou:
Sure. So as with everything in functional medicine, it’s all personalized. There’s just so much that goes into how I’m going to create a program from somebody to their history with exercise, to any injuries that they may have to their current status in terms of their work environment to social environment and any disease process they may be struggling with. So it’s always going to be personalized, but there’s a general approach. So the general approach is you need to have an aerobic baseline. So you start with zone two. Zone two is basically 60 to 70% of your maximal heart rate.

Dr. Mark Hyman:
It doesn’t sound like very much.

Dr. George Papanicolaou:
No, it’s not. But that is your base.

Dr. Mark Hyman:
So can you have a conversation when you’re working at that level? Yeah,

Dr. George Papanicolaou:
So that’s conversational exercise. I explain to people, if you and your wife are on a treadmill and you’re next to each other, you can have a conversation where you can get one or two sentences out and need to take a breath. If you get more than a sentence or two out, then you’re not working hard enough. And if you can’t breathe, you’re working too hard. The reason why that’s important is that’s your aerobic capacity. You’re going to maintain a metabolic rate in which you’re using up oxygen and you’re not beginning to create too much lactate. Once you go through that threshold, then you become a little more anaerobic and you can’t maintain that long enough. And that aerobic level allows you to develop that oxygen delivery system that’s very important to maintaining your VO two max on a mitochondrial level. So you need to get that baseline, and that should make up the majority of your training of your VO two max.

Dr. Mark Hyman:
So is that like a brisk walk or is that a jaw light? It

Dr. George Papanicolaou:
Has to be brisk enough. It has to be brisk enough that your heart rate is up, you’re sweating a bit, and you’re definitely can’t have a full conversation. It’s not walking the dog and talking about your investment portfolio with your

Dr. Mark Hyman:
Buddy. Right. Okay. So how does somebody figure out their zone two? Because there’s a calculation in medicine, which is your maximal heart rate is two 20 minus your age. That’s the maximum heart rate that you should get at your age. Now I’m, let’s say I’m going to 65 this year, so that’s 1 55 1 what?

Dr. George Papanicolaou:
Well, I think it’s

Dr. Mark Hyman:
1 55. 1 55, okay. Now I’m highly trained, so I often get my heart rate to 180. This is great. This is great. I get it to 180. I’m like, oh, I’m going to die. No, I’m not going to die. I’m just fitter. And so my maximum heart rate is younger than I would calculate, but for most people it’s two 20 minus races are maximal and then it’s 60, 70%, 60 to 70% of that. Now, there are devices, like I have a Garmin watch and there’s many other devices, Samsung, apple, so forth, Fitbit, and a lot of the measure your cardiometabolic health. And this watch tells me when I’m in zone two, when I’m in zone one to five and I can see where I’m in my exercise routine, and that’s really helpful. But for most people, how do they determine what’s their true maximal heart rate and their true zone two?

Dr. George Papanicolaou:
So for most everybody, it’s really going to be that calculation. The way I work with people is you do that calculation, but to your point, there’s something called the rating of perceived exertion, and it’s your ability to understand where you’re at in your fitness. So I can get my heart rate up still into the one eighties. So my max heart rate, I get into 180 8, 1 90, I’m okay.

Dr. Mark Hyman:
I don’t also glitch in my watch, but the other day it said 1 99. I’m like, I don’t think that’s right.

Dr. George Papanicolaou:
But the reality is that if I go to my calculated zone two, I’m not working hard enough. So I go by my rating of perceived exertion. I’m not in zone two until I’m at that point where I’m getting one sentence out. So I always tell my patients, correlate your calculation with your experience.

Dr. Mark Hyman:
That’s one sentence out, and then you have to take a breath and do another one pretty much. Is that the idea? Yeah,

Dr. George Papanicolaou:
Pretty much one to two sentences out. I mean, for all intents and purposes and our practical level, which I’m truly trying to make it for my patients, make this as lower the threshold as much as we can make it as practical as possible. So the only real tools that you won’t have, you’ll get from us, that will be your VO two max and your body comp. But after that, I want you to be able to do everything else at home.

Dr. Mark Hyman:
So what you’re telling someone to do zone two, how long do they have to do it? How many days a week? And then what else do you do to increase your VO

Dr. George Papanicolaou:
Two max? Okay, so the recommendation is about 150 minutes of zone two activity just for basic cardiovascular health. Will 300 be better? It’s the law of diminishing returns 150 or more, maybe 150 to 200. That’s about 30 minutes to 45 minutes of zone two activity per day. That could be swimming, that could be running, that could be treadmill, that could be rowing, whatever you like. It could be biking. Okay. Then what then is going to increase your VO two max? Zone two is considered moderate.

Dr. Mark Hyman:
Oh, by the way, that’s more exercise than probably 85%,

Dr. George Papanicolaou:
86, 80 6%. Let’s go. 86% of Americans do not meet that goal. Yeah. So 80, 86% of

Dr. Mark Hyman:
America, America, you got to get moving.

Dr. George Papanicolaou:
So 86% of America is sedentary and inactivity leads to disability and mortality. So go back there anyhow, so then you have that baseline, and at least 10 to 20% needs to be high intensity interval training. That baseline is more of your moderate intensity training. When you compare the two, high intensity interval training is far superior. I think I’ve read a number eight times more superior in improving your VO two max than moderate cardio respiratory training or intensity training. So the high intensity interval training is when you get up to 90, 85 to 90% of your max, and then you maintain that for an interval period rest, then do that interval again.

Dr. Mark Hyman:
Basically the speed you’d be at if you’re running from a tiger for 30 to 60 seconds, as long as you can maintain it, and then you take a break and you kind of go slow it really slow for three minutes and then you do it again. There’s all these different

Dr. George Papanicolaou:
Approaching, right? So what you want to do with your high intensity interval training is you start with your baseline. So you warm up and then you do your baseline training and you do it on a different day. So you’ll do your zone two activities Monday through Friday or let’s say Monday, Tuesday, Wednesday, and then on Tuesday, Saturday, you do your high intensity. Your high intensity, the intervals will be, you can go one-to-one to three. So let’s say do 30 seconds of running as fast as you can, then you can rest for 90 seconds. As you increase your fitness level, you can increase the duration of your intensity. So instead of 30 seconds, you can go up to three minutes. And so as you are able to do that, that is your subjective measure that your VO two max is improving. So then you can increase. So you start 30 seconds, you rest 90. Then as you get more and more fit, you may go one minute and rest three minutes.

Dr. Mark Hyman:
So do this on a treadmill on a bike,

Dr. George Papanicolaou:
And then if you get really fit by the way, then you can do one to two, one to one. So then you do one minute really hard, only rest one minute, one minute really hard, and that way. So that’s progressive.

Dr. Mark Hyman:
And how long you have to do that? Like 10 minutes? Half an hour,

Dr. George Papanicolaou:
20 to 30 minutes.

Dr. Mark Hyman:
Yeah. So it’s 23 minutes twice a week, twice

Dr. George Papanicolaou:
A week at most.

Dr. Mark Hyman:
Not that much. No. Right. No. And you’re saying it has a dramatic effect.

Dr. George Papanicolaou:
Dramatic effect. Yeah. Yeah. You’ll definitely see an increase.

Dr. Mark Hyman:
Yeah. I saw a paper years ago, I wrote about, I think in my book, ultra Metabolism, that if you compared traditional aerobic training to VH max training and people would exercise less minutes, less duration, higher intensity, they would exercise far less and get far more fit and burn nine times more calories if they actually were just, and it is basically burning more while you’re sitting on the couch. Watching TV is we’re talking about here.

Dr. George Papanicolaou:
And one of the concepts I want to bring up is the idea of what we call exercise snacks. You can think about it in regards to aerobic training, and you can think about it in regards to your strength training as well. These exercise snacks, you can get just as much benefit doing a five minute high intensity interval training three times a day or four times a day than doing it all 20 minutes at one time. So you can, in the course of your day, instead of napping or just keep working or eating, you can just take one to three minutes and do a high intensity interval workout. You can do right in your office. So

Dr. Mark Hyman:
Do burpees. Yeah,

Dr. George Papanicolaou:
Do burpees and do intervals of them 30 seconds on, 30 seconds off. And you can do that for three to five minutes, recover. And if you do that four times a day, there’s your 20 minutes.

Dr. Mark Hyman:
That’s amazing. It doesn’t have to be all at once.

Dr. George Papanicolaou:
Yeah, it doesn’t have to be all at once. And that’s what I really want to emphasize to our viewers and listeners, is that we want to try and find ways to get you to exercise that lower the threshold, lower the bar, make it less confusing, make it less complicated, use your own body, use minimal amount of equipment, and that way you’re more likely to do it. So that’s how you take a 40-year-old who’s lost their way and get them back on track. Tiny steps, tiny changes that lead to bigger changes, and then ultimately hugely improved fitness, longer life, healthier life.

Dr. Mark Hyman:
Yeah, no, I absolutely agree, George. And I think what’s quite amazing is studies I’ve seen on people who with dementia using VO two max training, they put ’em on a bike and they do VO two max training and they cognitively improved dramatically.

Dr. George Papanicolaou:
And there are also,

Dr. Mark Hyman:
And part of it’s because it basically creates this thing called miracle grow in the brain or called BDNF, which is one of the things that gets triggered by exercise. So I think it is quite amazing when you see the power of this when there’s no drug that can do it, but you going to have a stationary bike and you goes as fast you can, and your brain wakes up pretty damn good,

Dr. George Papanicolaou:
Pretty damn good as another. Just looking at more data, there are studies that have been done that looked at people that have cardiovascular disease, have had catheterizations, and they compare their improvements in functionality using moderate intensity exercise versus high intensity exercise. They’re able to do high intensity exercise and they make vast improvements in their VO two max and their functional capabilities doing high intensity exercise. So even if you’ve had a cardiovascular event, you can do high intensity training and increase your VO two max and your functional capability.

Dr. Mark Hyman:
And it’s not just a vanity metric. It’s actually a really an important metric of how you’re aging, what your metabolic health is, what your fitness level is, and how it’s going to determine everything that happens going forward. So again, this is something you’re not going to get at your regular doctor. You’re not going to get the right prescription. You’re not going to know exactly what to do. And it’s the kind of stuff we do at the Ultra Wellness Center. I want to talk about the other important measurement that you mentioned earlier, which is something we also do at the Ultra Wellness Center called body composition. Now, what is body composition?

Dr. George Papanicolaou:
So body composition is really what are you made up of? We’ve just been talking about cardiovascular fitness, you’re talking about heart, you’re talking about blood vessels, but when we’re talking about your body comp, we’re talking about fat and we’re talking about muscle. Those are your two major body parts or body subtypes. So they’re really important because they’re metabolically active and fat has its role in providing us energy, but when we have too much fat, we have certain types of fat, it’s inflammatory, and it alters our insulin sensitivity, which has a significant role in metabolic syndrome. And then the development of cardiovascular disease, which is the leading cause of death in men and women. So we need to really be aware of fat, but we’re not always aware of fat because when we go to our conventional doctor’s office, we get a BMI and BMI is not telling us anything about body comp. No. It’s just telling us about your total mass compared to your surface area,

Dr. Mark Hyman:
Right?

Dr. George Papanicolaou:
Whoever thought that would make any type of sense. So when we do a body composition, we can actually look and see how much muscle mass do you have, particularly axial muscle mass. Muscle mass in your arms, muscle mass in your legs. They’re highly correlated to your health span. Then we could also look at your body fat. So when we look in the mirror, we see our fat. If we do a waist to hip ratio, which is actually better than BMI when it comes to identifying what your body, your body count might be, because it really represents your visceral adiposity and visceral adiposity.

Dr. Mark Hyman:
Belly fat,

Dr. George Papanicolaou:
Belly fat, English. So you’re

Dr. Mark Hyman:
A smart jerk. You can use English.

Dr. George Papanicolaou:
Yeah, so belly fat. So that’s obvious. But you also can get your visceral adiposity, not your centrifugal adiposity, but your ce,

Dr. Mark Hyman:
Your visceral is around your organs, inside

Dr. George Papanicolaou:
Your visceral organ. That’s the fat inside around

Dr. Mark Hyman:
Your organs and your belly.

Dr. George Papanicolaou:
Yeah, inside. And that’s a really measurement that really opens up people’s eyes because when they see on their body composition that their visceral fat is above what it should be, they’re like, wow, I can’t see that. So well, that’s the really dangerous stuff. And so when we do a body composition, the body composition that’s really used most in research and in practical medical and exercise physiology settings is your bioelectrical impedance. And that’s when you send an electrical signal through the body and the electrical signal at a low level frequency will pass through the different tissues and it passes through the tissues at different rates. Each tissue is going to impede the flow of that electricity based on what it’s made up of. So we’re 70% water. The electrical signal is going to go pass quickly through the water versus fat. It’s going to go slower. And so using a computer algorithm, you can then begin to define what a person’s made up of based on the electrical signals that you got from the test. So we use an InBody in the practice, and it has multiple

Dr. Mark Hyman:
Electrics, pretty advanced machine. It was very expensive, but we got it. We think it’s such an important vital sign.

Dr. George Papanicolaou:
And it’s a really good one. And it’s a really important one. Everybody gets it when they come in and it has eight electrodes that are spread between your hands and your feet. And so it’s very sensitive and it can pass multiple different frequencies. So it is very sensitive and it’s very accurate in being able to determine how much fat of it is visceral, how much of it is not, and also look at your muscle mass. And when you compare it to dexa, it actually will, that

Dr. Mark Hyman:
Sort of what’s used a lot of research. It’s kind of an X-ray, which is some low level radiation that’s used to check bone density, but also can check body composition and fat and muscle and distribution. So that’s also used to measure body.

Dr. George Papanicolaou:
It’s also used, but his BAI, so it used to be the gold standard, but his BAI has really increased and the technology has really improved. BI

Dr. Mark Hyman:
Actually I is body

Dr. George Papanicolaou:
Impedance. Body impedance analysis analysis.

Dr. Mark Hyman:
So it’s basically using what we just talked the InBody machine,

Dr. George Papanicolaou:
Right? Embodied machine. Yep. Thank you for helping me make this simple for people. That’s

Dr. Mark Hyman:
Okay.

Dr. George Papanicolaou:
That was my goal. Make it simple for you. Okay. So in doing that, the BIA will actually more accurately determine your muscle mass, because DEXA doesn’t account for any fat that might be in the muscle, so it will overestimate your muscle mass. So BIA is actually really effective. And if you can get that done, you can certainly get it done in our office, but if you can get it done, that’s a really good baseline for knowing, okay, where am I at with my body composition? And what does that mean? It means I would actually distill it down to being able to say, where am I at metabolically? Because how much fat and how much muscle you have in comparison to one another really does determine if you’re going to be metabolically flexible and metabolically stable.

