Hack Your Health from the Inside Out: Why Food is Medicine with Drs. Stephanie Coulter & Casey Means

On this Inside the Texas Heart Studio episode, Dr. Stephanie Coulter and Keri Sprung sit down with Dr. Casey Means to discuss how food should be viewed as medicine and how we can understand the root causes of illness.  

Dr. Means dives into the alarming statistics on chronic disease in the United States and how they fueled her quest to understand the root causes of inflammation. She explores the link between processed foods, increased caloric intake, and a decline in metabolic health.

For more information regarding the importance of metabolic health, click here.

Watch the sit-down interview here.

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Chapters

• 4:19 Prevalence of Metabolic Health Issues
• 6:16 Grocery Shopping for Better Health
• 9:05 Levels - Continuous Glucose Meter (CGM)
• 10:35 Metabolic Health Management

Transcript

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We're here with Dr. Casey means she's come

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to visit us at the Texas Heart Institute from California.

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Dr. Means is the founder of Levels,

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and she's an author of a book called Good Energy,

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and we were so inspired by Dr Means and her framework

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and approach to healthy living and prevention

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and metabolic health that we just had to have her come in.

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Thank you so much for having me, Dr.

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Coulter and Carrie. Thank

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You. So fun. So

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we're kind of drinking the Kool-Aid here, so, um,

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we support a lot of activities

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that support a healthy lifestyle,

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and we've been bringing in really interesting grand round

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speakers to discuss it.

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And, you know, we're very interested in the Levels company.

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Yeah. And so I'm really interested in your background. Yeah.

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Because, you know, um, as a, a professional female

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who went down the hard track

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and actually completed a residency

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and otolaryngology, what inspired you

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to take such a divergent path from the traditional path

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that we try to hang to here?

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Yeah. Um, what, what inspired you to take that leap? Hmm.

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Because it's a brave leap.

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Thank you. Yeah.

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You know, I mean, I think, I think I did like one of the

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potentially most dangerous things you can do in a huge

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system like the healthcare system, which is to start asking

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questions like, why, and then going down that rabbit hole

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and seeing where it took me.

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So one of the big questions as I was sort of nearing the end

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of my residency was, you know, I'm looking at the statistics

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that we're seeing in the country about cardiometabolic

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health and about general chronic

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disease trends in the United States.

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And the reality is, is that every single year in America,

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we're spending more and more money on healthcare.

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We're at what I think, $4.3 trillion now it's over 20%

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of the largest GP in the world.

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But all of that, you know, the, this journey from ear, nose,

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and throat to sort of a food is medicine evangelist.

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I think it, it was, it was one, it was sort of waking up

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to some of these trends in the US that feel concerning

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to me about the state of children's health

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and women's health

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and people getting Alzheimer's at young ages

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and, you know, just these really

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astronomical chronic disease rates.

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Coupled with the fact that I was sort of this

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very specialized, you know, surgical trainee.

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And so many of our patients were coming back

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for revision surgeries, a little like a wake up I had was,

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wow, I'm prescribing like dozens,

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if not maybe a hundred prescription like, uh, prescriptions

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for steroids per week.

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So it's like topical, inhaled, oral

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nasal sprays, nasal rinses, all these steroids

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and fundamentally like steroids are

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to decrease the immune response for chronic inflammation.

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And so much of chronic inflammation is

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showing up in the head and neck.

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I was sort of looking at what I was treating,

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and I'm like, it's sinusitis, laryngitis, thyroiditis,

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otitis, cellulitis, otitis.

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Like it's all itis, it's all inflammation.

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And I kind of was like, I'm an inflammation doctor.

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And I don't even think I really realized that.

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And then you kind of pairing that with what I've, you know,

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of course learned in medical school,

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like obesity is fundamentally very much a pro-inflammatory

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state heart disease, even depression.

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Like a lot of the, you know,

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the cellular biology research on this is showing us

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that there's this heightened state

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of inflammation obviously in all these different things.

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And I think that one thing that was concerning to me was,

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well, we're, we're doing a lot of surgery

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on fundamentally inflammatory disorders,

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but you can't, you can't operate on the immune system.

