8. Dr. Casey Means: Impact of Metabolic Dysfunction, Actionable Tips to Optimize Metabolic Health, Key Metabolic Biomarkers and More

Is your metabolic health the key to unlocking overall wellness? In our latest episode, we sit down with Dr. Casey Means, a leading voice in metabolic health, to talk about how your metabolism affects everything from obesity to Alzheimer's. Dr. Casey also dive into how our industrialized world is disrupting cellular biology and fueling chronic diseases, but she also shares hope through precision health and functional medicine. Plus, she also shared actionable tips to boost wellness, the importance of tracking key biomarkers, improving metabolic function for women in menopause, and so much more! Dr. Casey Means is a medical doctor, writer, tech entrepreneur, aspiring regenerative gardener, and outdoor enthusiast who lives in a state of care for the miracle and mystery of existence and consciousness. Her book, Good Energy: The Surprising Connection Between Metabolism and Limitless Health is available now! We also discuss: (04:24) Mitochondrial Health for Overall Wellness (09:36) The Power of Walking & Movement (15:41) Accessing Ancient and Modern Wisdom (21:53) Metabolic Dysfunction and Obesity (32:45) Early Detection of Health Issues (37:58) Optimal Health and Fasting Glucose (48:26) Understanding Atherogenic Cholesterol Particles (54:21) Promoting Human and Planetary Thriving (01:02:26) Revolutionary AI Simplifies Nutrition Tracking (01:32:00) Blue Zones and Longevity Secrets To learn more about Dr. Darshan Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ To learn more about Dr. Casey Means: Instagram: https://www.instagram.com/drcaseyskitchen/ Book: https://www.caseymeans.com/goodenergy Website: https://www.caseymeans.com/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease and, most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Is your metabolic health the key to unlocking overall wellness? In our latest episode, we sit down with Casey Means, a leading voice in metabolic health, to talk about how your metabolism affects everything from obesity to Alzheimer's. Dr. Means and I have known each other for over a year, and she is as knowledgeable as she is passionate, and I've come to know her as a true friend. Dr. Means dives deep into how our industrialized world is disrupting our cellular biology and fueling chronic diseases. But she also shares hope through physician health and functional medicine. She shares actionable tips to boost wellness, the importance of tracking key biomarkers, improving metabolic function for women in menopause, and so much more. Dr. Casey Means is a medical doctor, writer,

• 1:33Dr. Darshan Shah?

  tech entrepreneur, and co-founder of Levels Health. She's an expiring regenerative gardener and outdoor enthusiast who lives in a state of care for the miracle and mystery of existence and consciousness. Her book, Good Energy: The Surprising Connection Between Metabolism and Limitless Health, is available now. I can't wait for you to hear my podcast with Dr. Casey Means.

• 1:59Dr. Darshan Shah?

  Casey, this is so incredible to have you here. Thank you so much for joining me.

• 2:03Speaker 01

  Oh, my gosh, Darsha, and I had such a pleasure to be here in your gorgeous new studio.

• 2:08Dr. Darshan Shah?

  Thank you. Yeah, we love this. We love the studio. And it's just like such a great vibe. Like, I feel like it's like so inspiring to be here and have these conversations. So that's why I like doing these live. And thank you so much for joining me live.

• 2:19Speaker 01

  Oh, my gosh, any chance I get to be near you and the next health ecosystem, I am in. So this is great.

• 2:25Dr. Darshan Shah?

  Thank you. Well, I have a ton of questions for you. You are such an incredible expert in our field and a friend. And so I love having these conversations because I know we'll get down to the real, the real information that's really going to help people. So with that, if you could just kind of tell the audience, what do you consider yourself an expert at? What are you passionate about? Who is Casey Means?

• 2:49Speaker 01

  So I'm a medical doctor, trained in the conventional system, took a hard right turn towards more precision health, functional medicine. And where I've really landed in terms of my passion is metabolic health, something that a lot of us are thinking about right now. Because as more and more research comes out and we start putting the pieces together, we realize that metabolic dysfunction is the root cause physiology driving most of the chronic disease and most of the chronic symptoms facing most Americans today. It is the issue that we need to be focusing on. It's broken in over 90% of American adults. It's caused by our, you know, toxic, modern, rapidly changing industrial world and how that's hurting our cellular biology. And this is ultimately where my path in medicine has led me and what I need to share

• 3:33Speaker 01

  with the world, because the vast majority of doctors do not understand metabolic health on the deepest level and how it connects these conditions we're facing today. And so that's really where my passion is, is educating about metabolism and how to track it, how to understand where you stand and how to improve it.

• 3:49Dr. Darshan Shah?

  Yeah, and you know, what you've done, Casey, is with your book, Good Energy, I love that book, my favorite read over the last couple, few months, thank you for writing that, but you've put a renewed focus, or maybe not even a renewed, an initial focus of just for everybody, all scientists, physicians, on metabolic health, because it really is, you know, I think about everything I've learned in medical school, it really is as simple as getting your metabolic health right. I feel like that being the guiding principle, we can help so many people. And I'm so glad you've simplified it to that, to that thing.

• 4:23Speaker 01

  Thank you.

• 4:24Dr. Darshan Shah?

  So on that, you know, when you're talking to people, what is the one kind of big overarching factoid that you want to give to the audience to say, this is, out of all the things out there, if you're going to look at the Pareto Principle, the 20% of the information is going to make 80% of the difference?

• 4:39Speaker 01

  Yeah, I mean, we have to all be focusing on the mitochondria, this part of our body that makes the energy that is the foundation of all health. I think just reorienting this crazy health journey that so many of us are on, trying all the different things, and orienting it around what is supporting the mitochondria. I think that's the key message that people, if they understood that and knew the basic ways to track the function of this beautiful little part of our bodies, and also know how to support it, we would get so much farther in our efforts. You know, we're just throwing a lot of spaghetti at the wall, but if we threw it towards mitochondrial health, that would really help. The amazing thing is that, and this is sort of a key factoid that I think can really help people, is that there

• 5:21Speaker 01

  are some very simple tests that can give us sort of a gestalt of what's going on with this aspect of our health. It doesn't need to be the $10,000 workup, it can be the $50 workup to get us the 80% of the way there. And that's really understanding the basic criteria of metabolic syndrome, things like triglyceride levels, fasting glucose, hemoglobin A1C, HDL cholesterol, your blood pressure and your waist circumference. I mean, these are basically free on an annual physical, and they will get you 70, 80% of the way there of having a snapshot of where you stand. If you are in the optimal range for all those biomarkers, you represent 6.2% of Americans. There are literally only 6.2%

• 5:59Speaker 01

  Of Americans now that meet the optimal range for all of those criteria. And the great news is when you see one that's out of the normal range, you can change it. They're all actionable in two to three months. And so if we can track those every three to four months throughout the rest of our life and just commit to that, we can answer the question that we all want to know, which is, how am I doing? Am I healthy? Am I doing the right stuff in my exercise and my food and my stress management? If you track those things, those basic biomarkers, you can actually have some clarity and certainty that what you're doing is working. And I think that's incredibly empowering. So knowing where you stand and tracking over time with the very basics that, of course, the sky is the limit with metabolic testing.

• 6:43Speaker 01

  And I love the more advanced metabolic testing. But I think for the average American, you should be able to rattle off triglyceride, glucose, A1C, HDL, as if it were your phone number. I should be able to say to you at a dinner party, what's your triglyceride? You should be able to say to me, 47 milligrams per deciliter. It should be able to come off the tip of our tongue that much. That needs to be a paradigm shift.

• 7:03Dr. Darshan Shah?

  Right, absolutely. And, you know, I talk about this a lot with my patients is, I know you're seeing me as your doctor, but I want you to become the boss of your own biology, become the CEO of your own health. And being a CEO, you're not going to look at your KPIs, your key performance indicators, once a year and have someone else come and do it for you. That's what you're doing with your primary care doctor, right? You go once a year, they're looking at it for you, and they're basically telling you it's okay or not okay. But to them, not okay is really you are now in a diseased state.

• 7:33Speaker 01

  Yeah.

• 7:33Dr. Darshan Shah?

  And we know these things changed 20 to 30 years prior.

• 7:36Speaker 01

  Yeah.

• 7:37Dr. Darshan Shah?

  And so understanding those biomarkers, and we're going to dive in as this conversation goes on, exactly what those biomarkers are, the optimal ranges. Everyone needs to know what they are for themselves. Don't let someone else track these for you. And I'm a big fan of just making it analog. Get a spreadsheet. Like, you don't need to do all these fancy, you know, services that plot things for you. Just even if you have a spreadsheet.

• 7:58Speaker 01

  Yeah.

• 7:59Dr. Darshan Shah?

  At least you know what the number is and what it means.

• 8:01Speaker 01

  Absolutely. Put it on the calendar every quarter. Get some basic labs drawn, tracked on a spreadsheet. You will be 100 times ahead of everyone. Around you.

• 8:10Dr. Darshan Shah?

  Exactly.

• 8:10Speaker 01

  Yeah.

• 8:11Dr. Darshan Shah?

  Exactly. So to that, once you know your biomarkers and you kind of understand where you're at, what's two or three habits that you wish more people would focus on to get their metabolic health in a good place and keep it there?

• 8:23Speaker 01

  Yeah. I mean, number one is never touch ultra-processed food ever again. And I really mean that. Take a vow today to just eliminate it. It is an experiment in history that's only about 75 years old that has totally failed. It's killing Americans. It's causing kids to have chronic illnesses. It's a science experiment that's done in factories to make Frankenfoods. It's totally unnatural. It's causing our bodies to freak out, our guts to be destroyed. Never eat ultra-processed food again. I don't love to start with the "don't do this." So what that really means is eat real, unprocessed, organic food that ideally is locally grown. And I actually used to be one of those people who's like, "Oh, local, that sounds kind of frivolous and sort of like a nice to have." The reason it's valuable to eat this fresh, organic food is because that comes from somewhere

• 9:07Speaker 01

  near you is because every mile of food transports from the farm to your house, which right now in America, the average piece of food is transported 1,500 miles from farm to your plate. It is losing its precious nutrients that are inside the food that are basically medicine for our cells. We want that food to be filled with all those molecular compounds that make our cell biology work, which is why we want to get it from the farmer's market, picked the day before, and eat it quickly or freeze it. So that's number one. Number two is really around, I mean, I would say it's a toss-up between resistance training and walking, but I would say we need to be moving more throughout the day. And this is where walking and steps are a great thing to track. The evidence shows from top journals, like Journal of American Medical Association,

• 9:52Speaker 01

  that if we walk over 7,000 steps per day, we slash our risk of premature death and obesity, Alzheimer's disease, depression, diabetes by 50 to 70%, depending on what disease and what study you're looking at. If we get up to above 10,000, the numbers are even better. So, but 7,000 is so attainable. And the average person really overestimates how much they're walking. They've studied this, and we think we're moving way more than we are. The body is spectacular. It's meant to be in motion. Moving our bodies in a low-grade way all throughout the day literally changes our genetic expression. It moves glucose channels to cell membrane and keeps them there. So even though over the past hundred years,

• 10:35Speaker 01

  we've become sedentary desk workers and knowledge workers, we must find a way to build movement into the fabric of our everyday lives. You talk about exercise snacks, which I love, but it's really as simple as making sure you're standing up and moving for a couple of minutes every thirty to forty-five minutes throughout the entire day to keep those glucose channels of the cell membrane. And you can use steps as a proxy for that. If you're getting seven thousand to twelve thousand steps a day, it probably means you've gotten up quite a bit throughout the day. Because if, I will tell you, on days where I'm sitting at my desk and I'm not thinking about moving, I can easily, it can be eight PM and I can have two thousand steps. So it's very easy to fail on this, which is why tracking is valuable. So I would say, Amin, for at least seven to ten thousand steps a day and holding yourself accountable with a wearable,

• 11:19Speaker 01

  like an Aura or Fitbit or an Apple Watch.