Dr. Mark Hyman:
That’s right. And metabolic health is such a huge issue because it’s a problem across America in a way we’ve never seen before. According to data I’ve talked about before, out of Tufts, 93% of Americans are metabolically unhealthy, and it has to do with some degree of problem with body composition, with fitness, with nutrition, it’s all there. But this is a huge factor, and I just want to sort of emphasize what you said. Everybody who comes to the Ultra Wellness Center, when they check in and get their vital signs done, they get their blood pressure, they get their respiratory rate, their heart rate, their temperature, and their body composition. It’s just basically one of the vital signs and we check it on everybody. Absolutely. And I think we learned so much about our patients, and it’s such an important tool to help ’em understand where they are in their overall health. And it’s such a critical measurement. It should be done as part of every doctor’s. Absolutely. And especially since 93% of people have, so imagine we have a problem, 93% of the population. We don’t have a really good way of measuring that in the average doctor’s office, and we don’t even pay attention to it. And yet, it’s one of the most important things we need to look at. And it’s important we can do something about it. We can actually change it, and we can alter our body composition at any age

Dr. George Papanicolaou:
Though, mark, as you’re talking to me and my little A DHD brain is just fired off in 10 different directions. I’m thinking about not even the doctor’s office. Mark, how about schools? Oh, yeah. How about what is this thing about having kids sit in a classroom all day long? That’s a great idea. And then they want to put me on a leash when I’m in third grade because I want to get up and move. Anyhow.

Dr. Mark Hyman:
People have EDD exercise deficiency disorder, not a DD.

Dr. George Papanicolaou:
So once you have your body composition, then we can start some real serious work. And as I tell everybody, just as a quick aside, I have patients come into the Ultra Wellness Center and they seem to be really proud of one piece of their medical record, and that’s their supplement list. They love their supplement list. And I get people that come in with 23 different supplements that they’ve gotten from different podcasts and the health and wellness space, and they’re really proud and they think I’m going to tell ’em, well, that’s great. But when I look at what they’re doing for exercise, I say, you know what? Let’s put that piece of paper aside because you cannot supplement your way out of no exercise

Dr. Mark Hyman:
Or a bad diet or anything

Dr. George Papanicolaou:
Else, or a bad diet.

Dr. Mark Hyman:
Right. It’s called a supplement, not a replacement. Yeah,

Dr. George Papanicolaou:
Exactly. So the reality is is that I tell people we’re going to spend our time on lifestyle because if I can’t fix your lifestyle, it’s going to be really hard for me to help you reach your goals or if you’re ill, to get you to be healthier. So lifestyle is critical. We’ve talked about the cardiovascular aerobic piece, and now there’s the body comp. Let’s just begin to understand, okay, what do we do to change that body composition? Specifically if we look at the data around muscle, we understand that you need muscle mass and you need strength. Muscle mass provides you that metabolic center where so much of your metabolism is going to occur, and it has a lot to do with glucose metabolism.

Dr. Mark Hyman:
I just want to emphasize that what George said is so important. Your muscle is where your metabolism happens for the most part. It’s in other parts, obviously your heart, your brain, your organs, but the vast majority of your metabolic function happens in muscles. Where you

Dr. George Papanicolaou:
Produce your muscle is the biggest organ in your body. It also becomes not only that metabolic reservoir, but it’s a protein reservoir, an amino acid reservoir. So if we take it down to the point where you get older and maybe you get sick or you fall, you have an accident and you’re sedentary for a while, you need a reservoir of protein and amino acid to recover. If it’s not there, then you’ve just taken a step down and you have no ladder to get back.

Dr. Mark Hyman:
So it happened to a lot of elderly people when they got covid, they just had no capacity to deal with it, and they had no protein reserve. And they’re often protein malnourished. And that protein is required to make your immune system, for example, your antibodies are made from proteins. Your immune system functions on protein. So if you have not the right amount of protein, you’re in trouble. And if you don’t have the reservoir in your muscles, you’re doubling in protein I doubly in trouble.

Dr. George Papanicolaou:
So then that’s the muscle mass piece. But then there’s the strength piece. So there’s muscle mass, but you need to have strength with that muscle. So the strength is your functionality.

Dr. Mark Hyman:
So you can’t do that big muscles. They have to actually be functional and

Dr. George Papanicolaou:
Functionally strong. They have to be strong. And so you have to think about it in both ways. And then when you think about it that way, then you have to think about protein and its role in helping to build and repair muscle. But protein by itself is not going to lead to strength. That’s when you need resistance training.

Dr. Mark Hyman:
It’s like putting ingredients for soup on the stove, but not turning the heat on.

Dr. George Papanicolaou:
Exactly

Dr. Mark Hyman:
Right. So approaching is the ingredients, but the heat is the exercise,

Dr. George Papanicolaou:
And that’s resistance training. And there’s just a lot

Dr. Mark Hyman:
Of otherwise known as weightlifting, strength training, band training, body weight training. There’s a million ways to do it.

Dr. George Papanicolaou:
And so there is resistance to resistance training. People just don’t like to do it. When I talk to my patients, they’re just like, I don’t

Dr. Mark Hyman:
Like to. My God. I hated that. I was like, this is painful. This is uncomfortable. I couldn’t do two pushups when I was 50 years old. I did 10 pushups. I would be sore for a week. I’m like, this is ridiculous. I don’t want to do exercise. It makes me feel horrible. So I just never did it. And then I started when I was like 59. I’m like, all right, I know I’m supposed to do this. I tell everybody to do it. I’m not doing it. I better do it. And it just changed my life,

Dr. George Papanicolaou:
Dude. When I see you on Instagram pumping iron in the gym, I am impressed. I mean, seriously, you work hard when you work, man.

Dr. Mark Hyman:
I try. I try. But what’s so important to realize right now is there’s a huge problem in our society, which is the Ozempic craze.

Dr. George Papanicolaou:
Oh, yes.

Dr. Mark Hyman:
And the reason I’m bringing it up is ozempic makes you lose fat and muscle. And if you’re on Ozempic or Wegovy or Monja or any one of these drugs and ones coming around every minute, you have to pay attention to what we’re saying today. You have to have the right amount of protein more than you think about a gram per pound. And we’ll talk about that per day. And you need to focus on resistance training if you’re going to be on those drugs. Absolutely. And if you don’t, what’ll happen is you’ll lose muscle and fat, but muscle burns seven times more calories than fat. So when you get to the weight you want, you’ll have a slower metabolism. And eating a lower amount of food will actually make you gain weight. So this is a huge problem. And this is why often people can’t get off the drugs and they don’t do it properly. And I am not opposed a hundred percent to these drugs. I just think they’re overused, and they’re also not prescribed in a way that’s taking care of the side effects of these drugs by properly addressing the protein needs and the resistance training needs that are increasing when you’re taking these drugs.

Dr. George Papanicolaou:
I can’t agree with you more. And if you hadn’t made the point I would have. These are called GLP one

Dr. Mark Hyman:
Agonists.

Dr. George Papanicolaou:
Agonists. And they have a role. They have a role, but

Dr. Mark Hyman:
Our bodies make it, by the way, there’s a lot of ways to increase our body making gpu.

Dr. George Papanicolaou:
Yeah. And they have a role. Our body makes it, but they’re being co-opted from weight loss specifically. And when you lose weight rapidly or lose weight ever, you can lose 20 to 30% of that in muscle.

Dr. Mark Hyman:
Well, in Ozempic, I think it

Dr. George Papanicolaou:
It’s higher. 40 or 50% of the weight be 40 to 50. Absolutely.

Dr. Mark Hyman:
50% of the weight you’re losing is muscle, which is a disaster. And that

Dr. George Papanicolaou:
Is a disaster. And so in regards to using these drugs for weight loss the way we are now using them in our country, very difficult for me to find rationale for that. I’ve always been about, and that’s why we’re having this conversation. It’s about lifestyle and capturing that lifestyle early in life so that you can maintain it and improve it and excel as you get older. So glad we took that little journey over. Yeah, I

Dr. Mark Hyman:
Think it’s important

Dr. George Papanicolaou:
To the dark side

Dr. Mark Hyman:
Because it sort of speaks to why, for example, everybody who know ozempic needs a body composition before they start, track them every month to see what’s going on. These machines are easy, you just stand on it. It’s like a wet scale, a fancy scale that you stand in for a few minutes and it measures everything. And I think if we don’t do that, in my view as someone who would be prescribing one of these drugs, I would consider malpractice. If you don’t focus on muscle health and prevention of muscle loss when someone are on these drugs, I think it’s akin to malpractice. And if you don’t measure body composition and track it, it’s like it’s putting people on a diuretic where you lose potassium and not checking your potassium, right? Absolutely. It’s like, well, as a doctor, if you’re on a certain drug, you need to check liver function test. It affects the liver function. So you just know to track the things that other problems. And we don’t do that with these drugs. And to me it’s criminal and I think it’s a quick fix, boom, boom, lose weight. But we’re creating a whole society of people who are going to become a more sarcopenic, have more muscle, wasted everybody,
And lower metabolism. And then it’s a vicious cycle of getting the weight back, eating less food, and being in this horrible, horrible tailspin that it’s hard

Dr. George Papanicolaou:
To get. Absolutely. And we are so body shape centric and we are so fat centric that we are losing sight of the fact that you emphasize, and I want to emphasize again because I’ve had this conversation recently with colleagues and with you as well, that using these drugs, using GLP ones have a real downside to them. And using, particularly for weight loss is an issue because you’re losing fat, but you’re losing muscle. And that is even more important. You may look good, but now you’re,

Dr. Mark Hyman:
You’ll be skinny fat,

Dr. George Papanicolaou:
You’re going to be, well, I don’t know what’s skinny muscle. Skinny

Dr. Mark Hyman:
Might mean you look thin, but you’re actually fat. Exactly. That’s what we

Dr. George Papanicolaou:
Call a skinny fat. Yeah, yeah, skinny fat, right? Yeah. So yeah, you’re in bad shape. So I think you and I totally 100% agree on that and have the same viewpoint. And then there’s also the complications that we’ve talked about before that can come with those drugs including intestinal obstruction. Yeah,

Dr. Mark Hyman:
There’s a whole, I’ve done a podcast on that. We’ll link to the show notes, but let’s talk about body composition and resistance training in particular. I think there’s two parts of body composition, what you eat. And I always say you can’t exercise your way out of a bad diet. So if you don’t get your diet sorted, and I’m going to spend a few minutes on that in a minute, you’re going to have trouble. There’s people who are in the gym all day long and overweight. I actually had a guy who was my trainer at Equinox when I lived in New York, who was ripped, could do. He was so strong. I mean he could literally go put, I don’t know, 150 pounds on him and do pullups. I’m basically two body weights and do pull-ups. I can’t even do one pull up way. And he kind had this thick layer of fat all over him and I said, why don’t you try eating this way for a little bit? And I have a before and after picture of him, which is quite amazing. And he was even more rich, but had lost that layer of fat and it was metabolically more healthy, even though he was so strong, he still hadn’t had his diet sorted. So diet really plays a role. Huge. Let’s talk about what is the dose and frequency of resistance training? What are the types available and what should people do A little bit intimidating? Oh

Dr. George Papanicolaou:
My gosh, yes.

Dr. Mark Hyman:
If you’re a bodybuilder, I mean, I would go to these gyms with all these bodybuilders and it’s this skinny guy. I’m like, Ugh, I’m sort of intimidated here. I don’t know what to do. I don’t want to hurt myself. I’m worried about this. How do you address the problem of just getting started if you’ve never done this before?

Dr. George Papanicolaou:
That’s the million dollar question. And this is why people don’t do resistance training because the bar is really high. It means they need to buy equipment because, or go to a gym. Then when you get to the gym and then they’re, you see all these machines, which ones do I use?

Dr. Mark Hyman:
Everybody can afford a trainer, right?

Dr. George Papanicolaou:
When I get on the machine, how much weight do I use? Do I use a little weight and do lots of reps? Do I use the heavy weight and not so many reps? What’s my range of motion? Do I do full range of motion? Do I do short length partials? Do I do long length partials? What do I do centric?

Dr. Mark Hyman:
What do I do? Yeah.

Dr. George Papanicolaou:
So in preparation for today’s talk, I said to myself, okay, I can’t go through the entire science of strength training, but I’m going to try and just distill it down. So what we want to do is we definitely need to do progressive resistance training in order to gain muscle mass. And okay, so progressive resistance training means that you start out whatever exercise you choose, one that everybody might know there’s a curl. Alright, so you’re going to start out with five pounds. Well, you do it the first time you do it, man, I could barely get to eight. Okay, alright, so then you’re going to go back three days later or maybe go back the next day you do a different body part, but three days later you’re going to go back, you do your curl and you know what? You’re going to notice that you actually do two more reps.
It’s not necessarily because you got stronger, it’s because you actually got more efficient biomechanically the message from your brain to your muscle. Some of the metabolic efficiencies occurred already, not necessarily stronger, not necessarily bigger muscle mass yet, but more efficient. But three weeks down the road, you’re going to find that it’s really easy. Now it’s time to increase your weight. And so now you’re going to 7.5 pounds. So by the time three months comes, if you’ve been really consistent, you’re going to find that you’ve progressively increased your resistance and now your net from five pounds, you went up to 15 pound curl. That is going to correlate to increased strength and increased muscle mass. As long as you’re eating correctly, you need to fuel that with the right amount of carbohydrates and healthy fats. And you’re going to also have to supply the building blocks with protein. If you’re not getting the protein, then you’re not going to be able to repair, you’re going to get injured and you’re not going to build a muscle mass and strength that you’re looking for. So that’s just a really basic basic.

Dr. Mark Hyman:
So progressive resistance training, I think that’s an easy concept to understand. You slowly build up the amount and of, but how many days a week should you do this? I mean, what are the different types people can do? What are the low friction ways? For example, I didn’t really ever do any weight training. So I went to the gym and I got a trainer and I could afford it, thank God. And I learned a lot and I kind of started and then covid happened and kind of fell off. And then I went and learned about band training, resistance bands, traveling a lot. I move around a lot and I can’t always get to a gym or I’m busy and I don’t have time to go to the gym, get to there, change, do the thing, change again, shower, come back, drive home. It took a whole thing.
So I’m like, I just need to be efficient. And I learned about TB 12, which is Tom Brady’s band resistance training program when Tom did this solely and he ended up being a seven time Super Bowl world champion. So I think he knows what he’s doing. And I started doing these bands and I could do them anywhere. I could hook ’em to a doorknob. I need a floor and a door and I’m good. And I’m able to literally build my strength and it’s so easy. And I can do light bands at first, heavier bands, heavier bands. I can do about 20, 30 minutes three or four times a week. I like to do five if I can, but even that keeps me going. And so it doesn’t have to be a big project. And there’s a lot of apps. I know there’s a TB 12 app you can use, but I think how do people just think about getting started on

Dr. George Papanicolaou:
This? So what you referred to are some of the alternatives to our classic understanding of progressive resistance using weights. So there are bands, there are kettlebells, there are body weight exercises. All of these can increase strength. They might be more difficult to increase the muscle mass and hypertrophy because you might not be able to get the number, get to the amount of resistance you need or the number of reps you need effectively to increase hypertrophy. So I will generally suggest to people that they move towards using weights for the resistance training. And you can do that at home. You can do that in a gym, usually recommend that you do at least two days a week. I think if you’re doing two days a week, you’re just breaking,

Dr. Mark Hyman:
Staying even.

Dr. George Papanicolaou:
You’re breaking it, you’re breaking in. I think if you’re doing three days a week, you, you’re going to be able to accomplish your goals four days a week, you’re going to be able to squeeze a little bit more water out of the sponge five days a week, you’re now probably nearing addiction. And how many of you do

Dr. Mark Hyman:
George?