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So are we really getting to the root cause

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of why these bodies in America right now are

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so chronically inflamed?

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There's the conversation about sort

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of like what's killing people, but then if we just look at

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what's happening in people's lifetimes in the United States,

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we've got kids who are now dealing with like adult

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A diseases, Adult diseases at,

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at like such alarming rates. The fact

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They, it's such a low age and these are choices

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that the children aren't making themselves.

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They're the families are, the parents

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are making these decisions.

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Right. Right. And the schools are making the decisions.

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Yeah. We had the guy last year who's from Dr. Lustig. Yeah.

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About, you know, the children are being poisoned in school

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by the right with Lunchables terrible lunches

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that we're all right, we're feeding them. So,

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You know, there's a lot of amazing innovation happening in

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healthcare, but our country's not doing great.

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And I think we all know that,

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like something's not quite right with the health

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of Americans with 74% of the country overweight

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or obese with some reports showing up

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to 30% of young adults.

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Mm-Hmm. Having fatty liver disease, 30%

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of young adults having pre-diabetes diseases

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that I think many endocrinologists never saw kids having

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that virtually in their lifetime.

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And so it's, it's wild

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because there's so much happening in healthcare,

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and yet the average American, you know, is,

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is not doing great.

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Well, one, the rules aren't strict enough. Yeah.

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We've been strict enough about the guidelines Yes.

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About healthy guidelines.

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And quite honestly since I believe 2000,

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the caloric content of the food Yeah.

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That an individual takes in every day has increased

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by almost 800 calories a day.

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Right. Yeah. So, I mean,

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we're talking too many calories consumed.

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Right. And they're wasted calories. Totally,

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Totally Wasted. And

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the reason is there's a lot of reasons for it.

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The processing. And I think what's processing,

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and moms have gone to work,

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I actually had a tweet a couple weeks ago

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where I talked about this topic, which is like,

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there's been beautiful things that have happened

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with women obviously being able to pursue their passions.

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Mm-Hmm. Outside of the home. I'm one of them.

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We're all one of them.

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But one of the sort of, I think collaterals of that is

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that it almost sort of the subliminal notion of that was

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that there didn't need to be someone

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who was a primarily responsible for food in a household.

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Right. And so we kind of

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Outsourced it. No, I think it's,

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I think it's been

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outsourced. Yeah. I really do. And

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Now we're getting so sick because at the end of the day,

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for someone in my belief system

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to be optimally cellularly healthy, they need

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to be eating primarily plant-based unprocessed

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Whole Foods plant that are not covered in pesticides

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pretty much every meal of the day.

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So someone needs to take responsibility for

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that if we're gonna be healthy.

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And it's almost like we had a huge cultural shift with

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home life and who's working,

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but we didn't actually really think about

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what was gonna happen with food.

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And now we've gotten so, so sick. Well, no,

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Because it's a side thought.

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Yeah. And people just take the easy road to eat healthy.

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You have to grocery shop

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It. It does take time.

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Yeah.

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You know, and, But it's the best

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investment we could possibly make.

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But it's time consuming.

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And, and if you're gonna have fresh produce, you have

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to shop frequently.

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Mm. Do you know? Mm-Hmm.

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So you can't, I mean there's, well, you can get

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fresh produce that's frozen Mm-Hmm.

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That lasts, which is great. Which is great. Yeah. Mm-Hmm.

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I did that and I was big into smoothies. Yep.

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I like to think about what I'm making based

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on what I see in the grocery store.

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Totally. Oh, absolutely. Be inspired by the food.

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This is how, that's how I feel. Yeah.

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And that's a part of my book is talked,

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talks about finding the awe in food

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as part of the health journey.

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Mm-Hmm. Because I think, you know, when we have

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so many things in boxes, we sort of forget

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that this is actually the substance, the molecular substance

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that's not only gonna build the next version of our body,

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it's also gonna be the, the molecular information

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that tells our genes how to be expressed

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and how our cell signaling pathways to work and

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How your hormones are Released,

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how your hormones are gonna work.

