Introduction:
Coming up on this episode of the Doctor’s Pharmacy.
Dr. Casey Means:
These chemicals can directly impact the diversity and function of the microbiome, the hormonal control of eating behaviors. They affect thyroid function, which is directly linked to metabolism.
Dr. Mark Hyman:
Welcome to the Doctor’s Pharmacy. I’m Dr. Mark Hyman, and that’s pharmacy with [inaudible 00:00:22] place for conversations that matter. And if you ever wondered about what affects your metabolism that’s far beyond food and sleep and exercise and stress management, what are they? That is the reason you’re going to be listening today to this podcast with Casey Means who have had many times on the podcast. She’s a brilliant physician, Stanford trained doctor, chief medical officer, and co-founder of a metabolic health company called Levels. I’m a advisor and investor, just full disclosure, because I believe in it so much.
She’s an associate editor of the International Journal of Disease Reversal and Prevention and a lecturer at Stanford University, no shabby job. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tools that can facilitate a deep understanding of our bodies and inform personalized and sustainable dietary lifestyle choices. And her company Levels is all about measuring your blood sugar and many other things we’re going to talk about today. She’s been featured in the New York Times, Wall Street Journal, Men’s Health, Forbes, Business Insider and more and more and more, so welcome Casey.
Dr. Casey Means:
It is so great to be back, Mark. Thank you so much for having me.
Dr. Mark Hyman:
Now, I literally had a patient this week who was a 55 year old woman who had struggled with weight her whole life after getting pregnant. And she tried everything and has been to every doctor or seen every specialist and nobody’s found anything. And she said, “I eat healthy. I eat great. I exercise. What the heck is going on here?” And there’s a phenomena I’ve seen over and over in decades of practice, which is this phenomena of resistance to weight loss where people do all the right things, they exercise, they eat great, they sleep, they deal with their stress, they take the right supplements and the weight just does not come off.
And it is something I’ve had to really investigate and I have written a bunch of pieces about it, about the eight reasons you can’t lose weight other than your diet basically and lifestyle. I think we’re going to dive deep into this topic today and look at the things that are beyond exercise, beyond diet, beyond sleep, beyond stress management. What are the levers of metabolism that go beyond that? What are the things that you found that are the real factors that are driving problems with people’s metabolism that have nothing to do with lifestyle?
Dr. Casey Means:
Yeah, that patient example you just gave really hits home because I think we’ve all had that type of patient who is really doing everything right and not seeing the progress that they want. And so this really inspired me to dig deeper into what does the research say about what other factors might be involved in improving our metabolism, our weight, our overall health, our longevity that aren’t just the main ones we talk about, which are food, sleep, stress management, and exercise. And there are really three additional factors that seem to really have strong research backing that impact metabolic health in a big way that you’re probably not going to hear about from your doctor. And these three are one, how much exposure we’re getting to sunlight and at what times of the day we’re getting it. The second one is the amount and types of metabolism disrupting environmental chemicals we’re exposed to.
And these now have a special name of this category of metabolism disrupting chemicals called obesogens because they actually promote obesity. And the third, and this one does relate to food, but it’s a little bit more specific, is the levels of specific micronutrients in the body that we know are critical for metabolic processes to run properly in our cells. We often stop the conversation at food around macronutrients, how much protein, fat, carbohydrates are in our food, but really shifting the conversation towards specific micronutrients, these vitamins, minerals, cofactors, antioxidants in our food is another level of the dietary conversation that I think often gets missed. Those are really three that I think are strong that can accelerate or enhance that journey of weight loss, of metabolism optimization, of improving insulin resistance for many people who are feeling stuck.
Dr. Mark Hyman:
Yeah, and can I add a few more?
Dr. Casey Means:
Please. Yes. Let’s go.
Dr. Mark Hyman:
Because I’ve thought about this a lot. In fact, a case in my first book on metabolism “Ultra Metabolism” in 2005, one of the chapters was Love Your Liver. And it was really about the role of toxins and the load of toxins causing obesity in ways that really had not really imagined before. And the data since I wrote that book in 2005, has just been overwhelming about its effect on all sorts of things from insulin resistance. BPA for example, which is what you get on credit card receipts, it’s in plastic bottles, cans that causes insulin resistance. And that’s just one example. There’s a whole slew of those things, but there’s more. For example, the microbiome turns out plays a huge role in our metabolism, independent of what we eat.
And they’ve done studies on mice and an animal, little rats or whatever they do the study and they found that just swapping out, for example, a poop from a thin mouse to an overweight mouse causes that mouse to lose weight, independent other dietary intake. The microbiome is huge. Also, hormones and a lot of things go on around hormones, thyroid hormones, sex hormones, obviously insulin, which is usually involved in diet, but that can be involved in many other things that are independent of diet. And also food sensitivities I think are one that people don’t often realize that anything that causes inflammation independent of calories can cause a problem. If you’re eating something you think is healthy, but actually your body’s creating immune response, that’s going to create inflammation and that’s going to cause insulin resistance. And then there’s also other phenomena that might happen, like mitochondrial disorders that are more uncommon or other factors.
I’ve looked at so many different things over the years that are driving resistance to weight loss. And usually if you’re a good detective and you drill down, you can really get to the bottom for most people. And the obesogen thing is really true. I had a patient who was this trainer, she was a fitness trainer, super healthy, ate great, and she just could not lose weight. And we did a deep dive and we found out she had really high levels of mercury. We got rid of the mercury and she dropped 40 pounds like that. It was pretty amazing. It’s super powerful.