Dr. George Papanicolaou:
Three to four. Three to four. There are weeks I get one or two. I mean, quite honestly, again, a quick aside, you cannot maintain the same exercise level throughout the year, whether you’re a world champion or a national champion or a really high level collegiality. You just can’t. And you have to concentrate on different areas of your physical health, whether it be nutrition or your fitness. And there’s various forms of fitness that you need to train at different times of the year. One of my favorite bike riders of all time is Lance Armstrong. I just think that regardless of anybody may say, despite all his

Dr. Mark Hyman:
Problems,

Dr. George Papanicolaou:
Regardless of anybody may say Lance Armstrong worked harder than anybody, well

Dr. Mark Hyman:
That’ll help from his friend. Yeah.

Dr. George Papanicolaou:
Well, we can put that aside for now. But he still really worked hard and I had a huge amount of respect for Lance, but needless to say, when he was, I could probably in the middle of winter when I was really riding hard, probably gone to Austin and ridden with Lance because he probably wasn’t doing intervals and sprints. He was probably doing 5, 6, 7 hours on the bike and I could just hang on his wheel and let him drag me around, but I would be able to hang with him, right, because you’re working on something different. He then changes his program so that as he’s getting closer and closer to spring classics and finally to the Tour de France where he’s getting more specific into power and sprinting, then I’m just taking pictures,

Dr. Mark Hyman:
Right? Same thing with strength training, right? Yeah.

Dr. George Papanicolaou:
The same thing with strength training to get back to it is I’m not going to sit here and tell everybody 365 days a year, I have the consistently same program. It’s impossible. I don’t. But I stay at that level where if I am too busy and I am on vacation, I can take that break and get very quickly back into my routine without that much of a loss and get right back to my physical fitness level and then continue to build as I need to for my next challenge in my life. So strength training one and one, I’m going to give it to your right, simple, get to the gym. I do think getting to a gym is probably going to be the most effective way to begin the process once you understand how to do it using kettlebells. I’ll take one thing back. One thing you can do is the Instagram and YouTube are huge resources for exercise programs. So I will take this back. My wife has turned me onto this recently. She has a whole catalog on her phone of Instagram posts of different resistance training and weight training programs that involve kettlebells, body bands, everything. So the bar for doing those things actually is so much lower than it used to be.

Dr. Mark Hyman:
And body weight, I’m

Dr. George Papanicolaou:
Actually going to take back what I just said. I don’t think you need to go to the gym to start. I don’t go to YouTube. Go to YouTube and Instagram. Pick your favorite, pick your favorite, whether it’s bands, whether it’s kettlebells, whether it’s body weight, and you’ll be able to find a plethora of different exercises that you can do at home in the office. So you can just

Dr. Mark Hyman:
Start there. You’ve got to be careful to not overdo it and be like where you injure yourself, you have to start, yeah,

Dr. George Papanicolaou:
We’re going to hope that everybody’s going to be using common sense,

Dr. Mark Hyman:
But well, what Mark Twain said, right? No, the problem with common sense is not too common right

Dr. George Papanicolaou:
Now. I’ve heard you say that before. I should have known. So you always start low, go slow. There’s no rush. You’ll make your gains with time. But when it comes to actual, if you’re going to use weights, which is my favorite approach, then here are the things that people always wonder about. Which exercises should I do? Well, you want to do exercises that use more than one joint. They’re going to give you the most metabolic response.

Dr. Mark Hyman:
For example,

Dr. George Papanicolaou:
For example, would be a squat, squat, squat, a deadlift, even a bench press, you are using multiple joints. The bench press, if you do bench press, squat, deadlift, you bench press, squat, deadlift, you’re talking about the power lifts and those, if you just concentrated on those, you’re going to get a full body workout that’s going to put you in a really good position of right now, those they take a, so it

Dr. Mark Hyman:
Doesn’t take a lot is what you’re saying. It doesn’t take a lot. And you don’t have to go crazy. You don’t have to be in the gym all the time. And you can actually learn a few key exercises that build large muscle strength and core strength and stability. Really, really important. And that’s why I love bands. They’re so easy and portable and they do all those things.

Dr. George Papanicolaou:
So on the weight piece, again, people are always wondering, should I do how much weight and how many reps? So it really depends. But I would say that for getting, if you want a good solid middle of the ground program, then you want to try to do anywhere from eight to 12 reps. Should I go to exhaustion or should I not go to exhaustion? Should my last rep be completely, I can barely get it up or not. Well, there’s some mixed data and some recent data indicates that getting to two to three reps before exhaustion is going to give you the same benefit. So you don’t have to go to exhaustion,

Dr. Mark Hyman:
You don’t have to have so much pain, right?

Dr. George Papanicolaou:
And so eight to 12, your last one can be one to two to maybe three reps from exhaustion. There it is. There’s your repetition number. Your weights should be weights that allow you to do eight to 12 reps. So you just find a weight, you have to test it out and figure out your first couple of times you go, which, what are you going to use? And then here’s something transformed my recent weightlifting. So there’s long length partials, there’s full range of motion, and then there’s short length partials. So when they compared, so full range of motion is when you do a curl like this, full range of motion from that position. A short length partial is you start here and go like

Dr. Mark Hyman:
This. So you start halfway and then you finish.

Dr. George Papanicolaou:
Yeah, long length partial. You start with the muscle fully extended and stretched and just go part way, part way. One third to half. Yeah. Right. And what does that do? So recent data is shown that when you compare the long length to the short length partial, the long length partial, there’s not even a comparison in terms of strength.

Dr. Mark Hyman:
So short length is better than long length? No,

Dr. George Papanicolaou:
No long length. Length than length. Long length. Long length. And when you compare long length, a full range of motion, long length is still superior. Amazing. So you can do a long length partial and get the same benefit as if you’re doing a full range of motion. The benefit I find for me in that regard, and for people that are going to be lifting,

Dr. Mark Hyman:
Is that why your biceps are bigger than mine?

Dr. George Papanicolaou:
I don’t know. I don’t know. Mark, look, I’ll write your next program for you. Make sure you get your biceps. So when you do the long length partial, what I like about it is I can actually use more weight. I can actually, and I just find it’s much less stress on my overall system body, right? So this

Dr. Mark Hyman:
Is fabulous.

Dr. George Papanicolaou:
These are basic things. I want people to get your weight. You pick weights that you can do eight to 12 reps. You don’t have to go to exhaustion, but if you want to, you can two to one to three reps before exhaustions. All you need to go to, you need to progressively increase your weights over time. And then you can use any type of format. You can use bands, you can use kettlebells, you can use body weight. And again, as we talked about with aerobic training, you have these exercise snacks. You can do exercise snacks with your resistance training as well. As you mentioned, I have dumbbells in my office and I use those for my exercise snack during day.

Dr. Mark Hyman:
No, I mean, I just talked to Lee Hood, who’s one of the world’s premier scientists in systems biology and medicine, and he’s 85 years old. He does 150 pushups a day. So not all at once obviously, but he drops in 30 here, drops in 30. There you that five times today, that’s 150 pushups. Very impressive. So George, this has been a great conversation about how do we look at things that are often missed with traditional medicine, what we do at the UltraWellness Center to look deeply into someone’s health and wellbeing and actually optimize their health and even treat diseases using exercise. How do we measure the fitness level using VO two max? How do we measure body composition using our in-body diagnostic machine we have in the office? And using that data to help inform people about what’s going on with their body and how to adjust their lifestyle to correct the problems so they don’t get into trouble in the longterm.
The one thing we didn’t talk about, I just want to touch on for a few minutes before we finish, is diet. Because body composition in particular and cardiovascular fitness to a lesser degree is so correlated with our diet. And part of the challenge we’ve had is that we don’t want eat enough of the right kinds of protein, and two, we eat too much of the wrong kinds of carbohydrates. And that will lead to increasing belly fat, visceral fat, fat marbled in your muscles, which you said we couldn’t measure the dexa marble. You don’t want to rib eye muscle. You want a filet mignon muscle, right?

Dr. George Papanicolaou:
No wagyu,

Dr. Mark Hyman:
No Wagyu beef muscles, but that’s basically what everybody in America’s walking around with. It’s true. And so we need to really help people understand that they need to reduce their refined starches and carbohydrate in their diet. They need to increase the good fats and they need to increase the quality protein. When I say quality protein, we’ve talked a lot about this in the podcast with Gabrielle Lyon, with Don Lehman and others, and we’ll link to those shows. But the quality protein matters. It does. And if you want to build muscle, you need muscle. It’s sort of if you want to build muscle, you need to eat muscle. And if you eat beans, it doesn’t work as well. You can, if you eat massive amounts or you have a highly processed bean powders or grain powders, you can concentrate the proteins and then they add extra amino acids, they add extra basically synthetic amino acids to jack up the quality of the protein, which if you are committed vegan, you can do, but you have to do that like a garden of life.
Sport protein, for example, has 30 grams of protein, but they also add all these other amino acids, which aren’t naturally in the products that are in. Yeah, exactly. So you have to eat either whey protein, beef, chicken, fish, lamb, these be bison, whatever you want to eat and make sure it’s the right kind. It’s regenerative raised. There’s great sources and we’ll link to the absolutely places you can get to force of nature, whether regenerative meats or zootopia fish with the great quality fish, it’s not toxic and so forth, go away I like. But you need the right amount of protein. And the right amount of protein is more than we typically think. If you’re resistance training and you’re doing the exercise, you need about a gram per pound, which is almost double what is considered the requirements. And just so people know, the requirements that we have are based on avoiding protein malnutrition.
So to avoid protein malnutrition, which is what was more prevalent when these guidelines were established, you need about 0.8 grams per kilo, which is about half of what I’m talking about. It’s not the amount you need to put on muscle or optimize your health. And secondly, as we get older, you mentioned early in the show, we have anabolic resistance, which means we are more resistant to putting on muscle. So we need to overcome that resistance with more protein, more exercise. So really nutrition plays a huge role. We deal with all that at the Ultra One Center. We look at your metabolic health through multiple lenses, including the body composition measurements and VO two max measurements.

Dr. George Papanicolaou:
So yeah, I 100% agree with that. And you mentioned the different speakers you’ve had on your show talking about protein. And so the literature on protein, the number that seems to have floated out in the last year or so has been like 1.6 grams per kilo. And so I would say that having looked at literature, definitely want to be somewhere between 1.2 to 1.6 depending on your exercise activity. Do you need to get above 1.6? Maybe? Probably not. Even if you’re lifting, I think 1.6, if you think about 1.6 grams per kilo for me is 130 grams per day. It is a lot of protein for me. I mean, I definitely need to use a protein powder shake, right?

Dr. Mark Hyman:
Yeah. But before the show here, we just had a protein shake and that was about 40 grams each boom like that. It was a sub

Dr. George Papanicolaou:
Protein shake. So I can’t get to 130 without a protein shake. Right? And I think going back to your point,

Dr. Mark Hyman:
Well, if you had steak for breakfast,

Dr. George Papanicolaou:
I had a really good steak last night, I made it myself. Anyhow, yeah, high quality proteins with grass fed beef. Farm raised poultry, get fish at least two to three times a week, get it from good clean sources and you can get your protein. But God gave us cattle and bison for a reason, and he gave us canines for a reason. Cattle and bison, they are protein factories. They eat the plants, they now take all the amino acids and all the proteins from all of the plants, combine them into one muscle that we can eat.

Dr. Mark Hyman:
Yeah, they have four stomachs. That’s why they can do it. We only one stomach

Dr. George Papanicolaou:
Because plant proteins are a little bit harder for us to digest and get out the amino acids that we need. So now,

Dr. Mark Hyman:
And they eat all day. I was in Rwanda, people were like, oh my gosh, gorillas, they’re so strong and all they do is eat plants. I’m like, yeah. And they basically have intestines that are two or three times larger than ours, and all they do all day is eat and they eat 50 pounds of food a day. Are you going to eat 50 pounds of food? Probably not. If you ate 50 pounds of grass, you’d be fine. Like I said, you can overcome the issue with plant protein if you eat enough of it, but it’s almost impossible to do that. So George, thanks so much for enlightening us about the role of exercise, the role of measuring the biomarkers, health and fitness, metabolic health VO two max body composition. Again, it’s just part of what we do at the Ultra Wellness Center. We took a deep dive into all your biomarkers, into your full spectrum of health. We are really in the practice of creating health. Absolutely. And what I say is, no matter how sick you are, we help you get healthy. And as a side effect, disease goes away. So George, thanks so much for being on the podcast again. Hopefully if those listening expire, you’ll come see us at the Ultra Wellness Center. Just go to ultra wellness center.com to learn more about what we’re doing and hope we see you soon.

Dr. George Papanicolaou:
That’d be great. Thanks, mark.

Dr. Mark Hyman:
Thanks George. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at Dr. Mark Hyman, and we’ll see you next time on The Doctor’s Pharmacy. I’m always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free Marks Picks [email protected] slash marks picks. I promise I’ll only email you once a week on Fridays, and I’ll never share your email address or send you anything else besides my recommendations. These are the things that helped me on my help journey, and I hope they’ll help you too. Again, that’s dr hyman.com/marks picks. Thank you again, and we’ll see you next time on The Doctor’s Pharmacy.
This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and Function Health, where I’m the Chief Medical Officer. This podcast represents my opinions and my guest opinions, and neither myself nor the podcast endorse the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. Now, if you’re looking for your help in your journey, seek out a qualified medical practitioner. You can come see us at the Ultra Wellness Center in Lennox, Massachusetts. Just go to ultra wellness center.com. If you’re looking for a functional medicine practitioner near you, you can visit ifm.org and search, find a practitioner database. It’s important that you have someone in your corner who is trained, who is a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public and keeping with that theme, I’d like to express gratitude to the sponsors that made today’s podcast possible.

Ingredients:

Crust

• 1 ½ cups blanched almond flour
• 2 tablespoons tapioca flour
• 2 tablespoons coconut sugar
• ¼ teaspoon Himalayan salt
• 1 teaspoon vanilla extract
• 1 large pasture-raised egg, yolk only
• 5 tablespoons ghee, unsalted

Lemon Filling

• 4 medium lemons
• 2 large pasture-raised egg
• 2 large pasture-raised egg, yolk only
• ⅓ cup coconut sugar
• 2 tablespoons coconut flour

For serving

Method:

1. Preheat the oven to 325°F.

2. Prepare the crust by adding all of the ingredients into a medium bowl and working them together using a rubber spatula or wooden spoon. Once combined, transfer the crust to a non-stick 9-inch tart pan, flattening and spreading to the edges.

3. Place the tart pan on top of a baking sheet, in case oil leaks. Bake until golden brown, about 25 minutes.

4. In the meantime, peel 2 lemons and remove large seeds, then transfer to a high-speed blender (do not worry if there are remaining small seeds). Blend for 20 seconds.

5. Into a medium bowl, add lemon purée, zest, and juice of the 2 remaining lemons (there should be 6 tablespoons of juice, use an extra lemon if necessary), whole eggs, egg yolks, coconut sugar, and coconut flour, and whisk until smooth.

6. When the crust is ready, remove from the oven and let it cool for at least 20 minutes. Then, carefully pour the filling over the crust and bake until the filling is set, about 25 minutes.

7. Remove from the oven and allow to cool completely on a cooling rack. Dust with powdered monk fruit and serve. Store in the fridge for up to 5 days.

