Parwy's Blog: Transform Your Health by Improving Metabolism, Hormone & Blood Sugar Regulation

In this episode, Dr. Casey Means, a physician trained at Stanford University School of Medicine, an expert on metabolic health and the author of the book, Good Energy, discusses how to leverage nutrition, exercise and environmental factors to enhance your metabolic health by improving mitochondrial function, hormone and blood sugar regulation. We also explore how fasting, deliberate cold exposure and spending time in nature can impact metabolic health, how to control food cravings and how to assess your metabolic health using blood testing, continuous glucose monitors and other tools. Metabolic dysfunction is a leading cause of chronic disease, obesity and reduced lifespan around the world.

The Global Metabolic Health Crisis

The latest research indicates that 93.2% of American adults have suboptimal metabolism.
Metabolic dysfunction underlies nine of the ten leading causes of death in the United States.
Chronic disease rates are worse, and life expectancy is lower in the United States compared to other high-income countries, despite higher healthcare spending.
This crisis is spreading to other countries that adopt the Standard American Diet and Western lifestyle norms.
Current healthcare systems are criticised for their focus on downstream symptoms and isolated specialties (siloing conditions), rather than addressing the underlying root cause of metabolic dysfunction. This approach is seen as profitable but ultimately failing to improve health outcomes.

The "Trifecta of Bad Energy": Root Causes of Dysfunction

Metabolic dysfunction is rooted in a "Trifecta of Bad Energy": mitochondrial dysfunction, chronic inflammation, and oxidative stress.

Mitochondria: These structures within cells are responsible for converting food into usable energy (ATP). When dysfunctional, they are like "rolling blackouts" in a city.
Environmental Impact: Rapid changes over the last 50-75 years in diet, sleep, movement, time in nature, exposure to toxins, temperature regulation, and emotional health synergistically damage mitochondria through different mechanisms. This leads to underpowered cells, and unprocessed energy substrates are then stored, contributing to obesity.
Cell Danger Response: Dysfunctional mitochondria can trigger a "cell danger response," releasing extracellular ATP which activates a massive innate immune response, leading to chronic inflammation.
Oxidative Stress: As dysfunctional mitochondria struggle, they produce damaging metabolic byproducts called reactive oxygen species or free radicals, which cause further damage ("wildfires").
Insulin Resistance: This is described as a cellular compensation for mitochondrial dysfunction; cells block glucose entry when they can't process it, leading to insulin in the blood rising and causing the body to turn glucose into a storage form like triglycerides.