Dr. Casey Means:
Absolutely. And I think you really get at a key point here, which is that there are so many factors that are involved in what’s happening with our metabolism, our cell biology, and you really need to dig deep and ask those questions and have time with the patient or the patient needs to have this baseline understanding to even go down that road of identifying what is going on and what are the potential barriers to actually having the health that we want. And this is where of course functional medicine absolutely shines because we tend to have a little bit more time with the patients and actually are going down all of these different pathways that actually lead to the reality of our cellular physiology in the body.
And so I think from that perspective, at this point, I think we probably named 10 things that are related to insulin sensitivity and metabolism. And really it comes down to being a detective, like you said, and figuring out in your life, in your body, which are the factors that are at play? What are the barriers to improving them and how do we do it? And so I think knowing these things can really help just a sense of hopefulness because there’s probably several avenues that any person has not dug into before they’re at the end of the road in terms of getting their health on track
Dr. Mark Hyman:
For sure. Casey, let’s dig into the toxins. And first I want to talk about how much we learned in medical school about this, right? Zero.
Dr. Casey Means:
Zero.
Dr. Mark Hyman:
We learned about acute poisoning, but we never learned about the low… Honestly, the three things that we really need to know about our health, our microbiome, toxins, and food. We know nothing about in medical school, so it’s insane. But these are the areas that have the most leverage in getting people healthy. In terms of the framework around obesogens, what are the ones we should be most worried about when it comes to metabolism? And then we’ll get into how we diagnose problems with that and actually how the mechanism of these toxins influences our metabolism.
Dr. Casey Means:
Yes. Like you said, obesogens are toxins. And obesogens, as you can tell from the name, it has to do with fat and obesity. And so the real landmark thing that’s happened recently is we’ve realized that obesogens are specific metabolism disrupting chemicals in the environment, that it directly increased fat mass. This is not a correlation, this is causation. And there was this great paper that came out earlier this year. It was 49 pages. It was a tome. And Dr. Rob Lustig was one of the authors, and it was called “Obesity Two.” And it was all about obesogens. And it concluded that these chemicals we now know directly increased fat mass through about a dozen different mechanisms.
And it is thought that potentially 15% of obesity is directly attributable to these chemical exposures. Where are they from? They are basically all around us. They are in the air we breathe. They are in the food we eat. They are on the food we eat. They are in our cosmetics and our personal care products, our home care products. They’re in our furniture, our electronics, papers. They are all over the place. And actually a few come from natural origins like lead and cadmium, and you mentioned mercury, but most are industrially manufactured chemicals that are largely unregulated. And so some of the specific examples of where you can find these-
Dr. Mark Hyman:
Well, mercury is natural, but it doesn’t mean it’s healthy. Right? Lead and mercury are natural-
Dr. Casey Means:
Exactly.
Dr. Mark Hyman:
… But that’s not healthy.
Dr. Casey Means:
And there is that handful of natural obesogens like the mercury and the cadmium and the lead that can in increase fat mass, but you want to be conscious of how much of this you’re consuming. But the vast majority of these are coming out of factories, coming out of companies that have huge lobbying power and that are putting these in everything. And so this is things like can linings, thermal papers, toner, printer toner, vinyl floorings. They are in basically all plastics even if the plastic is BPA free. They’re found in our personal care products, especially shampoos, conditioners, lotions, deodorant, sunscreens, makeups, food preservatives, food colorings. They’re actually in drugs. Antidepressants have been known to have obesogenic properties. They’re in car exhaust. It gets in our air. Paint that goes on our walls, our clothing, they’re in flame retardants on children’s toys, on mattresses, on couches, a lot of different home care products like disinfectants.
And then of course one that is on everything, which is agricultural pesticides. All of these things that I just mentioned have been shown to have mechanistic properties that increase fat, basically the printing of fat in our bodies. This is fascinating. And the mechanisms are, it’s not just one thing. They really all work together synergistically to cause metabolic problems. And some of the big ones, touch on one you were talking about earlier today, which is microbiome. These chemicals can directly impact our microbiome, the diversity and function of the microbiome. These chemicals can alter the hormonal control of eating behavior, so actually affecting our satiety hormones and our hunger hormones. They affect thyroid function, which is directly linked to metabolism. They impact sirtuin genes, which are of course, as Dr. Sinclair has popularized, these are very important for our longevity. They change the folding of our genome, so actually our epigenetics and the way genes are expressed.
They can directly cause gene mutations. They cause inflammation. And then they can really affect our hormone receptors. This is a big one. They can either be activators of hormone receptors or blockers of hormone receptors. And of course hormones are so critical to this nuanced balance of our health and our day to day functioning. And these chemicals can literally go in and block or activate those receptors. One frightening thing I’ll just mention is that they not only affect all these things in our bodies, but they also do it to our sex cells, so our germ cells like our sperm and eggs, which means that the impact of these chemicals that are all over our environment can affect our offspring through germ cell, which is essentially our sperm or eggs, epigenetics, and DNA. We really need to all be familiar with the term obesogen, understand where they come from, and understand how to advocate both for ourselves and on a systems level to minimize the exposure that we’re getting to these in our environment. And many of them last for generations.
Dr. Mark Hyman:
Like you were saying, just thinking about how, for example, leptin is, you get leptin resistance with increased environmental toxins you get, which makes you feel like you’re hungry all the time and you get effects on your mitochondria, which helps affect your metabolism and how fast your metabolism works. There’s so many different mechanisms that are underlying this, and I think we’re now beginning to understand this. And we also see how they trigger inflammation. Any toxins, they’re also immunotoxins. They increase this process of making more inflammatory cytokines through this mechanism called NF Kappa B. And you get high levels of these cytokines like TNF Alpha, interleukin six. It’s so central to everything. This inflammation from any cause will cause weight gain and obesity. And here’s a problem that’s even worse. When people start to lose weight, guess where all the toxins are stored?