• 11:22Dr. Darshan Shah?

  Oh, that's such great advice. On the food thing, you know, buying local, you and I, before our hike, we go to Thorn Farms and it's just such a great experience, too, just being out in nature and buying food from farmers markets. If you haven't done it, I highly recommend. It's actually a fun, a fun thing to do, right?

• 11:38Speaker 01

  Yeah, it's not only fun as a family outing. It has so many benefits. One is, I think that you get to be out in the sunshine while you're shopping and that would be probably my third actual quick tip is get outside more. I mean, the sun is our life source. The sun is the source of all energy on our planet. It's incredible. Our metabolism, one of the reasons that inspires me so much is because fundamentally, what our mitochondria are actually doing, yes, it's breaking down food and turning it to energy. But what it's really doing is breaking down stored solar energy from the sun that's stored in the carbon-carbon bonds of plants or the animals that eat the plants. And we liberate that in our bodies to use solar energy to power our lives. That's miraculous.

• 12:21Speaker 01

  And now the average American spends ninety-three percent of their time in a car or a home. We are separated from the sun and And this is one of the key problems with our health because it screws up our circadian biology. It actually, I think, more spiritually depletes us from connection to nature, which is so important. And so when you go to the farmer's market, you are getting fresher food, you are in the sunshine, you are walking around and you are buying food that is not covered in toxic pesticides or plastic wrappers, both of which are destroying our health. We're now finding that nanoparticulated plastic are in the mitochondria and destroying our mitochondrial health. So those are all reasons to shop at the farmer's market. And there's now 9,000 farmer's markets in the country.

• 13:05Speaker 01

  It's worth the effort to drive a little bit farther to go to it.

• 13:08Dr. Darshan Shah?

  Absolutely. It reminds me of a little story. The other day, someone sent me a message on Instagram saying, I feed my kids these canned peaches. Is that healthy? And I'm like, OK, well, send me a picture of the canned peaches, but send me the nutrition label. Grown in Mexico, packaged in, canned in Thailand.

• 13:26Speaker 01

  No.

• 13:26Dr. Darshan Shah?

  And then sent back to us with added high fructose corn syrup.

• 13:29Speaker 01

  No. It's actually hard to fathom.

• 13:32Dr. Darshan Shah?

  Right.

• 13:33Speaker 01

  And also, when you just think about the emissions, you know, and just what's happening to our planet, you know? I mean, we have really, there is a mass extinction of biodiversity happening on our planet right now. And a lot of that is because we're doing crazy stuff like this, like shipping peaches from Mexico to Vietnam to the US when you could tomorrow, you could today, plant a peach tree in your yard. It would take five years to start blooming probably, but like, we gotta rethink our, these, these things that we have normalized and realize that it is a fraction of a second of human history that this stuff has been normalized. And we need to realize it's not, it's not working. It's not working for our health. It's not working for the planet. We are inextricably linked to the planet.

• 14:18Speaker 01

  And as consumers, we have to reject buying these things. If your product's being grown in Chile, Vietnam, China, it's not serving you. It's not serving the planet. I really do believe that part of really healing our chronicity epidemic is actually getting closer to nature, which means eating food closer to the source.

• 14:36Dr. Darshan Shah?

  Yeah, exactly. My next question for you is, you talk to a lot of people. I see a lot of patients. And I want to know from you, what do you think that most people struggle with in getting their metabolic health in order?

• 14:49Speaker 01

  I think one of the biggest issues is that there's so much competing information out there about what is the right strategy. And you go on social media and there are just thousands of voices yelling about what's the right thing to do. Is it keto? Is it vegan? Is it zone two training versus resistance training versus walking versus Pilates versus heliotropic breath work versus the box breathing? It's like, it actually is, it'll make you go crazy. It's overwhelming. And so I think people get paralyzed. Right. Analysis paralysis. And that's why I actually have, you know, a part of my book that says, don't trust doctors, don't trust influencers, don't trust the science, don't trust me.

• 15:34Speaker 01

  Trust yourself. Because, and I mean that, it's a bit hyperbolic, but what I mean by that is don't blindly trust anyone. We are in this beautiful moment in human history where we have access to all the information, which can be overwhelming, but we have access, which is really cool. Not only of American science, but global science and also every indigenous and, you know, ancient culture, what they did for health and healing. So we have access to all of it. That's incredible. We also have tools and technology that are cheap and easily accessible to know exactly how our body is functioning. And we also have the power to slow down a little bit and actually just listen to what our bodies are telling us, listen to our symptoms, realize our symptoms are a gift,

• 16:17Speaker 01

  unplug a little bit from the crazy distraction industrial complex of our modern world and just sit with our bodies for a few minutes every day and see how it's doing. Ask it what it needs. Together with ancient wisdom, modern wisdom, modern technology, simple analog, you know, habits, we can actually know exactly what's working for us and what's not. The world doesn't want people to realize that because if they can sell you a solution with you sort of being a passive bystander, that's a lot easier. But this is why I recommend being the owner of your labs, getting them done regularly. Because let's say you do commit to a whole food plant-based diet, you know, and you're like, I'm gonna try this. I've read Michael Greger, I've read Neil Bernard, I believe this, I want to try it. Good for you.

• 16:59Speaker 01

  Track your biomarkers. If they're improving, if you feel incredible, if you're waking up with joy and energy, go for it. But test your biomarkers, test your micronutrients, test your blood pressure and your waist circumference, maybe get a DEXA scan, make sure everything's looking good. And if it is and improving, good for you. You get to unplug from this confusion matrix that we're in. So that's why I empower people to trust yourselves. And what I mean by that is listening to your body, knowing what biomarkers matter, making investments in your health, seeing how it works, and then iterating. And then you get off that treadmill of confusion.

• 17:36Dr. Darshan Shah?

  Yeah, that's such a great point. I think on the trust thing, you know, I think another aspect of that for everyone to realize is every single human on this planet has a different biology. And it's when you're given advice, you're given advice as though this is the one thing that's going to work for everybody. And you and I both know that, just like with your diet, you know, whether you eat carnivore or you're going vegan, opposite ends of the spectrums. There's some people that veganism will totally work for their biology. And there's some people that a carnivore diet will totally work for their biology. And then you have people in the middle that it's some combination and you just got to figure out what's right for you.

• 18:10Speaker 01

  Yes.

• 18:11Dr. Darshan Shah?

  So on the trust aspect, I feel like, you know, we talked about this a little bit earlier, is that there's this pyramid of evidence that we that we all, you know, look at when we're evaluating studies. And we always like to focus on the randomized controlled trials. But what's more impactful for you as an individual human is to realize you're at the end of one. You need to do a study on yourself. You need to figure out, using self experimentation and tracking your own biomarkers, what is going to work for you. And that's what I love about your message as well, is that once you figure that out, like you said, you unplug, you stop listening and stop trying to trying to make more adjustments that are contrary to what's already working for you, because you've already found what works.

• 18:53Speaker 01

  Yeah, yeah. And I think with randomized controlled trials, one of the things that's an inherent flaw of them is that they isolate very specific variables and try and basically say, okay, with this one variable versus placebo, let's see what the Outcome is, but that's not the way the world works. We live in a web of interdependencies. We live in a deeply rich contextual universe, you know? And I think it's, it's, you can never almost isolate one thing. And also, when we do try and isolate one thing, we often default to the studies being about drugs because that's a very easy intervention. It's much harder to do an RCT on a holistic dietary and lifestyle strategy

• 19:38Speaker 01

  because it's, it's too many variables. And so this is where N of one is so helpful because if you have an ORA ring, if you have your quarterly next health or function health or levels lab work, and you have maybe a continuous glucose monitor, and then you try on a bunch of different habits and maybe a several supplements, and maybe you are on some medications. You can take all those variables as like this, is this orbit that's working with your body and see on all these biomarkers how it's affecting you, which is ultimately all that matters. Maybe we can use the RCTs with, for some directional information about what seems to work in populations. But all that actually matters is what's happening to you.

• 20:21Speaker 01

  And so I love that point and I think it's really, really important. And I think science, you know, needs to evolve its thinking now that we do have the ability to track people individually. We don't need to lump them into huge populations and then give blanket recommendations, basically advertising to the mean.

• 20:38Dr. Darshan Shah?

  Right, no, that's such an important point. With that, I want to talk a little bit more about something that I see a lot of, and I'm sure you do and every practitioner does as well. I would say at least half the people that come to me when, when I ask them, what are your health goals? The number one answer is weight loss, right? And so there's such a focus that's happened over the last 50 years on weight loss. And when there's a focus on this, you have a ton of marketing around it, people trying to sell you things, et cetera. And a goal that I try to have with all my patients and just for the population in general is to refocus the conversation away from weight loss and more into, weight is just one biomarker. Of what's going on and it's probably one of the least important biomarkers.

• 21:24Dr. Darshan Shah?

  And just breaking that conversation down into what's really important. Things like skeletal muscle mass, metabolic health. And I want to get your perspective on the conversation around weight loss and how you're trying to make kind of a change in that, in that conversation.

• 21:38Speaker 01

  Yeah, I think we would move forward by leaps and bounds in our culture if we oriented less around talking about weight, which is emotionally and culturally charged, and it always will be, towards metabolic health, because while obesity does track with metabolic dysfunction and your likelihood of having metabolic dysfunction, if you are dealing with obesity is much, much higher. It is, obesity in many ways is a symptom of metabolic dysfunction, just like heart disease and Alzheimer's and fatty liver disease and hypertension and all these issues that we're facing are symptoms.

• 22:17Speaker 01

  They're branches of this tree of a cellular dysfunction that's happening all over the body and showing up as all these different faces. One of those faces is obesity. One of the words in healthcare that I really hate is the word comorbidity, because we were trained in medical school like, oh, how interesting that like obesity and heart disease might go together. Like if you see this, you should look for that, without actually learning that on the invisible intracellular level, we've got these core disturbances happening in our cells that are leading to all these issues that are actually fundamentally, if we looked at it through a cellular lens, in many cases, the same thing. And in the book, I talk about this as the trifecta of bad energy,

• 23:02Speaker 01

  which is really means the trifecta of physiologic factors that we see in metabolic dysfunction, which is chronic inflammation, mitochondrial dysfunction, and oxidative stress, excess free radicals. Those things are present in most American bodies and they're leading to all these issues, including obesity. And so what would be so great is if we could help people really track their metabolic health. And then maybe, you know, if someone is a little bit overweight, but their metabolic biomarkers are Perfect. The data says that they are probably going to live a full lifespan. That's pretty cool. You know, they should know that and, you know, be able to think about and identify with their health through that more realistic, true framework as opposed to thinking, God, I have these extra pounds like this sucks.

• 23:46Speaker 01

  Maybe they're totally metabolically healthy and it's actually not negatively affecting their health that much. Similarly, someone who's very lean, who feels like, well, I'm lean, I'm healthy, could be dealing with intense metabolic dysfunction. This is the term we talk about sometimes in healthcare, toffee, thin on the outside, fat on the inside.

• 24:04Dr. Darshan Shah?

  Skinny fat.

• 24:04Speaker 01

  Skinny fat. And this is a large percentage, up to 40% of people who are lean are dealing with metabolic dysfunction. So we have to know, and they are going to have a shorter, harder lifespan, you know, if they are metabolically dysfunctional, even if they're thin. One thing, I don't think it's necessarily helpful to totally throw out, and I'm not, not that you're doing this, but to throw out weight as part of the conversation. Because especially, and you might feel this way as well, being a surgeon, there are aspects of excess adipose tissue that make life harder regardless of whether you're metabolically healthy or not. For instance, chronic knee pain. We know that, I think for every pound of fat, it's what, like six extra pounds of force on our knee with every step?

