Guys, welcome in. We are so thrilled you're here for this intimate lecture and chat with Dr. Casey. I am Dr. Kate Kresge.
I work at Rupa Health, which is now, as you may have heard, a full-skirt company. We're going to have Quinn dropping links in the chat. He's going to drop a link to some of the news about that. I am so thrilled to just be able to have this platform to hand over to Dr. Casey.
She needs no introduction, as you guys know. Dr. Casey is the best-selling author of Good Energy, the book you saw in Adrian's background that is in all of our backgrounds, actually, and that you must get if you have not read it. Dr. Casey Needs is a Stanford-trained physician and co-founder of Levels, a health technology company with the mission of reversing the world's metabolic health crisis. She is an incredible educator, and we are so proud to partner with her to bring education to practitioners about how to use the latest advances in metabolic health to truly help their patients reverse and prevent chronic disease.
It is such a needed movement right now. We are going to be talking about a lot today. And if you love learning from Dr. Casey, we're actually going to have a six-week course where she is your instructor, you're watching videos from her, and then you get six live hours of Q&A with her. So over the course of six weeks, you have an hour where you get to show up and ask her your questions. How do you implement this in practice?
You also get her Dr. Casey Means Good Energy panel included in that. We always, so many of us pour out. We care for people all the time.
We neglect our own metabolic health. And so we want to give you the tools and insights to truly understand your metabolic health first, put your own oxygen mask on first. You can test yourself and then follow along with your results and actually learn in that kinesthetic experiential way. These slides and this production are copyrighted.
And just remember, Dr. Casey's teaching you today. There's no medical advice, though. Not for you, not for your patients, not for anyone.
Last thing, we have a really cool announcement at RootBuds. So many of us are ordering lab work for clients and have spreadsheets. I had a Google spreadsheet that clients would share with me with their results over time. We now have trends. So you and your clients can upload lab results and track them over time in this beautiful interface.
If you have not checked it out, please do. Anybody can sign up for this. If you're a patient with the RootBud Health account, you will see it. And with that, let's get started.
Hello. everyone. I cannot believe there are 589 of us here. Happy Friday.
I am so excited to talk to you about the topic that I really do think is so magical in health, which is understanding our metabolic health. We're going to understand metabolic health 101, some testing and how to optimize. So let's get started. Here are my disclaimers. Key objectives today.
Here's the plan. So first we're going to do a high level overview of metabolism 101. Then we're going to do a discussion of the metabolic spectrum of disease, all the different diseases that metabolic health touches. It's a lot.
Then I'll discuss the three physiologic hallmarks of metabolic dysfunction, what inside our cells is causing all of this metabolic dysfunction in our modern world. We're going to talk about how to assess metabolic function through lab tests and also through biomarkers and wearables. And then we'll end with a bit about the bigger picture.
What does all this metabolic dysfunction that we're dealing with mean for humanity and the future? By the end, I want you to feel equipped with a list of labs that can tell you about your metabolic health and that are really helpful to understand where you stand and where your patients stand. So to start off, I want to express that metabolism is not a part of health.
It's not a component of health. It's actually the foundation of all health. We talk about brain health and hormone health and gut health. But we got to remember that every single one of the cells in our body, 40 trillion plus cells, they all require energy to do their jobs, to do their work. So if we're making hormones, if we're maintaining a strong epithelial lining of our gut, if we're synthesizing neurotransmitters, all of that requires energy.
And that energy comes from metabolism happening in the mitochondria of the cell. And that metabolic process is happening 24 hours a day, seven days a week for our entire life. Metabolism is the gas to our car. It's how we convert food energy to cellular energy. And it is the foundation of all health.
So it's not a branch of health. It really is the base layer. So we've got to get it right. The bad news is that we are flagrantly failing at metabolic health in the United States. And there was recent research from the Journal of the American College of Cardiology based on 55,000 U.S. adults.
And it showed. that 93.2% of us are metabolically suboptimal. And the vast majority of people who have metabolic issues, this core foundational issue with our health, have no idea, probably about 90% don't know.