They’re stored in our fat tissue. When you start to liberate fat tissue, you start to liberate more toxins and actually there’s a phenomena of resistance to weight loss. As you’re losing weight, you’re going to actually stop losing weight because the toxins interfered with the very process of weight loss. They affect your thyroid function and many other things. It’s a little bit of a mess. You have to really help people detoxify properly and learn how to get their systems working. And that’s what’s so great about functional medicine. And I wrote an article, gosh, I don’t know when it was. It was probably forever ago. It was called Systems Biology, Toxins, Obesity, and Functional Medicine.
And it was, I think, gosh, in probably early 2000s. And it was really just looking back then at the data that we had on this. And now like you said, there’s so much more data and we’re so exposed to toxins and they’re really pretty much everywhere. It’s a little discouraging for people because what do you do and how do you start to think about this? You have these toxins. People listening are, okay, well gosh, we live in a sea of toxins, this is pretty depressing. If I eat straw. I’m still going to gain weight. What do I? How do we avoid them? How do we get them out? What do we do to help address this phenomena of obesogens in our environment?
Dr. Casey Means:
This is the key question, and I think it’s a battle that’s going to be fought on many different axes. And I say battle because it really is an uphill battle against industry that uses these chemicals and wants them in a lot of different things, and of course top priority is not necessarily our health. I think there’s really four main axes that we’re going to need to approach this on. And one is on the systems level, one is on the individual choice level. We can of course advocate through our vote and our dollar about what happens at the systems level. But then of course, day to day we also just have to choose what we’re putting in, on, and around our body. Then the other two axes really is focusing on personal avoidance, but also improving biologic resilience. How do we actually build a body that processes these chemicals effectively, detoxifies them, gets them out, and is healthy enough at baseline that we can manage this additional stress, which unfortunately is almost inevitable.
I think just briefly touching on that systems level, which you have written about in such detail and Food Fix gets into this a lot. And so I’ll just very briefly touch on this one. I think it’s a crazy statistic, but our rate of global chemical production is increasing at a rate of almost 4% a year and will probably double by 2030. And since just the year 2000, deaths from just ambient air pollution linked to fossil fuels and chemical pollution has risen by almost 70%. And very little regulation has come from this. We have a law that’s meant to protect us, which is called the Toxic Substances Control Act, which came out in the 1970s but has really been poorly implemented and we see things happening all the time where strong science comes out.
Recently the EPA put forward a proposal to get rid of a chemical called trichloroethylene, which is used in dry cleaning and removing grease from different things like clothing or car parts or bikes or things like that. And the proposal to ban this was strongly supported by science and was just completely basically rejected and withdrawn because of strong complaints and lobbying from the chemical industry. The systems level we can think about using our dollar and advocating for legislation that helps, but really it comes down to acutely what we’re doing on a day to day basis. There’s definitely some easy practical tips that we can do to help ourselves. I think the first one is eat real, clean, sustainably grown food. This is the basic building block of the body for improving biologic resilience. And if you’re eating whole foods that are grown in a clean, sustainable way, you’re getting a lot of the way there.
It means that you’re getting the micronutrients that are going to help your body process these chemicals. It means that you’re getting the different plant chemicals that are going to up-regulate our antioxidant defenses and our anti-inflammatory pathways. It means that we’re going to be avoiding pesticide exposure, which is an obesogen. It means that we’re not buying things that come in plastic. Just by eating fresh, whole clean sustainably grown food, you’re hitting a lot of the different boxes with the obesogen problem. Within whole foods, there are some that are extra special. Of course cruciferous vegetables, which are going to have the sulforaphane that activates our antioxidant defense system. This is the cauliflower, broccoli, kale, bok choy, cabbage, sauerkraut, these things that are directly going to change gene expression to protect us from some of these obesogenic chemicals. Then of course it’s what’s your food stored in?
We want to avoid plastic storage as much as we can and really try and opt for glass and other materials. And now it’s so easy to find this stuff. You can go on Amazon, you get glass Tupperware, glass water bottles, aluminum or ceramic, things like this. And again, it’s not just about BPA. We often now look for BPA free plastics, but plastics contain as many as 15 endocrine disrupting chemicals. BPA is just one and it’s great that doesn’t have that. But there’s other things like BPS and BPS and these other chemicals that we know are end endocrine disruptors. Be the weirdo who brings the bamboo fork and knife in your purse to the takeout restaurant. Be the person who always has the glass water bottle and who brings your own storage containers because these things actually do add up and make a difference. The next category that is really important-
Dr. Mark Hyman:
Be the weirdo.
Dr. Casey Means:
Be the weirdo, be the weirdo. And give these things as gifts. I have a running Google Doc of gift ideas and a lot of them are becoming basically these types of things. Give people the portable reusable wood cutlery and things like this that they might not think about but that can really help their health. I am someone who loves personal care products. I love cosmetics and all this stuff. And so this one has been really important to me, figuring out how to basically reduce the toxins and toxic load of all these products I’m using. And so I think this is a really low hanging fruit.