• 24:46Speaker 01

  And you're going to have much higher rates of osteoarthritis when you are doing surgery. If someone is, has excess adipose tissue, it makes it more difficult for the surgeon to find the nerves, to see the blood vessels. It's just a, I mean, it's a harder surgery. And, you know, other things related to like skin folds and fungal and all these things. So that's the reality is that there are aspects of weight, I think, above and beyond metabolic health that we should also be thinking about. But I think orienting the conversation towards, am I metabolically healthy or not? Yes or no? And helping every person know how to track that would be a much richer and more helpful and actionable conversation.

• 25:24Dr. Darshan Shah?

  Yeah, I totally agree with you. So to dive into the science a little bit more, just as simple as you can make it. You mentioned the trifecta, right? So I would love to get your simplest explanation of what mitochondria are, what are they doing? And how does the trifecta happen in a cell? And what does that then lead to in our physiology? So I know that's a big question, but I, you've, I've heard you talk about this so many times. I'd love to hear.

• 25:51Speaker 01

  Well, the mitochondria do a lot of things, which, and we're learning more and more every day, all the roles they have in our body. But for the purpose of this conversation, I think one of the key roles that they do is they simply put, convert food energy to human energy. And I think we sort of forget this idea that like food, we take in so much food in our lifetime. We eat on average about two to three pounds a day. So over a thousand pounds per year, somewhere between, depending on the person, forty to seventy metric tons of food in our lifetime. And of course, that's pleasure and that's nutrients. But one of

• 26:30Speaker 01

  the purposes of food is to convert potential energy stored in the carbon-carbon bonds of food into ATP, a currency of energy that our cells can use to power every single chemical reaction that we do in all of our cells, every second of the day, for our entire lives. Death is the absence of metabolism. So when we stop powering the body, we're dead. And one of the interesting things I think about metabolic dysfunction, and one of the things that empowers me to be so passionate about is that the fact that so many Americans are metabolically dysfunctional, it's basically like we're, our environment in our modern American, Western world, is hurting these energy factories, our mitochondria, synergistically through our toxic food system and our sedentary behavior and our environmental

• 27:15Speaker 01

  toxins and our lack of sunlight, all this stuff. So it's kind of like, we're all living a little bit dead while we're alive, which is really sad. We have this one moment in eternity to be here, the ultimate privilege, being alive. And we're allowing the environment to make us a little bit dead while we're alive. That is so disturbing. It's a dimming of our life force. And so when we talk about the physiology, basically, you have the mitochondria being damaged by exogenous factors, this exome, all these things around us. And there's really like eight or nine main things I think about that are hurting the mitochondria. We've got the ultra-processed food covered in pesticides and not enough nutrients in our food to support our mitochondrial health. We've got sedentary behavior.

• 28:00Speaker 01

  We're sitting almost 80% of the day and we're sarcopenic. We don't have enough muscle. We're not sleeping enough. Our sleep is now fragmented because of light and sound and our culture. We're not getting enough quantity, quality, or consistency of sleep. And we're sleeping 20% less than we were 100 years ago. Our emotional health is shattered. 40% of 18-year-olds report a mental health diagnosis. Mental health issues are through the roof. We are living in chronic fear. The average American feels fear every single day and loneliness. Emotional health is poor and our stress is high. We're dealing with environmental toxins that hurt our mitochondria. 80,000 synthetic toxins in our food, water, air, home, personal care products that were invented by industry over the past 100 years.

• 28:43Speaker 01

  We also have these interesting things that have changed with our relationship to light. Like we talked about, we're not outdoors getting the solar energy during the day and then we're blasting our retina with blue light. At night, that's screwing up our circadian biology. Our relationship with temperature has changed drastically in the past 100 years. We're living in this like 72 degrees thermo-neutral existence where we never get real swings in temperature, like hot or cold, which previous to about 75 years ago, I mean, there wasn't AC or central heating in most homes. We were feeling the temperatures and that was a stimulus to our mitochondria to do their best work. And then the last one I would mention is just medications. The average American's taking, getting about 16 prescription medications per year. And many of these medications are actually disrupt mitochondrial functions, cellular functions.

• 29:28Speaker 01

  So our world has changed. It's synergistically hurting our mitochondria. And this is leading to mitochondrial dysfunction that generates oxidative stress, which is basically, essentially, if you've got this broken furnace machine, it's kind of going to spew out bad byproducts. And that can be these unpaired electrons on molecules that then go around trying to neutralize themselves and bind to things all over the cell, the fats, the proteins, the DNA, and create dysfunction. You do not want a free radical neutralizing itself on some important cell structure. This is why antioxidants are important because they will neutralize the free radical. So we've got all this oxidative stress happening because of the mitochondrial dysfunction from the environment. But you also have oxidative stress actually independently being created by a lot of those factors. Factors that I mentioned as well.

• 30:12Speaker 01

  Then, so now you've got this cell. So we're thinking about this orb with these mitochondria inside that are damaged. They're spewing out these reactive free radicals and they're not able to produce enough energy. So what does that cell feel? It feels threatened. It can't do its work. It is a shit show. And so what does that do? That recruits the immune system. The immune, that cell is sending out inflammatory mediators saying, I am under duress. I need help. And our immune system in its incredible power comes to help that cell. But the immune system, unlike if there was like a bacteria or a virus where it could do something about it. It could engulf it and kill it. It can't do anything to help this cell.

• 30:56Speaker 01

  Because everything that's hurting this cell is outside of the body. It's our environment. It's our food. It's our, it's the toxins. And so they are trying, and this leads to chronic inflammation. Because until we change these inputs and the exosome and the environment, we never change the situation. And that cell continues to be under duress. And so you've got this tornado of mitochondrial dysfunction, oxidative stress, chronic inflammation. That is the cluster that's going on in the average American body. Not in one place, but all over the body. So then what you kind of get is the collateral damage of all those processes. You get underpowered cells throughout the body that cannot do their work, that cannot power the chemical reactions that let them be functional. And what does dysfunction look like?

• 31:41Speaker 01

  In the liver, it could look like stored fats inside the cell that's fatty liver disease. In the brain, it could look like dysfunction of our glial cells, our neurons, our astrocytes, which could show up as chronic fatigue syndrome, migraines, Alzheimer's dementia, brain fog, ADHD, autism. All conditions which are now linked to mitochondrial dysfunction, oxidative stress and chronic inflammation. In the ovary, it could look like polycystic ovarian syndrome, which is the leading cause of infertility in the country, which is a metabolic disease. In the penile arteries, it could look like erectile dysfunction. In the vessels elsewhere in the body, it could look like stroke or hypertension or heart disease. So what we need to focus on when we're thinking about Disease is instead of siloing everything into different specialties focusing on the

• 32:24Speaker 01

  symptoms, we need to go deeper inside the cell, understand if this trifecta is happening inside the body, and then work to eliminate the causes in our environment that are causing them. So we get mitochondrial dysfunction, we reduce oxidative stress, we quell the chronic inflammation, and we have a functional, well-powered body that can do its work and give us the happiest, healthiest life that we want.

• 32:45Dr. Darshan Shah?

  Yeah, that's such a beautiful explanation, Casey. I love that. Like, why do we all learn this in high school biology? Like, this is what they should be teaching us.

• 32:53Speaker 01

  Or middle school.

• 32:54Dr. Darshan Shah?

  Or middle school, right? Exactly.

• 32:55Speaker 01

  It's simple.

• 32:56Dr. Darshan Shah?

  It's so simple, and it can change your life, you know? And so what's really incredible about our human bodies, but also concerning, is that we mask all the damage that this entire system, toxic exposure, cellular health dysfunction, we mask this for decades until it's too late. And that's where, and what's really, what was really counterintuitive about about the whole thing with going to your doctor and checking your biomarkers is, we only tell people when it's too late, right? And this is where I love, like in your previous company with, not your previous, you're currently there, with the continuous glucose monitor, we have the technology now between things like the ORA, continuous glucose monitor,

• 33:39Dr. Darshan Shah?

  all these biometric tracking devices, sleep monitors, we can see on a day-to-day basis what is going on inside of our biology and get indication that this is happening way earlier, even earlier than your biomarkers will change, your blood biomarkers, right? And so this is where I think people need to empower themselves and understand that this is available, you can track it yourself, you can find out moment to moment the data, and you can do something about it a lot sooner. And so, yeah, I'd love to start talking about some of these biomarkers with you and the tracking devices. So where do you want to start? Tracking or biomarkers?

• 34:15Speaker 01

  Ooh, let's start with biomarkers.

• 34:17Dr. Darshan Shah?

  Let's start with biomarkers.

• 34:17Speaker 01

  Because I think those are going to be more accessible to people, although I recommend all of it.

• 34:22Dr. Darshan Shah?

  And when you say accessible, like you can literally write these five or eight biomarkers you're going to mention on a piece of paper, bring it to your primary care doctor, and your insurance should cover this, right?

• 34:32Speaker 01

  Yes.

• 34:32Dr. Darshan Shah?

  And so if your doctor is refusing to order it for you, what should you do?

• 34:36Speaker 01

  Find a new doctor.

• 34:37Dr. Darshan Shah?

  Exactly.

• 34:38Speaker 01

  I would say.

• 34:38Dr. Darshan Shah?

  That's what I say too, just find a new doctor.

• 34:40Speaker 01

  If your, if your doctor, ooh, this is going to be a controversial statement. But if your doctor won't order you a fasting insulin and HSCR P and you take a good faith effort to educate them and, and get them to understand why you want it and they won't, I would say you should find a new doctor. There are basic, cheap tests that tell us so much about our longevity and health. And if your doctor doesn't understand that, then it's a problem.

• 35:05Dr. Darshan Shah?

  Yep. And I will back you up on this totally because, and I know we're going to get a lot of hate messages from doctors that are like, what are you talking about? But I will a hundred percent back you up on that because people need to be empowered with these numbers and they're so cheap to get.

• 35:19Speaker 01

  Yeah.

• 35:19Dr. Darshan Shah?

  I mean, literally a lab can get these, get these for 30 bucks, right?

• 35:23Speaker 01

  Yeah.

• 35:23Dr. Darshan Shah?

  And so.

• 35:24Speaker 01

  I would also say if your doctor is not willing to order these for you every quarter, that's also a big red flag.

• 35:29Dr. Darshan Shah?

  Right.

• 35:29Speaker 01

  Because it means they don't understand the dynamicism of the human body and how these markers are leading indicators of so much down the road and, and really actionable. So, and you know, so ways that you can deal with that is you could go to ifm.org and find a functional medicine doctor in your area. You could potentially try a naturopathic doctor. You could do virtual care with Next Health. You could order Function Health Labs. You could do Parsley Health online. Like, there's actually a lot of options now to, to get access to this stuff, some of which are not very expensive and some of which are actually covered by insurance. So, yeah.

• 36:06Dr. Darshan Shah?

  Excellent. And even your insurance company has a list of in-network doctors and sometimes this takes visiting a couple of them before you find one that aligns with what you're trying to do here.

• 36:15Speaker 01

  That's right. Yeah.

• 36:16Dr. Darshan Shah?

  So some of these biomarkers, these blood biomarkers that you're testing every quarter, what are some of the most important ones there?

• 36:21Speaker 01

  So number one, fasting glucose. And at first I'll list the ones that every doctor will likely order and then some of the more nuanced ones. So fasting glucose, right now, normal, non-diabetic, non-pre-diabetic range would be under 100 milligrams per deciliter. I think it's probably better to be trying to get your fasting glucose in the 70 to 85 milligram per deciliter range for most people because there's actually been a lot of research that has shown that as you creep. Up into the high end of the normal range. So like that 98, 99 milligram per deciliter. Your risk of future disease goes way up. I would rather be in the lower risk category of the normal category. So for talking normal range is less than 100. Optimal range, I'd say the research points more to 40 to, sorry, 70 to 85 milligrams per deciliter.