Nutritional analysis (per serving) Calories: 236, Total Fat: 15g, Saturated Fat: 7g, Cholesterol: 121mg, Fiber: 3g, Protein: 7g, Carbohydrates: 19g, Sodium: 80mg, Sugars: 11g, Net Carbs: 16g

Dr. Mark Hyman:
Coming up on this episode of the doctor’s farmacy.

Dr. Casey Means:
So you need to load the body with the highest quality food possible unprocessed from good soil because you are gonna increase the probability that those little cells are gonna have the right thing floating around them to do what you wanna do, which is be healthy and not be sick.

Dr. Mark Hyman:
Before we get into today’s episode, I’d like to take a minute to remind you some exciting news My new cookbook, the Young Forever Cook Bookbook will be released on Tuesday, June 4th, nationwide. In my new cookbook, the cooking companion to my book, Young Forever, you’ll find over 100 mouth watering anti inflammatory recipes that are gonna help you live a longer healthier life. You can preorder the young forever cookbook atyoungforevercookbook.com. Just click on the pre order button at the top right. I’m so excited to share these recipes with you and so much more.

And, again, the young forever cookbook comes out on Tuesday, June 4th. Preorder yours today. Hey, everyone. It’s doctor Mark. Time is our most valuable asset.

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And now let’s get back to this week’s episode of the doctor’s pharma Welcome to the doctor’s farmacy. I’m Doctor Dr. Mark Hyman:. That’s farmacy gonna have a place for conversations that matter. And today’s conversation is about good energy Who doesn’t want good energy? You’re gonna love this conversation with a good friend of mine, a brilliant physician, doctor Casey Means.

She’s a Stanford trained physician and cofounder at Levels, a health technology company with the mission of reversing the world’s metabolic health crisis. Her book on metabolic health, good energy is out now, She received her BA with honors and MD from Stanford. She’s just a legend. She’s a president of her Stanford class. She is served on the Stanford faculty, and she also trained as a head and neck surgeon and would left that amazing career to devote her life to tackling the root cause of why Americans are so sick and overweight.

She’s been featured in New York Times in New Yorker, Wall Street Journal Forbes, Women’s held in lots more. And Casey and I dive deep into a topic of her new book, good energy. You know, we all have bad energy. Our body’s ability to make energy and our resulting fatigue and cognitive function and metabolic health dysfunction are all caused by a lack of proper energy we’re gonna get into what that means and why it’s important and how we have such an epidemic of poor metabolic health that affects 93% of Americans how her own story through discovery of this topic and through her mother’s illness changed her view of everything. She talks about how you need to trust your own body.

I’m not just, the doctor. Right? The most intelligent person in the room in terms of your own health is your own body. Don’t trust the doctors. Don’t trust science.

Don’t trust me. Trust yourself. We’ll talk about that. It’s a really interesting frame. We also talk about the 6 principles of good energy eating that can apply any dietary pattern or philosophy from vegan to carnivore and simple rules when it comes to food and lots Mark.

Very exciting conversation about this as well as things we can do to really fix our food policy So I hope you’ll love this conversation coming right up with Doctor Casey Means. Casey, it’s so great to have you back on the podcast today.

Dr. Casey Means:
Mark, it’s such a joy to be here with you always.

Dr. Mark Hyman:
You know, I I was thinking about both of us and how our medical careers took such a different trajectory. We’re both trained in the orthodoxy of traditional conventional medicine into top medical schools, top residency programs. You’re at Stanford. You’re at the pinnacle of medicine. You were a head and neck surgeon.

You had this incredible career ahead of you, and then something changed in your mind about what you were learning. You realized that maybe the orthodoxy wasn’t completely true. Not that it’s all bad or wrong, but like something fundamentally was flawed about medicine.

Dr. Mark Hyman:
Yeah.

Dr. Mark Hyman:
And about how we’re trained, about how we think about disease and health, you know, how we get indoctrinated in ways that make us blind to what’s really true about human health and biology. And I’ve heard you talk about this in podcast. And I just I just think you have such an incredible story to tell about this being this top doctor at the one of the top institutions in the world, and you’re just like, nah, I’m getting out of that cult. What happened?

Dr. Casey Means:
I think that The easiest way to describe how I got out of the cult is that I did the most dangerous thing that you can possibly do I think as an American living today, which is you you can start to ask the question, why?

Dr. Mark Hyman:
Why?

Dr. Casey Means:
Why?

Dr. Mark Hyman:
Yeah.

Dr. Casey Means:
Why is it that I’m 9 years into my medical training, and I don’t really understand why patients are sick. Why is it that we’re spending $4,300,000,000,000 on health care costs, and we’re getting sicker every year. Why is it that the more 100 of millions of prescriptions for chronic disease medications were prescribing. We’re actually increasing the rates of the chronic diseases. Why the more specialties that we literally invent in medicine, the sicker that we are getting why the more surgeries were doing our patients getting sicker, asking the question why this doesn’t really make sense.

So what’s really going on here. Yeah. And once you start opening that box,

Dr. Mark Hyman:
you know

Dr. Mark Hyman:
box inside.

Dr. Casey Means:
You can’t go back. Yeah. It’s over. Yeah. Because you start to see that the true foundation that the whole system is built on is actually so fundamentally flawed that it’s not gonna be an incremental fix that gets us out of this monumental you know, devastating hole that we’re in in America where literally we’re getting sickier sicker, heavier, more depressed, more infertile every year life expectancies going down and it’s getting worse.

We’re not gonna get out of that hole by changing, you know, a few words on the Medicare Mark d, page 250. It’s gonna be a

Dr. Mark Hyman:
That’s cover Ozempic on Medicare Part b, the drug benefit. That’s gonna fix everything.

Dr. Casey Means:
Yeah. So it’s it’s a wholesale reimagination of the foundation of the whole thing of the whole health care system, of our relationship with our bodies and building it from the ground up. And that’s why I wrote this book, good energy, and that’s, of course, why I just so honor the work that you’ve been doing because it’s not about incrementalism. It’s about it’s about following the rabbit hole of the question why and getting to the root cause of why we’re sick and reimagining the future of humanity, not just the health care system, but actually future of human thriving.

Dr. Mark Hyman:
Wow. I love that. That’s so beautiful. You know, and I I think about the question why it reminds me of a couple of things. 1, my mother used to say to me when I got home from school, Mark, not what did you learn in school today, but what questions did you ask?

Like, what questions did you ask? And so I’ve been that question asked her. I’m like that annoying kid in the front of the class. Hey. What about this?

What about that? And I literally would not leave a medical classroom until I actually asked all the questions that I need to know. And functional medicine, the way I describe it to people, is is traditional medicine is the medicine of what? What disease do you have? What drug do I give?

Functional medicine is the medicine of why? Why is this happening? Why is my immune system so pissed off and I have an autoimmune disease? Not what drug do I give it and what do I call this particular disease? And when you start asking why the whole world is up?

And we began to wonder Wait. Wait a minute. We did not learn about health in medical school. We did not learn about anything that really matters about how to create health for people. And my daughter right now, she’s in her 3rd year medical school.

I said, Rachel, did you learn about the microbiome? No. Did you learn about insulin resistance? No. Did you learn about

Dr. Casey Means:
The mitochondria.

Dr. Mark Hyman:
Mitochondria. Well, the Krebs cycle in 1st year medical school biochemistry. Did you learn about nutrition? No. And I’m like, well, what are you learning about?

These are the fundamental things that are wrong today in human beings in the 21st century that we have to address that are at the root of our dis ease and dis ease. And and your book good energy, the surprising connection between metabolism and limitless health, is is just a tour de force. I think even that’s a quote I give you on the cover. It’s it’s it’s one of those books that I think is a paradigm shifting book. Because it helps us to understand what’s really at stake here, what the problem is with the why, the answers to all the whys of the questions that you were asking, you went not just asked the questions, but you made sure you dug deep to finding the answers of why.

And then you built the sideways career. Not a next surgeon, but you started a company. You want to empower people with their own health and information about own metabolism. And this is really what good energy sort of came from was this insight about what really matters and how do we start to think about what’s making so many people sick in this country. Yeah.

And I talk about this head nausea. I mean, you’re probably probably sick on the podcast, but Metabolic Health is the fundamental barometer of everything that’s wrong with with our society today. We’re seeing over a 120,000,000 Americans with pre diabetes or type 2 diabetes I think it’s way more than that because if 93% of us are metabolic and healthy by the definition according to NHANES trial, which is basically the government national health and nutrition examination survey. It’s a massive study. It’s been going for decades decades that attracts people’s lab tests and all their biomarkers and their health status.

And basically said, hey, you know, like, 95% have high cholesterol, high blood sugar, high blood pressure, have had a heart attack or stroke, or or overweight.

Dr. Casey Means:
Yeah.

Dr. Mark Hyman:
93% of us. And all of that All of that is about metabolic health and good energy. Your book is really the insight into why that’s happening, what to do about it, and how to fix it for yourself. So everybody other than the 7% who don’t need this book, 95% of you listening out there have this and you know, I just to kind of go on for a second. I know you this is your podcast.

Like,

Dr. Casey Means:
I could listen to your talk all day.

Dr. Mark Hyman:
Yeah. One of the things that one of the things that was striking is, I co founded company function health. You heard me talking about it, and we we tracked over 3,000,000 biomarkers now. And these are health forward people. These are not, you know, necessarily people who are you know, just the average Americans, these are early adopters.

Right?

Dr. Mark Hyman:
Who are,

Dr. Mark Hyman:
like, who are the first producing of iPhones or, you know, Apple Watches? Like, these are early adopters. 95% have elevated Olympic particles and 9 89% have elevated, small lipid particles or LDL particles. And and, 56% have high APO B, which is a marker of poor metabolic health. So you’re looking at these numbers.

And what do they mean? Well, they basically mean that we’re seeing 89% of people at least have poor metabolic health in this group of people. And this is this was stunning to me. Yeah. And I’m like, holy crap.

Weren’t too big deep doo doo. So how we ended up like that? And how do how do we have have people having this metabolic dysfunction, which at the root is something called insulin resistance. Yeah. Which is sort of the thing I talk about a lot, but what what one should explain that what that is and why why we ended like this.

And why why is it half or maybe more than half? Maybe it’s 93% of the population. And it’s like, you know, it’s a it’s a continuum. Like, you don’t just go, sick. It’s Right.

You don’t get pre diabetes one day and then diabetes the other day, you have this continuum from wellness to illness. And this transition happens slowly over time. And so this 93% is those people on that transition.

Dr. Casey Means:
Yeah.

Dr. Mark Hyman:
How do

Dr. Mark Hyman:
we get here? What are we doing?

Dr. Casey Means:
And I so agree with you. I think Mark than 93%. Because if you actually look at the 1 of the 93%, that’s that’s just looking at people who fall into the normal range for all the metabolic health criteria. But if you look optimal range, I’d get I’d guess it’s less than 1% of Americans are actually optimally healthy, but

Dr. Mark Hyman:
Well, I wanna be a net 1%.

Dr. Casey Means:
I think you probably are, Mark, but, you know, to get at your question of, like, how how did we get here where 93% or more of the American adults in our population have a fundamental problem with metabolic health. Meaning how their cells are powered. And I could go into the food and the lifestyle and the sedentary behavior and the systems issues and Rockefeller and the bad economic incentives. And I’m sure we’ll talk about all of that. But I think at the highest level, the real root of why we’re here is fundamentally, it’s about disconnection.

And I think the way that I can most easily explain that is to just give people a picture of what happens your last year of medical school. You went through this. I went through this. You are asked to choose from one of over 40 medical specialties. Separate specialties to devote your entire life to.

Yeah. And climbing the ladder in the Western Healthcare System means becoming more and more specialized on a smaller and smaller part of the body, that is success in our system. Like, if you’re in a just two focuses on a one square centimeter part of the entire body. That is prestige.

Dr. Mark Hyman:
Yeah.

Dr. Casey Means:
And so you’re you’re in that system of hyper specialization. And what is built into that fundamentally is fragmentation. It’s an idea that the body is all these different separate parts that are disconnected. And so we have these fragmentation goggles as doctors that don’t let us practice medicine and treat medicine as, you know, this whack the mole game of symptom management, but also in the way we view the fundamental nature, of the body. So you in that system, it’s almost blast me to to ask the question or think, how is erectile this function connected to Alzheimer’s dementia.

That just seems so out of left field through our conventional system. How does

Dr. Mark Hyman:
your microbiome think his autoimmunozy or depression or autism. Right?

Dr. Casey Means:
Exactly. It’s all about disconnection. And, actually, there’s a disincentive to focus on other parts of the body from what your special tie specialized in because of liability. That’s out of your lane. What if you do it wrong?

And that’s a problem. And because of this, we don’t the basic framework to see the blaringly obvious fact that all of the symptoms and diseases that we are facing and suffering from in the modern western world are fundamentally the same disease. They are disease of metabolic dysfunction, insulin resistance, as you said. And

Dr. Mark Hyman:
It’s like the blind Hyman in the elephant. None all the specialists taking care of all the different parts of your body can actually see the hole and don’t understand the root causes and it’s what you’re talking about. I mean, there’s other things that drive it, but that’s like, I have a huge one.

Dr. Casey Means:
Disconnection. And I think, you know, the first part of my book is called Everything is Connect. Did because I really do think that we could just keep throwing more money at the problem, but unless the actual foundation of what we’re dealing with is true is based in truth, which is an interconnected system, we’re just not gonna heal. And I think, you know, a real a real call to action I have for people when reading this book is to to re embrace an idea of connection on all aspects of our individual lives and of the system. And I I really think about 44 main key things.

The first is this fundamental, internalization that the root cause of most of the things that we are truly suffering from that are shortening the lives of our parents, of ourselves, that are hurting our children, are fundamentally rooted in the same things, metabolic dysfunction, insulin resistance, and how ourselves power themselves, seeing that connection between all parts of the body. The second It’s

Dr. Mark Hyman:
an energy crisis.

Dr. Casey Means:
It’s an energy crisis, an underpowering energy crisis this manifesting in all these different trunks of that tree in different cell types as different diseases. So number 1 is understanding that the root cause of what is making us sick is metabolic dysfunction. The second piece of connection that people need to internalize oh, yeah.

Dr. Mark Hyman:
The second one, just just unpack a little bit specifically the conditions diseases that are linked to this that because people say insulin resistance. I don’t want it that. I I my doctor never talked to me about it. I never had a test for it. I don’t know what she’s talking about.

Like, what are the what are the diseases just quickly? And then I wanna hear your second point.

Dr. Casey Means:
So fundamentally metabolic dysfunction, insulin resistance is a problem with how cells are powered. How these Beautiful machines of our cells are powered. We have 40,000,000,000,000 plus cells in our body. They all are doing trillions of chemical reactions per second. Every single one of those kind of glick reactions needs a currency of energy to pay for that work.

That energy is ATP, that energy is made by ourselves by our metabolic processes to pay for all that work. In 93% of American adults, that process is damaged. The flow of food energy, which is a potential energy, to human energy, which is ATP, that process is blocked. So that is the fundamental issue.

Dr. Mark Hyman:
What it means diabetes is diving in the midst of plenty.

Dr. Casey Means:
Exactly. It’s

Dr. Mark Hyman:
like your cells are starting to, like, type 1 diabetes essentially as they they can eat 10,000 calories a day, but it without insulin, it’s not getting in the cell. So insulin, not working properly. Right. You’re not getting the energy. So this is this is a really important point.