Basically, look at your bathroom, look at your shampoos, conditioners, lotions, makeup, deodorant, toothpaste, and probably throw out most of what’s in there and look for the brands that have very few ingredients, that are ingredients that you recognize and know, and that are approved ideally by the Environmental Working Group website, which has basically a registry of all personal care products and you can just walk through the store and search things on your phone and find out what is least likely to be toxic. I’ve really moved away from a lot of the complex products to things like, for moisturizer, you can use organic coconut oil or jojoba oil. You can use castile soap like Dr. Bronner’s for dish soap, for hand soap, for body soap. You can use vinegar and water for disinfecting sprays for your countertops. It’s actually, once you get on this train, it’s quite easy-
Dr. Mark Hyman:
It’s not that hard. Yeah. It’s not that hard.
Dr. Casey Means:
… and there’s so many great brands these day. It’s not that hard.
Dr. Mark Hyman:
Yeah, it’s super important. And then of course you need to give your body the things to detoxify, right?
Dr. Casey Means:
Right. And actually supplements can be helpful in that regard. Whole food of course is the foundation, but supplements like vitamin C, curcumin, probiotics, resveratrol, vitamin E, these have all been shown to have basically resilience boosting effects on our ability to process toxic chemicals. And I think the last one I would mention, we could go on and on forever about how to avoid these, but I think another important one is air filtration because air pollution is such an under recognized contributor of chronic disease. And so getting a really high quality air filtration system actually has been studied and has been shown to have a clinical effect on mitigating the effects of toxic air pollution. Really personal care products, whole foods, making sure you’re including cruciferous vegetables and anti-inflammatory foods, avoiding plastics and getting your air under control and maybe supplementing with some high yield supplements, those are definitely some of the things that we can do that are pretty simple to avoid the mega impact of these chemicals.
Dr. Mark Hyman:
Don’t be too depressed because there’s a lot of things you can do to reduce your exposures, to upregulate your own detox pathways. Things like saunas are great, very good for detoxing chemicals, making sure you’re eating a lot of fiber, which helps you eliminate the chemicals and sometimes you need more aggressive detox protocol with the doctor, but it can be a very effective strategy for people to help them lose weight. Let’s jump to the next topic because toxins are a bit depressing.
Dr. Casey Means:
They are. Yeah.
Dr. Mark Hyman:
But before we jump off of that topic, I saw a report recently, which shocked me. And we know about 11 million people die every year from eating bad food, not enough of the good foods, which I think is probably an underestimate, but there’s about nine million people that die every year from the environmental toxins in the environment. It’s a huge cause of global deaths, which makes it really high up there. There’s about 70 million I think deaths every year, but about I think nine million are from toxins and those are something we just don’t know anything about from a perspective of traditional medicine.
But thank God functional medicine provides a way for you to assess and treat those problems. It is a real problem. We should definitely all be focused on it and we can shift the market by changing what we buy and what we purchase and what the demand is. That’ll also help. Casey, let’s talk about the next topic, which is micronutrients. And I think it might be surprising for people to think that vitamins and minerals and micronutrients play a role in resistance to weight loss. How is that so?
Dr. Casey Means:
This is one of my favorite topics in health, I think, in part because I don’t think I learned about the idea that these micronutrients are so useful for health until way after medical school. It was really in my functional medicine training that I even, you probably remember this, but there was this whole dogma in medical school that, oh, vitamins and minerals just make expensive urine. And of course now we realize, wait a minute, what are these actually doing? That doesn’t really make a lot of sense. I hope to help people understand-
Dr. Mark Hyman:
Well, just something quick on that, Casey, I hate to interrupt, but I always say on that theory then we shouldn’t drink water because we just drink water and then we pee. We shouldn’t just drink water because it just creates a lot of excess discharge you don’t need. It’s just a dumb argument.
Dr. Casey Means:
And especially when you really actually just turn on your brain and think about the biology of this. I think just breaking down briefly, what do these micronutrients do? It makes it so obvious that line of thinking just doesn’t work. And so big picture, our bodies are energy factories. We have around 37 trillion human cells in our body. Every single one has energy factories, mitochondria to basically create the energy we need to run and to function properly. And within each of those 37 trillion cells, there’s probably in many of those cells, thousands or more of mitochondria. The numbers are gigantic and every single one of those mitochondria need vitamins and minerals as cofactors to allow their cellular machinery to work. And so micronutrients are this category of small molecules that we get mostly from food that are involved in these enumerable metabolic processes and they’re totally necessary for glucose regulation and ATP production.
And these include things like vitamins, minerals, antioxidants, and some that you’ve probably heard of are of course vitamin C, D, E, B vitamins, magnesium, selenium, chromium. There’s many, many more. And they really function in three main ways. The three ways that micronutrients function are first they can actually be structurally incorporated into proteins to make them work properly. An example of this is selenium and we have this whole class of super important proteins in the body called solenoproteins. And these are critical for our immune function. And for that protein to literally be built in this cell because all of these proteins are basically put together like Lego sets, you need that micronutrient selenium to be a part of it. And these are super important and protective antioxidant proteins and again really involves an immune cell function and many, many people are deficient in selenium.
And so that’s one way that micronutrients function is actually being a structural part of proteins. The second way that micronutrients function is to be a cofactor for cellular processes. And so an example of this would be if you are trying to convert something in the cell from A to B and it requires a protein to do that chemical reaction, that protein might need a little lock and key cofactor to basically activate it like a key in an ignition. And that is where a vitamin or a mineral can actually bind, create this tiny, tiny molecular shift in that protein that basically gets it to work properly to do that chemical reaction that might be critical for some step in a cellular signaling process. The second reason micronutrients are important is because they act as these lock and key co-factors to get these cellular reactions to work properly.