• 37:04Dr. Darshan Shah?

  And just, I'm so sorry to interrupt you, but just double click on that.

• 37:07Speaker 01

  Yes.

• 37:08Dr. Darshan Shah?

  Everyone is hyper focused on this. You have disease levels, you have normal levels, and then you have optimal levels. And they're all three different numbers. And so just because you're not in a disease and you're a normal, doesn't mean you're optimal. In fact, you could be so far away from optimal that you're almost in a disease state. And the directionality of this, the sooner you find out that you're headed in the wrong direction, the sooner you can make changes that will get you back on course, right?

• 37:35Speaker 01

  Absolutely. Yeah. And especially if you're looking at a combination of labs, if you're in the high normal for a lot of them, that together is painting a picture for you. The tea leaves of that say that there is a problem. And if you are low normal or optimal range for all of them, like that's a pretty good sign that you're kind of crushing it. So you need to look with, so for every test that I mentioned in my book, and I know that you focus on it, Next Health, there's a disease, pre-disease, normal, and optimal. We want to shoot for optimal. And the reason fasting glucose is such a valuable test is because glucose and fatty acids are the two substrates that we generally use to create that cellular energy ATP through mitochondrial processes.

• 38:19Speaker 01

  And when the mitochondria is damaged through all these exogenous factors, the cell is essentially going to reject glucose from coming in because the cell can't handle it. It can't do anything with it because the mitochondria is broken. Then you're going to see it start rising in the blood. So that's why it's like, if you squint a little bit, it can be a helpful marker of what's actually happening with our mitochondrial health. But in its own right, it's a better test used with these other tests, but it can give you a bit of information for sure. The next one I would say is triglycerides. I love this test. Triglycerides, the normal range is considered less than 150 milligrams per deciliter. I would say for me, I definitely think of the optimal range as more like less than 100, maybe even less than 70.

• 39:01Speaker 01

  It's also really actually not that hard to get your triglycerides less than 70 if you're essentially eliminating all processed grains and sugars. It's not, it's not that hard. I've seen people drop their triglyceride levels from 350 to 80 in six months just by cutting refined grains and sugars. So that's really important. And what triglycerides is telling you about your mitochondrial health is if your glucose is rising in the bloodstream, because again, it can't be shuttled through the mitochondria effectively to make ATP. That glucose needs to go somewhere. It can't just sit in the bloodstream. The bloodstream doesn't like that. It causes inflammation and other problems. Glycation, it sticks to things, creates issues. So the body actually converts a lot of it to triglycerides as a storage form. That thing lives in our bloodstream or goes to our fat cells. So again, it's another,

• 39:46Speaker 01

  if you understand a little bit about what it is, it can tell you about what's happening inside the cell. So I'd like to see a person walking in with a fasting glucose of 79, a triglyceride of 45, and I'm thinking, wow, this person's really trying. Then hemoglobin A1C. So this is a marker of average glucose over the course of about three months. What it represents is what percentage of our red blood cells hemoglobin molecules have sugar stuck to them? Glycation, like I just mentioned. And if the blood concentration of glucose is higher, more glucose is going to stick to hemoglobin. The percentage of glycated hemoglobin is going to go up. So it's another marker of average glucose levels. And basically what your tissues are being exposed to in terms of glucose in the bloodstream and the interstitial fluid.

• 40:28Speaker 01

  Because glycation, sugar sticking to things, causes problems in the function of our cells and tissues. We want that number to be lower. So less than 5.7 would be considered non-diabetic. And the research more shows that around the five range would be much more optimal. So that's hemoglobin A1C. HDL cholesterol, this one is one that I think is emerging in real time, our understanding of HDL. It sort of formerly was thought to be the lipoprotein that was good for, for health, so good cholesterol. And you actually, it's one of the only ones in this category that you want higher. But there's more research coming out about essentially that HDL is a complex,

• 41:12Speaker 01

  you know, category of lipoproteins and function of our HDL actually makes a big difference, not just number. With that said, it is still part of the metabolic syndrome criteria. And what is considered normal by that criteria is above 40 for men and above 50 for women. So you want it higher. But when, in my review of the research for my book, really more in the like 50 to 80 range, a little bit higher than what's considered normal would be more optimal. But that's a biomarker that's going to continue. We're probably going to have better tests for HDL function down the line. Weight circumference and blood pressure are interesting because they don't take any blood. So waist circumference is helpful because

• 41:54Speaker 01

  it's telling us about how much fat is around our organs, which is visceral fat. So there's different types of fat in the body, some which are more likely to cause metabolic dysfunction and others aren't. So the fat like under our skin, the subcutaneous fat that you can pinch is actually not that dangerous to our health. It's the fat that we have in much smaller quantities around our organs, which is visceral fat, metabolically active fat, that is going to cause big problems for us. And that is deposited more because of insulin resistance and metabolic dysfunction. And so by just taking a tape measure, and if you're above 35 inches in women or 40 inches in men, that's a sign that there might

• 42:34Speaker 01

  be too much fat around our organs, that more of that apple shape. And so the stricter, there's, it's hard to say what the optimal ranges are because it's actually ethnicity dependent, but probably lower is better for most people than 35 inches for women and 40 inches for men. So that's a sign of visceral fat, which could be a sign of insulin resistance, which of course is related to mitochondrial and metabolic dysfunction. The last one, blood pressure, which is so fascinating and so easy to check, and we could be checking it every single day, easily, at home. We want this less than 120 over 80. And for this one, optimal range and normal range seem to be pretty close. I mean, a little bit lower is better. You don't want to be symptomatically hypotensive. But this is, this one's so interesting because that mitochondrial Dysfunction that leads to insulin resistance.

• 43:19Speaker 01

  The cell essentially protecting itself from taking up more glucose by becoming insulin resistant. In high insulin levels and insulin resistance is going to impact our body's ability to make nitric oxide, which is the molecule that dilates our blood vessels and lets us have normal blood pressure. So, blood pressure, you know, people might think, well, how is this related to mitochondria and our metabolic health? And it's all through that insulin nitric oxide pathway. So if we're having trouble producing the chemical that dilates our blood vessels, we're going to have higher blood pressure. So you want to see that low and healthy. There's other things that affect blood pressure too, but that's a big piece. So together, those simple, less than $50, often free on our physical biomarkers, give us quite a snapshot.

• 44:02Speaker 01

  Then, just briefly, I'll mention the some sort of higher level test that I actually do think we should get every quarter, but they're going to add costs and probably a longer conversation with your doctor. Is a fasting insulin, because again, when that cell can, is not processing glucose well to energy, the cell's going to protect itself by blocking the function of insulin, which is what takes glucose out of the bloodstream into the cell. And that's going to cause your insulin levels to rise because the body's going to be like, we gotta get this glucose out of the bloodstream, more insulin, drive that glucose into the cell. And the cell's like, help, I can't do anything with it, I'm broken. So that's insulin resistance. And so as insulin levels rise, it can be one of the earliest signals of all that we've got metabolic dysfunction. Because the insulin levels will rise and actually that will work for a while.

• 44:46Speaker 01

  That higher insulin level will drive glucose into the cells. And there was a paper from The Lancet that was astonishing a few years ago, that showed that insulin levels may rise 10 to 15 years before our fasting glucose starts changing. So we've got to check this for, as an early marker. There is no designated normal range for fasting insulin. Some lab slips will say less than 25. We want it to be between 2 and 5, 2 and 6 milli- I use per milliliter, really tight. To us, that's saying my insulin is low, my body can take this glucose out of the bloodstream without much work. That's where we want to sit. CRP, this is a nonspecific inflammatory protein marker made by our liver.

• 45:31Speaker 01

  And this is helpful because it tells us a piece of that bad injury trifecta, chronic inflammation. Do we have an inflammatory burden in the body? CRP will go up. Normal ranges for this typically are less than one. Sometimes between one and three, it will be considered like moderate risk. What the data actually shows, based on my review, is that it needs to be, for optimal outcomes, less than 0.36 mg/dL. Much lower than the optimal range of one. You want your body to not be in a chronically inflamed state. So I like to see it on the lab slip, less than 0.3. But 0.36 is seems to be the threshold where we really reduce all-cause mortality.

• 46:15Speaker 01

  And then vitamin D is wonderful because it's very related to insulin sensitivity, and it's so actionable. Like you can get out in the sun more or take more vitamin D, K2. And so that one, we want to see between about 60 and 90. And then the last one I'll mention is liver function tests. I love liver function tests. AST, ALT, these are the transaminases that will leak from our liver cells if they're damaged. And one of the key things causing damage in our livers today as modern Americans, it's not hepatitis C, it's not even alcohol. It's the food we're eating, which is overwhelming our liver. And the liver is the first pass for all digestion. So it's getting hit by all this processed food we're eating,

• 46:58Speaker 01

  and it's overwhelmed and it's laying down fat inside its liver cells. The cells are filling with fat. This is non-alcoholic fatty liver disease, which is affecting about 40% of American adults now, 20 to 25% of children. And the cells will essentially die or explode, release transaminases, and you'll see your AST and ALT go up. Normal ranges for these often are around like less than 45. It depends on the lab. But when I was reviewing the literature, I actually found that like less than 18 for both AST and ALT is optimal in terms of future health risks. So. I really try and get it below 18.

• 47:39Speaker 01

  And often on a liver function test, they'll also throw in this other test called GGT. Gamma-glutamyl transprise. And this one's actually a fascinating liver marker as well because it's actually one of the only cheap tests that we can get that tell us about oxidative stress. GGT is involved in glutathione recycling. And so glutathione is our master antioxidant in the body that we make. We can eat antioxidants or we can make antioxidants. So if you're using up, if you're having a high burden of need for glutathione, probably because there's a lot of oxidative stress in the body, your GGT will rise. So having GGT low, like around less than 10 is a sign that the oxidative stress burden is low.

• 48:19Speaker 01

  So that's kind of my package of pretty cheap, easy tests to give me a peek. You know, ApoB for sure, really helpful. I guess that would be one other I would add as well. The only one I'd add to that list is ApoB. To give you a sense of atherogenic cholesterol particles. And a lot of debate on what optimal range is for that. If you're Peter Attia, you're like saying you want it to be in infantile levels, like 20 to 30. Others like more like the Tom Day Springs say, I believe, like around less than 60. If you actually look at the literature, they say like less than 130. So probably we want to be closer to that like 60 level. And ApoB is a fascinating one because particles, cholesterol particles in the blood that

• 49:04Speaker 01

  are known to promote heart disease will have a protein on the lipoprotein, you know, cholesterol triglyceride protein sphere, the lipoprotein that is an ApoB particle. So it's going to tell you about all the pro-heart disease causing particles in the bloodstream. And so obviously we want that to be lower. And having read and listened to a lot of, you know, the experts in this topic, it appears that there's almost no lower limit. Like there's not a deleterious health effect by having a very, very low level of that, which is so fascinating. And so that's certainly part of my health journey is working on continuing to get that lower and lower. So that's kind of the package. And if you were

• 49:46Speaker 01

  Write those down while listening, like, ask your doctor and maybe they'll, maybe they'll get them for you. You know, I think that would put you on a really, really far ahead in terms of understanding your health.

• 49:56Dr. Darshan Shah?