Dr. Casey Means:
Absolutely. And every aspect of our rapidly changing environment has hurt the Beautiful structure inside ourselves, the mitochondria that converts this cosmic energy, food energy to human energy. So we are blocking that miraculous flow of potential energy into human energy. And because of that, we have underpowered cells. And because we have over 200 cell types in the body.

We have all these different types of cells. We’ve got retinal cells. We’ve got astrocytes. We’ve got glial cells. We’ve got hepatocytes.

We’ve got kidney cells. We’ve got know, we’ve got

Dr. Mark Hyman:
Fibrocytes and

Dr. Casey Means:
Oh, various Zika cells, myocytes. Because we have all these different types of cells, the underpowering of different cell types looks like different diseases, because, of course, the manifestation of dysfunction in a particular cell type will look different based on where it’s showing up. And so to get to your question, what does that look like? It can look like anything from polycystic ovarian syndrome The leading cause of female infertility to erectile dysfunction, fatty liver disease, stroke, heart disease, Alzheimer’s dementia, cancer, depression, anxiety, migraine, fibromyalgia, It can look like almost anything gout, premature blindness. And so and and people might say, god, these things are totally different, but the the key thing that people need to realize is that these are different cell specific manifestations of the same underlying process, which is under powering due to mitochondrial dysfunction that’s caused by our modern environment that is blocking us from converting food energy to human energy.

That is the core of our metabolic crisis, and that is what this book is about is how to both understand that. Learn about how that process is going in your own body and then take the the steps, the evidence based steps to rapidly improve that in own life so that we can cultivate the internal cellular life force that powers every cell of our body to do good work And when we have cells that are functioning properly and are powered properly, that is health. So And

Dr. Mark Hyman:
and that that’s just such a beautiful breakdown of this. And, you know, as you’re talking, I’m just thinking, you know, yes, we we we really don’t think of medicine properly. We don’t think of is fundamental root causes. And and what you’re talking about, it was sort of even insight for me. I’ve been doing this for a long time, is It it’s linked to everything.

Right? It’s heart disease, diabetes, cancer, Alzheimer’s, fertility issues, mental health issues, on and on and on. And so the the conditions that we’re all suffering from, that we’re all getting sick, all the things that you laid out at the beginning, the health care costs going up, the diseases going up, are all related to this phenomena. Hey, everyone. It’s doctor Mark.

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Dr. Mark Hyman:
One of

Dr. Mark Hyman:
the problems is why aren’t we fixing this? Like, our health care institutions profit when we’re sick. We lose money when we’re healthy. The whole system thrives on perverse financial incentives. The more things you do, the more you get paid as a matter of a patient gets better or not.

You know, we have a huge food industry in this country, $10,000,000,000,000 processed food primarily, and health care is kind of a a a huge industry all connected to, you know, this one problem, and it’s all predicated on our disease care system and our dependency. In fact, I think, I think fast food, in industry was is is invested in by the insurance companies.

Dr. Casey Means:
Like, it’s just like So dark.

Dr. Mark Hyman:
Yeah. And that

Dr. Mark Hyman:
and recently, I don’t even heard this, but the the fast food makers and and, processed food makers called the CEO of Novo Nordisk stressed about losing their market or stomach share.

Dr. Casey Means:
That’s right.

Dr. Mark Hyman:
So, you know, why why is this system working like this. Why is our help not a priority for these institutions? How do we take back control? Why is the system so screwed up?

Dr. Casey Means:
It’s very simple, Mark. It’s it’s a devil’s bargain. It’s a devil’s bargain that involves 10 plus $1,000,000,000,000 of industry that form a revolving door of customers. And I would say the 2 main industries that we’re dealing with, like you mentioned, are the ultra processed food industry and the health care system, which comprises hospitals, doctors, offices, the pharmaceutical industry, and insurance. And The stark financial reality is that every institution in America that touches our health makes more money when we are sick and they make less money when we’re healthy.

And as you know, health care is both the largest industry in the entire United States. And it’s also the fastest growing industry. It’s a business that’s designed to grow. And right now, with the incentives that we have at play in the United States, the way that the health care system grows is more patients engage in the system for a longer period of time having more things done to them and put into their bodies or taken out of their That is how the system grows. Yeah.

Dr. Mark Hyman:
It reminded me. I wanted I wanted to cut you up, but I do.

Dr. Mark Hyman:
You

Dr. Mark Hyman:
know, I remember this slide I used to show, looking at the health care costs. In 2000, when I started doing talks on this stuff, it was $1,600,000,000,000. Now it’s 4,300,000,000,000. This is in 24 years.

Dr. Mark Hyman:
Mhmm.

Dr. Mark Hyman:
It’s staggering. Right?

Dr. Casey Means:
The largest economy in the world. Right. R richest country in human history 25% of the GDP and growing. It’s wild. It’s absolutely wild.

And so you’ve got the food system that benefits, of course, and it gets its shareholder returns by having more people addicted to their products and essentially

Dr. Mark Hyman:
eating themselves to death

Dr. Casey Means:
through addiction to their food products. And then you have a health care system that happily is there to take on those patients who have made made sick due to those ultra process addictive foods, and then sent and then, of course, they aren’t incentivized, trained, or taught, or even have the framework, the connection goggles, to teach the patients about how food is related to their health care issues, sends them right back out to eat that food. And it’s just a

Dr. Mark Hyman:
Doesn’t really matter with this disease. Just do whatever you want.

Dr. Casey Means:
Yeah. Whatever you want. Yeah. So it’s just a it’s a cycle that’s based in these Mark economic realities. And I think it it’s probably similar for you as a doctor.

Like, every doctor I know is a good person. Yeah. They went into health care to help people. Yeah. But when you have $10,000,000,000,000 of an invisible hand that has insidiously corrupted every aspect of the system from the research that’s published, to how the medical school classes are taught to how you get paid in health care What happens is that you become entrenched in a system that is abjectly harming patients when it comes to chronic disease management, which is now the the, of course, the biggest part of what we treat and also takes the wins we had in the last century of health care, which were all based on treatment of acute illnesses.

And you take the trust that was in gender from that.

Dr. Mark Hyman:
And he

Dr. Casey Means:
asked people to trust the science with chronic illnesses, which has been an abject faith failure. And so that’s what’s happening in doctors. I think in in a sense, doctors are also victims, but I I remember vividly when I was in my surgical residency. And I was heading into my 5th year of surgical residency about to launch in the world as an independent surgeon, and the doctors would sit you down at lunch the attendings and say, we gotta talk about the business of this because, you know, you’re gonna have to make money. And in surgery, the unofficial mantra and euphemism of how to make money as a surgeon is you eat what you kill.

Yeah. And that’s a Mark that’s dark. That’s one that’s

Dr. Mark Hyman:
one of the punches you hear in medical school. You do. Kill.

Dr. Casey Means:
And what that means, of course, it doesn’t mean you actually kill the patient, because that would be losing a customer. But you you are the amount of surgeries that you that you book Yeah. Will determine your livelihood. And so And the the

Dr. Mark Hyman:
the nice way of saying that as a chance to cut as a chance to cure, but it’s it’s still incentivizes surgery. Right?

Dr. Casey Means:
Yeah. And of course, that that exact statement is why we all go into surgery. Those of us who go into surgery, it’s that a chance to cut is a chance to cure. I remember deeply thinking, you know, you’re at the end of medical school, and I’m like, I wanna be a badass. I wanna be hardcore.

So I’m gonna become a surgeon. I want that drill. I want that bone. So I’m gonna get in there a badass. And you think I’m gonna be a hero.

And then the rude awakening is to realize that What we’ve put on a pedestal in our society and our intervention first reactive system is that who is the hero in medicine? When you think about the hero, you think about the old white guy in the operating room with a bone saw doing a heart surgery or doing a brain surgery. That’s the hero. And when you really step back and think about it, that person in that 8 hour surgery with a patient on bypass with you know, probably a $250,000 surgery, the patient in the hospital for several weeks, that heart surgery does absolutely nothing And I mean literally nothing to change the underlying physiology that caused that heart blockage 0.

Dr. Mark Hyman:
Right. We have another terrible, you, you, the thing we say, treat them and treat them.

Dr. Casey Means:
Treat them and treat them.

Dr. Mark Hyman:
Email, like, you get them. You could do your procedure. You do your treatment and then you get get them out of the office, which is horrible to say, but it’s

Dr. Mark Hyman:
it’s

Dr. Mark Hyman:
one of the things we say because it’s like we don’t really wanna deal with all the things that actually have to be done, which is how do you address the root cause of why they’re sick? How do you change their lifestyle? How do you change what they’re eating? How do you change their social network?

Dr. Mark Hyman:
How do

Dr. Mark Hyman:
you change their nutritional status? None of that becomes part of what we do.

Dr. Casey Means:
No. And then Somewhere on that ward, somewhere down the hall is a tiny little broom closet where a nutritionist is sitting, who is, you know, an after in the system who might be tailing around on the rounds and, you know, but not the hero, not the center. In fact, probably like in afterthought, sort of like the wimpy part of the team. That’s the way nutrition has looked at. And that nutritionist, if trained properly, a functional nutritionist, has the potential to reverse the heart disease for which that patient is on the operating table.

So our paradigm of who is a hero and who is a wimp is very much dictated by the financial incentives and has just clouded us. And I would sit in the workroom as a head and neck surgery, cultrainy, and and bring in papers that said, hey. Think if we try this diet on this patient with sinusitis, you know, they might they might do better. We might wanna get rid of some of these inflammatory things in the diet. And I was told, and I quote Really?

Don’t be a pussy.

Dr. Mark Hyman:
Wow.

Dr. Casey Means:
And that was that was the mantra was, like, you did not come here to give nutrition advice.

Dr. Mark Hyman:
Wow.

Dr. Casey Means:
So of course, now I’ve embraced that. And I I’m thrilled. You know, I and so and so but it’s really dark. What what the financial incentives do to drive us to see something as heroic and

Dr. Mark Hyman:
I think you’re you’re just hitting on something. I just wanna unpack because it’s it’s it’s I don’t think most people understand the nature of our system. And it’s not is not their bad people, but the system itself creates perverse incentives that allow people to do and encourage people to do the wrong things for the bad things. And and what’s happened is that our entire like as you unpack our entire educational system, research infrastructure, professional associations, like the American Heart Association, Academy Nutrition of Nutritional Analytics, are all co opted and funded in large part by pharma and food. And it creates

Dr. Mark Hyman:
a very muddied waters

Dr. Mark Hyman:
for anybody navigating the science And we think science is this sort of high level, perfect, ethereal sort of discipline where The truth is told. And once it’s out there in a published period of journal, that’s the truth. And, unfortunately, friends, that is not true. What’s really true is that most of the system is corrupt. Most of the funding is from pharma even the NIH funding doesn’t fund nutrition, doesn’t fund root cause analysis, doesn’t fund systems thinking, doesn’t fund systems approaches, and we have a very reductionist model.

It’s based on a very outdated paradigm. There’s really been this corporate capture of our entire health and food care system. And it’s like the people in it, the doctors, the nurses, hardworking

Dr. Casey Means:
Good people.

Dr. Mark Hyman:
Good people are in the matrix.

Dr. Casey Means:
Yeah.

Dr. Mark Hyman:
They’re in the freaking matrix, and they don’t know they’re in the matrix. And so it it’s hard for them to see outside the box. So if you bring an independent paper that says, oh, here’s data that shows that if you change this diet, this this health problem will go away. That’s not really in the paradigm. Right?

So don’t bother me with that. Piece of information. Even if it’s good science.

Dr. Mark Hyman:
Yeah.

Dr. Mark Hyman:
And so we get really focused in a very narrow way with blinders on and only looking at data that’s really promulgated and pushed by food and pharma.

Dr. Mark Hyman:
That’s right. I mean,

Dr. Mark Hyman:
I I was I was, got someone said, oh, listen, artificial it aren’t so bad. And they sent me a couple of papers. I’m like, oh, really? Okay. I’ll look at the paper.

I’m very interested in science. So I looked at the paper, read the paper. Oh, this is interesting. It doesn’t seem to be a problem. Oh, who funded the study?

Oh, yeah. It was entirely funded by the American Beverage Association also previously known as the American SOTAP Association, and the other study was funded by by this guy who worked for was, done by this guy who worked for Coca Cola, was on the board of the international sweeteners association.

Dr. Casey Means:
Yeah.

Dr. Mark Hyman:
So guess what? You know, science isn’t pure and perfect. You have to be very Mark. And I would say the first thing you look at is who funded the study.

Dr. Mark Hyman:
Yes. What are

Dr. Mark Hyman:
the conflicts of interest? And even if they’re not listed, do a little homework. You might find there’s another layer that you might not know about. And so it’s really important when you start to look at this to understand it. And it’s unfortunate for consumers out there for people wanting to take care of their health or patients.

It’s very tough to know it’s true. Casey and folks like her and what I’ve tried to do over my life in my career is try to bring a sense of what what’s the wheat from the chaff? What’s true? What’s true? How do we navigate this horrible landscape that we’re in?

Dr. Mark Hyman:
Yeah. And I

Dr. Mark Hyman:
think good energy your book is just is just a really beautiful road map for people to follow to understand how we got here Yeah. And how we out here because, you know, the truth is there’s good energy to be had. Yes. But right now, most people have bad energy.

Dr. Mark Hyman:
Yeah.

Dr. Mark Hyman:
So let’s talk about What is actually causing, good energy? How do we think about what is

Dr. Mark Hyman:
the root cause of the

Dr. Mark Hyman:
bad energy and how do we shift that to create good energy. And that and that good energy isn’t just like, I have more energy. It’s really about fundamental metabolic energy that drives our life force and is at the root of all diseases. So whether you have Parkinson’s or Alzheimer’s or cancer or diabetes or many, many diseases, they’re often rooted in Hyman energy issues, which have to do with all the things you’re talking about in your book. So help us sort of unpack that.

Dr. Casey Means:
Yes. Absolutely. So, you know, good energy as well.

Dr. Mark Hyman:
Sorry for the diatribe on that. On the corporate capture of our food system.

Dr. Casey Means:
It’s my dream. So let’s just listen to you talk about this. Everyone read food fix. The way I think about how bad energy created is I is created is I think about health as really like a matching problem. Our cells have basic needs.

They have basic inputs that they need to function properly And when they get those needs met and they are not overburdened with things that they do not need, we have health. It’s really that simple. Sometimes I think about these 40,000,000,000,000 cells that as this whole self, we are essentially here to care take these cells and meet their needs. And I think about them sort of as it’s like we have 40,000,000,000,000 little children that we’re caring for, like babies and infants. And if you think about like an infant, If an infant is crying, then you go through your basic checklist of what a baby might need.

It’s like, are they hungry? Do they need a diaper change?

Dr. Mark Hyman:
Do

Dr. Casey Means:
they need to sleep? Is the temperature okay?

Dr. Mark Hyman:
Yeah.

Dr. Casey Means:
And you run through it because they can’t speak to you. They can only cry. Yeah. And so you run through it, and then you Do you change the environment? Yeah.

And they’ll settle down. That’s

Dr. Mark Hyman:
why I say that the body has only so many ways of saying out.

Dr. Casey Means:
It only has right. And with the cells, they also can’t speak. They also can’t speak, and they can’t cry like a baby. So what do they do? They generate symptoms.