And then the third way that these micronutrients act is that they can directly act as antioxidants. They not only can be a part of building proteins that become antioxidants, but they themselves can do it. And your audience is probably very familiar at this point with what antioxidants are. But really briefly, we make all these metabolic byproducts and all of our chemical reactions in our cells every day. And when there’s an excess of these, they can be damaging, they can build up, and they can hurt our mitochondria, they can hurt our DNA, other cell structures. Antioxidants actually bind to these reactive molecules and neutralize them, so these reactive molecules don’t go around damaging things in the cells. And things like vitamin E and vitamin A, they actually have the chemical structure to bind that reactive unpaired electron on one of these reactive molecules and essentially turn it into a neutral species.
And literally sometimes if they have an oxygen and a hydrogen, these antioxidants, they can buy them with an electron and turn it into water. And so it’s truly neutralizing damaging things in your cell. And one fun thing I learned in my functional medicine training was that a common feature of these antioxidant molecules is that they have this hydrocarbon ring that basically has space for unpaired electrons. And so it’s taking the load of this reactivity in the cell and taking them out of commission. There’s really three very clearly understandable ways in which these micronutrients are so critical for ourselves to function properly. And since we get them from largely food and when we don’t have enough, we can get them from supplements, we can see why it’s so important to really be eating a nutrient dense diet to load our body with as many micronutrients as possible.
Dr. Mark Hyman:
Yeah, the truth is there’s so many ways in which these nutrients work. They’re not just a uni-functional substance like a drug, which essentially you take and it has one mechanism of action on one receptor and it’s very limited. These are multifunctional compounds which act across all sorts of pathways in our body. And I just want to highlight a couple of key things that I think complement what you’re saying, which are around how, for example, nutrients affect metabolism. And your blood sugar and your thyroid are critical in terms of regulating your weight, metabolism, and your overall health. And magnesium is of critical importance in regulating blood sugar. And Casey, your company’s all based on regulating blood sugar levels health, which is quite an amazing company for measuring continuous glucose monitoring, which helps you see what’s going on. But magnesium is so critical, but so is biotin and chromium and B vitamins and a host of nutrients that we often are very insufficient or deficient in.
And then thyroid is another one. It’s really important. For example, selenium, you mentioned selenium, that’s important to convert the inactive to the active thyroid hormone. And if you don’t convert it enough, you can’t get enough T3, so your metabolism is sluggish or let’s say your low in vitamin D, which is about 80% of Americans, or low or insufficient or deficient, the vitamin D is needed for the thyroid to actually work on the nuclear receptor to actually affect the gene expression that turns on your metabolism and all the other beneficial thyroid effects. If you’re low in vitamin D, you’re low in selenium, if you’re low iodine for example, another trace mineral that’s really important for producing thyroid function, thyroid hormones. There’s so many ways that all this is connected and we really don’t pay attention much to this in medicine, but it’s critical to have the optimal levels of these nutrients so everything can work properly.
Dr. Casey Means:
That’s exactly right. And so following up on two things you just said. I think magnesium, which so many people are deficient in, magnesium is involved, I believe, in over 300 chemical reactions in the cell. And one that we never learn about is that for ATP to be biologically active in the body, it actually has to be bound to magnesium. And there’s a little pocket on ATP that binds magnesium. And so-
Dr. Mark Hyman:
What’s ATP for those listening who don’t know what that is?
Dr. Casey Means:
ATP, adenosine triphosphate, so this is the end result of those mitochondrial energy producing processes that give us this currency of energy that we can use to run all our cellular processes in the body. ATP is just so critical. It’s what our body spends to basically do work and we’ve got to make it effectively. And to do that we have to protect our mitochondria, which means being insulin sensitive, reducing cortisol, inflammation, [inaudible 00:33:46] of stress, and really focusing on protecting ourselves with all these resilience boosting factors that we find in whole nutrient dense clean foods. Magnesium is a critical one, of course has a huge impact on neurologic function as well. And another point you touched on, which I think is so critical is that over half of Americans are now deficient in at least one critical micronutrient.
Dr. Mark Hyman:
Yeah, I think 90%, Casey, actually according to N Haynes data.
Dr. Casey Means:
So way over half then.
Dr. Mark Hyman:
And by the way, that’s at the minimum level to prevent efficiency disease. How much vitamin C do you need to not get scurvy? Not very much. Right?
Dr. Casey Means:
And we now know that the functional need that we have for a lot of these vitamins is actually much, much higher than what is recommended to just avoid deficiency. And one interesting thing about micronutrients is that it’s dynamic in our bodies. There are different days and different weeks and years that we might need different amounts of these vitamins based on what the stressors and what is being asked of our body. For instance, if you are particularly stressed or sleep deprived and are really burning through your stress hormones, you may have a higher functional need for B vitamins that week or year to basically continue producing these things. The idea that oh, we need 1000 milligrams of vitamin C per day, that’s a crude way of looking at it. It can actually be very, very dynamic. And for people who may be generating more oxidative stress and need more antioxidant capacity in the body, maybe they need much more vitamin C.
I think that’s another really important point is that these things are dynamic and unfortunately some of them are difficult to test for right now. I think really understanding, hopefully through podcasts like this and others that getting at least the baseline understanding of, okay, I need a lot of micronutrients in my body and when I’m going to the grocery store, I’m not there to buy bread and tortillas and chips. I’m on a micronutrient hunt. I am there to find as many micronutrients as possible. And I think at baseline a really good thing for everyone to do to take ownership over some of this is to learn what the maybe 10 to 20 really important micronutrients are for key metabolic processes and where you can get some of those things. And so that can at least help you shop to get those things in your kitchen.