So we're going to go into the biomarkers of how they define suboptimal metabolic health in this paper. But I would argue that it is one of the most important things we can possibly do is to understand whether we're in that 6.8% of people who are metabolically optimized or not. And if we're not, work to get there.
Work to get those biomarks in the right range because they're all modifiable and they can actually change really quickly. You'll know how to do that by the end of this lecture. So... Again, so 93.2%, that's a big number.
Here's another way of looking at it. This is actually NHANES data of this prevalence of metabolic syndrome from 1988 to 2012. And you can see here that 1988, we were at about 25% of the country with metabolic syndrome. Now we're at about 41.8%.
And metabolic syndrome means like we have a full-blown issue with how our metabolic health is functioning and requires having three of these different disturbances being present. Another way to look at it is type 2 diabetes prevalence because type 2 diabetes is an overt form of metabolic dysfunction. This graph shows how it is just going up and up and up and up over the past 30 years.
And if you extended this graph that ended in 2015 to today, we'd be up here. We're now, we've gone from 25 million Americans to 38 million Americans in the past 10 years from 8% to 14.7%. So metabolic dysfunction is a big deal.
So the question is. Why are we doing such a poor job of recognizing metabolic syndrome and preventing it in the United States? And I think in part it's because our Western medical system loves specialization.
We silo everything into different specialist office and different specialties based on symptoms. If you've got a big prostate, you're going to the urologist. If you've got acne, you're going to the dermatologist.
Because those symptoms are obviously super different. But when we look at the root... causes, meaning what is actually happening on that invisible layer inside the cell that's actually leading to the symptoms, we find a different picture.
So if we classify disease as based on this intracellular physiology rather than just the symptoms that emerge, we'd find that almost every chronic symptom we're facing in the modern Western world are rooted in the same poor thing, metabolic dysfunction. On the bottom of this slide here, the trunk of the tree, metabolic dysfunction actually has subcomponents that are, again, these invisible processes happening inside our cells. And those are oxidative stress, mitochondrial dysfunction, and chronic inflammation.
These are processes happening inside most American bodies today that lead to this problem with making energy in the cell, which then in different cell types all over the body can look like different diseases. And more than just that tree where I just listed a couple of the different diseases we know are associated with metabolic dysfunction, this slide just shows a list of all the diseases that I at least can find in my research that have some connection with metabolic dysfunction, meaning if metabolic health is poor, if oxidative stress, mitochondrial dysfunction, chronic inflammation are happening inside the body, it is either going to cause or accelerate all these different diseases. And again, the reason for that is because an underpowered cell, a fundamentally distressed cell that can't do its work can look like almost any disease based on where that's showing up in the body.
So what factors of our modern world are causing this huge burden of metabolic disease? When we go to the literature and we see what are the different aspects of modernity, of our environment, of our exposome that are causing metabolic dysfunction, that cause mitochondrial dysfunction, oxidative stress, and chronic inflammation, these are the factors that really show up. It is our... Modern food, our industrial food, 67% of our calories are now coming from a factory, not from the earth. They're micronutrient poor.
And because we're eating so much processed food, we're becoming insatiable because it doesn't make us full. So we have chronic overnutrition that's basically burdening our cells with too many substrates to process not enough nutrients. Our movement patterns have changed hugely since we become more desk-based knowledge workers. We are spending 80% of our waking time just sitting in a chair these days. That's what the data is showing us, and that really impairs our mitochondrial function.
Our relationship with light has actually changed a lot in the modern world. We take it for granted that the light bulb is not that old of an invention, a few hundred years. And so we are surrounded by artificial light all the time, and that's having a huge impact on our circadian biology, which has a big impact on our metabolic processes. Recent data shows that...
Americans are actually spending less than 7% of their time outdoors. We spend 93% of our time in a home or in a car. So we're not actually getting those signals from the sun that set up our circadian rhythm to actually let our metabolic processes work properly.
We're also dealing with very different emotional health than we have in the past. We have this chronic low-grade stress. And we're living in a time of a lot of fear.
