Robust Good Health In The Spotlight

Are we at an inflection point?

I’m so grateful that our country’s collective ill health—and especially the terrible and declining health of our children—is getting national attention. It feels like everybody is so sick and tired of being sick and tired that things might actually shift in a positive, healthful direction.

I have to be cautious about this sort of thing because I have a tendency to get enthusiastic. Then, if nothing changes, I can wind up feeling discouraged.

But! This feels different. For one thing, at a moment when our country seems utterly bifurcated, split into the deplorables and the cognoscenti, or into regular people and the elites—according to your perspective, biography, and geography—better health for everyone is something we can all agree on and root for together.

I’ve especially taken note of the attention currently focused on the ideas and praxis of Casey and Calley Means, brother-and-sister authors of Good Energy: The Surprising Connection Between Metabolism And Limitless Health. The book is currently #3 on Amazon’s list of the most frequently bought nonfiction books, and has been a New York Times bestseller for 15 weeks—almost since it was released—and counting.

Casey Means is a doctor; Calley Means is a health policy advocate. After years and years of school, culminating in an ENT surgical training, Casey Means left the practice of “traditional” medicine because she did not feel that she was helping people to become healthier. She and her brother are articulate espousers of what’s wrong with our current healthcare, food, and regulatory systems, and of how to improve all of them.

They’ve been interviewed for more than two hours by Tucker Carlson—please put aside your feelings about Carslon, even if they result in revulsion; he barely gets a word in edgewise in the interview (it’s mostly the Means siblings talking), which is full of good information and clear thinking on topics that should matter to all of us. If you loathe Carlson, skip his plug for his new documentary series at the beginning of the YouTube video, and go straight to the interview. And if you really can’t stomach Tucker Carlson, or if you want more, Andrew Huberman did a nearly three-hour interview with Casey Means.

These interviews are information-dense. I’ve listened to both of them, but over the course of days. There’s a lot to take in.

The book covers a lot of ground. I can’t do it justice in a Substack column, but I’d like to share some takeaways. To be fair, ideas about the importance of a healthy metabolism are not new. (Metabolism is the set of biochemical processes that change food into energy that fuels—well or poorly—every single cell in your body, affecting, for good or ill, hormonal balance, clearheadedness, immune function, cardiovascular health, and musculoskeletal soundness, among many others.) To be fair, Casey and Calley Means are not the first doctors or knowledgeable laypeople to emphasize the fundamental importance of metabolic health. Dr. Catherine Shanahan has done so in her book, Deep Nutrition, as have Dr. Sean O’Mara, Dr. Jason Fung, Dr. Thomas Seyfried, Dr. Robert Lustig, and Mark Sisson in their work. But there’s something about the way the Meanses are presenting these issues, coupled with a favorable zeitgeist, that seems to be bringing the importance of metabolic health to a wide audience. Hallelujah!

A few significant takeaways from the Means’s book:

*The chronic disease crisis is the most important issue facing our country right now. In the past year and a half, four young people in my world (by young, I mean between 26 and 34 years old) were diagnosed with serious breast or colorectal cancers. I don’t remember this happening with this kind of frequency 40 years ago. This is something new and unwelcome.

Meanwhile, older people in my world are constantly getting diagnosed with cancers (I’m one of them); having surgeries to insert stents or to bypass arterial blockages; learning they have Alzheimer’s; and dying. Sorry to be bleak here, folks; I’m calling it as I see it. That’s just the circle of people I know. Statistics drive home the point: While cancer deaths have decreased over the last 30 years, cancer incidence is up, up, up, with 2024 expected to log the highest number ever—2 million new cases, about 5500 new cancer diagnoses per day.

Surviving cancer is great—sure beats the alternative—but it’s nearly always going to leave a residue: Parts of the body that were radiated may not function as they did before treatment; energy levels may be permanently depressed; and there’s often anxiety around any ache or pain, worry that the cancer might be back in a different incarnation. My point: Better not to get it at all. Increased incidence of cancer cases, even coupled with better survival rates, is not a win.

We’ve had a threefold increase in diabetes over the past three decades, and obesity has tripled in the last sixty years. You’ve heard all this stuff. I’m not telling you anything new.

Here’s the new part that individuals like Casey and Calley Means are spearheading: This is the most serious issue facing our country because without health, we don’t have vitality, we don’t have innovation, we barely have a future. And we can fix it (more on fixing below).

*Kids are faring horribly. You’ve heard these statistics: Children today are way more likely to be obese, prediabetic, depressed, anxious, and to have non-alcoholic fatty liver disease than kids fifty years ago.