Dr. Mark Hyman:
Yeah, I love this. You and I were trained in this, We go in the store, we know. And it’s almost like, what is it that Iron Man guy that he’s got that head goggle with the computer and you can see that monitoring everything. I walk in, it’s like I have this super position on all the food and what’s in it, what the phytochemicals are, what the nutrients are. But maybe we just for fun, let’s just go through the nutrients and just start talking about where they are. Let’s just start with vitamin A, and we’ll go through the list A, Bs, we’ll go through the whole thing and some minerals and quickly go through where people can find these things.
I’m going to start with vitamin A. Vitamin A. The best source by the way is liver. And I was just at the farmer’s market and I bought some pasture raised chicken livers and I had that for dinner with onions. It was super cheap, super delicious. That’s for sure the best source. But there’s also other sources. For example, a lot of the carotinoids get converted into vitamin A in the body, so sweet potatoes, carrots, even green vegetables have a lot of vitamin A in them.
Dr. Casey Means:
I love that.
Dr. Mark Hyman:
How about the B vitamins? Let’s go through some of the B vitamins. What’s a great source for the B vitamins?
Dr. Casey Means:
There are so many B vitamins and we basically want to get all of them in good levels. And so B vitamins, you can get them from meat, from tuna, from asparagus, from Brussels sprouts, chickpeas, lots and lots of different sources. Do you have any favorite B vitamin sources that you go for?
Dr. Mark Hyman:
The organ meat thing is gross for people, but if you actually look at the most nutrient dense source of B vitamins, it’s liver. It really is liver.
Dr. Casey Means:
Liver, yeah.
Dr. Mark Hyman:
No people want to eat that, but it also is all in the greens. And a lot of animal foods have a lot of the B vitamins, B12 particularly, eggs for sure. And also it’s found in beans and in grains and so they’re all over the place. But B vitamins are relatively easy to get, although we do get a little low in folate because we don’t eat enough greens. And if you’re vegan you tend to be low in B12. Those are those.
Dr. Casey Means:
And nutritional yeast is one. It’s fortified with vitamin B12 and so that is one place for vegans to get some B12 that I use a lot of.
Dr. Mark Hyman:
:et’s do C and D then next. We’ll just going in alphabetical order.
Dr. Casey Means:
Oh my gosh, yes.
Dr. Mark Hyman:
Where can we get vitamin C?
Dr. Casey Means:
Vitamin C-
Dr. Mark Hyman:
Not just orange juice because that’s not what you want to do for your blood sugar, right?
Dr. Casey Means:
Absolutely not orange juice. No, I think my favorite place to get vitamin C is bell peppers, so red peppers, orange peppers, yellow peppers. You can of course get it from oranges and citrus fruits, carrots as well. But those are some of my favorites. And certainly not from juice because you’re going to get a huge dose of sugar along with that vitamin C. And then for vitamin D you can get it from fish, so salmon, trout, and then mushrooms.
Dr. Mark Hyman:
Herring.
Dr. Casey Means:
Herring. Only mushrooms that are grown in UV light. If you’re at the farmer’s market, a lot of mushrooms now are grown indoors and so you want to ask the farmer, were these grown outside or were these grown in UV light? And then of course the best place to get vitamin D is just exposing your skin to sunlight outside. And so getting that UV light during the day and not being quite as photophobic as we are these days.
Dr. Mark Hyman:
For sure. And porcini mushrooms are a great source too of vitamin. They’re harder to get. And I love going to Italy because I can get those fresh porcini mushrooms, but they’re really the highest mushroom in vitamin D. Yeah. And E obviously we can get from grains and beans. The grains that have a lot of them, they germ and the whole grain foods have a lot of vitamin E. How about some of the minerals? Let’s talk about some of the minerals like magnesium and iodine.
Dr. Casey Means:
Magnesium is one of my favorites. My favorite source of magnesium is pumpkin seeds. It is the highest amount of magnesium. I think there’s 156 milligrams per one ounce serving of magnesium. That’s like what you would get in a supplementation you’d buy in the store.
Dr. Mark Hyman:
And zinc too. It’s one really high source of zinc.
Dr. Casey Means:
Great source of zinc, which is so important for our immune function. Pumpkin seeds, at least getting an ounce or so per day. I often make pumpkin seed milk in the Vitamix. I will pulse pumpkin seeds and dates in the food processor to make a crumble on top of yogurt. It’s really easy to get it in. You can crust chicken.
Dr. Mark Hyman:
I love them toasted on my salad.
Dr. Casey Means:
Yeah, toasted on your salad. The other great source of magnesium is actually chia seeds, which have over 100 milligrams per one ounce serving of course coming along with a ton of omega threes and fiber. Chia seeds are great. You can also get a lot of from very dark chocolate, from spinach, almonds are an amazing source, cashews, black beans, kidney beans, tofu, and some animal products as well, like salmon. Avocado’s a great source of magnesium. It’s pretty easy to get it if you’re thinking about it. But I especially try and back load magnesium rich foods at the end of the day since magnesium can be really good for relaxation and getting ready for bed.
Dr. Mark Hyman:
Now, here’s a trick question. What is the best source of most minerals? Do you know?
Dr. Casey Means:
Ooh, best source. Is it going to be liver again?
Dr. Mark Hyman:
No, no, no. It’s not liver. But liver’s good actually. But it’s not liver. It’s actually something that most people probably don’t eat, but is one of the most important foods you could eat for your health for many reasons. It helps prevent cancer, it helps to support your thyroid function. It’s detoxifying. Any ideas? You have it when you go to Japanese restaurants.
Dr. Casey Means:
Oh, like-
Dr. Mark Hyman:
Seaweed.
Dr. Casey Means:
Seaweed. Oh, seaweed, Okay.