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For sure. And so, you know, all the packaged food, it,

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I think it some in some way divorces us from this sense

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of like real sort of like cosmic awe of like,

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this is actually the molecular substrate

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that's gonna become meat.

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Mm-Hmm. You know, it's, we sum

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it up by saying you are what you eat.

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But it's so true. And I think the closer that we can get,

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like you said, to touching the food, interacting with it,

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kind of feeling, um, you know, the energy of the food

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because fundamentally you're gonna take on everything that,

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that food is like, that's just the atomic reality of it.

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And so I think there's a mental reframe.

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And this is why, I mean, I primarily love

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to shop at the farmer's market, which is I love

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that a life hack in some ways with the food going bad

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because the average piece

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of food in the United States actually travels 1500

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miles to get to your plate.

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And so by the time you get it, it goes bad so quickly

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when you buy food that was actually picked

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that day or the day before.

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Mm-Hmm. It lasts for so much longer.

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It tastes better. It Tastes better.

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And often actually people of course are concerned about cost

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of healthy food, but are really actually like a nice way

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to get around some of that is that a lot of the farmers

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who put their food at the farmer's market,

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they're not certified organic,

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but they're not using any synthetic pesticides.

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They're just not going through the cost

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and the ordeal of becoming certified organic.

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But the nice thing is you can talk to the person

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and say, Hey, are you using any glyphosate or roundup

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or any of this stuff on your food?

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And they'll say, oh no, we never use any of that.

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We're just not certified organic.

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So their food is much cheaper. Mm-Hmm.

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Because they're not certified organic,

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but they're not using any of the stuff that's problematic.

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Mm-Hmm. And so that food will often last.

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I've got Brussels

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sprouts in the fridge that have been there for

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No, they last a long time. Two

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Weeks. Yeah. And they're perfect.

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So I try to help my patients focus

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on the things that they do.

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They can control. Control. 'cause literally 60%

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of your life expectancy is really how you live your life.

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Yes. So it's lifestyle. Yeah.

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It's the choices that you every day

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and we make as a community

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to encourage one another to be healthy.

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And so I'm super interested in your little device. Yeah.

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Because, you know,

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we've used those devices in patients with diabetes.

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Yeah. But now we're moving the needle from diabetics

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to, you know, the period

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of the most vulnerability in diabetes, which is

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before you cross that threshold.

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Yes. And I think it's very valuable to patients

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in that early period

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before their pancreas has

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declined its production of insulin.

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Right? Yeah. Before the pancreas has literally given up.

250
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Right. And if you can catch the patient before that time

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and reorganize their metabolic health Yes.

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And knowledge is important. Yes.

253
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So tell us about how you came

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to develop this device for Yeah.

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And who did you intend it to be for? Yeah.

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You know, was having some

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of those wake up calls about sort of, hey,

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how do we actually focus on the modifiable factors

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of inflammation rather than just treating it

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with medications and then ultimately surgery.

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And that led me down the road straight to metabolic health

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because fundamentally I think one of the biggest factors

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that is actually causing chronic inflammation in the human

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body is the fact that our cells are

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fundamentally underpowered.

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I mean, that is metabolic dysfunction. Mm-Hmm.

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It is a issue with how we're making energy in our cells.

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Mm-Hmm. And so what could be more threatening

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and cause more of an inflammatory response in the body than

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literally cells that are at, at scale in the body,

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not creating energy properly.

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So that's really the thesis of the book.

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And that led me to a sense of how I wanna use my medical,

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you know, knowledge to help people

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as best I can in this country is

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to help people understand their metabolic health Mm-Hmm.

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And improve it. And like you said, you know,

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we've been using technology to help people understand

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and optimize their metabolic health in sort

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of a late stage Mm-Hmm.

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Clinical population for a long time.

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Yeah. That's mostly what we do.

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But then we step back and say,

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well these diseases are almost nearly entirely preventable.

285
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Most people do not need to develop type two diabetes.