Most Americans feel fearful and lonely on a regular basis. And this is actually through cortisol and stress hormones can change our mitochondrial function, our metabolic health. The toxin burden of our world now is monumental. We have about 80,000 registered synthetic chemicals, many of which are toxins that are now in our homes, our furniture, our personal care products, our water.
air sprayed on food, in our packaged food, food additives. And many of these we know directly impact our cellular biology, aspects of our microbiome that impacts metabolic health, even our gene expression and many genes that impact metabolic function. And so the toxins are a big part of this too, this sort of invisible layer of our world that has cropped up over the past hundred years. We're also sleeping very poorly, which again impacts cortisol, which impacts metabolic health.
We're actually sleeping about 25% less on average than we were 100 years ago, and that has a big impact. There's an incredible study that shows that you can take a set of healthy young men who are totally normal in terms of metabolic function and subject them to sleep deprivation for about five days where they get four hours of sleep per night, and it induces prediabetes. So this has a profound impact on our metabolic health. Another one that's a little more obscure. is that our relationship with temperature has actually changed over time, especially in the modern world.
We're living at this like 72 degrees thermoneutral existence. But what's really interesting is that both hot and cold swings in temperature are triggers to our body to change metabolic processes. If we're cold, it actually tells our mitochondria to work harder to generate heat.
So this thermoneutral environment is actually impacting our metabolic health. And the last one I'll mention is meds. We are taking so many over-the-counter and prescription medications today. Some are life-saving and very necessary, but we are taking a lot of meds, probably many of which are overused and unnecessary, and many of those have an impact on our metabolic health. Here's just a slide showing this is what a normal day looks like in America.
We're indoors at the gym. We're taking over-the-counter medications. We're ordering to-go food. We're eating cereal and pastries for breakfast.
We're driving in traffic. We're using standard home and personal care products that have artificial scents, dyes, and parabens. We sit almost all day at a desk. We use a computer. We see blue light at night.
We're consuming packaged processed snacks while working. We're eating by ourselves often on our devices. We wind down with alcohol.
We use our devices in bed. We drink from unfiltered water or water from plastic bottles. Every single thing on this slide, there are papers that show us that these hurt our metabolic health.
And that's just the world we're living in. leads to these sad, tired mitochondria up in the top right. But then we think about it's not actually that. When we know what's causing metabolic dysfunction, we can tweak these little aspects of our day in subtle ways to create happy mitochondria. We do our exercise outdoors rather than indoors.
We do walking meetings and sitting meetings. We make sure our food is nutrient-dense and fresh. We buy non-toxic products. We drink filtered water from glass bottles.
We take time to relax. We keep our blood sugar stable. We use a standing desk.
We eat our meals outdoors. We might use blue light blocking glasses at night or just put the phone down in the evening. It's not about changing all of the world. It's about making these subtle research-based tweaks to just make the environment we expose our bodies to more conducive to healthy metabolism.
So let's move into assessing metabolic function through biomarkers and wearables. So on the right. you can see two studies, one of which I've already mentioned, which is the one from the Journal of American College of Cardiology that showed that only 6.8% of Americans are metabolically healthy. This came a couple years after a 2018 study that showed that only 12% of Americans are metabolically healthy. So it's gotten actually worse in just a few years.
This top study came out in 2022 and the bottom one 2018. This was from UNC. And both of these studies used a very limited set of metabolic biomarkers. to understand whether we're metabolically optimized.
So I want to just run through those because I consider these basic biomarkers sort of like the core foundational tests that we should get at least twice a year for ourselves, our patients, everyone in our family. And we should be able to rattle off our values for these as easily as we'd rattle off our phone number or our email address. If someone says, what's your triglyceride level?
You should be like, 57. It's just these. let us know if we're in that 6.8%. So the six basic biomarkers are triglycerides, HDL cholesterol, fasting glucose, hemoglobin A1C, blood pressure, and waist circumference. And these are not comprehensive for every nuance of metabolic health, but they are the basics that we just have to know and be tracking throughout our lifetime and working to keep them in the optimal range.