Dr. Mark Hyman:
Seaweed. Seaweed.
Dr. Casey Means:
Nice.
Dr. Mark Hyman:
Seaweed is amazing.
Dr. Casey Means:
Iodine
Dr. Mark Hyman:
And there’s so many different kind of seaweeds Iodine obviously, but it’s full of minerals, polysaccharide for cancer prevention. We could go on and on, but the whole point of this conversation is that in your grocery store is a cornucopia of both phytochemicals and vitamins and minerals. And if you know where to find them, you can find them. For example, if you want selenium, we talked about selenium earlier, buy Brazil nuts. Each Brazil has 50 micrograms of selenium. You don’t want to overdose on Brazil nuts because you can get actually toxic from selenium. But it’s amazing how our food supply can be a great source of nutrients. I had a patient once, she was like, I don’t want to take any vitamin minerals and I’m committed to getting everything I need. I’m like, okay, fine. She’s like, Well I’m going to eat 17 pumpkin seeds and four Brazil nuts and one egg and [inaudible 00:42:46]
She had everything sorted out and did all the math and the spreadsheets. I mean she must have been OCD, but I was very impressed that I was like, okay, but most people are not going to be so, even I am traveling and this and that, so I make sure I take my vitamins. But it’s really important to think about thinking of your grocery store as your pharmacy. That’s really a great conversation about micronutrients. We covered obesogens. Let’s talk about something else which we don’t think about influencing our metabolism, which is light, sunlight. And you talk about five different ways that sunlight affects our metabolic health. Can you go through that with us and talk a little bit about weight, metabolism, and light?
Dr. Casey Means:
Oh, absolutely, yes. This one is fascinating and I think that the real framework I have for this is that we think of food and you have really, really brought this to the world, is that food is molecular information. Food is molecular information that tells our cells how to function. It tells our genes how to be expressed. It tells us what we’re building our body from. But sunlight is energetic information. Food is molecular information, sunlight is energetic information that does all those same things. It tells our body how to express our genes, it tells our body what time it is and which signaling pathways to activate. And so we’ve got to think about it like that, a really key input. And another really neat thing to think about is that your body doesn’t really know what time it is. It doesn’t really know whether it’s day or night.
It needs to come through our skin or our eyes to essentially tell our body what’s happening. We need to think about exposing our bodies, our eyes, and our skin to this energetic information each day at the right times to have optimal biology in our body. And so that’s just the framing. And there’s so many ways that sunlight impacts metabolism. The first of course is impacting vitamin D production and vitamin D has a huge impact on insulin sensitivity, glucose uptake, and overall metabolism. Vitamin D is a big one. The second reason is that sunlight has a big impact on our serotonin activity and the way that serotonin signals in the body. And serotonin is often that neurotransmitter that we think about in relation to contentment and a sense of general happiness. If dopamine’s more the pleasure, reward, and motivation neurotransmitter, serotonins more the contentment and calm neurotransmitter.
But it also actually has a really important impact on metabolism and our desire to eat and our desire to pursue food. And so higher serotonin levels, which we know sunlight can promote, can actually reduce our sense of craving and hunger and also stabilize mood, which has an impact therefore on our eating behaviors. Serotonin is also an interesting one. There’s also the impact of just sunlight on this family of genes called clock genes. These are genes which essentially self-regulate their expression on a 24 hour cycle. Although, when you expose your eyes to light impacts how those genes are expressed and downstream of a lot of these clock genes are our metabolic pathways. What we really want to do is get that bright light exposure first thing in the morning to tell the inside of our bodies via our eyes that it is morning, it’s time to activate these pathways, and set ourselves up for success throughout the rest of the day.
And then I think one other thing to just touch on that I of course, I’m one of the co-founders of a metabolic health company and we talk about glucose literally constantly. But I think it’s fun to think about where does glucose come from and really trace it back. And it’s actually fascinating to think that the sun is really the original source of how glucose on the planet is created in many ways in the process of photosynthesis where we take carbon dioxide and water and then the sun catalyzes the production of starches and carbohydrates in the plant that we then eat that drives all these process we talk about and that we’re monitoring on our continuous glucose monitor, it all starts with the sun. It’s sun energy that’s in the molecular bonds of this sort of substrate that we’re talking about so much.
I just think it’s also fun to back up and think about that cosmic level of this is really both the sun’s energy and the photon packets it literally sends to us across huge distances are not only driving our biology and our gene expression, but also driving the production of this molecule that we now talk about so much in relation to metabolic health. There’s just such an interrelationship between the sun and our metabolism. And really what the research is showing us now is that we have so separated ourselves from the natural cycles of the sun by being indoors all the time. And the science term for this is irregular photic signals. We’re supposed to be getting bright light in the morning and no light at night. And instead we’re really flipping that script. We’re staying inside in the mornings and then at night we’re getting all this blue light exposure from our screen.
You can imagine for a body that has evolved for millions of years to expect one thing, and then in the past 100 years or so, it’s all of a sudden getting the opposite. Well yeah, disease results from that mismatch of the information the body’s expecting and what it’s actually getting. And one last thing I’ll mention is that there’s actually also papers that are talking about blue light exposure as an energetic endocrine disruptor. We talked about obesogens as a chemical endocrine disruptor, but we need to start thinking about blue light as an actual energetic endocrine disruptor because it’s changing our hormones to have this light late at night and it’s not a small thing. Really getting back in touch with the natural cycles of when our bodies are supposed to be exposed to bright light, which is the first half of the day, and ideally within an hour of waking up, and minimizing it late at night can have really, really important effects for our metabolism.