  Absolutely. And then, so that's exactly my package. And then I also add, I also add one more thing. I try to get people to buy a biolip, but it scales something like an in-body H20N, which I'm not, I don't have any relationship with the company. I just use it a lot and find it to be the one that most accurately gives you a good indication of the directionality of your total body fat and also your muscle mass. And so just because a number isn't exactly accurate, because sometimes, you know, you compare that to a DEXA scan, it's going to be off. However, you know, the directionality of it. And with all of this, it's all about the directionality versus, you know, really focusing in on just one number. And so, you know, you get a scale, you get a blood pressure cuff. There's also some intricacies around blood pressure. You have to make sure, you know, getting your blood pressure done at

• 50:41Dr. Darshan Shah?

  the doctor's office is just basically a garbage measurement. The person doing your measurement is rushed, you're stressed, it's not done in the right position. So making sure you're doing it, you know, the same time, first thing in the morning, three measurements in a relaxed state. I think that's really important, doing that once a month, and then getting those blood tests every quarter. So I'm going to list these out in the show notes for everybody. And that way they can download it with the optimal values. And I'll even put in a spreadsheet so that people can track these values over time. And really, like, it might sound a little bit overwhelming to people to listen to this for the first time on this podcast, because you're listening to them. But once you have it in a piece of paper, it's really not that much. This is very manageable for most people to do this on their own. Understand what, just, just these, just understand these. Now, obviously,

• 51:26Dr. Darshan Shah?

  there are thousands of biomarkers you can do. But these are the ones that really have a lot of great science behind them. They have a lot of, they have the ability for you to really understand what they mean and to follow them directionally. I think that's what's really important.

• 51:42Speaker 01

  And I think people might think like, well, what about my hormones? What about my thyroid hormone? What about this and that? And it's like, those are all great, too. However, there is no hormonal health without metabolic health.

• 51:52Dr. Darshan Shah?

  Exactly.

• 51:53Speaker 01

  It is, we're talking about the base of the pyramid of health. Because any cell that makes any hormone or neurotransmitter or anything, all of them require energy to function.

• 52:05Dr. Darshan Shah?

  Right.

• 52:06Speaker 01

  And energy is metabolism. And these biomarkers tell us about that set of processes in the body. This is the foundational level, which is why we have to track it over time. Because certainly if your TSH or your thyroid hormones or your estrogen or any of that is off, worth addressing, but no matter what, you're going to have to get the metabolic health right. You can't fix the hormones without fixing the base layer. So that's why that I stick to these rather than the hundred biomarkers to start. So yeah, I'm glad that we're in concordance here.

• 52:40Dr. Darshan Shah?

  Total concordance. And yeah, and with hormones, like you said, those are indicators of metabolic health causing other dysfunction in other organs. And you can even, your doctor's going to check your BUN creatinine for your kidneys. They're going to check other markers, but those are ones that you probably need some more help interpreting and how they kind of fit into the big picture puzzle. But those metabolic health biomarkers that we talked about, like you said, that's the base of the pyramid. That's the basics that people need to take control of for themselves.

• 53:06Speaker 01

  Yeah.

• 53:07Dr. Darshan Shah?

  And then we have now, we're so lucky to be living in this time where we have wearables. I have two rings on, I have an UltraHuman and an Aura.

• 53:14Speaker 01

  Yes.

• 53:15Dr. Darshan Shah?

  And

• 53:15Speaker 01

  A Fitbit? Or no, what is that?

• 53:17Dr. Darshan Shah?

  This is a continuous blood pressure monitor. Yes, this thing is pretty incredible. It's a TIA device, it's not available in the US yet, going to be in Canada, it's in Europe right now. I found this to be super accurate. I've been using it for months and very correlated to other blood pressure cuffs.

• 53:32Speaker 01

  Wow.

• 53:33Dr. Darshan Shah?

  So I'm really excited about the, and I have my CGM on too.

• 53:36Speaker 01

  Yes.

• 53:37Dr. Darshan Shah?

  And so, you know, I'm doing all the tracking and I just want to just frame big picture. You know, we talked about this earlier, there's all sorts of different patients out there, people out there, and there's a bell shaped curve. And bell shaped curve meaning, you know, people Have different biologies and most people kind of fall somewhere in the middle, but a lot of people don't. And so I'm more on the, I like to do a lot of tracking. But then you also have people that they just don't want to know the numbers. And they're on the other side of the bell shaped curve. So what's kind of your talk track when you talk to people about tracking? I, I know you're a big believer and proponent of it. But also you have those people that just get stressed out by the numbers. They just don't want to know. So how do you kind of ease people into some of this?

• 54:21Speaker 01

  Yeah, you know, I think the way I think about it is that like fundamentally in my true nature, I'm not a very pro tech person, to be honest. Like I, I want to be outdoors in a sundress in a field of daisies. You know, I like, or gardening, like I don't, I'm not, that's not my natural inclination, which people are surprised by because I co-founded Levels. But what I do believe in is helping promote human thriving. And right now the cards are stacked against us in such an unbelievably monumental and invisible way that we are getting sick from birth without even realizing it. And so we also need some resources to help essentially understand how this industrial environment is crushing our biology. So that, that's why I love it.

• 55:06Speaker 01

  It's because I, I care about, you know, human and planetary thriving and people reaching their highest purpose in this lifetime. And right now, without, I think some pretty intense effort, it makes it really hard to do that. That's why I love wearables. And so the second piece is that all of the biomarkers that the now consumer accessible wearables can tell us about. So with the Aura and the Apple Watch and the Fitbit we're talking about, resting heart rate, heart rate variability, sleep tracking, steps, active minutes, breath, oxygen saturation, they're all actionable. They're all actionable in a very short period of time. And continuous glucose monitors like I'm wearing, ultra actionable.

• 55:51Speaker 01

  And in the face of a world in which 50% of American adults now have prediabetes and type 2 diabetes, clinical disorders of blood sugar, which are almost entirely preventable. It is unconscionable to me that we would not have wider accessible access to a device that allows you to track your blood sugar. Diabetes and prediabetes represent one of the branches of this metabolic dysfunction spectrum. But we know that if you have that, you'll have a shorter, harder life and rack up so many other diseases that will impair the quality of your life,

• 56:32Speaker 01

  like heart disease, dementia, fatty liver disease, depression, anxiety, pain, all of these things. And so the continuous glucose monitor is so incredible because as opposed to getting a crumb of information from your doctor once a year, which is basically useless for actionability and behavior change, you are getting a movie of over 100,000 data points per year if you wear it and can learn how your diet, how your lifestyle are impacting your blood sugar. And what really motivates me is that if these were more accessible to people, not to necessarily wear all the time, but maybe like a week a quarter, two weeks a quarter, we would eliminate the really devastating situation that's happening in doctors' offices all over America today,

• 57:15Speaker 01

  where patients are walking in thinking they're healthy and the doctor sits with them and drops a bomb on them and says, hey, I'm so sorry, but you have diabetes. And the person now is diabetic. When you wear a monitor, what you realize is that A, you can change your blood sugar all the time with simple habits and you will never be in that vulnerable position where someone else has to drop that bomb on you because you're in control of the data. If I wear a CGM five, 10 weeks a year for the next 50 years, no doctor will ever surprise me with information about my blood sugar. How cool is that? That's so cool. You know, I mean, it's just, why are we still? And there are still doctors and publications and journals

• 57:59Speaker 01

  that are basically saying this technology is frivolous. It's for the worried well. It is dangerous because what are we going to do? Are we going to stop eating? You know, all this crazy stuff in the face of trillions of dollars of healthcare costs per year related to people not understanding how to monitor their blood sugar. So that makes my head explode. That's why I love it. But yeah, simply put, it gives us agency. It gives us power. It empowers us. It helps us change our behavior. Years in real time to optimize our health. It helps us give us a form of recourse against a very toxic environment that's hurting our health. And and they're becoming cheaper by the by the year.

• 58:39Dr. Darshan Shah?

  I heard they're gonna be over the counter soon.

• 58:40Speaker 01

  Yeah, continuous glucose monitors are gonna be over the counter in the US theoretically by end of summer. The Stelo is gonna be the first over the counter. They've been over the counter in every other country in the world for years, just not the United States.

• 58:53Dr. Darshan Shah?

  Will they work with the Levels app?

• 58:55Speaker 01

  That is the hope. That would be, yeah, yeah. So then you can have, you can go into a pharmacy, get this product, pair it with the Levels app, and be able to really understand what changes to make.

• 59:05Dr. Darshan Shah?

  It's ridiculous to me that you need a prescription to get a continuous glucose monitor. It just, and I know at Levels, you guys have streamlined that process so we can get them.

• 59:14Speaker 01

  Yes.

• 59:14Dr. Darshan Shah?

  Which, thank God, because, you know, most people never had access to them. And even if you did, for the people that don't know out there, like, there's a monitor, and then there's an app that interprets the data for you.

• 59:24Speaker 01

  Yeah.

• 59:24Dr. Darshan Shah?

  I think the magic is really in the app, where you're tracking your food, you're looking at the curves, you're seeing how sleep impacted your glucose levels. That's where the magic really is. So the app is so important.

• 59:34Speaker 01

  Yeah.

• 59:35Dr. Darshan Shah?

  Just the little monitor thing, I mean, there's many companies that make them. It just feeds the data to the app.

• 59:40Speaker 01

  Yeah, yeah, and the technology has just gotten so much better over the past few years. So we started Levels about five years ago. But the the most recent versions of the app are absolutely blowing my mind. I'm learning so much more because there's now a lot of AI that's involved in the app, which used to be kind of like a hand wavy thing, and now it's like real. There are really cool AI tools. So I cook these crazy meals with like 20 different vegetables and seeds and a little bit of salmon and all this stuff. You know, they're crazy, but you can just take a picture of your food now, and AI pulls out almost perfectly every item of food in the photo. And now there's catalogs of macronutrient and ingredient information.

• 1:00:23Speaker 01

  So it actually automatically with one picture tells you every single thing that's in your meal, and you can adjust it a little bit if anything's wrong. And then it gives you your macronutrient breakdown. So, you know, I don't think the average person, really unless they're tracking, knows. If they're eating forty percent carbs or sixty percent carbs per day, but it makes a difference. And so now the app just tells you that. It's really amazing. You can barcode

• 1:00:46Dr. Darshan Shah?

  So with levels, you can take a picture now?

• 1:00:47Speaker 01

  Oh, yeah.

• 1:00:47Dr. Darshan Shah?

  Oh, that's amazing.

• 1:00:48Speaker 01

  It's called AI photo. It's an AI photo feature. There's also, the premise is that if you log more inputs, like your food and you pair with the aura, so you get the sleep and the step data and the heart rate data, we can give you so many more interesting, actionable insights. So in the pursuit of ease of food logging, we have now the photo feature, which will have an AI recognition. There's also something called AI Describe, where you actually just speak with a voice note, everything that was in your meal. So I'll just be like, okay, I had basil seed zen basil pudding with one third of a white peach and eight strawberries and two tablespoons of nutso butter. And then AI will just actually pull each of those

• 1:01:31Speaker 01

  items out and has the nutrition information. The third feature that's really cool is barcode scanning. So if you have a physical product, you can do its barcode and it'll pull up all the information. And you can also take a picture of a nutrition label and it will pull in all the information. So it's, what was used to be clunky is now seamless. And I, my head is exploding because I'm realizing like, wow, I actually, some days that I think I'm going low carb, I am not at all, you know? And I can see that on my glucose, but I can also see in my macro ratios. There are some days that I think I'm getting my one hundred and thirty grams of protein, I am not, you know? And then there's other days that I'm like, wow, I got eighty grams of fiber and that's a win. So very, very

• 1:02:13Speaker 01

  cool stuff, but I could wax poetic. But I'm really impressed by how as AI and technology improves, it's making it much more actionable for people using it.

• 1:02:23Dr. Darshan Shah?

  Yeah, it's just revolutionary. I think, you know, it's so, it's so, it hits home for me because it's really hard to know what's actually in your plate, you know? Unless you're measuring everything out, which I did for a couple of weeks, and it was, it was difficult. But I actually recommend people do that as well. Because, you know, I don't think people really know, like, this much salmon gives you this much protein.

• 1:02:46Speaker 01

  That's right.

• 1:02:47Dr. Darshan Shah?

  Like really understanding what your food actually has in it and do a week or two of educating educating yourself, maybe work with a nutritionist on understanding what's really in your food. And with this AI, now we can just, it's all done for us automatically, which is just incredible.