286
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That's right. Like these diseases almost didn't exist

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before 150

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Years ago before exactly when food was scarce,

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When foo. Right. And so

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how do we actually

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Help people Before there were no

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restaurants before there were

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Exactly. When people

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Were before, there was no refrigeration, if you think

295
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About it, and know synthetic pesticides.

296
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Yeah. And all people were just eating fresh food. Mm-Hmm.

297
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And so how do we actually take populations

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that haven't developed disease yet?

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So that was always the intended population is

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how do we help people early to hopefully never get

301
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to that stage Mm-Hmm.

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Where they have diabetes by learning

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how food is affecting their health in this real time

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closed loop biofeedback.

305
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So this device for people who don't know about it,

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it's you put it on your arm

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and it's got a little probe that goes under the skin

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and it's actually doing a lab test on your arm every 10

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to 15 minutes, 24 hours a day,

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sending those blood sugar levels to your phone.

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Mm-Hmm. So you see a movie

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of what's happening with your blood sugar.

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So as I'm eating different types of foods

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and different pairings or you know, sleeping more or less

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or exercising more or less Mm-Hmm.

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You can put it together and see exactly what's keeping

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blood sugar more stable.

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Which is ultimately what we want to,

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to prevent the long-term insulin resistance is keeping the

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blood sugar under better control.

321
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Right. And giving people so much empowerment.

322
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'cause I think a lot of people have this fear right now

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of like with, with 50%

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of American adults having pre-diabetes

325
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or type two diabetes, now all of us are sort of thinking,

326
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well, I might just walk into the doctor's office

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and get this bomb dropped on me of like,

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I have diabetes because,

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So how do you use your device for

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managing people's lifestyle so they can see

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what their levels are and they can know what they ate

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and they can know what they just did

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and they can see in real time that eating a candy bar

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Is gonna do something Is is

335
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gonna raise my glucose. Yeah.

336
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And you can know something.

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I mean, we all kind of could look at a table.

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I think most people could say like,

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this is junk food and this is not.

340
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Right. We know that the Snickers bar is not

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what we should be eating for Tal Health and that the apple

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or whatnot is, but there's something about knowing the

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information and then seeing the information own

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Body. I totally agree with that.

345
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It just changes things. We can tell people all day

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long, you have lethal LDL cholesterol,

347
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but until you show 'em on a scan

348
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what their plaque looks like in their heart

349
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or in their carotid artery, it just, they're like, yeah.

350
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That's just information. Information

351
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Yeah. Seeing is really

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believing.

353
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Yeah. I totally agree with that.

354
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People who have been eating kind

355
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of more typical American breakfast like cereal, um mm-Hmm.

356
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You know, or toast and juice and instant oatmeal

357
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and things that like many people would just think are

358
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totally normal and, you know,

359
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but then they put this, the glu glucose monitors on

360
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and they see, oh my gosh, my glucose went up 80 milligrams

361
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for deciliter right after breakfast

362
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and then came crashing down.

363
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And it's actually the crash people seeing the crash

364
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that I think is so interesting

365
00:13:51.245 --> 00:13:54.005
because this re reactive hypoglycemia period

366
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after a big spike Mm-Hmm.

367
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And then a big crash where it actually dips below baseline.

368
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That is often when people don't feel good Mm-Hmm.

369
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It's when they feel jittery, they need to,

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their bodies basically put into a state

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of alarm saying bring the glucose back up.

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Mm-Hmm. And so that's often when people feel

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intense sugar cravings.

374
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Mm-Hmm. So people will say, okay,

375
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mid-morning is when I need the extra frappuccino,

376
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I want the extra muffin.

377
00:14:15.505 --> 00:14:18.725
I'm having a post-meal crash. I feel anxious.

378
00:14:18.985 --> 00:14:20.885
And then they try and of course mitigate that

379
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with the muffin and the frappuccino and whatever.

380
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And then they realize, wait,

381
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if I just smooth out my breakfast spike,

382
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maybe I won't even have the crash.

383
00:14:29.385 --> 00:14:30.485
So then they move towards or

384
00:14:30.485 --> 00:14:31.485
Skip it. Or skip it.