Dr. Mark Hyman:
Yeah, it’s so important what you’re saying Casey, because most people don’t realize that light is medicine. Food is medicine, but light is also medicine. And if you have the wrong light at the wrong time, it’ll mess you up. And I’m researching a lot about light for my new book, Young Forever, which is coming out next February ’23. And I was shocked to see the amount of data on the impact of light on our health, particularly in terms of aging, cancer, longevity, all the pathways around heart disease. It’s quite amazing. And I think our circadian rhythms are so important, and as doctors we just learned that they were irrelevant. You just stay up all night, you work all day. It was insane. I think I’m still recovering from all that abuse. And the reality is that we now know how important it is.
There’s lots of ways, like you said, early morning sunlight exposure is critical. 20 minutes, no glasses, no sunglasses, and be outside in the bright sun if you can. Ideally blue blocker glasses at night when the sun goes down. Candles are great. I love it when the wifi goes out and the electricity goes out and we got candles in the house, it’s awesome. I always feel better. I sleep better. I think it’s important to make sure we really understand the power of light and on our circadian rhythms and disturbing those rhythms is a big factor in health. And the light bulb can really screw us up. I read a book years ago called Lights Out about the effect of the light bulb on our chronic disease epidemic, and it’s quite significant.
Dr. Casey Means:
It’s so true.
Dr. Mark Hyman:
Let’s talk about how we measure our metabolism. We talked about some of the big factors that affect resistance to weight loss in metabolic health, whether it’s environmental toxins and obesogens, micronutrient deficiencies, disturbances in circadian rhythm and light. We talked about the microbiome a little bit briefly and talked about a few other things that we don’t have time to cover today. But the reality is that people who are struggling with resistance to weight loss can find a way through and they can learn how their bodies work and they can start to fix these disturbed metabolic pathways by optimizing their health. And the thing I love about you, Casey, as a doctor is you just realized it was this big problem and you decided you wanted to do something really strong to fix it. And you created a company called Levels Health, which allows people to measure their metabolic health through looking at their continuous glucose monitor. Talk about what that tool is, what it does, how it works, what you can learn from it, what we’re seeing, and the role of a continuous glucose monitor in the management of our metabolic health.
Dr. Casey Means:
The CGM is really a revolutionary tool in that for the first time ever, we are able to track what’s going on with our metabolism in real time. And we can understand in a closed loop way how each thing that we’re eating and how we’re living in terms of our exercise and our sleep and our stress are affecting our metabolism in real time. And the really cool thing is that we own this information. You’re seeing it from a sensor on your body to your smartphone. You’re not going through a doctor and waiting on hold for two hours to get your results of a one single snapshot test that you get once a year.
It’s real time data that you’re generating all the time.These continuous glucose monitors are a small sensor that you wear on your body that are taking essentially a lab test, a lab measurement of your glucose, your blood sugar, every 10 to 15 minutes depending on the sensor that you’re using, and sending that information to your smartphone so you can iterate and pivot and make different decisions each day that are going to compound to improve your overall glucose control, insulin resistance, and then all the downstream things that come from that.
And so that’s why I’m just so excited about this technology and why we started a company around it is because empowerment and understanding your own body is the name of the game in terms of how we’re going to reverse this metabolic disease epidemic. CGM is definitely one of the really important aspects of my health journey personally and as well as I think going to be a really powerful tool in helping with general metabolic awareness that’s going to hopefully drive doctors to practice differently and insurers to act differently. And we’re going to hopefully start to see a real change in the tide of this epidemic of blood sugar problems that are now affecting over 50% of Americans.
Dr. Mark Hyman:
Honestly, I’ve been doing this for so long, Casey, and I’m thankful for what you’re doing because I first started writing about this over 20 years ago and diagnosing and treating it probably 25 more, 20 more, I’m old anyway, a long time ago. And it’s just been disheartening because we just keep getting worse and worse and worse and the data just gets frightening. We thought, okay, well there’s maybe 60% of people overweight, now it’s 75%, used to be 30% obese, now it’s 40, 42% of the population’s obese. And then we got this new data on metabolic health and 88% of Americans are in poor metabolic health. That means 12% are metabolically healthy. And then this new data came out from Tufts, which is even worse. It was 6.8% of Americans are metabolically healthy. What does that mean? That means that means that 6.8% of Americans don’t have high blood sugar, high blood pressure, high cholesterol, are not overweight and haven’t on a heart attack or stroke. That means 90, I’m not good with math, 93.2% of Americans have one of those things. That’s frightening to me.
Now more than ever, it’s important for people to get a hold of their metabolic health. And that’s really why I love what you’re doing. And by the way, if anybody’s really interested in trying out Levels, you just go to levels.link/hyman, levels.link/hyman. You can learn more, sign up. And for anyone using my link, you’re also going to get exclusive bonus content of Dr. Casey and I walking through our five daily longevity tactics that we’re implementing in our own lives right now. I hope you love this podcast. Thank you, Casey, for joining us. If you loved it and you know someone with blood sugar, which is probably 93.8% of the population or 2% whatever, 2% of the population, give this podcast to them, share it on social media. Give a comment, how have you managed your metabolism? What have you learned about your resistance to weight loss? How have you fixed it? What people can learn from each other. It’s pretty awesome. And subscribe wherever you get your podcast and we’ll see you next week on the Doctor’s Pharmacy.
Outro:
Hi everyone. I hope you enjoyed this week’s episode. Just a reminder that 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. If you’re looking for help in your journey, seek out a qualified medical practitioner. If you’re looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It’s important that you have someone in your corner who’s trained, who’s a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.