No bueno. We have really not been doing right by our kids for a long time now. We feed them crummy, industrial food, made almost necessary by the over-demanding, pressure-cooker world of work and school that we consensually participate in, leaving us little time to shop for or cook healthy food, let alone think or get in our 10,000 steps. We marinate in environmental toxins—and I don’t mean the poison water of Flint, Michigan or the poison air of East Palestine, Ohio, neither of which have been properly cleaned up yet. Instead, I mean the garden variety insecticides, pesticides, fungicides, and rodenticides that saturate our world. I’m talking about our air, polluted with asbestos, heavy metals, and volatile organic compounds (VOCs). And how about the chemicals in our food, in our skincare products, in our clothes, in our household cleansers? We’re all affected negatively by this toxic stew, but children’s smaller, developing bodies are affected more. Stress and hurry are permanent fixtures in many children’s lives, with their attendant health risks. We park kids in front of screens for hours a day—everybody’s cooked by the end of the day, everybody needs a break, I get this. But there are costs. Many children barely encounter the natural world. This is not a recipe for robust good health or optimal development.

*Metabolic dysfunction lies at the root of many of our physical, mental, and behavioral ills. This is a core issue that the Means team points out: Our metabolisms, both adults and children, are out of whack because of the non-nutritive, addicting, artificial food we eat coupled with our lack of physical activity, and cavalier attitudes toward high-quality sleep. We know that obesity, diabetes, and prediabetes are all metabolic dysfunctions. The Meanses suggest that many other conditions stem from suboptimal metabolic function, and that we can start to correct that dysfunction by fixing our diets.

In 2012, when I was diagnosed with cancer, lipid biochemist Thomas Seyfried published Cancer As A Metabolic Disease: On The Origin, Management, And Prevention Of Cancer. That cancer’s root cause might be metabolic was a radical idea. Like the Meanses, Seyfried considers diet a frontline defense against cancer, and makes a compelling argument that the disease is more a problem with metabolism than genetic destiny. The Meanses would cite many other inflammatory conditions that they believe begin with disordered metabolism, among them arthritis, polycystic ovary syndrome (a major cause of infertility), and Alzheimer’s disease.

The Means’s biggest takeaway: Through lifestyle changes, largely in diet and movement, you can dramatically improve metabolic function, and thus reduce your risk of developing many chronic diseases.

*And that’s the most important thing the Meanses offer: agency. People want to feel like they can help themselves, particularly with doctors nowadays spending so little time with their patients. Isn’t there anything I can do besides pop a pill or go under the knife, doc? Healthcare pretty much sucks right now, essentially designed to intervene when disease processes are already well underway with a pharmaceutical or surgical fix—rather than shoring up robustness and good health much earlier in the game.

I want to acknowledge that doctors are victims of our lousy “healthcare” system too, which seems to only benefit insurers and Big Pharma. “Health” insurers and Big Pharma make the big bucks when people are sick, especially with lifelong conditions that require their services unto death.

The Means’s book goes into detail on recommended dietary and movement changes, ways to optimize quality sleep, and many other accessible interventions. They are also quite focused on data; this is not a guessing game. They identify the five major biomarkers of metabolic health—HDL cholesterol levels; triglycerides; fasting blood glucose; blood pressure; and waist circumference. The first three can all be ascertained through simple blood tests. The Meanses also explain how the ranges on some of these values have been considered acceptable, but are actually problematic. For example, if you get your fasting blood glucose tested, anything under 100 mg per deciliter of blood is considered normal. According to the Meanses, your blood glucose levels should not rise above 85 mg/dl.

The Meanses also recommend using a wearable device to track daily steps, sleep quality, heart rate, and amounts of moderate and vigorous physical activity. Turns out, when people estimate these values, they tend to think they slept more soundly, walked more, and exercised harder than they actually did. With a device, it’s all objective.

The potential consequences are huge. If we took all this seriously, it could have implications for how we organize what we call education and what we call work. But even if we just focus on the diet and the movement and the sleep and the thoughtful collection and interpretation of data in our individual lives, we could make huge strides. Maybe getting older doesn’t need to be characterized by dysfunction and disability punctuated by pain and an ever more compressed life. Maybe children don’t need to be diagnosed with diabetes before they start shaving. Will there be disability and disease? Yes, of course. They’re part of life, just like death is.

But wouldn’t it be amazing if our population, our people could move in the direction of physical strength and health, rather than declining into weakness and disease, as all age groups seem to be doing now? We face a lot of challenges in our country. We need sharp, healthy minds in vital, healthy bodies to face them.