And that is what’s happening, which is that our cells are not getting their basic needs met, and so they’re crying out and they’re crying out through these symptoms and these diseases that are fundamentally rooted in the mitochondria not getting what it needs. And for a baby, it might be diaper change. Milk or sleep. For the cells, it’s just a basic set of things. It’s what’s the food that’s going in, how is our stress, how is our sleep, How is our movement?

What’s the toxin exposure? What’s the light exposure getting? And what is the temperature around us? I think about those seven things as some of the key vectors that we can just run through in our head very simply. Like, okay.

How am I doing on food? Or is it getting what it needs? Are we taking away the things that are bad? How’s the movement? Are we getting enough?

Are we stimulating the cells in the way they need? How’s our sleep getting to? Are we getting good consistency, quality, quantity of sleep? Just run through the checklist. And so the book has very clear sort of quizzes that you can take to to to really take an honest stock of the different vectors that we need to think about to see if we’re meeting the needs of the cells and taking away the things that can over burden them.

Because when we run through that and we do that, health emerges fairly effortlessly.

Dr. Mark Hyman:
So busy, we’re saying take out the best at putting the good stuff, and your body knows what to

Dr. Casey Means:
And have intense compassion Yeah. For your cells. Symptoms and diseases do not arise in a you. They are fundamentally and necessarily related to dysfunction in ourselves and dysfunction in ourselves is necessarily caused by ourselves getting too much of what they don’t need or not enough of what they do need. And, of course, you’ve been talking about this for years, but

Dr. Mark Hyman:
Yeah.

Dr. Mark Hyman:
By the way, this is every doctor learns this in 2nd year medical school in a textbook we all read called The Pathologic Base of Disease by Rob is in Cotran. And in that book, in the first chapter, and I reread it a number of years ago, it basically says that that every disturbance, every pathological change, meaning anything you can see on a microscope or you can see like clara arteries or damage to the brain, every pathological change is preceded by a biochemical change. And that’s biochemical changes are related to all the things you’re talking about that we have influence over. Yeah. And also to back up mitochondria folks is basically the little things in your cells that make energy.

And it’s a powerhouse of ourselves. It takes food and oxygen. It combusts it and produces energy. And that’s a very straightforward process, but It’s screwed up by what we do and how we live. Yeah.

And that’s what you’re really talking about. It’s just as key to life. And you can, you know, you can live 30 days without food. You can live a week without water, 11 days without sleep, maybe 4 minutes without oxygen. But if you poison your mitochondria, you’re dead like that.

Yeah. But if you take cyanide, you’re done. Right? Yeah. Yeah.

Which poisons a mitochondria.

Dr. Casey Means:
So Yeah. I think a lot of our health journey can actually improve if we really start to meditate on how really miraculous these these structures and ourselves are. We have you know, tends to literally hundreds of thousands of mitochondria and different cell types. And they are the powerhouse of the cell. They convert, you know, food to energy.

But If you really think about it, it is miraculous what they are doing. They are taking this cosmic energy, food energy that’s, like, literally created when the sun hits the the leaves

Dr. Mark Hyman:
of plants and is and the sun’s energy is stored in

Dr. Casey Means:
the carbon carbon bonds of plants And then we take up that

Dr. Mark Hyman:
energy into our bodies, break

Dr. Mark Hyman:
it down, and unleash that

Dr. Casey Means:
incredible cosmic sun energy in our mitochondria Yeah. To create a currency of energy that powers us loving living, thinking, and reaching our highest potential. We’re solar powered. Exactly.

Dr. Mark Hyman:
I love that. And so anything

Dr. Mark Hyman:
that we do

Dr. Casey Means:
to hurt our mitochondria, which we do through eating ultra processed food, eating refined sugars, or fine grains, or fine seed oils, not eating real food, by not sleeping enough, by not managing our trauma and our stress, by seeing artificial light at night, by not seeing the sunlight in the morning, by living a thermonetrol existence by not protecting ourselves from environmental toxins, anything that we do to hurt that miraculous structure of the mitochondria Yes. What it does is it creates insulin resistance. It creates metabolic dysfunction, but really what it’s doing is blocking the unbridled flow of light energy, of cosmic energy through our form to power our life force and our highest potential. And so it’s it’s bigger than just these clinical terms. It’s bigger than insulin resistance.

It’s about giving our bodies what they need to create form that can that can process energy in a way that allows us to to to reach our highest purpose. And and so it’s it’s beautiful. And it’s so simple. It is actually so simple to improve mitochondrial health. And I think a message I really wanna get across to people is that the system depends on you thinking that it’s complicated.

Some profits off you being confused about what exercise is

Dr. Mark Hyman:
gonna cost?

Dr. Mark Hyman:
Industrial food complex. Is that what you’re

Dr. Casey Means:
talking about? The influencers, the fitness industry, the health care industry, the food industry. They have us all running around, like, chickens with our heads cut off consuming every strategy, you know, this month, I’ve gotta do resistance training. Now I’ve gotta do yoga. Now I’ve gotta do hot yoga.

Now I’ve gotta do pilates. Now I’ve gotta do keto. Now I’ve gotta do paleo. Now I’ve gotta do vegan. You know, now I need this mattress.

It’s like it’s it’s fascinating to just step back and realize the more research, we’re publishing on pubmed about nutrition and fitness, the sicker we’re getting.

Dr. Mark Hyman:
Well, something applied. That’s part of it.

Dr. Casey Means:
Yeah. I think it’s deeper than that, though. I think when you just like you talked about with the funding of a lot of this research.

Dr. Mark Hyman:
Yeah. Yeah.

Dr. Casey Means:
There is an incentive to make it complicated when it’s actually quite Simple.

Dr. Mark Hyman:
Michael Pollan, eat food, not too much mostly plants.

Dr. Casey Means:
Yeah. You know, maybe start by, like, not not putting toxins all over our food. Right? Maybe maybe we start by just, like, eating food that came out of the ground. You know, if if people literally just did that, like, didn’t get most 70% of their calories from a factory, We’d cut health care costs by 90%.

Like, it’s it’s really quite I don’t it doesn’t matter if that’s carnivore or vegan. If it’s real unpoisoned food, we’re gonna be a lot healthier. And so I think the system benefits off our confusion, and that’s built into every layer of our research industry, our medical education, etcetera. And so the real empowerment is to understand that and then just blow it up and take total control in your own life. And, I mean, I think a message that I put in the book that can be scary to people, as I say, don’t trust doctors.

Don’t trust the science. Don’t trust influencers. Trust yourself.

Dr. Mark Hyman:
Yeah. Yeah.

Dr. Casey Means:
Because we are living Yeah. In an age where the incentives are working against us, it’s an uphill battle. And in the last three years, we now have the tools at our disposal, at home to understand more about our bodies and how our personal choices are working for our biology than we’ve ever had in human history. We literally can have the answers and don’t need to give away our trust to other people outside of us that profit off our confusion. Yeah.

All you have to do is step back and look at the world and realize we’re the only species with experts, and we’re the only species with a chronic disease epidemic.

Dr. Mark Hyman:
I love that. I would say the smartest doctor in the room is your own body. Yes. Let’s into that.

Dr. Casey Means:
You know? And we have the tools now to do that. And everyone can access it. Literally, this is function health that you created that I invested in, which allows people to go deep inside of the center of the cell and know is it working? Yeah.

Is it working? And if it’s not, There will be clear biomarker changes that are saying that your cells are crying. Your cells are the babies that are wailing, and that’s a clear signal Shift your strategy. It’s not working. Yeah.

It doesn’t need to be confusing. It actually can be quite black and white. If I wake up in the morning, And I look at my function health results, and they are pretty much all in the optimal range. And I look at my continuous glucose monitor and I am in the very healthy normal range with minimal glucose spikes over the past 24 hours. And I wake up and I feel incredible with no symptoms, and I feel happy joyful, creative, and limitless, I know that my strategy is working.

Working. Right. And that is gonna be a different strategy from you and everyone else. And so but with that empowerment of looking at my sensors, looking at my biomarkers, and looking at my body, awareness and my knowing and my symptoms. With those things, I can say with absolute certainty that I know my plan is working, know compromised research necessary.

So I think there’s a a movement that’s gonna It’s

Dr. Mark Hyman:
actually we talked about this before in the podcast, but the highest level of evidence according to the institute of health is end of one studies. Meaning, you’re your own control. You do something, you change something, you see what happens. Yeah. You know, I I I had a patient who used the continuous glucose monitor and you created levels that really allows people to be democratizing their own biomarkers in real time by having a a monitor that you stick on your skin that tracks your blood sugar over time and you get instant feedback about what’s happening.

And, you know, most of the time is the obvious stuff. Right? It’s, you know, what we’re eating. It’s not exercising. But what was really interesting with this patient, I I had just, talking about on Saturday, Basically, he he, has been involved in optimizing his health for a long time, but his sugar was still dysregulated.

Exercise is great. Eats great. Doesn’t do anything bad. Doesn’t drink. And what we decided was he probably had some level of toxins, which we now know are another factor that drive insulin resistance.

So it’s not only what we eat. It’s petrochemicals, plastic phthalates, PCBs Yeah. BPA, heavy metals, all these things, arsenic. All this we know is linked to diabetes. It’s this is in the literature.

Yep. But, of course, if you go to endocrinologists, they’re not talking about this. We put him on a cellular detoxification regimen. And he’s like, man, my sugars for the first time are actually normal. This is amazing.

And I was like, wow, that’s really interesting feedback. So now we’re able to get feedback in real time about what’s happening in embody. So you could you could say, well, where is a randomized controlled trial that you know, environmental toxins with your detoxify someone using this protocol actually fixes their blood sugar and regulates that You might not find it.

Dr. Mark Hyman:
Yeah.

Dr. Mark Hyman:
And that’s and this is what happens in medicine. There’s this discrediting of anything that doesn’t fit the orthodoxy with this rubric of evidence based medicine, which essentially says that if it doesn’t meet the standard of the highest level of evidence, which is a randomized controlled human trial, then there’s no evidence for it that ignores an entire set of other types of evidence, basic science evidence, animal studies, smaller clinical trials, population studies, cohort studies. There’s a lot of evidence, and we have to sort of read the tea leaves. It’s not like black and white. And so anything that doesn’t fit the orthodoxy against this credited, and the way research is done is only to drive these large trials for pharma.

So you’re not getting trials on cellular detox protocols for diabetes. You’re not getting trials on big trials on nutrition for diabetes. Right? You’re getting little bit here and there, but it’s not really building the evidence base that conventional orthodoxy says has to meet Yes. That standard in order to actually believe it or do And so what it means is it’s it’s it’s a way of discrediting anything that people don’t wanna include in their in their framework or that doesn’t fit this medical industrial food complex.

Dr. Casey Means:
What you just brought up is a perfect example of how we are so blinded to the influence of some of these, these industry forces on something as foundational as our research and the hierarchy of evidence. At the top of that pyramid, is double blind placebo controlled randomized studies, you know, and baked into that, the fact that you’d have a placebo and an intervention is that it must be a pharmaceutical. Cause, obviously, if you’re doing exercise or a dietary intervention, you can’t have a placebo. You know what you’re doing. So baked in to our hierarchy of evidence is a bent towards medication intervention.

And this is where, of course, I have one studies where you’re just looking at your interventions, your complex, interdependent suite of choices that you’re making and how they’re affecting your core biology. And we can look at that with these incredible tools and technology that we have today coupled with slowing down and making the time in our lives to hear the signals from the body in the form of symptoms, intuition, and body awareness. So

Dr. Mark Hyman:
Essentially, that’s what your book is about. It’s empowering people with the knowledge, the data, the information. To actually do this for themselves. You know, and I I I think you and I both believe in democratizing health care, democratizing what we do getting out of the, you know, guilt of medicine where everything is protected by health care systems and doctors. And you can only get your health data from them and you have to ask you have to beg for it and maybe they won’t do it or maybe they will do it or maybe they’ll do a little bit, but not all what you want.

Yeah. Or not even what actually should be done because they might not know about it. No. I’d I’d asked the head of, Quest Labs and I was like, how many of your, lab tests include, you know, insulin? Right.

There’s less than 1%.

Dr. Casey Means:
Yeah.

Dr. Mark Hyman:
Know, how many include life approaching fractionation less than 1%. But these are things that are the most essential things you need to know, and then we’re completely blind to Yeah. So your book is is just is just so good in that way that helps us think about this and and empower people. So what are the what are the, principles for for good energy and for how we eat. And what do we what do we, do with the information that you’ve learned in researching all this data?

I mean, you’re like, Stanford train doctor. Super smart. You’ve dug into this. You’ve kinda try to sort through what’s true, what’s not true.

Dr. Mark Hyman:
Yeah. How

Dr. Mark Hyman:
how what did you come up with as as, the principles of good energy and how do we do that per ourselves?

Dr. Casey Means:
Well, I think one thing that every single person can do literally today as their listening to this podcast is they can go back to their health record from their last annual physical and find out if they are making good energy or bad energy. And it’s very simple. There are 5 key biomarkers that can give us a sense of where we are on that spec term. And so those 5 biomarkers to understand if you have good energy or bad energy are fasting glucose.

Dr. Mark Hyman:
My biomarker is like a blood test or Right. Any kind of thing that tells you anything about your body. Right? It could be your wearable. It could be blood tests.

It could be urine. So these are these are things we have to know. So what what are the biomarkers?

Dr. Casey Means:
Yeah. And and, you know, you can go down the rabbit hole of getting very complex about these things. But again, I I really wanna bring forward this idea that it can actually be quite simple and quite inexpensive. And so 5 of the signals from your body that there may be bad energy brewing are your levels of lasting glucose, triglycerides, HDL cholesterol, blood pressure, and waist circumference. So if you look And

Dr. Mark Hyman:
you mentioned insulin.

Dr. Casey Means:
The these are the 5 biomarkers of simple biomarkers of metabolic syndrome. Absolutely. We can go so many layers deeper with insulin, and we talk about that in the book, but just foundational, like cheap, pretty much free. And probably on your last physical would be those biomarkers, fasting glucose, triglycerides, HDL, blood pressure and waist circumference.

Dr. Mark Hyman:
And so

Dr. Mark Hyman:
triglycerides, you said. Yeah.

Dr. Casey Means:
Tregulatory. Yeah. Fasting glucose, HDL, triglycerides, waist circumference, and blood pressure. And so if you look at those, which are probably on your your panel from last year. And if you’re fasting glucose is under a 100 triglycerides under a 150 HDL above 40 for men above 50 for Hyman, waist circumference than 35 inches for women, less than 40 inches for men, and blood pressure less than 130 over 85.

If all of those are true, and you are not on medication for any of those, then you are part of that 6.8% of American adults who are categorized as quote, unquote, metabolically healthy, AKA making good energy. So that’s the just the first place to start is look at those 5 pretty much free biomarkers and see where you are. Yeah. So if triglycerides are above 150, if fasting glucose is above 100, if blood pressure is above 130 over 85. If your woman and your waist circumference is above 35 inches or HDL is lower than 50, you need to start looking at what’s going on in your cells because even though they’re pretty simple biomarkers, what they’re each saying is something about what’s happening on the inside of the cell.

But as doctors, we’re not actually even trained to think about how these biomarkers relate to internal cellular physiology, we just look at them in an algorithmic way.

Dr. Mark Hyman:
Does a drug treat this one or that one?