• 1:03:03Speaker 01

  Yeah, it's incredible. Yeah, I also, I agree with you. I think macro tracking with a scale for maybe a week or two of your life, you start to realize like this much chicken has this much protein, this much salmon has, and then it becomes just mental math, you know, but then having a app to help you take that mental math and make it really refined is so helpful. But I've been astounded, you know, now we have the very seamless Aura integration and other wearables, but my glucose and my sleep are so in connection. So if I'm sleeping really well and I'm getting over seven and a half hours of sleep, my glucose is just better the next day. And that's amazing to know because on those nights when you want to stay up a little later, if you know that your glucose is going to be all over the place and you're going to be bummed basically all day with

• 1:03:46Speaker 01

  these spikes, it might get you to turn off, you know, the show or whatever, and actually put yourself to bed. So I love how even after five years, and I took about a year break because I was kind of burnt out on wearables, but I, you know, I have some new health goals around, you know, fertility and pregnancy. And so for me, this is I'm back into it and I'm learning a ton.

• 1:04:06Dr. Darshan Shah?

  So yeah, I love it. Yeah, I take breaks too. Sometimes around vacation, I leave by ringing home or, you know, if I know I'm feeling sick that week, I'll take it off just so I don't get overly stressed with the information. But you're right, it's a game changer. And for my patients that and my clients that don't want to get a lot of data and have to worry about it, I try to encourage them to at least do it for a couple of months, just so we can put some behavior changes in place. Because with the continuous feedback of the continuous glucose monitor or or rings or whatever, you really see things making a difference. And I think it's so, it's so important on that as well.

• 1:04:39Speaker 01

  Absolutely. And I think it's just important to remember, like, every tool can be used for good. Every tool can exacerbate issues that you already have inside, you know, anxiety and things like that. If you're finding that you're using the tool as a self critical self flagellation mechanism, oh, I'm doing so poorly, oh, I got A spike, this is so bad. Like, that's worth examining. Like, it's a tool and it doesn't need, it should be used to spark curiosity and awareness, not to punish yourself. And so, we build the app to support positive psychology around these wearables. I think Aura does a great job of that, too. It's not, but, you know, I think there are people who can find that they get obsessive about it, or it becomes,

• 1:05:23Speaker 01

  you know, I think it's worth double clicking into that. Like, why are you taking this piece of data and making it something about a shortcoming? And, and work, work, you know, that's something to double click into, I think. Like, I think I had more of that in the beginning. And I've, you know, in my therapy journey, in my, it's like, oh, like, this is just data. And I can take it as a, with a growth mindset, or with sort of more of a, you know, a negative mindset. So, yeah.

• 1:05:50Dr. Darshan Shah?

  The mindset around it is really important as well. I have kind of a different topic question to ask of you. So, yesterday, I had a conversation with somebody, and, you know, they were feeling a little bit overwhelmed with all of the information out there. And I think a lot of it, they get from social media. And so, the question was, I don't know, I don't know what I should focus on first, metabolic health or muscle health?

• 1:06:11Speaker 01

  Ooh.

• 1:06:12Dr. Darshan Shah?

  And my answer was, yes. They're the same thing. And so, talk about that a little bit, muscle health as it relates to metabolic health.

• 1:06:20Speaker 01

  Oh, my gosh. I want to like, tap in Gabrielle Lyon. Get over here.

• 1:06:23Dr. Darshan Shah?

  Exactly.

• 1:06:24Speaker 01

  Our queen, yeah, no, of muscle health. But, yeah, I mean, it is the same. I love your answer. Yes. So, muscle, and I will just paraphrase Dr. Lyon here, it's our metabolic armor. This is our protective sink for metabolic resilience. Muscle is, has the capacity to take up so much glucose. So, when we have more of it, and it's healthy, and we use it more, we are putting ourselves in a position where we are constantly able to clear glucose from the bloodstream in a way that keeps our mitochondria less overwhelmed from all this excess substrate from chronic overnutrition that we're dealing with in our processed food culture. So, building more muscle sets us up for much better

• 1:07:07Speaker 01

  Or glucose dynamics because it's this huge regulator. It's this huge sink. And we build the muscle with resistance training and we use the muscle with things like zone two training. So more like low intensity endurance exercise or walking, basically just low grade movement that's getting those muscle cells contracting. And in doing so, we're activating AMPK and we're getting the glucose channels, the cell membrane to constantly absorb glucose throughout the day. So it's like build the muscle and then use the muscle low grade throughout the day as this incredible sink for glucose. On top of that, muscle, we're learning more and more is an endocrine organ. It's a hormone secreting organ. How cool is that?

• 1:07:50Speaker 01

  And it's secreting myokines, which are cellular mediators that come from the muscle that do things like promote brain health and promote mitochondrial health. And so every pound of muscle that we put on with resistance training is going to make our metabolic journey so, so, so much easier. And I love what Dr. Lyon says about, you know, we're not, we're not really just over fat. We're under muscled.

• 1:08:15Dr. Darshan Shah?

  Absolutely.

• 1:08:16Speaker 01

  And the reason if we focus, it's similar. It goes back to the conversation about do we focus on weight or metabolic health? If we focus just on our fat, we're basically in this negative spiral of like, how do I lose part of myself? How do I like shrink? How do I, you know, get rid of this terrible part of me? If we focus on muscle, it's about building and growing and showing up with power. We're not losing anything. We're building this sexy, fabulous, powerful part of our body. We're getting toned and what happens? The fat goes away because of the biochemistry of how muscle essentially helps us just burn a lot more fat. So I really love that framing and I think, I will say like, I've talked to a lot of Levels members.

• 1:09:01Speaker 01

  I'm not practicing medicine anymore, but I've talked to hundreds of Levels members over the years. And one of the things that devastates me is that a lot of those menopausal, perimenopausal, postmenopausal women who are struggling with their metabolic health because as estrogen levels decline. Our insulin sensitivity gets poorer and that's when women are putting on the belly fat and rates of obesity, diabetes, Alzheimer's are starting to creep up postmenopausally because of the decline in estrogen. I always ask them, what are you doing for your workouts? I'm walking, I'm doing some yoga, you know, I'm very, very active. Are you resistance training? Are you lifting heavy weights? The people who are struggling almost universally say no. So I think there's this magic bullet that we do have to face the challenging periods of our

• 1:09:45Speaker 01

  life and it is building muscle metabolic armor because we're losing muscle at a much more rapid rate after 35 and if we're not working hard to keep it on, put it on, eat the protein to simulate muscle protein synthesis, we are going to lose muscle and it's going to set us up for metabolic issues, sarcopenia, which is low muscle mass of old age, which will set us up for falls, fractures, chronic disease and early death. So build muscle, do resistance training. If you're a woman listening to this at any age, start lifting heavy weights. You're not going to bulk up. It's going to change your life and the fat will be easier to get rid of.

• 1:10:20Dr. Darshan Shah?

  Yeah, I just read a study too that it doesn't matter what age you start building muscle at, you will still increase muscle mass as the same rate as someone half your age. So whether you start, you know, doing it at age 30 or age 60, you're still going to be able to build muscle at the same, almost the same rate.

• 1:10:38Speaker 01

  Yes.

• 1:10:38Dr. Darshan Shah?

  So it's and getting that into your routine combined with adequate protein intake will keep your muscle healthy. And most of our mitochondria in our body, the organ that they're in is our skeletal muscle. That's where you have most of your mitochondria. And also that mitochondria is some of the most active mitochondria in our body as well.

• 1:10:55Speaker 01

  Yeah, yeah, yeah.

• 1:10:55Dr. Darshan Shah?

  And so that's where you're going to really create metabolic health is on a focus on your skeletal muscle mass.

• 1:11:01Speaker 01

  Yeah, yeah. I mean, build it. I mean, you're literally every, as you build more muscle hypertrophy, you are 3D printing more mitochondria to fill that up.

• 1:11:09Dr. Darshan Shah?

  Right, right.

• 1:11:09Speaker 01

  The more mitochondria you have, the more you're churning through all these excess substrates in the body. So I love thinking about that. How do I 3D print more mitochondria? How do I recycle old mitochondria to make new mitochondria, which is mitophagy? And then how do I get each of those mitochondria working harder for me? If you're thinking about Out those through things and can identify a couple lifestyle habits that health would help with each of them. Make more, recycle old ones, use them more. You are on your way to metabolic health. And a lot of the stuff we've already talked about in this episode hit on one of those three things.

• 1:11:44Dr. Darshan Shah?

  Exactly. I think the one thing we should probably hit on a little bit more is this whole concept of mitophagy and some of the things that we can do to improve mitophagy. Things like temperature exposure, those types of things. Can you talk a little bit about about kind of doing low grade stress and homeostasis?

• 1:12:00Speaker 01

  Yeah, absolutely. There's a whole sort of suite of things we can do to promote mitophagy. Some food, some temperature, some lifestyle. But certainly, high intensity interval training seems to be really good for recycling mitochondria. And also zone two training. So this like low, lower heart rate, lower VO2 max, but longer exercises really stimulate this recycling of mitochondria, the pathways that make that active. Resistance training is more going to build more mitochondria. And then these other types of training are going to help you recycle old ones. There's also food compounds. So there's a really neat compound in the human body that we can make called urolithin A.

• 1:12:41Speaker 01

  And it's actually made by the mitochondria in our gut when they process certain alagatanim compounds, like those that come from dark berries and specifically pomegranate seeds. And not everyone is very efficient at making urolithin A from these compounds because of their microbiome or their particular biology. So we can, you know, load up on those foods and try. There's also supplements like a supplement by Mitopure or by Timeline that is actually pure urolithin A that you can take that promotes mitophagy. And they have incredible clinical research about the outcomes for that, like increased muscle strength even without excess, like working out, like it just literally is making people stronger because because they're taking this supplement that promotes mitophagy.

• 1:13:23Speaker 01

  And then cold exposure. So we can get in a cold plunge, which is going to promote mitochondrial biogenesis and mitophagy. And it doesn't, I say cold plunge, but it doesn't really matter what kind of cold you're doing. I have done every type of cold exposure. On the sun, cold showers, actually getting in cold submersion in water. I love cryotherapy, one of my favorite things to do at Next Health. But the freeway and the analog way is just go jump in a cold river or lake in the middle of winter. I was living in Bend, Oregon when I was writing my book and there was a cold plunge group that I met on meetup. And we went all the time in the snow and just went in the river and got cold exposure. So it doesn't need to be expensive or fancy, but you do need to stress your cells and think of temperature

• 1:14:08Speaker 01

  as a thermal piece of information that stimulates it's it's a temperature speaks to our mitochondria and tells them you need to make more heat because I'm cold. And if you're giving that information to the mitochondria, they will replicate themselves and renew themselves in order to do a better job of creating heat for us because that's part of metabolism. And so I love to think of when I'm getting that cold plunge, I'm speaking to my mitochondria, telling them to basically rise to the occasion. So, yeah. So those are some of the things we can do for mitophagy. Any others that you think about with mitophagy?

• 1:14:44Dr. Darshan Shah?

  I think sauna.

• 1:14:45Speaker 01

  Sauna, yeah.

• 1:14:46Dr. Darshan Shah?

  Can definitely help.

• 1:14:47Speaker 01

  Yeah, for sure.

• 1:14:48Dr. Darshan Shah?

  Right. And I think there's some evidence around infrared light therapy potentially helping as well. That also improves nitric oxide, which is great and great for biology as well. But yeah, there's a lot of little things, but I think, you know, like you, like you mentioned, some of this stuff is free and easy. Just go out and go for a hike in the sun. And that's going to be so incredibly beneficial for you in many ways. Let's kind of just bring it all together and talk about a few different types of people that are out there. And what would be your advice to them if, if you were to talk to them, you know, at a, at a dinner or whatever? So I'm either a male or a female, totally sedentary because of work all day long.

