Podcast Interview Offers Key Insights into Pervasive Metabolic Disease

By: Dr. Ron Hunninghake, MD, CMO 

Metabolic syndrome is a common – and growing – problem. Some studies show that 80% or more adults have at least one factor, and many don’t even realize it, until they are “suddenly” diagnosed with another condition such as heart disease or cancer. 

The recent podcast “Honestly with Bari Weiss” featured an interview with Dr. Casey Means, MD, a Stanford-trained physician and the chief medical officer and co-founder of Levels, a metabolic health company. She is also associate editor of the International Journal of Disease Reversal and Prevention. 

During the episode, which aired September 19 and was titled “Eating Ourselves to Death,” Dr. Means discusses food, obesity, and its impact on our metabolic system, particularly as it relates to diabetes. According to her biography on LevelsHealth.com, her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tech-enabled tools that can inform smart, personalized, and sustainable dietary and lifestyle choices. 

In the podcast, Dr. Means and Bari White evaluate the goals and challenges of the past 15 years of the obesity epidemic and its evolution over time. According to the Centers for Disease Control and Prevention, nearly 74% of adults age 20 or older are overweight, with 42% of that total classified as obese. [1] 

Meanwhile, social dialogue has shifted to “healthy at any size.” Instead of trying to prevent poor health and diseases that are within our control, people are being told that there’s nothing wrong with being fat, weight doesn’t matter, and foods are not “good” or “bad.” “Every year, patients in America are getting sicker, heavier, more depressed, and life expectancy is going down,” Dr. Means said on the podcast. 

The CDC reported in August 2022 that the average life expectancy at birth in the United States declined for a second straight year between 2020 and 2021 – 77.0 years to 76.1 years. That marks the biggest two-year decline in life expectancy since 1921-23. [2] 

Dr. Means writes on LevelsHealth.com that blood glucose levels are the key to metabolic health, and that keeping glucose levels in a stable and healthy range is critically important for one’s metabolism to work effectively. [3] 

“Glucose is a simple sugar that is a breakdown product of the carbohydrates that we eat. When glucose enters the bloodstream, it signals to the pancreas to release insulin, a hormone that tells cells to absorb glucose. Excess glucose is stored in the muscle and liver as glycogen, and can also be converted to triglycerides and stored in fat cells.” – Dr. Means, LevelsHealth.com [3] 

Poor control of blood glucose is the central cause of a massive, silent epidemic of pre-diabetes and type 2 diabetes! Preventable type 2 diabetes and pre-diabetes are widely prevalent in the United States, with the CDC estimating that 37.3 million individuals have diabetes, or 11.3% of the U.S. population. Of those, an estimated 8.5 million people, or 23%, do not know they have it! Additionally, approximately 96 million people age 18 or older – 38% of the adult U.S. population – have pre-diabetes. [4] 

A fasting blood sugar test of 100-125 mg/dL indicates pre-diabetes, and 126 mg/dL or higher indicates diabetes. [5] An A1c test can give individuals a longer-term look at their glucose level trends, as it measures levels over 2 to 3 months, which is a test offered by the Riordan Clinic. Issues with insulin can occur years before type 2 diabetes is reflected in blood testing. Elevated insulin levels over time can lead to insulin resistance, as the pancreas wears out and is no longer able to produce enough insulin to overcome the cells’ resistance. [6] 

Diabetes matters because cells aren’t making energy properly, and it can show up as a variety of conditions such as infertility, erectile dysfunction, heart disease, migraines, low sperm count, high blood pressure, and much more. [7] 

Changes in Food

Food is different today and doesn’t contain the same nutrients it used to. Studies have found that nutritional values of popular vegetables have dropped significantly since 1950. [8] In the ‘50s, a typical dinner would consist of starch, protein, and a vegetable, most of which was made in the home with fresh ingredients. [9] 

Today, ultra-processed food consumption is growing. A study published in the American Journal of Clinical Nutrition analyzed the food intake of 41,000 participants from 2001-2018. The survey found that consumption of ultra-processed foods grew from 53.5% of calories consumed in 2001 to 57% in 2018. [10] 

It is also well known that portion sizes have doubled or tripled over the last 20 years, which has contributed to an increase in obesity rates in both children and adults. In one day, an individual could consume 1,500 more calories than if he or she ate the same foods at typical portions served 20 years ago. Over the course of a year, the larger portions could amount to more than 500,000 extra calories! [11] 