Dr. Casey Means:
Right. Fasting glucose up, give Metformin or insulin. If the, you know, triglycerides are high, we don’t even know what to do that with that because there’s not a drug. You know, it’s if the you know, waist circumference is high. We need to give those them thick.

Right? And so but but if you think deeper to really the core of of this mitochondrial, paradigm, you can actually know more than probably your doctor knows. Let’s think about it for a second. If you’re mitochondria, this powerhouse that converts energy, food energy, the literally the 7 70 metric tons of food we take in our body in our lifetime to convert to cellular energy. If that mitochondria is broken because of all the things we talked about.

The food, the exercise of sleep, the stress, the toxins, the artificial light, the the lack of temperature swings, these these vectors that we can talk to our mitochondria with, if they’re broken because of all these issues, sleep, liberation, sedentary your overabundance of toxins. If the mitochondr is broken, it’s not gonna be able to convert that food energy to cellular energy. And so the cell is gonna say, we can’t do it. We don’t have the capacity because I’m broken from this modern world that we’re living in. And it’s gonna protect self by blocking the cell from taking in more food energy, I.

E. Glucose into the cell to convert to energy because it can’t process it. So now the body creates insulin resistance. And of course, insulin resistance is the body essentially making the cell impenetrable to glucose by blocking the insulin receptor from working, insulin is, of course, the hormone that binds the cell and lets glucose in. So now you have insulin resistance essentially as a protective mechanism.

And So what will happen is the body the the glucose will rise in the bloodstream because it’s not able to come into the cell because the mitochondria is fundamentally broken. So how does this show up on these basic Mark? Well, our fasting glucose goes up and then also our cerides go up because the body doesn’t know what to do with all that extra glucose floating on the around in the bloodstream. So one of the things it does

Dr. Mark Hyman:
right from the

Dr. Casey Means:
Yeah. Exactly. And it’ll convert a lot of that glucose to our triglycerides. So through this framework of of mitochondrial function and the overburdening of the mitochondria, we start see these basic clinical biomarkers of metabolic syndrome and really understand what they’re actually saying about the inside of the cell and what they’re saying is that the mitochondria is suffering. So that’s just 5 basic biomarkers that you can look at.

And then the next level is to go deeper into other biomarkers that can give you even more nuance. So this is things like the fasting insulin and the high sensitivity CRP and the liver function. Yes. Liver function tests. And essentially these other lab tests that tell us what arises in the body when that mitochondria is dysfunctional.

And so uric acid, And and so in the book, we talk about this this higher level of tests. And, of course, those are the tests that your doctor probably isn’t gonna those are the all included

Dr. Mark Hyman:
in the function health basic panel for 4 99, then you go to function health dot com. It’s forward slash Mark. You jump right in and pass the wait list, and you can get all this data And what’s really important, and I just wanna sort of emphasize something, you you did the numbers you quoted for those 5 biomarkers are are numbers that are accepted by traditional medicine as the thresholds for when you kinda cross over into pre diabetes. But the truth is that those numbers are not optimal in any way. Like, your blood your triglyceride should not be a 150.

It should be in the seventies. Your blood sugar shouldn’t be a 100. It should be in the eighties. Right? Your blood pressure shouldn’t be 130 over 80.

It should be like 110 over 70. Right? Right? Your waist of covering shouldn’t be 35. It should be, like, 32 or 33 or 34 depending on how big you are.

But I and so all these numbers that are that we think of as sort of the threshold Mark really you’re already way down the road.

Dr. Casey Means:
Oh, yeah.

Dr. Mark Hyman:
And so I I think by the time your blood sugar starts going up, the this can be going on for decades. Right? The insulin resistance and the insulin that you mentioned is a better way to test for it. So you really need to do the right test, and that’s really why we created function health. That’s why, you know, you create levels and help people actually see what’s going on inside their bodies.

Dr. Casey Means:
Yeah. And I actually believe that every single person listening to this absolutely has the capability to understand their key metabolic biomarkers interpret them and understand what the tea leaves are saying. And I not only think that they are able to. I think it’s that it’s imperative that they do because meta school is not changing in the next 5, 10, 15 years, unfortunately. I would hope so.

Dr. Mark Hyman:
My daughter’s in and out. It’s like their

Dr. Casey Means:
Doctors are not learning how to read the tea leaves so you have to. Yeah. And I absolutely believe that everyone can. You make it simple. I make it simple in this book.

Sit down with a printout of your lab tests. With the book, with your articles and books, and figure figure it out. And I think there’s such a infantilizing perspective within the health care system of of patients not able to understand this, or even to go as far to say it is dangerous for patients to have this information because what are they gonna do with it?

Dr. Mark Hyman:
Right.

Dr. Casey Means:
You know? And I think that that is something I really wanna bunch

Dr. Mark Hyman:
of health. Trained to never give people their lab results. Just tell me. Your everything’s fine. Your panel is fine.

Your cholesterol is fine. Your blood chemistry is fine. You know,

Dr. Casey Means:
they might freak out. They might freak out. Yeah. And it’s like, when you actually wake up from the matrix and realize, oh my god. That perspective was put into me of not trusting patients, thinking patients are noncompliant and can’t handle their data.

They’re not educated enough to understand their data. That’s part of the system. Very paternalistic. Essentially to drive not only the industry, but to truly get us to be divorced from our common sense so that we put our trust outside of us and feed into this huge industry. And a big call to action and good energy is to actually reclaim our internal power and our internal knowing of what’s right for us and our body.

Couple that with tools and technology. And use your, you know, dot find good doctors and use your doctors as a counselor and a coach and, of course, use the health care system for acute issues. Of

Dr. Mark Hyman:
course. Yeah.

Dr. Casey Means:
But for the chronic issues, we really do need to be the CEO of our own health, as so many people have said, and and that’s a key message of actually realizing that the The the infantilization of patience is part of the whole game.

Dr. Mark Hyman:
Yeah. It’s it’s true. I think that’s really why why you created levels, why we created function health was to empower people with their own health data.

Dr. Casey Means:
Yes.

Dr. Mark Hyman:
And to make them the center of their health and the C of their health and not the health care system and take back your health from the health care system. Mean, I actually created a bill in Congress, with with, Mike Rosen, a few others, years ago called the Take Backer fact of 2009 during Obamacare. I never made it into the law, but it was basically about empowering people to actually change their lifestyle, change their behavior, and take back their health. So going back to the 6 principles, but let’s go kind of through them a little bit because they’re I think they’re quite good. The first one you sort of talked about was how food determines the structure of ourselves and a microbiome.

Right? So so just give us

Dr. Mark Hyman:
a give us a

Dr. Mark Hyman:
little unpacking of that.

Dr. Casey Means:
Yeah. So in my chapters in the book about How to eat. It’s really saying, like, the we need to stop with the dietary dogma. We need to stop with the food wars, and we need to focus on principles. Of eating.

And the first principle And

Dr. Mark Hyman:
so I wrote the vegan diet because

Dr. Casey Means:
I was like

Dr. Mark Hyman:
making a joke between paleo and vegan. And I’m like, yeah.

Dr. Casey Means:
Yeah. And and actually just think first principles. Like, food, you this is a quote from Dr. Mark Hyman:, but food is molecular information. And when we see food as molecular information, It becomes so much simpler to say, okay. There’s lots of different ways I can get the proper molecular information for my body.

My job is to get that information to the body, but there’s a lot of different ways that you can do it. All of them are thoughtful and all of them need to be based in real whole foods. But there’s many different ways to do it. So so the first principle I talk about in the book is that, you know, food determines really the structure and function of our body. And so from a structural perspective, you know, just think about, like, the cell membrane.

The cell membrane is made of fatty acids that that come from our diet, and we want there to be a healthy ratio of omega threes fat to omega 6 fats, and that is totally determined by what we put in our mouth in just a few days. We can change the composition of our cell membranes by what we’re actually

Dr. Mark Hyman:
Yeah.

Dr. Casey Means:
Putting in our mouths, and then that has a huge trickle down effect for how our cells fundamentally function and how our immune system functions because a lot of the inflammatory mediators our immune system makes are actually done by snipping fatty acids off our cell membranes and train them into inflammatory chemicals. And so based on what that ratio is that you’re eating, you’ll change the structure of the cells, which then changes the function of the cells. Similarly, if you think about Neutrogenomics, which I think is probably like one of the coolest things in all of health care, you realize that this gene. These we’ve we had this idea that genes are our destiny, but then when you learn about nutrients, no makes you realize every single bite of food you take into your mouth are actually these little little pieces of information that change our gene expression, not only our gene folding, but which genes are actually expressed and how much and when it’s absolutely incredible. So I talk about things like Curcumin and things isothiocyanates and these chemicals

Dr. Mark Hyman:
in foods. Yeah.

Dr. Casey Means:
So cruciferous vegetables. We’re not

Dr. Mark Hyman:
gonna find that in the grocery. Right?

Dr. Casey Means:
Choy, arugula, you know, these crystal just literally Google crucible’s vegetables and eat them, and it’s gonna change your gene expression of your antioxidants. Accident genes. Eat the curcumin from the turmeric and the curry, and that’s gonna change your expression of of inflammatory genes. And so Food is the structural and functional information that we put into the body. And if you really just know some basic concepts about what the information your cells need, you can choose to eat properly.

And that feeds into the 5 elements of good energy eating that I tell people to just Just learn these and learn what the sources of these are and put them on your plate. And we I talk about how the information for structure and function that your body needs comes from a fiber antioxidants, healthy protein, omega 3 fats, and probiotic sources. And if you can learn, basically, your favorite food in each of those categories and just craft your meals based on those principles, which can come from any dietary pattern. You are going to give yourselves the building blocks and the information to have good structure.

Dr. Mark Hyman:
It’s not that hard to learn. You know, like, you just have to do a little homework, read the book, look at look at what

Dr. Casey Means:
It’s simple.

Dr. Mark Hyman:
Casey’s done. And and when you go to the grocery store, think of it as your farmacy. So when I go to the grocery store, I’m like, looking, I’m hunting, like hunting and gathering. I’m hunting for the medicine. When I think of it as my farmacy

Dr. Casey Means:
Yes.

Dr. Mark Hyman:
Like p with an f, but still, even not even in William F. It could be pH, you know. And I think it those drugs in the good drugs

Dr. Casey Means:
Yeah.

Dr. Mark Hyman:
Good modulators of biology that are in the grocery store. We need to understand what they are where to go for them. So I’m always going for the christopher festival. I’m going for the Shiitake mushrooms. I’m going for the phytochemical rich berries.

I’m I’m going for the omega-3 rich sardines. I’m going I’m going for the olive oil with the oleuropean, which is an antioxidant. I I know what to choose because I and then the rest stuff just kind of fades into the background, you know. And I think if you just learn a little bit about these things, you can really be your own advocate and navigate how to do the right thing because we just don’t learn that. We don’t know.

And I think, you know, what Casey’s talking about is not just abstract. Oh, your cells, you know, aren’t great and you you make yourselves better. But, you know, we both had surgery training. I mean, your actual surgeon I was and, you know, I was a family doctor who did some surgery on the side, but I didn’t know, assist in a lot of surgeries. And I remember these patients who were super unhealthy, overweight, really metabolic and healthy, and we would try to operate them on them and they’re they’re tissues.

We’d like fall apart in your hand and you try to sew them together and the the tissues wouldn’t stick. It’s literally their cells were not functioning and the inside. And when you saw that, it was like really shocking. You know, we even had a terrible nameprint PPP. But remember what that is?

Dr. Casey Means:
Oh, no.

Dr. Mark Hyman:
PISport protoplasm. Oh. You heard that? Dark.

Dr. Mark Hyman:
Yeah.

Dr. Mark Hyman:
And it was like, PIP Protoplasm is like, what you’re made of. Right? So it’s It’s just really bad tissues.

Dr. Casey Means:
Oh, yeah.

Dr. Mark Hyman:
And it was a thing in medicine that we never talked about. We didn’t really understood. We never

Dr. Casey Means:
thought about it.

Dr. Mark Hyman:
I was like, oh, this person has that. But it’s It really affected the ability to stir surgically repair something.

Dr. Casey Means:
Yes. Oh, I saw that. I I remember saying to my family once after a day of surgery, I said, The number one motivator at this moment in my life for me to be healthy is that if I ever have to have an emergency surgery, I don’t want to be a body that is you know, so, like, yeah, like, mal functional that when that the person has to operate on me, I’m making it more difficult for them because you go in and you we were working in the neck and, you know, people who had weight, you know, so much extra fat, it’s like you’re digging through the fat for the nerves. And these are nerves that control every aspect of your facial motion and your voice.

Dr. Mark Hyman:
And

Dr. Casey Means:
it makes it so much harder to even see the nerves if it’s surrounded by in and inches of fat. Similarly, if the patient is really unhealthy, the tissues almost fall apart under your, you know, four steps. And so it’s much difficult to stitch things. So I’m with you. It’s like, if you really see the tissues up close and personal, but but of course, this is happening on our the surface of our bodies.

You don’t need to have surgery to know this. You can look at one and look at their skin and how healthy it is. And that can be a a such a signal of what’s happening

Dr. Mark Hyman:
Yeah.

Dr. Casey Means:
Under the surface. So and all of this, you know, is is a reason why I talk in the book about how so much of this actually also comes down to the food quality that

Dr. Mark Hyman:
you

Dr. Casey Means:
buy because if you if you really, really internalize that food is the building block and the molecular information of how your body will function. Of course, you are going to invest in higher quality food, but you have to believe it.

Dr. Mark Hyman:
Yeah.

Dr. Casey Means:
You know, and you really need to internalize it. So I think one of the quickest ways that people can move towards health is to just buy more of their food Yeah. From the farmers Mark. Yep. Because We take in 70 metric tons of food matter into our bodies in our lifetime, and that’s constantly turning into and 3 d printing the next version

Dr. Mark Hyman:
Yeah.

Dr. Casey Means:
Of our body, literally 3 d

Dr. Mark Hyman:
printing. 100%.

Dr. Casey Means:
And if we we, you know, because our soil is so depleted, coupled with the fact that we are processing all our food, we are literally just The micronutrients and the antioxidants and this information is literally falling out of the food because the soil’s poor and we’re processing it. So the closer you can get to food that is from good soil, so it’s enriched with more nutrients and unprocessed. More of that 70 metric tons of information that you’re both building yourself from and that is dictating the function of your body will be helpful material. Right now, it’s not only empty, it’s harmful.

Dr. Mark Hyman:
Well, well, I think I think the the the Michael Pollens had eat food. Right? What does that mean? Well, what is food? And I I talked about another podcast you know, the definition of food, if you literally go to the dictionary and look it up, it’s it’s something that maintains life or growth.

So If it’s not doing that, it’s not food. Right? So if it’s some processed junk, if it’s Cheetos, Doritos, or things that even resemble real food that aren’t real food, even like the Impossible Burger, which is a science project that’s made from weird GMO soil that I wouldn’t touch. That that’s not food. It doesn’t maintain life or growth.

And I think we have to be really straight with ourselves. I’m like, what am I doing? This is what I put, like, you know, water in my gas tank. What I put dirty gasoline in? What I Yeah.

I mean, it’s not your your car is not gonna run. I had someone do that. I I left my car in residency to a friend of mine. It was a diesel Mark, and he put gasoline in it. And the thing wouldn’t go, and it ruined the car.