In this study from NIH, they were looking for triglycerides less than 150, HDL above 150. 40 for men or 50 for women. Fasting glucose less than 100. hemoglobin A1C less than 5.7%, blood pressure less than 120 over 80, and waist circumference less than 35 inches in women or 40 inches in men. And if all those things were true, then you were considered to be part of that 12% of healthy, metabolically optimized American adults. Now, this is going to that other paper, the one that was the 6.8%.
They used a slightly different criteria, similar tests, but just slightly different. So for them, they were looking for them to consider someone. optimally metabolically healthy. They had to have a body mass index less than 25, waist circumference, and this is 35 inches in women or 40 inches in men, which is 88 centimeters or 102 centimeters. Fasting glucose less than 100. That was the same.
A1c less than 5.7%. They looked at a total cholesterol to HDL ratio less than 3.5 to 1. Again, systolic blood pressure less than 120 over 80 and not on medications for any of these biomarkers. So not on a blood sugar medication or a hypertension medication. So. If those things are true based on your lab results, that means that you would be categorized in this paper as that 6.8%.
So that's the light metabolic testing that I just think it's usually free on an annual physical. Your doctor's not going to fight with you about getting these tests. And they're things that we need to know about ourselves. And they're all very modifiable. So that's like the basic light metabolic testing that we should all get.
Then you move into sort of media metabolic testing, getting a little more. nuanced. So for this, and I write about these extensively in my book, Good Energy, but these together give us like a little bit broader of a picture of what's happening with our core energy production processes in our body.
So I love fasting insulin, high sensitivity CRP, which is a marker of inflammation, uric acid, which is a great metabolic biomarker that can tell us a lot about fructose metabolism, liver enzymes, AST and ALT, because the liver is our really... a key metabolic organ, and we want those liver cells to be pristine and healthy so they can do their metabolic work. And these two enzymes can tell us about that. Vitamin D, which is highly modifiable with supplementation and sunshine, which has an impact on hundreds of different metabolic processes.
We want vitamin D to be optimized. GGT, which is another protein made in the liver that actually can tell us about oxidative stress, one of the trifecta of metabolic health. And then apolipoprotein B100, so ApoB, which is a really helpful...
marker of the cholesterol particles in the body that can lead to metabolic issues and heart disease. So these give us just a deeper picture. And also, these are tests that your regular primary care doctor is likely to order for you.
Sometimes they'll argue a little bit about a fasting insulin if you're not diabetic, but it can be really, really helpful. And I just want to paint a quick picture of why some of these tests can really help us above and beyond the basic tests because... Here's an example. So let's say you have person A and person B, and they both have a fasting blood sugar of 85, which is in the normal range, less than 100. So both people walk into the doctor, they have a fasting glucose of 85. And the doctor theoretically would say to them, oh, you're both the same, you're both fine, you both are metabolically healthy.
But let's say that person A goes a little further and gets a fasting insulin test. And person A has a fasting insulin of two. And person B gets a fasting insulin, and their insulin level is 30. That then helps the patient and the doctor understand that they actually have a very different picture of metabolic health.
Person A is metabolically healthy. Person B has signs of what's called insulin resistance. The fact that the cells have become metabolically damaged and actually can't process glucose as well.
So the cell is actually rejecting glucose from coming into the cell and the body's having to churn out all this hormone insulin to try and drive glucose into the cell. So person B is basically. On the path towards metabolic dysfunction, their body's already overcompensating to that insulin resistance and mitochondrial dysfunction by pumping out more insulin to try and drive glucose into the cell.
And they are going to probably develop problems down the road. Without this second level of testing, you wouldn't necessarily know that because you would just have the fasting glucose. So this is why I highly recommend these tests to give a richer picture of what's going on.
Then, of course, there's like the sky's the limit on metabolic. testing where you can go much, much, much deeper. And this is what more of a functional medicine doctor is going to order for you and not the type of things you're probably going to get in a primary care conventional doctor's office. But this is stuff like comprehensive thyroid testing, sex hormone testing, body composition testing.
So looking for actual levels of visceral fat or subcutaneous fat via a DEXA scan or an in-body scan, looking at true levels of micronutrients? How are your levels of the key micronutrients that impact mitochondrial function? Looking at stool testing for our microbiomes, since we know that certain microbiome patterns have an association with better metabolic health. We could look at genetics.