385
00:14:31.485 --> 00:14:32.485
Yeah. They could fast,

386
00:14:32.635 --> 00:14:36.805
they could eat maybe some, you know, uh, a lot

387
00:14:36.805 --> 00:14:39.325
of people have shifted from cereal or granola

388
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or instant oats to something like chia pudding.

389
00:14:41.885 --> 00:14:44.965
Mm-Hmm. Because that has way more fiber and protein

390
00:14:45.225 --> 00:14:46.485
and healthy Omega-3 fats

391
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Keeps your glucose stable, totally

392
00:14:47.865 --> 00:14:48.865
Stable. Mm-Hmm. Or

393
00:14:48.865 --> 00:14:51.045
they'll go from a fruit smoothie to more

394
00:14:51.205 --> 00:14:53.365
of like a veggie based high protein smoothie.

395
00:14:53.365 --> 00:14:54.805
Mm-Hmm. Totally flattens it out.

396
00:14:54.825 --> 00:14:58.245
So it's not about like getting rid of everything you love so

397
00:14:58.245 --> 00:15:01.085
They can literally see the connection

398
00:15:01.155 --> 00:15:02.445
between how they feel

399
00:15:03.105 --> 00:15:04.105
Yes. And what

400
00:15:04.105 --> 00:15:05.165
their glucose is. Yeah.

401
00:15:05.355 --> 00:15:07.525
Yeah. So it's not, it's super the data

402
00:15:07.525 --> 00:15:08.805
and the eating, it's the eating

403
00:15:09.025 --> 00:15:11.005
and the data and the feeling.

404
00:15:11.115 --> 00:15:12.965
Yeah. I, I get it. That I feel like is the magic moment.

405
00:15:12.965 --> 00:15:14.005
Right. Who doesn't like to take

406
00:15:14.005 --> 00:15:15.165
pictures of their food these days?

407
00:15:15.315 --> 00:15:17.645
Your app actually allows you to take pictures of the food

408
00:15:18.105 --> 00:15:21.205
and there's some AI that's actually figuring out

409
00:15:21.205 --> 00:15:22.845
what you ate and it logs it. Is

410
00:15:22.845 --> 00:15:23.845
That correct? Yeah. And it helps you

411
00:15:23.845 --> 00:15:25.325
figure out what to do differently.

412
00:15:25.585 --> 00:15:28.245
So if it knows that you're like a cereal person,

413
00:15:28.825 --> 00:15:31.245
we can suggest things that are kind of similar to cereal

414
00:15:31.425 --> 00:15:33.445
but aren't gonna cause that big glucose spike.

415
00:15:33.445 --> 00:15:35.125
Like a, like a chia pudding

416
00:15:35.125 --> 00:15:37.765
or like a grain free, uh, granola.

417
00:15:37.785 --> 00:15:40.445
We have amazing recipes for more nut and seed

418
00:15:40.465 --> 00:15:42.245
and coconut based granolas.

419
00:15:42.245 --> 00:15:44.165
Mm-Hmm. Do not spike your glucose,

420
00:15:44.865 --> 00:15:47.205
but that give you that same satisfying

421
00:15:47.385 --> 00:15:48.885
crunch and that type of thing.

422
00:15:49.665 --> 00:15:51.925
So five of the key things that I believe,

423
00:15:51.925 --> 00:15:53.565
and I'd love to hear your guys' thoughts on this,

424
00:15:53.635 --> 00:15:56.325
that I really think can help the body do well if we try

425
00:15:56.325 --> 00:15:58.805
and incorporate them in almost every meal is a really good

426
00:15:58.805 --> 00:16:01.565
fiber source, a healthy protein source, an Omega-3 source,

427
00:16:01.805 --> 00:16:04.285
a probiotic source, and an antioxidant source.

428
00:16:04.825 --> 00:16:08.725
So then the key is actually having a mental model of

429
00:16:08.835 --> 00:16:11.445
what are your favorite things in each of those categories.

430
00:16:11.445 --> 00:16:13.045
Mm-Hmm. And just making sure they're in your kitchen.

431
00:16:13.225 --> 00:16:15.205
So it becomes almost like mixing and matching.