Sugar intake alone has skyrocketed, with Americans eating 25 times more refined sugar than we were 100 years ago. [12] In fact, a report by the U.S. Department of Agriculture showed that the #1 purchase by households in the SNAP (food stamp) program was soft drinks. [13] 

Inadequate chemical regulation is contributing to health risks, partly due to the limited funding and resources for the Food and Drug Administration, which has the authority to ensure the safety of chemicals in food. [14] 

There is growing evidence that chemicals in our food are “obesogens” – additives and fillers such as microplastics and pesticides that can contribute to obesity. Approximately 50 obesogens or potential obesogens have been identified. [15] 

Healthcare System 

In her podcast, Dr. Means discusses some of the things she views as shortcomings in our current mainstream healthcare system, including care models being driven by profits. She said that success criteria in many hospitals includes: [7] 

• Targeting 15 minutes or less in exam rooms with patients 
• The push for new medication prescriptions 
• Charting that can be billed for 
• Focus on ruling out with lab tests anything that could be life-threatening 
• Emphasizing patient compliance with long-term medication usage 

She added that in conventional care there is no incentive to discover the real underlying causes of chronic symptoms or how to effectively treat the whole person. She said there has been a social shift in the way conventional providers talk to patients about diet and exercise. Care is taken to avoid the implication of any personal responsibility and thus appearing “elitist,” “racist,” or “ableist” because not all patients have equal access to healthy foods or healthy behaviors. [7] 

Key Take Home Solutions 

Dr. Means said it is important to address the widespread conflict of interest and get the money out of the hands of the individuals responsible for writing guidelines that are designed to protect us. That could also include changes to campaign finance laws, changes to farm bill subsidies for sugar, corn, wheat, and soy, and pharmaceutical advertising. [7] 

Individuals can be proactive about improving their metabolic health with these tips: 

• Eat real, unprocessed, clean food [16] 
• Shop on the outer perimeter of the grocery store where processed food is less likely to be located [17]
• Get quality sleep [18] 
• Manage stress [19] 
• Move your body [20] 
• Get sunlight [21] 
• Avoid toxins in food and the environment [22] 

One of the innovative tools that Dr. Means discussed in the podcast was the personal use of a continuous glucose monitor (CGM), which gives users personal metabolic insights in real time.

Individuals often react in unique ways to different foods (i.e. an unexpected rise in blood sugar after eating a bowl of blueberries) or alternative eating habits, such as intermittent fasting. With a tool like this, your doctor can talk to you about your individual metabolic status, not simply metabolic status in the abstract. I am considering trying it for myself with the intent of offering a “metabolic wellness program” here at the Riordan Clinic if there is sufficient interest from our co-learners. 

I encourage readers to learn more about their metabolic status and listen to the podcast, which is available at https://www.honestlypod.com/.