We can look at what are the different tiny little changes in our genome polymorphisms that may be associated with a predisposition for different metabolic issues, maybe that point us towards needing to have a certain type of diet. Advanced lipid testing is amazing. So that's like a cholesterol test that's much more nuanced and can tell us about things like our particle size of our cholesterol particles. We can get toxin testing.
We can see what are the toxin burden in our body that we know could be affecting our metabolic health. Omega-3 and omega-6 testing. We can look at our cortisol with salivary cortisol testing, since cortisol has a really strong impact on our mitochondrial function.
And then things like imaging, so like a calcium score or a CLEARLY scan, which are literally looking at the heart vessels and whether metabolic issues have led to... of calcifications and plaque in our heart. So that's really looking at more like the end stage.
Aside from all the biomarkers and the things we're testing, what's actually happening in our blood vessels? How far has this advanced? So that's kind of like, this is like the kitchen sink of things we could possibly do. And some of these can be very, very valuable to help us really understand where we stand. So that's blood work and imaging and biomarkers.
I want to speak a little bit about daily tracking. So things that we can do on our body, in our home, wearables and tracking that is actually not the sort of like single time point benchmarks that we get with our labs, but the data that we can get every single day to know whether we're putting in the inputs like sleep and steps to get these real-time metabolic outputs that can give us a picture of how we're trending and help us stay accountable. to the behaviors we know that are important for metabolic health.
So I categorize daily tracking in terms of monitoring metabolic inputs and monitoring metabolic outputs. Inputs means tracking what you put into the system to create healthy cells, and outputs are showing you how that's all working for your health. So for inputs, I think about food journaling and wearables, and for outputs, I think about continuous glucose monitors and also wrist and ring-based wearables. So here's metabolic inputs. So this is the sleep and activity trackers.
So why does this matter? For sleep, which is key for metabolic health, people shockingly overestimate how much they sleep. There has been studies showing that people who are actually sleeping five hours per night overestimate their sleep when they're surveyed by 80 minutes.
So they could be sleeping five hours, which is going to put you at high risk for developing metabolic issues, but they're telling you they're sleeping six hours and 20 minutes. So We don't do a great job of self-assessing how much time we're actually sleeping. This is why a wearable that tells you about sleep can hold you accountable. Because you can imagine a situation where you tell your doctor, I'm sleeping seven hours a night. I don't know what's going on.
And then you actually track it and really you're getting like five hours and 40 minutes or six hours. And then we can identify that that is probably part of why we're not getting the actual outcomes we want. It's a similar thing with activity.
So. Research has shown that people significantly overestimate the amount of moderate to vigorous physical activity they do. There was a study of 215 participants, and the self-reported amount of moderate to vigorous physical activity was 160 minutes per week. And this is just absolutely mind-blowing to me. The wearable data showed that the moderate to vigorous physical activity was only 24 minutes per week.
We might be taking a hike, and it's a 60-minute hike, and we're like, yeah, my heart was beating pretty hard. That was moderate. That was vigorous. And then if we're actually tracking on the wearable, maybe the heart rate never actually got up to the moderate range. Maybe it was just below.
So it keeps us honest here. And this matters because when you look at big research, there was a paper in JAMA, Premier Medical Journal, that showed 2,100 adults. They were followed for about 11 years. And those that got just 7,000 steps per day. compared to lower, had a 50 to 70% lower risk of dying during the 11-year follow-up period than those who got less than 7,000 steps per day.
So that, to me, what that says is we want to know if we're getting 7,000 steps per day. We don't want to estimate or guess this. That also doesn't take very much time to do. But the average American adult is getting about 3,500 steps per day now. So just seeing that can help us stay accountable.
And then based on the CDC's basic guidelines for physical activity. only 28% of Americans meet the basic guidelines. So this is where trackers can help us know, are we meeting the inputs for activity and sleep that we know are associated with good metabolic health?