Strategies to Improve Metabolic Health and Mitochondrial Capacity

Improving metabolic capacity involves making more mitochondria (biogenesis), mitophagy (recycling old, dysfunctional mitochondria), making each mitochondrion more functional, and increasing their processing of energy substrates.
Movement:
- Walking: Walking 7,000+ steps per day is associated with a 50-70% lower risk of all-cause mortality. It acts as a glucose disposal signal, stimulating muscle contraction that pushes glucose channels to the cell membrane. Short, regular walking breaks (e.g., 2-3 minutes every 30 minutes) throughout the day are more metabolically beneficial than one long exercise session. A 10-minute walk after meals can drastically reduce glucose response.
- Varied Exercise: Endurance exercise and Zone 2 training stimulate mitochondrial biogenesis. High-intensity interval training (HIIT) improves mitochondrial fusion. Resistance training promotes muscle hypertrophy, requiring more mitochondria. Meeting basic guidelines (e.g., resistance training 2-3 times/week, 75-150 minutes of moderate/strenuous cardio/week) can be potent stimuli for mitochondrial health.
- Under-Desk Treadmills: Highly recommended for knowledge workers; even slow-speed walking (1 mph) for 2.5 hours/day can lead to fat loss and lean mass gain. This helps integrate "constitutive movement" back into daily life, which modernity has removed.
- NEAT (Non-Exercise Activity Thermogenesis): Fidgeting and small movements throughout the day tell the body to stay metabolically active, a practice that was historically built into human life.
Nutrition:
- Food Quality: Prioritise real, unprocessed food from good soil, as ultra-processed foods are nutrient-depleted, addictive, and lead to overconsumption. The body is designed to self-regulate hunger when consuming natural, nutrient-rich foods.
- Key Nutrients: Aim for fiber, Omega-3s, adequate healthy protein, probiotics, and high antioxidant sources in the diet.
- Calorie Regulation: Eating ultra-processed foods causes people to eat significantly more calories than unprocessed foods, as cells aren't getting what they need to function properly and drive continued hunger.
- Timing of Eating: Compressing eating into a moderate window (e.g., 6-10 hours) during daytime hours improves metabolic health by lowering 24-hour glucose and insulin levels. Eating the same meal later at night (e.g., 8:30 PM) results in higher glucose and insulin responses compared to earlier in the day (e.g., 9:30 AM). This promotes metabolic flexibility by giving the body time to tap into fat stores for energy.
- Meal Composition & Order: Adding fat and fiber to meals can significantly reduce glucose spikes. Protein (especially valine and glutamine) potently stimulates GLP-1 secretion. Eating soup first, then an entree, then salad, can lead to steadier and lower blood glucose rises.
- GLP-1 Stimulation (Natural): Short-chain fatty acids (from microbial fermentation of fiber and polyphenols found in colorful fruits, vegetables, spices, teas, cocoa) stimulate the differentiation of more GLP-1-producing L-cells in the gut. Thylakoids (from spinach), specific amino acids (valine, glutamine), green tea (ECGC), and curcumin can also stimulate GLP-1 secretion. Inhibiting the enzyme DPP4 (with foods like black beans, Mexican oregano, rosemary, guava, myricetin from berries) prevents GLP-1 breakdown.
- Avoiding Glucose Spikes: Large post-meal glucose spikes lead to significant crashes (reactive hypoglycemia), which predict higher 24-hour energy intake and increased carbohydrate cravings. Lowering these spikes can help manage cravings.
Sleep: Adequate and quality sleep is crucial for metabolic health. Poor sleep can alter morning blood glucose levels and negatively impact daytime fuel regulation. The brain and body cycle through different metabolic modes throughout the night, which acts as a rehearsal for metabolic pathways.
Temperature Exposure:
- Cold Exposure: Throughout human history, bodies were exposed to wide temperature fluctuations. Cold acts as an energetic signal to mitochondria to produce more heat, increase their number, and activate brown fat (mitochondrial-dense fat).
- Heat Exposure: Can activate heat shock proteins, which upregulate antioxidant defense systems, helping to quell oxidative stress.

Assessing Metabolic Health

Key Blood Biomarkers: Dr. Means recommends everyone get the following basic blood tests: fasting glucose, hemoglobin A1c (HbA1c), fasting triglycerides, HDL cholesterol, total cholesterol to HDL ratio, waist circumference, and blood pressure. These markers are easily accessible, relatively inexpensive, and define metabolic syndrome.
Interpreting Results: Reading these markers through the lens of cellular physiology helps understand underlying mitochondrial dysfunction. For example, high fasting glucose and triglycerides indicate that cells are blocking glucose entry and converting excess carbohydrates to storage. High hemoglobin A1c reflects average blood sugar over 90-120 days, showing how much sugar is sticking to red blood cells. High blood pressure can be linked to insulin resistance affecting nitric oxide activity, which dilates blood vessels.
Optimal vs. "Normal" Ranges: Dr. Means advocates for striving for optimal ranges (e.g., fasting glucose less than 100, triglycerides less than 150, HDL above 40/50, HbA1c less than 5.7%) rather than just "normal" ranges, as being at the high end of normal for multiple markers often signals metabolic dysfunction.
Continuous Glucose Monitors (CGMs): These provide a "movie" of glucose levels, offering insights beyond single-point blood tests. They can reveal:
- Individual Food Responses: How different foods uniquely affect one's blood sugar.
- Time to Baseline: How long it takes for glucose to return to normal after a meal (should be within 1.5-2 hours, indicating insulin sensitivity; longer suggests resistance and a high "area under the curve").
- Glycemic Variability: How "spiky" glucose curves are; high variability is associated with worse metabolic biomarkers.
- Dawn Effect: The magnitude of the glucose rise upon waking, which can correlate with insulin resistance and stress levels.
- "Sneaky Spikers": Foods often perceived as healthy (e.g., instant oatmeal, some green juices) can cause significant glucose spikes.
- Impact of Lifestyle: How sleep, stress, and exercise modulate glucose responses.
Accessing Testing: While basic tests are often covered by annual physicals, more comprehensive tests (e.g., fasting insulin) may require advocacy with doctors. Direct-to-consumer lab testing companies (e.g., Function Health, InsideTracker, Levels) provide accessible alternatives for frequent monitoring.
Future Monitoring: Continuous monitoring technology is expanding beyond glucose to include ketones, lactate, alcohol, and is expected to soon cover hormones and lipids.