• 1:15:28Dr. Darshan Shah?

  Don't go to the gym and have, you know, in obese category, body mass index over 30, but definitely under muscled and over fat and really like have no real diet program or nutrition program, other than I try to avoid ultra processed food if at all possible. What's a, what's a good way for them to launch into a new kind of health paradigm, health journey? Because, you know, they're really starting at square one. Where would you get them to maybe, what's the first one, two or three things you would have them do?

• 1:16:00Speaker 01

  Are they willing to cook?

• 1:16:01Dr. Darshan Shah?

  Yes.

• 1:16:02Speaker 01

  Okay, okay. Because I would have a different path for people who are not willing to cook. Not willing to cook, I would actually say Daily Harvest. Just like get a one month membership to Daily Harvest. Frozen food, all organic and natural. Put a can of salmon or beans on top of it and just eat that for a month.

• 1:16:19Dr. Darshan Shah?

  I love that.

• 1:16:20Speaker 01

  It will get you started. Just have it shipped to you, you know? But if people are willing to cook, then I would say, because it all starts with food in my framework. You know, you got to pick one or two ultra simple meals. I'm talking like chicken breast and steamed broccoli with some sauce you like. Or baked salmon with whipped cauliflower. Just like really simple. Pick three or four and eat that every day for a month. You'll feel infinitely better, you know? And so I think, don't make it hard. Don't do recipes. Just have a cooking technique. Like you walk into the kitchen and you set the oven for 350 and you get a pan out. And you put vegetables on the pan and a protein on the pan and you put it in.

• 1:17:05Speaker 01

  Like you gotta keep it simple. I think that really helps people. And I know a lot of people in this type of category who have committed to basically just eating a small selection of types of foods for like six to eight weeks. And they lose like 20 pounds because it's moving from ultra processed food to real food. And then stock up with like healthier snacks, like the nuts and seeds, you know, the venison, you know, regenerative venison bars like from Epic, fruit that you can just take with you, you know, like yogurt, things like that. So start with real food and keep it really, really simple with a couple of basic cooking techniques. And then I would say, start with walking and ideally join a gym or a program for the resistance training.

• 1:17:49Speaker 01

  Cause I think that if you're starting from ground zero, it's very hard to just start lifting weights. I think having accountability with some sort of program or a gym that can help you start lifting weights can be really, really helpful. So get a wearable and just try to start with 7,000 steps per day, which takes less than an hour if you spread it out throughout the whole day. And Just sign up for something that involves resistance training. Prepay. This is key. If you prepay, you will go. People who, you know, do à la carte, I think it's much less likely to actually go. But if you sign up for classes and you're going to be charged $35 if you don't go, it's much more motivating. That's something I do for myself, actually.

• 1:18:33Speaker 01

  So I think it would just, it would be moving and eating clean food would be like the first step. And I think the wearable I would start with is not, probably not a CGM, probably not something fancy, but actually just like a Fitbit, like a $60 Fitbit Charge 3 that you can get on Amazon. It'll get there the next day and tell you about your steps. I think that would be my, my first steps for someone like that. And then read my book, you know, like you really understand the landscape and educate yourself on the other pillars. Now, with that said, what I do talk about in my book, because I have a four-week plan, there's 25 good energy habits in the book. And I think for some people, especially if they're feeling like depressed and really unmotivated to start, the other thing I say is,

• 1:19:15Speaker 01

  I ask people to pick three habits for, for, for, for the period of the program in the book. And I just say, pick anything that feels exciting to you that you feel like you can stick with. Because wins beget more wins. And maybe for someone, the only thing they can think about doing at that time is drinking more water. Or maybe it's steps, or maybe it's just reading labels or something like that. But I think also starting with kind of where you're motivated is a good strategy as well. To get a couple wins, start feeling a little bit better, and then take that momentum and keep going deeper.

• 1:19:51Dr. Darshan Shah?

  Yeah, that's such great advice.

• 1:19:53Speaker 01

  And do it with community. That's the other thing I would say. I also, in my program, you have to have an accountability buddy. So, you know, for me, my accountability partner is my, my partner, my boyfriend. And, you know, we really are very vocal about our health goals and what we're trying to achieve, and we help motivate each other. But I can't overstate how looping in a trusted friend or a paid coach to make sure you're staying on track definitely accelerates progress. I don't know if I- In your health transformation, did you have anyone like a friend doing it with you? Or like, or did you kind of just like brute force it?

• 1:20:29Dr. Darshan Shah?

  You know what? I did it by brute force initially and I spent a lot of time having moments where I fell off course.

• 1:20:37Speaker 01

  Yeah.

• 1:20:37Dr. Darshan Shah?

  And no one really did bring me back.

• 1:20:39Speaker 01

  Yeah.

• 1:20:40Dr. Darshan Shah?

  So then I did pay a health coach to coach me, actually a functional health coach, train at IFM, who was excellent that helped me through the journey and helped me more accountable. And you know, I think this whole thing about reading your book or just learning in general, when you commit to 15, 20 minutes of reading or educating on a daily basis, first thing you do in the morning, it's so motivating. It kind of opens up your entire growth mindset around all of this. And I think that that's such an important point is commit to a little bit of learning, right?

• 1:21:09Speaker 01

  Oh my God, I love that so much. I actually talk about this in my book. When I was writing my book, because that's a different journey, right? Like there's a health journey and then writing a book is a journey. I started every morning of writing my book, listening on my Audible to 15 minutes of an author talking about their writing process. So I listened to The Creative Act by Rick Rubin. I listened to The War of Art by Steven Pressfield. I listened to Big Magic by Elizabeth Gilbert, The Writer's Way. But having the seed planted in the morning while you're brushing your teeth and making breakfast of like, this is why I'm doing it. This is, learn something about a habit. And when I'm also moving towards a health goal, I do exactly that.

• 1:21:52Speaker 01

  I get a podcast going in the morning. I get an audio book about health going in the morning. 15 minutes, it sets you on the path of the day. I think that is brilliant advice.

• 1:22:01Dr. Darshan Shah?

  Yeah.

• 1:22:01Speaker 01

  Yeah.

• 1:22:02Dr. Darshan Shah?

  On my drive to the gym every morning, I make sure I listen to like Andy Galpin or,

• 1:22:06Speaker 01

  Yes.

• 1:22:06Dr. Darshan Shah?

  You know, someone, someone who's talking about exercise and it just, I get to the gym. That's all I think about.

• 1:22:11Speaker 01

  Yes.

• 1:22:11Dr. Darshan Shah?

  And I'm more motivated in the gym.

• 1:22:13Speaker 01

  Totally.

• 1:22:13Dr. Darshan Shah?

  So that little bit of education you're committing to it is, and listening to this podcast, you know, reading your book.

• 1:22:18Speaker 01

  Yeah.

• 1:22:18Dr. Darshan Shah?

  Gabrielle Lyons book is an excellent read.

• 1:22:20Speaker 01

  Yes.

• 1:22:20Dr. Darshan Shah?

  Before working out too. So that's made a massive difference in my journey. And then you touched on this a few times is just becoming an expert at forming habits. And really, Forming habits, if you know four or five key skills, things like you talked about, start off small, just pick two or three, stack these on top of each other, just a few key skills and habit formation, you're you're going to launch yourself in the right direction. It's mindset and habits.

• 1:22:45Speaker 01

  Yeah, yeah. And also, I think it's always good to keep your why front and center. You know, I think knowing why you're doing it, and I really encourage people to not focus, ideally, don't focus on like a why that's appearance based or material based, but really think about the deeper levels that motivate you, like being there for your family and being able to reach your highest purpose. Like for me, a big part of my why is like spiritual development. I want to get closer to God in this lifetime. And part of the way I have to do that is build a body that can think and feel and and and function properly. I want to have a healthy pregnancy. I want to be able to have as functional of a delivery

• 1:23:27Speaker 01

  as possible. So for me, when I think about those things, when I wake up, you know, I want to be able to show up for my loved ones. It's so much, and I keep that very clear image in my head, and I relive them over and over, like showing up for my family, having a healthy pregnancy, you know, it just helps everything be easier. So I encourage people to really think about, like, on your deathbed, what do you want to, how do you want to feel? And how do you want to have showed up in your lifetime? And then keep that front of mind as you're making hard choices every day, because all the choices we're making every day are what ultimately bubble up into, you know, whether we get to where we want to go in our lifetime.

• 1:24:04Dr. Darshan Shah?

  Great advice, great advice. Okay, second group of people, twenties and thirties, you know, going to the gym, trying to do the best they can, and they just want to really up level that what their health routine is. Okay, so twenties, thirties, still young, still at the prime of their life, wanting to up level their health routines and, you know, going to the gym, eating is eating right as well. What would you add to someone like that? Because I see a lot of those people at Next Health, you know, they're going to the gym, they're using all of our technology. Well, maybe maybe doing stuff like cold exposure, sauna, those.

• 1:24:38Speaker 01

  Yeah, I would say that's the type of person that I'm like, let's. Dive into like the tracking game.

• 1:24:43Dr. Darshan Shah?

  Yes.

• 1:24:43Speaker 01

  So let's get the extended biomarker panel for that first guy that we talked about. He or she should definitely start with the basic biomarkers to know where they're starting. I think that's very helpful, but this, this person you're talking about, it's like, let's get the 110 biomarkers. Let's see what the homocysteine and the ApoB and the thyroid hormone and the testosterone. Let's see what all that stuff is because I think it can really be motivating to kind of go up to the next level and understand what you're actually tracking and where, where you need to tweak on the diet or the exercise. And so big biomarker panel, I'd want them to maybe get an Oura ring or an Apple watch because maybe they're training really hard, but their HRV is really low and they're actually stressing their body quite a bit. Maybe they're burning a candle at both ends early in their professional career and they need to sleep a lot more.

• 1:25:28Speaker 01

  And maybe that's part of the unlock. Maybe they're sitting at their finance job all day long and then working out for an hour in the evening and they actually need to start walking more. So they're motivated, they're interested. Let's see what the detailed biomarkers are. Let's get the wearable data on to understand sleep, resting, heart rate, HRV, active minutes per day. And then I think a CGM could be really, really interesting as well because I think that's when we start to see, you know, especially in the twenties and thirties, it's like often eating a lot of takeout, a lot of like sort of, you know, to go food and see actually what's happening with your glucose spikes. Cause you might be, you know, with an insulin level and a glucose monitor,

• 1:26:10Speaker 01

  you might see that there's actually some dynamics that you want to clean up in the way that you're eating and how you're doing food that could be really helpful. And of course you're not going to have any major symptoms yet of any of that stuff. But compound that over 30 years, you could get into issues. So learn early and yeah. And, and, and I think of a woman in that category who's maybe entering fertile years, we're dealing with an infertility crisis right now and a lot of women that look otherwise healthy. So get on top of that stuff early so you can see under the hood.

• 1:26:37Dr. Darshan Shah?

  Yeah, that's such great advice. I can tell you the number of times I see someone who's in their 50s and I'm like, have you ever had any blood work done? And it's just like the minimal biomarkers that started when they were 40, you know?

• 1:26:47Speaker 01

  Yep.

• 1:26:47Dr. Darshan Shah?

  And I'm always like, gosh, I wish you had a set of biomarkers from your twenties so I could like. Compare where you were compared to now and see directionally. And like you said, like, you know, figuring out where you are in your twenties and thirties, like you will prevent almost all causes of disease if you make some directional changes back then.

• 1:27:05Speaker 01

  Totally.

• 1:27:05Dr. Darshan Shah?

  And then you're not playing catch up later on.

• 1:27:07Speaker 01

  Totally.

• 1:27:07Dr. Darshan Shah?