When we're looking at our trackers and the apps associated with the trackers, I list a few of the trackers up here that I like, Fitbit, Apple Watch, Aura, and Whoop. For sleep, you want to not just be looking at total time of sleep. We're looking for quantity.
We're looking for quality. So how much awakenings, how much deep sleep, and then consistency. Are we going to bed and waking up at similar times each day?
The data is clear. Quantity, quality, and consistency of sleep independently impact metabolic health. So if we're getting seven hours of sleep a night, but we're going to bed at different times every single night. By one night, it's 9 p.m. One night, it's midnight.
One night, it's 10.30 p.m. That's still going to have issues for our health. So we've got to focus on quantity, quality, and consistency. Movement, we're looking at steps, number of active minutes per day and week with elevated heart rate.
So we really know how many minutes per week we're getting into that moderate to vigorous heart rate zone, which you want to be doing for about 75 to 150 minutes per week. So this is just also talking about steps. This other...
research has shown that if you get up to 10,000 steps a day, you're looking at incredible improvements in health associations. So 70% lower risk of premature death, 50% lower risk of dementia, 44% lower risk of getting type 2 diabetes, 31% or more lower risk of obesity, even things like improvement in gastric reflux and major depression. So all that is to say, we got to know. We got to know if we're getting these steps. The next metabolic input is food.
What are we putting in our body? And similar to sleep and activity, The reality is people vastly overestimate the healthfulness of their diet. And so food journals and tracking can really help us stay on the money here and really stay accountable.
There was a Kaiser Permanente study of about 1,600 people that showed that people who kept food journals during a weight loss program, a 20-week weight loss program, lost twice as much as people who didn't. And I think there are only two statistically significant variables in this study of what predicted weight loss and the number of food records the participants kept. was one of those significant factors. So I really think it's positive to do this, at least for a short period of time, to really know what's actually going inside our bodies and whether we're getting the nutrients we need for good mitochondrial function. So now let's switch to outputs.
What can the trackers tell us about essentially what's coming out of the system when we put those awesome inputs in like sleep steps and good food? We want to look at resting heart rate, which is a marker you can see on any of these wearables. And Resting heart rate is important.
It's basically tracked like when you're sleeping, what is the heart rate? What does it go down to when you're just at rest? And the reason this is important is because a higher resting heart rate is significantly associated with increased risk of heart disease, type 2 diabetes, and all-cause mortality. You look at Mayo Clinic, Cleveland Clinic, American Heart Association, they say that a normal range is 60 to 100. But that is far too broad of a range.
We actually want to be much closer to 60 or below. Someone with a resting heart rate. above 80, which is just considered right in the middle of the normal range, has an almost three times higher risk of getting type 2 diabetes than someone with a resting heart rate less than 60. And there was a meta-analysis over a million people, and they showed that all-cause mortality and cardiovascular mortality increased linearly and significantly for any resting heart rate above 45 beats per minute. And this, of course, has to do with if we've got metabolic dysfunction in ourselves.
That's going to be taking place at the level of our heart muscle and also our endothelium of our blood vessels. And that oxidative stress, that mitochondrial dysfunction, that chronic inflammation, the resultant insulin resistance that happens from all of that, all of that affects the dynamics of our cardiovascular system and basically makes our heart work harder and our resting heart rate is going to go up. Beautifully, resting heart rate can improve by consistent exercise and also all the metabolically healthy living and habits and especially lowering stress.
Another output we want to look at is heart rate variability. So low heart rate variability. Heart rate variability is a metric that you can see on your wearables that actually just is talking about what is the time between each heartbeat. We want there to actually be a little bit of variability between each heartbeat, not like one second for each heartbeat, but maybe 800 milliseconds for one heartbeat, and then 600 milliseconds, and then 1.1 second for a heartbeat.
That's actually a sign of elasticity of the whole system. And low HRV, meaning low variability, more like a metronome-like heartbeat, it's associated with Physical activity, immune dysfunction, high blood pressure, diabetes, cardiovascular disease, depression, decreased social engagement, decreased cancer survival, and even infertility and a low HRV can predict COVID-19 before even PCR testing is positive. So HRV is another thing that if our metabolic system is doing well and we're sleeping and we're getting the movement and all the things are coming in, HRV usually rises and that's a good thing. So those are the outputs.