And so, like, that’s we’re doing, we’re putting the wrong fuel in. And what you’re talking about with good energy is how do we fuel ourselves? Yeah. How do we fuel ourselves as the as the answer to not only our our own well-being, but to our collective social and and economic well-being as a society.

Dr. Casey Means:
Another sort of piece about the body, like, framework that I really think about all the time is like, our cells are blind. They don’t have eyes and they don’t have arms. Right? They just are cells with little receptors. And So they’re in the dark and they’re all all this stuff is just floating around.

And what’s floating around is determined by what we’re eating. And so let’s say a a cell wants to make a solenoid protein, like glutathione, an antioxidant, or a protein that’s gonna be a critical factor of our immune response, and it requires zinc or selenium to actually build that protein. Well, you get to determine whether that cell’s gonna be able to reach out and grab that micronutrient to build that protein or that amino acid based on what you’re putting in your mouth. So you need to load the body with the highest quality food possible, unprocessed from good soil, because you are gonna increase the probability that those little cells are gonna have the right thing floating around them to do what you wanna do, which is be healthy and not be sick. And You know, to have the the the support to free up the mitochondrial function so it can process that energy and power your life.

Cause fundamentally, Our life and everything we’re experiencing is just the bubbling up of the trillions of chemical reactions that are happening every second. And and what we when how we view food is is such a big piece of that. And it’s it’s another piece of the connection conversation, because I think, you know, a second kinda going back to the beginning, it’s like, second piece of connection that we’ve so lost is is this idea that we’re connected to everything else in the environment. We are connected this body to the soil, to the air, to the food, to the water, to the sunlight. All of these material and energetic forces are in constant conversation with our bodies and There’s this fascinating statement that I love from the the Dallas philosophy that’s this idea that that we need to look at the human body for what it is, which a process.

Yep. Not an entity. Yeah. And we have been entrenched in this system of thinking of the body as a thing that is separate from everything else. We are a body that lives and dies.

I’m a body. You’re a body. This is a miracle.

Dr. Mark Hyman:
Found on. It was individual.

Dr. Casey Means:
Not mutualism.

Dr. Mark Hyman:
And because of

Dr. Casey Means:
that, not mutualism. And because of that, it has entrenched to view that that sunlight and that artificial life and the computer and the food and the water and the air and the soil are all separate from us rather than the true which is that we are this swarm, this buzzing hive of of material of atoms that’s constantly exchanging matter and energy with everything around us. It is all us. And because of that individualistic sort of very western mindset, We actually it it allows us to trash the environment and not really understand how that’s what that’s gonna do to us. It allows us to totally kill the soil with industrial agriculture and pesticides and not realize that we’re just poisoning ourselves because it’s all the same thing.

So there’s an element of the book where I really ask people to internalize and meditate on our true nature, which if we had a microscope that could actually see what our bodies really are and and see how we are are just these swarms of material, we would get that but because of the limitation of our visual system, we think of ourselves at these separate things and I’ll never forget in, medical school and histology class. It was really one of impactful classes for me because, you know, you take these slides.

Dr. Mark Hyman:
Is basically the study of the cells.

Dr. Mark Hyman:
They learn

Dr. Mark Hyman:
all about the different kinds of cells in the body. Yeah.

Dr. Casey Means:
Well, you cut the body up. And you look at the tissue under the microscope. Timeline. Yeah. You’re like, okay.

Here’s skin, but really what is skin? Skin is these your little teeny thin piece of tissue is tens of 1000 of individual cells that are actually in all stages of life. Some are being born. Some are dying, some are replicating. So this this idea that we’re a thing and we’re alive and we’re separate, it’s all false.

Dr. Mark Hyman:
Yeah.

Dr. Casey Means:
And until we get back to that true understanding of our true nature and of that interconnection, we will continue to build the healthcare system on a false premise, on a false god of individualism and separation that dictates every aspect of what we do and points us in the wrong direction. So

Dr. Mark Hyman:
So you’re talking about in your book a lot of things. I mean, you cover so, so many things that have to do with not just food, but exercise and dealing with your environment, circadian rhythms, you you have a 4 week plan. It’s really very robust. And I I think it’s almost like a like a Bible snake for for health, and then it takes you from a to z. So we couldn’t cover all of it during this podcast, but I encourage you really get this book.

It’s good energy. The surprising connection between metabolism and limitless health. It’s by Casey and her brother, Cali, who’s also been on introduction podcast. And and it’s it’s I think it’s gonna make a big big big impact. I I wanna just close by, you know, zooming out because a lot of the things we talked about were the forces that are driving us to have bad energy and that are preventing us from having good energy.

In other words, from being healthy and vibrant and having our metabolic health great and our mitochondrial are great. And and there’s things we can do about it. And a lot of these have to do with with Mark social political issues that that are kind of a little out of people’s reach, but I think it’s important to touch on them. And I I wrote a book called, of Whofix, and, and we talked about some of the policy issues that some of these can be done with executive orders. They can fix things tomorrow.

Sort of kinda run through a few of the ideas. Are gonna be the most impactful because I think people need to understand that they need to be advocates when they’re at the voting booth. When they’re voting for their Congressman or senator or president, they need to think about what do they stand for on these issues.

Dr. Mark Hyman:
Yeah.

Dr. Mark Hyman:
What are they doing about this?

Dr. Casey Means:
Yeah. I mean, first of all, no one In I think the world has brought this more to the forefront than you and Cali and I are truly just, like, foot soldiers in this mission. And, you know, but I think when we really step back and think, like, what would make big difference tomorrow if this changed in our culture. 1 is we we need to not have the pharmaceutical industry controlling our media. And the way that happens is by the pharmaceutical industry essentially paying for 60% of all advertising on mainstream media.

So I think what Who

Dr. Mark Hyman:
spends the other 40%.

Dr. Casey Means:
Right. I mean, just

Dr. Mark Hyman:
Mostly big

Dr. Casey Means:
Process food. Yeah. Exactly. The rub off.

Dr. Mark Hyman:
11. Eleven commercials for junk food in the first half. I didn’t watch the second half. I just got so disgusted.

Dr. Casey Means:
Yeah. It’s hard to watch and and and watch that revolving door. And I think something that people need to internalize is that you are not the customer of the news network. The pharmaceutical industry is the customer of the food network because who’s paying the bills. It’s not you who’s watching it for free.

Dr. Mark Hyman:
The ads. Right.

Dr. Casey Means:
It’s ads. And so what does that do? It changes the core information that we’re getting that we think of as journalism and truth.

Dr. Mark Hyman:
It’s not

Dr. Casey Means:
Yeah. So you just you got your hand in your head.

Dr. Mark Hyman:
No. Because I have been involved and been on television so many times, and I how it works in the back end and how you can’t say certain things. You can’t talk about certain things. You can’t discuss. I mean, I I I my Mark example is I went I was on the, I think it was a today show.

And I did a great segment without Roker, and it was like a great thing and I met the producer. And then I say, hey, I got a great idea for another segment. She’s like, what? And I’m like, well, how about we do this 100 calorie comparison of a 100 calories of the snack packs of Oreos or whatever, whatever it And and compare that to a 100 calories of, like, blueberries or almonds. And let’s talk about this sort of difference that these have on on your body.

What are the impact of these different foods as food as medicine. She’s a great idea. So we did this thing. We got all set. I think she kinda didn’t ask for higher ups, and the talent came on.

And literally wanted to sidetrack the entire conversation because it was basically showing that all of this processed food wasn’t good and what and I was talking about the deep science of how the molecules in the real food were working on the body and how the molecules and things that weren’t really food were affecting the body. Yep. And it was a little bit challenging. And I got I never got asked back on the today show.

Dr. Casey Means:
Wow, Mark. I mean, that’s so telling. That’s a perfect example. I think of what we’re talking about. And so the basic place that we’re getting our information is deeply influenced by a 4 that wants us to be chronically ill so that we can be customers of the pharmaceutical industry.

So that’s number 1. I think number 2 is so basic, which is we’ve gotta change the farm bills to incentivize the production of nontoxic real nutrient dense food rather than talks and covered commodity crops that get current turn into processed food. So we are literally Yeah.

Dr. Mark Hyman:
We’re working on that. How how to incentivize your cat

Dr. Casey Means:
a miracle. Yeah. And I I’m I’m I mean, I will if it’s okay, I will literally quote you on your own podcast because I think it’s it’s one of the most important points that I think we just have to realize because so much the conversation about healthy food comes back to, like, that’s elitist. And it’s only for for wealthy people, but every person paying a taxpayer dollar in America, this matters for. If you are buying processed food in the United States, you are paying for that food at least four times over.

You are paying for the food in the store. You are paying for the farm bill subsidies that made that food cheaper, that unhealthy food cheaper. You are paying for the environmental damage of what that the way that food was grown is doing to our water, air, and soil, and you are paying the health care dollars taxpayer money for the health ramifications and the chronic disease of that food.

Dr. Mark Hyman:
For Medicare and Medicaid.

Dr. Casey Means:
Yeah. Is a $100, whether you like it or not. And we are the voter We are the consumers. It’s our it’s no one’s responsibility but ours. And the first way that you can do that is invest your, you know, money in buying real food from sustainably you know, growing farmers, farmers markets, and making sure that you understand who your representatives are and getting in their face through letters emails going to their office and telling them what you care about because, you know, Cali and you, have been in front of Congress, have talked to these people.

And they got a million issues on their plate. They’re not bad people, just like the doctors. But

Dr. Mark Hyman:
Right.

Dr. Casey Means:
The person who’s in their office every single day lobbying is the person Yeah. That they’re gonna get the most information from. And right now, that is the food industry who spends more on lobbying than any other industry.

Dr. Mark Hyman:
Yeah.

Dr. Casey Means:
Health care and food than oil. So food, the farm bills, We we need to understand how much of a root cause of our sickness right now is the fact that we are making the unhealthy food cheaper through taxpayer dollars. And refuse to allow that to happen because we are literally the citizens who can do that. So that’s the second one. I think a third one is Get the added sugar out of this national school lunch program.

It’s ridiculous that we’re serving children added sugar in schools. This is criminal, literally criminal.

Dr. Mark Hyman:
No biological requirement. And it’s, yeah, it’s crazy.

Dr. Casey Means:
We need to get the money out of the FDA, the USDA, and the NIH. These federally funded organizations huge part of their budget is coming from the pharmaceutical industry. Yeah.

Dr. Mark Hyman:
And food industry.

Dr. Casey Means:
That’s crazy. You know, these institutions should be representing the individuals, not the interest of the corporation. So if you’re an academic institution. If you’re an if you’re accepting federal dollars, which would be, of course, academic institutions, NIH FDA USDA, USDA, no conflicts of interest with food industry on the advisory boards, and no money from these industries. Because, of course, you know, when 95% of the people who made the USDA food guidelines for America have a conflict of interest with the processed food industry, which is what it was.

Yeah. Of course, there’s gonna be more leniency towards those foods. And the most egregious thing happened in the last food guidelines determination for the 20 20 to 2025 period.

Dr. Mark Hyman:
For America.

Dr. Casey Means:
Diitary guidelines for America, the scientific advisory board for the guidelines recommended that we decrease the percent of added sugar as total calories in the American diet from 10% to 6%. And the guidelines, the the the people who finalized the guidelines rejected Yeah. The scientific advisory board’s recommendation. And so You gotta get the money out.

Dr. Mark Hyman:
It used to be the scientists that actually made the final determination, but under, president’s George W Bush, that was chain and it became a political decision. Yeah. And now it’s politicians who make the decision.

Dr. Casey Means:
It’s very bad.

Dr. Mark Hyman:
It’s

Dr. Mark Hyman:
very bad. The one thing that occurred to me though, and then this could be a, you know, really interesting framework for thinking about this. If we actually did the right research and it’s a little bit of a chicken or anything, if we did the right research on nutrition, lifestyle, and all these things we know work, we actually funded that properly from the government, it would save us 1,000,000,000,000 of dollars in health care costs because the government pays in some way or another for about half of all health care costs in America. And so you’re talking a couple of $1,000,000,000,000. What if we took some of that savings.

We pocketed and paid down the debt. And what if we took some of that savings and we invested it in research where the government’s funding large trials and and basic science and other studies looking at this from a really dispassionate view and trying to get to the answers because I think we’re able to do that and we got pharma out and we got the food industry out and we stopped funding all of our research and restructures through industry, we maybe maybe get you some of the answers.

Dr. Casey Means:
Yeah. And I mean, I think that is very important, but just as important is to, I think, also to realize that I don’t think we’re gonna research our way to the answer. Again, it’s like no other animal in the entire war has a chronic disease epidemic. We I think it’s it’s a lot of it’s actually, like, kinda getting away from the cult of we need evidence. And, I mean, I’m sure people will bulk and say like, oh my gosh.

This is, you know, not evidence based medicine, but evidence evidence based medicine is broken. It’s corrupted. And so I’m not saying that because I’m saying you should absolutely verify what’s going on in your own body with the data for sure. Yeah.

Dr. Mark Hyman:
And a lot of good energy is all backed up by scientific evidence and research and A

Dr. Casey Means:
lot of molecular biology research. And it’s when we start to get into the, like, the nutrition interventional research that things get really hairy. And I think that we know enough right now in the science to know that nutrient dense, nontoxic, non pesticides covered, whole food, Unprocessed diets are better for health. So if I think about, like, what if we could take 2,000,000,000,000 of those dollars and literally just give people healthier food, which has been done, you know, or, like, or promote, put it towards the school lunch program, real food. And and so it’s I think it’s gonna be, But but but bottom line is we have to be eyes open in this.

And I think right now, a lot of people aren’t even aware of the issues. So that’s why of course, we have these conversations. Yep. So

Dr. Mark Hyman:
Casey, you are just an incredible spokesperson for the future where we all need to be going for how we need to rethink health care, rethink our own health, and rethink all our food policy. So you you just heard Twitter force, and the book is a Twitter force. To get a copy, good energy. It’s out now. You can go find it anywhere you get your books.

It’s called the surprising connection between metabolism and limitless health. And they can find you where?

Dr. Casey Means:
I’m at caseymeans.com. The book is everywhere. Books are sold. I’m on Instagram at doctor Casey’s Kitchen, and everywhere else all the other social media channels, I’m Casey means I’m deep. So, and then levels health is levels health dot com.

And that’s, of course, how you can get continuous glucose monitors to really under stand your own metabolic health and, be empowered to know how your diet and lifestyle is affecting you.

Dr. Mark Hyman:
Amazing. And we’ll put all those links in the show notes get the book. You won’t be sorry. KC, thank you so much for writing it for all of us Thank you.

Dr. Mark Hyman:
And for

Dr. Mark Hyman:
the world. It’s a gift.

Dr. Casey Means:
Thank you, Mark. You you know you are my hero and my inspiration

Dr. Mark Hyman:
Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts and follow me on all social media channels at doctor Dr. Mark Hyman: and we’ll see you next time on the doctor’s farmacy. I’m always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and Morin. Now you can have access to all of this information by signing up for my free Mark picks newsletter at doctor Hyman Mark I promise I’ll only email you once a week on Fridays, and I’ll never share your email address or send you anything else besides my recommendations.

These are the things that helped me on my health journey, and I hope they’ll help you too. Again, that’s doctor hyman.com forward slash Mark picks. Thank you again, and we’ll see you next time on the doctor’s farmacy. This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic And Function Health, where I’m the chief medical officer. This podcast represents my opinions and my guest opinions.

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