Resources 

1. Centers for Disease Control and Prevention. (2022, September 6). FastStats – overweight prevalence. Centers for Disease Control and Prevention. Retrieved October 5, 2022, from https://www.cdc.gov/nchs/fastats/obesity-overweight.htm
2. Centers for Disease Control and Prevention. (2022, August 31). Life expectancy in the U.S. dropped for the second year in a row in 2021. Centers for Disease Control and Prevention. Retrieved October 5, 2022, from https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220831.htm
3. Casey Means, M. D. (2022, October 1). The Ultimate Guide to Metabolic Health. Levels. Retrieved October 5, 2022, from https://www.levelshealth.com/blog/the-ultimate-guide-to-metabolic-health#:~:text=Glucose%20is%20a%20primary%20precursor,and%20minimize%20large%20glucose%20swings
4. Centers for Disease Control and Prevention. (2022, January 18). National Diabetes Statistics Report. Centers for Disease Control and Prevention. Retrieved October 5, 2022, from https://www.cdc.gov/diabetes/data/statistics-report/index.html
5. Centers for Disease Control and Prevention. (2022, July 7). What is diabetes? Centers for Disease Control and Prevention. Retrieved October 5, 2022, from https://www.cdc.gov/diabetes/basics/getting-tested.html
6. Insulin resistance. Insulin Resistance | ADA. (n.d.). Retrieved October 5, 2022, from https://diabetes.org/healthy-living/medication-treatments/insulin-resistance#:~:text=Over%20time%2C%20though%2C%20insulin%20resistance,prediabetes%20or%20type%202%20diabetes
7. Weiss, B. (2022, September 15). Honestly with Bari Weiss: Eating ourselves to death on Apple Podcasts. Apple Podcasts. Retrieved October 5, 2022, from https://podcasts.apple.com/us/podcast/eating-ourselves-to-death/id1570872415?i=1000579559765
8. BBC. (n.d.). Why modern food lost its nutrients. BBC News. Retrieved October 5, 2022, from https://www.bbc.com/future/bespoke/follow-the-food/why-modern-food-lost-its-nutrients/
9. Dinner is served, 1950’s style: 1950s housewife, housewife, vintage housewife. Pinterest. (2019, June 14). Retrieved October 5, 2022, from https://www.pinterest.com/pin/dinner-is-served-1950s-style–186547609552209259/
10. ScienceDaily. (2021, October 14). Americans are eating more ultra-processed foods. ScienceDaily. Retrieved October 5, 2022, from https://www.sciencedaily.com/releases/2021/10/211014102038.htm
11. U.S. Department of Health and Human Services. (n.d.). Portion sizes and obesity, News & Events. National Heart Lung and Blood Institute. Retrieved October 5, 2022, from https://www.nhlbi.nih.gov/health/educational/wecan/news-events/matte1.htm
12. Consumption of sugar. Consumption of Sugar. (n.d.). Retrieved October 5, 2022, from http://www.sugar-and-sweetener-guide.com/consumption-of-sugar.html
13. O’connor, A. (2017, January 14). In the shopping cart of a food stamp household: Lots of Soda. The New York Times. Retrieved October 5, 2022, from https://www.nytimes.com/2017/01/13/well/eat/food-stamp-snap-soda.html
14. Maffini, M. V., Neltner, T. G., & Vogel, S. (2017, December 20). We are what we eat: Regulatory gaps in the United States that put our health at risk. PLoS biology. Retrieved October 5, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737876/
15. Obesogen. Obesogen – an overview | ScienceDirect Topics. (n.d.). Retrieved October 5, 2022, from https://www.sciencedirect.com/topics/neuroscience/obesogen#:~:text=Obesogens%20are%20chemicals%20that%20disrupt,and%20the%20products%20they%20use
16. Team, N. O. V. I. (2022, June 18). Processed Food: What is it and why is it bad for metabolic health? NOVI Health. Retrieved October 5, 2022, from https://novi-health.com/library/ultraprocessed-foods-and-your-metablic-health#:~:text=Unprocess ed%20or%20minimally%20processed%20foods,-There%20isn’t&text=Unprocessed%20foods%20are%20whole%20foods,meat%2C%20fruits%2C%20and%20vegetables
17. Mayo Clinic Health System. (2022, June 23). Shopping the grocery perimeter. Mayo Clinic Health System. Retrieved October 5, 2022, from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/grocery-store-tourshopping-the-perimeter
18. Sharma, S., & Kavuru, M. (2010). Sleep and metabolism: An overview. International journal of endocrinology. Retrieved October 5, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2929498/
19. Ryan KK. Stress and Metabolic Disease. In: Committee on Population; Division of Behavioral and Social Sciences and Education; National Research Council; Weinstein M, Lane MA, editors. Sociality, Hierarchy, Health: Comparative Biodemography: A Collection of Papers. Washington (DC): National Academies Press (US); 2014 Sep 22. 11. Available from: https://www.ncbi.nlm.nih.gov/books/NBK242443/
20. MediLexicon International. (n.d.). Study reveals how exercise improves Metabolic Health. Medical News Today. Retrieved October 5, 2022, from https://www.medicalnewstoday.com/articles/study-reveals-how-exercise-improves-metabolic-health
21. Stewart, K. (2020, January 29). Fat cells sense sunlight, which supports a healthy metabolism. Today’s Practitioner. Retrieved October 5, 2022, from https://todayspractitioner.com/metabolic-syndrome/fat-cells-sense-sunlight-which-supports-a-heal thy-metabolism/#.Yz2vKnbMKUk

22. Elizabeth Tringali, P. A.-C. (2022, January 21). Do toxins cause metabolic syndrome? Tringali Vibrant Health. Retrieved October 5, 2022, from https://tringali-health.com/new-posts/do-toxins-cause-metabolic-syndrome/