And then in terms of another output we can look at for what's happening with... all our lifestyle habits. We can look at our glucose, our blood sugar, which is a key metabolic biomarker. There's now these devices, continuous glucose monitors that you can actually put on your arm and see your blood sugar 24 hours a day, literally see a movie of what's going on with your blood sugar 24 hours a day.
And what the research has found, this is a paper from Stanford called Glucotypes Reveal New Patterns of Glucose Dysregulation, is that when you put continuous glucose monitors on otherwise healthy people who don't have a diagnosis of prediabetes or type 2 diabetes, so the doctor would say, you're healthy, you're normal, you actually see very different types of patterns of blood sugar throughout the day. Very low variability, medium variability, and high variability. Even though by regular diagnostic criteria, these people do not have prediabetes or type 2 diabetes.
And what this research found was that this higher variability type of pattern of our blood sugar over the 24-hour period is associated with worse future outcomes of diabetes and metabolic dysfunction. It's essentially more variability on this type of wearable is showing us that there's a problem brewing even if our diagnostic criteria that we use currently for diagnosis of metabolic issues and diabetes is not there yet. So it can maybe portend future issues.
So that's why these types of monitors are great. And what the data shows us is that most cases of diabetes, again, type 2 diabetes is an overt representation of metabolic dysfunction. Likely 83% of new diabetes cases could be totally avoided if we just were in the low risk category for modifiable risk factors.
And for men, that was 78%. So In this particular study, low risk meant a healthy BMI, limiting meat intake, moderate alcohol consumption, greater than four hours a week of strenuous physical activity and non-smoking status. But just those things alone could potentially avoid 83% of new diabetes cases.
And the key point here is that these conditions are largely preventable and new types of technology and wearables can help us see earlier if there are patterns that are associated with. future problems and then help us get on top of it earlier, change our diet, work on a lot of those lifestyle factors that I showed in a previous slide. This will be in the slide deck that you get, but this is just a overview of all the things that wearing a continuous glucose monitor can show you above and beyond blood work that you're just getting at a single time point once or twice per year.
So benefits of wearing a CGM, or we'll start with 11 things a CGM can tell you. It can tell you what your fasting glucose is. So first thing in the morning when you wake up, it can tell you about the dawn effect, which is basically after you wake up in the morning, sometimes people see a sharp glucose rise because the body mobilizes cortisol in the morning to help you get up and go.
And that can actually cause some glucose in the liver to be mobilized and a bigger dawn effect. So a bigger jump in the morning can mean too much cortisol in the body or more. that the body's a little bit insulin resistant. So that's something you can see from a CGM. You can see what your responses to meals are.
So postprandial glucose is the food you're eating, causing big, big glucose spikes. You can see things like reactive hypoglycemia. So after you eat, do you spike and then crash and have reactive hypoglycemia where you're feeling tired and sluggish and shaky?
You can see what your stress levels, like giving a big talk at work, what's that doing to your blood sugar levels via cortisol? How is your exercise impacting glucose? Is it causing your glucose to come down after you lift weights?
You can see if a poor night of sleep or good sleep impacts your glucose levels. It basically gives you this biofeedback of how all these different factors of our lifestyle are impacting our metabolic health in real time. And so the goal would be that as you learn those things and get in tune with second nature about how your blood sugar and your metabolism is responding to all the things you do each day, you can tweak little things and work towards.
ultimately being in this lower variability range that we know is associated with better future health outcomes. Another thing I just wanted to mention about glucose responses is that people are very different in how they respond to different foods. So there's like hundreds of us on this call, 826 now, that's amazing. And if we all put a continuous glucose monitor on and we all ate the exact same standardized meal, let's say a totally standardized cookie, we might... all have different glucose responses because there's actually a lot of bioindividuality in this.
What is our current level of insulin sensitivity? How much sleep did we get last night? How much exercise have we done today or yesterday?