Mindset, Nature, and Psychological Well-being

Psychological Impact: Mindset, psychology, and the relationship with fear and control profoundly impact metabolic health. Loneliness and stress are risk factors for mitochondrial dysfunction, and stress can directly elevate blood sugar. Our cells hear every thought through biochemistry, influencing metabolic function towards defense (threat response) or thriving (repair/homeostasis).
Modern World's Influence: The constant exposure to fear-inducing media through devices, coupled with societal issues like unresolved childhood trauma and a "death-fearing culture," creates a state of chronic psychological threat that impacts cellular biology. This environment can drive dopamine-seeking behaviours (social media, processed food, gambling, alcohol) as coping mechanisms.
The Role of Nature: The average American spends 93.7% of their time indoors, disconnected from nature. Spending time outdoors is crucial because it provides vital light exposure for metabolic health and chronobiology, and it serves as a powerful teacher. Nature instills a sense of awe, harmony, and fundamental abundance, which is an antidote to fear and scarcity-driven decisions that harm health. Reconnecting with nature (e.g., working outdoors, walking meetings) allows individuals to understand their dynamic conversation with the environment, promoting gratitude and a joyful health journey.
Agency and Safety: Cultivating a sense of safety in our bodies, setting boundaries with media, engaging in therapy, and reconnecting with nature are critical steps to redirect mitochondrial resources towards thriving.

Chapters

00:00:00 Dr. Casey Means
00:02:18 Sponsors: Maui Nui, Eight Sleep & AeroPress
00:06:32 Metabolism, Metabolic Dysfunction, Medicinal Blindspot
00:14:17 Trifecta of Bad Energy
00:24:02 Western Living, United States, Specialization & Medicine
00:27:57 Insulin Resistance, Tool: Mitochondrial Capacity & Exercise
00:33:33 Sponsor: AG1
00:35:03 Tools: Walking & Glucose; Frequent Movement
00:44:25 Tools: Exercises to Improve Mitochondrial Capacity; Desk Treadmill
00:51:18 Soleus Push-Ups & Fidgeting, Non-Exercise Activity Thermogenesis (NEAT)
00:57:14 Sponsor: InsideTracker
00:58:21 Tool: Blood Test Biomarkers, Vital Signs & Mitochondrial Function
01:11:16 Navigate Medical System & Blood Tests, Consumer Lab Testing
01:16:46 Tool: Environmental Factors; Food, Life as a Process
01:21:58 Tool: Ultra-Processed vs. Real Food, Obesity, Soil & Micronutrients
01:32:03 Ultra-Processed Foods: Brain & Cellular Confusion
01:39:10 Tools: Control Cravings, GLP-1 Production, Microbiome Support
01:51:42 Ozempic, GLP-1 Analogs; Root Cause & Medicine
02:00:54 Tool: Deliberate Cold & Heat Exposure, Brown Fat
02:07:27 Tool: Intermittent Fasting & Metabolic Flexibility; Insulin Sensitivity
02:17:03 Tool: Continuous Glucose Monitors (CGMs) & Awareness, Glucose Spikes
02:24:34 Tool: CGMs, Glycemic Variability, Dawn Effect, Individuality
02:33:10 Sleep; Continuous Monitoring & Biomarkers
02:37:39 Mindset & Safety, Stress & Cell Danger Response
02:44:04 Tool: Being in Nature, Sunlight, Fear
02:54:44 Zero-Cost Support, Spotify & Apple Reviews, Sponsors, YouTube Feedback, Social Media, Neural Network Newsletter