  Yeah, so true. Okay, next category is I see a lot of these patients, forty, late forties, early fifties, man and woman, you know, slamming into andropause, sarcopenia, menopause, really frustrated with their weight, you know, that's always a problem that it's always an indicator of a lot of other disturbances going on underneath the hood. And, you know, I think also a lot of people that I see in their forties and fifties, they've been doing one specific kind of training, whether it's like long bouts of, you know, steady state zone three, four on the treadmill, or just hitting the gym and lifting weights and really not making any progress too, you know, I think a lot of people get stuck in a routine. So kind of how would you talk to that person?

• 1:27:51Speaker 01

  Yeah, probably be thinking a lot about protein, thinking about resistance training, especially for the women, and then I would be thinking a lot about stress management because that's like peak of career, peak of child raising. I think that it's a, especially in American culture without the village around us, this is a phase of life where people are getting crushed by societal expectations of just every, on every level, on professional, on family, elder parents. It's like, it's just so, so, so much. So this might be a time for some of the deep emotional work too, boundary setting, maybe some therapy, maybe retreat, maybe psychedelics, maybe, you know, really just examining midlife

• 1:28:35Speaker 01

  in a deep way and where you want to go for that next phase of life as hormones are changing and as kids might be getting older and as parents are getting older and like face those things that we've been conditioned to not face in American culture, just power through, power through, and it starts catching up to you then. So emotional health, making sure we're really focusing on muscle, protein synthesis through diet, creatine. And and then, of course, I would think a lot about hormone testing at that time. Sex hormone binding globulin, progesterone, estradiol, testosterone, all these things. And then, of course, because at andropause and menopause, we're looking at a tougher hill to climb with metabolic health after that.

• 1:29:19Speaker 01

  At that time, making sure you've got great baseline on all your metabolic biomarkers. And you're starting to check your fasting insulin every year to make sure it's not creeping up and and things like that. So some of it might be actually just really slowing down and investing more in your own health because you have to. Because things are getting harder and setting better boundaries and building strength for this this next period of life.

• 1:29:40Dr. Darshan Shah?

  I love that. Yeah, I think I think, like you said, in this American culture, we're just really taught to power through. And you hit 50 and you've never dealt with any of your traumas or emotional

• 1:29:50Speaker 01

  Yeah.

• 1:29:51Dr. Darshan Shah?

  levels of stress, all of that. So that's such an important aspect of it. Okay, final category, getting a little bit older, maybe 60 plus. And, you know, finally retired, found yourself now thinking about your longevity. Like, you want to be around for your grandkids.

• 1:30:06Speaker 01

  Yeah.

• 1:30:06Dr. Darshan Shah?

  What are some of the things that we can add in when we're trying to get this renewed focus on longevity?

• 1:30:12Speaker 01

  Yeah, I mean, I would say continued deep emphasis on movement. Because contrary to popular belief or thought, as osteoarthritis and pain starts getting worse as we get older, movement is the best possible thing we can do. Like, it's not like, like even running or impact things do not make the osteoarthritis worse, they make it better. So low-impact movement, really helping, you know, motion is the lotion. I actually love that saying. And keep it moving and then keep focusing on building strength, maybe even increasing protein because it's harder to build muscle as we get older. And then I think from the cognitive perspective, I think we're really thinking about like a pro all throughout life.

• 1:30:54Speaker 01

  But like, how do we use nutrition to support our brain health and to make sure our cognitive function is good? So we're eating anti-inflammatory foods, omega-3-rich foods, choline, turmeric, things that are going to reduce inflammation and oxidative stress in our brains and really protect. The berries, the antioxidant-rich colorful foods, all the things like that. So clean, whole foods that support neurologic and brain health and muscle health. And then I think it's also about novelty. So this is a time to really be leaning into engaging with life and finding new hobbies, engaging in hobbies that you love, reading, exposing your brain to things that are going to keep it sharp and active, really doubling down on community and support engaging in

• 1:31:39Speaker 01

  multi-generational play, like with your grandkids or your children, things like that, that I think just help build that purpose and emotional resilience that we know is actually deeply related to longevity. When people lose purpose or community, lifespan gets so much shorter. The data shows it. Loneliness is actually a key risk factor for premature mortality. So going out on a limb and finding ways to connect with people, maybe even new people later in life.

• 1:32:07Dr. Darshan Shah?

  Yeah. Such great advice. You know, you look at the Blue Zones and they're still moving and they still have their community and they're eating really great whole foods. And that's why they live to these ages. You know, it's really

• 1:32:22Speaker 01

  It's not rocket science. And they don't even have the biomarkers and everything. You know, it's like a lot of this stuff is pretty common sense when you really think about it, but it's not so common anymore.

• 1:32:33Dr. Darshan Shah?

  Absolutely. You know, you mentioned a couple of supplements. I always like to ask this question of all the guests, like what are your top five?

• 1:32:39Speaker 01

  Oh, my gosh. I take a lot of supplements. I do. I do. I love supplements. But I would say for me, well, first of all, I think it's great to target your supplement regimen based on your biomarkers. I love a test actually by Genova Diagnostics called Nutrival. Or there's actually a direct to consumer test now called Metabolomics. We could just order without a prescription, which is amazing, which will tell you how to focus your supplementation for your body. Amazing. But for me, omega threes, I take about 2,000 milligrams a day. I take a lot of turmeric. The data on turmeric is overwhelmingly positive. So I take about 2,000 milligrams of curcumin, which is the active ingredient in turmeric per day.

• 1:33:19Dr. Darshan Shah?

  You can buy that with a papaverin or peppers?

• 1:33:21Speaker 01

  It's got, the supplement I take has a little bit of piperine in it. So the, the black pepper and the turmeric work together for bioavailability. That has actually almost cured my partner's in bad knee osteoarthritis after eight surgeries on his knee. He was a professional athlete. Incredible, I think, along with whole foods diet and everything. So turmeric, omega threes, I take a high quality multivitamin. I take weenatal, which is a prenatal for both men and women, since 50% of infertility is male infertility. And then I love urolithin A, so I do take that, that supplement I mentioned, Timeline Mitopure for mitophagy.

• 1:34:00Speaker 01

  I take, because of my lab tests and a higher homocysteine level than I want, I take a methylated B vitamin on top of my multivitamin, which is that brought my homocysteine down three points or so, which I'm thrilled about. I take a lot of liposomal vitamin C. Vitamin C is incredible, not just for immunity, but also for oxidative stress. So I take live on brand lipospheric vitamin C. And because of my testosterone levels were actually a little bit low on my next health testing. And I talked with Dr. Egler about this. And so I'm working on some things to actually support testosterone levels, including ashwagandha. So that's one that I added in from my lab testing as well. So that's my personal kind of stack.

• 1:34:42Speaker 01

  And I think, oh, and then, and then at night I do take magnesium for sleep and apigenin and L-theanine all through Momentus. And to me, that's my cocktail that just like really helps me like ease into beautiful rest. So I do take a lot of magnesium as well. That's most of it. Yeah. And I don't think everyone needs. And I take five grams of creatine a day. I don't even, yeah. So that I actually put in my matcha every morning. So my matcha, geez, people are gonna have a crazy list, but I feel so good. So I'm, so I'm gonna go with it.

• 1:35:14Dr. Darshan Shah?

  The point of all this is you try it on yourself. You see what makes you feel good. You see your biomarkers and you've found all this stuff.

• 1:35:19Speaker 01

  I get a milk frother. I put my organic peak matcha powder, colostrum by Chris Kresser. I do creatine by Momentus. I put 20 grams of protein from Vital Proteins or Momentous, usually collagen, a little bit of RX sugar, which is allulose. And I think that's it, but that is my pre-workout at 6:00 a.m. before I go work out. And it just, I feel fueled, I feel energized. I love the creatine for brain health and muscle health. So I'm probably a little off the deep end on this stuff. And full disclosure, I do get some of this stuff for free. It is pricey, but there are ways to do it cheaper. But the way I judge it is, how do I feel? I feel incredible, so I'm gonna keep doing it. And

• 1:36:04Speaker 01

  my biomarkers are getting better. Like the homocysteine is coming down. I check my omega-3 levels at least once a year. And I adjust accordingly. So don't just take my advice. Trust yourself, trust your body, trust your biomarkers.

• 1:36:17Dr. Darshan Shah?

  Yeah, incredible advice. Well, we have had such a great conversation. I know we could talk for hours, but I would love for you to just tell us a little bit about you and kind of what's coming. You know, the first couple of chapters of your book after a bit like I got a tear by eye reading about your mom. And you've been through such an incredible health journey, but also personal journey in your life that informs the message that you're putting out there. And I just, I just love your message because it's not just all about biomarkers and health. It's about emotional health and spirituality and saving our society and our environment. And I just love everything you tie into what you do. It's just beautiful. What's next for Dr. Means?

• 1:36:58Speaker 01

  Well, yeah, I mean, I think part of my purpose on this planet is to help people reach their highest purpose. And part of that is building a healthy body that can do everything we want to do in this lifetime. And that starts with metabolism. So I will definitely continue talking about that. You know, I'm in the phase of life, I'm 36, and I would love to be pregnant in the next six months to a year. And so I'm thinking a lot about that, too, because, as you know, fertility in this country, it's a deficit. The statistics should be front page news every single day. The fact that they're not actually concerns me. 30% of women are dealing with infertility and sperm count's down 50%. What do we think the end game is here? And we kind of know why it's, we do know why it's happening. It's metabolic dysfunction, it's environmental toxins, it's the chronic stress, it's all of it. We need to be talking about this.

• 1:37:39Speaker 01

  So I think for me, to answer your question, I think really moving into more about that intersection with fertility metabolism, thinking deeply about that, thinking about how we actually honor the birth process more in this country. I think one of the reasons we're sick is because of our obsession with overconsumption and convenience culture. And we've applied a lot of that to parenting and motherhood and birth, I think. We've industrialized birth, we've desanctified the whole process of creating life. At the same time, we're destroying our earth with industrial agriculture, which is essentially creating infertility of the soil. So in a way, for the sake of some illusion of convenience, we've basically mortgaged the sanctity of life, both on earth and in humans. And that

• 1:38:24Speaker 01

  is deeply tied to metabolism. It's deeply tied to our environment. It's deeply tied to our interconnection with the planet. But that's, that on the both biologic, physical and spiritual level is, is I think what the next probably three to five years of my life are going to be thinking about. Because ultimately, if we, if we destroy the mother, which is the earth, which is, you know, the life-giving capacity of humans, we are not going to do well, long-term. And right now, our habits are unsustainable. And I think a lot of the depression we're seeing is fundamentally a spiritual crisis about how we have so disconnected from our true nature as miraculous beings and have separated ourself

• 1:39:06Speaker 01

  from, from, from nature. So that's kind of where I think a lot of my evolving passion is going, but very much tied into a lot of what I talk about in Good Energy. So, yeah.

• 1:39:16Dr. Darshan Shah?

  Beautiful, beautiful. I love it. So if you haven't read Good Energy, one of the best books I've ever read on health, and I encourage everyone to pick it up. How else can people find more of your content and find you?

• 1:39:28Speaker 01

  Best place is kaceymeans.com. All my stuff is there, social media links, my newsletter. I pour my heart and soul into every week. I really dive deep into what I'm thinking about, topics around mind, body and spirit and planetary health. So Good Energy Living, you can sign up on my website. But that's just like really where a lot of my deepest thoughts go. So, social media, newsletter, book. Yeah.

• 1:39:51Dr. Darshan Shah?

  I read your newsletter every time I get it.

• 1:39:53Speaker 01

  Thank you.

• 1:39:54Dr. Darshan Shah?

  Well, thank you so much for joining us here on the Podcast Extend, and I look forward to continuing the conversation with you.

• 1:40:00Speaker 01

  Thank you, Darshan.

• 1:40:01Dr. Darshan Shah?

  Thank you.

• 1:40:05Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.