What is going on in our microbiome? These are the factors that predicted whether people will respond with a big spike or a low spike to a particular meal. So that's very interesting because it shows us that there's not really a one-size-fits-all plan for food because we each may respond to different patterns of food or different types of food differently.
This bottom graph here is showing you that they gave people a standardized piece of bread and it was just all over the board in terms of the reaction from going up to about 120 milligrams per deciliter to going up to 240. And these were all non-diabetic participants. So wild. The second thing that's cool, this was a nature metabolism paper from 2021. This is showing a blood sugar spike after a meal. And they basically showed that The bigger your spike after a meal based on what you're eating, the bigger the crash you're going to have below baseline because your body's mobilized all this insulin to take glucose out of the bloodstream, and then you might crash below your baseline. And this crash is predictive of how hungry you're going to be for carbohydrates later in the day, what your cravings are going to be.
Because if you crash, your body's actually in a state of panic, like, I got to get back up to baseline. I'm going to drive this person to eat more carbohydrates to get us back up to baseline. So again, sticking more with this.
These top two curves of like gentle rolling hills rather than spikes and crashes is going to actually lead us to have likely less cravings. So just to wrap up here, and then we can move to Q&A, I just want to share a little bit about the bigger picture on metabolism, like why I have devoted my life to this work and why I think it's so fascinating. It's very science-y, oxidative stress, mitochondrial dysfunction, chronic inflammation, endothelium, all this stuff. But the basics of it are that metabolism is our life force.
It is how we convert energy from outside of us, which is food, energy from the land, from the earth, turn it into something that our bodies can use to power every single chemical reaction in our body that ultimately bubbles up into our consciousness and our life and our thoughts and our motivation and the way we're able to love and live. It's our life force. And it is being dimmed. Like, you saw those slides in the beginning, the rates of type 2 diabetes, the rates of metabolic dysfunction. 93.2%.
Our modern world, if we just look at the data and look at what's happening, the way we're living today, the way our culture has changed so rapidly in the past 50, 75 years, it's doing something to our bodies that is blocking our life force. We need to think about that. Each of us, all 827 of us, each make decisions every day of how we're going to shape ourselves, our life, our families, our communities, our workplaces.
And right now we know without a shadow of a doubt. based on the science, that the world we've created, which we consider very comfortable, and we're really focusing on comfort. And I think we really prioritize comfort and luxury in the Western world. But something about that is not working for ourselves.
We need to reflect on that. We need to reflect on the choices that we're making for ourselves, our families, our communities, our workplaces, because we want life force. We want humans to have this amazing life force. Again, metabolism is at the flow of energy.
And... When we actually think about really backing up, I put sun rays on this slide because the energy that we're actually converting in the mitochondria to human energy, to ATP, which is what the mitochondria makes when it converts food energy to human energy, that energy that we're actually liberating in our mitochondria comes from the sun, which is crazy. So photons travel 92 million miles through space.
They hit the chloroplasts of plants, and a chemical reaction happens where that sun energy that literally traveled through space is converted into energy that's stored in the carbon-carbon bonds of plants, which either we eat or animals eat, and then we eat the animals. And then what we are doing with mitochondria and metabolic health is liberating the sun's energy to power our lives. What's also cool is that our mitochondria, we now know, emit light.
Our mitochondria emit photons back, and that's called bioluminescence. And again, the world we're living in right now, the industrial world, this is blocking that process. There's our... bodies are becoming the bottleneck to liberating solar energy to human energy.
And I think we should think about that really deeply. And I would just say that the daily choices, a lot of this comes down to motivation to make different choices in the face of a world that's not really conducive to our cellular biology and increasingly becoming hostile to our cellular biology. But what really motivates me is that the daily choices that support our mitochondria metabolism honor the miracle of being alive and help us channel more energy through our bodies in this precious lifetime.
to reach our highest purpose and do good work to better the world and to be stewards of this beautiful planet and each other. With that, thank you. I would love to answer some questions and I so appreciate this opportunity to be with each of you today. Thank you for being here. Welcome to Root the Health, the best place to order, manage, and track results from over 30 different lab companies in one single place for free.
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