Episode 117 | Feb 13, 2025

Solving the Modern Healthcare Problem, With Dr. Casey Means

Is our healthcare system designed to keep us healthy, or just to treat sickness? This week on Health Coach Talk, Dr. Sandi brings listeners a special episode featuring excerpts from a past interview with Dr. Casey Means, originally recorded for What the Func?! and recreated here with full permission. In this conversation, Dr. Sandi breaks down Dr. Casey’s powerful insights on the failures of our current sick-care system and explains why health coaches are the key to bridging the gap between knowledge and action. As a Stanford-trained physician, co-founder of Levels, and leading voice in the metabolic health movement, Dr. Casey left behind a promising career in conventional medicine to advocate for a prevention-based approach—one that aligns perfectly with the work health coaches do every day to help people live longer, healthier lives.

“There’s this whole ecosystem that pushes you towards this mindset of like, ‘They come in with a disease, I diagnose it, I treat it,’… this is not how I want to be interacting with patients. I don’t want to just be waiting until they go down this road of sickness… I want to be many miles before that station, where I’m like, ‘How do we actually keep you out of the operating room?’”

Casey Means, MD

In this special episode, Dr. Sandi breaks down key insights from Dr. Casey Means, highlighting the deep flaws in our healthcare system and the critical role health coaches play in bridging the gap. Dr. Casey discusses the stark difference between health span and life span—how long we live versus how well we live—and the alarming rise of chronic illness in younger generations. With rates of metabolic dysfunction skyrocketing, she explains why a proactive approach is essential and how lifestyle factors like diet, movement, sleep, and stress management are the real drivers of long-term health. She also exposes how industrialized food has reshaped human biology in ways that fuel disease, making it more urgent than ever to rethink our approach to healthcare.

As Dr. Sandi explains, the solution to these challenges isn’t found in more prescriptions or reactive treatments—it’s in prevention. Health coaches are at the forefront of this shift, helping people make sustainable behavior changes that support metabolic health and extend health span. While Dr. Casey’s journey from conventional medicine to functional health advocacy was fueled by frustration with the sick-care model, she ultimately found her answer in lifestyle-driven solutions—the very work that health coaches do every day.

Throughout the episode, Dr. Sandi emphasizes that health coaches are the missing link in healthcare. They provide the guidance, accountability, and personalized support that turn knowledge into action. Instead of waiting for disease to take hold, coaches empower individuals to take control of their well-being before it’s too late. As more people recognize that lasting health starts with daily habits, health coaches are proving to be a vital force in reshaping the future of care.

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Transcript

Dr. Sandi: Welcome to a special edition of “Health Coach Talk.” I’m bringing you an interview that was recorded a few years ago with Dr. Casey Means, and it was recorded for our sister podcast, “What The Func?!” with co-hosts Laura Schein and Clayton Ferris. We have taken some clips of the interview that we will be sharing.

Let me tell you just a little bit about Dr. Casey Means. She is the author of “Good Energy,” along with her brother, Calley Means. This book took off. It’s skyrocketed to number one. It is a New York Times bestseller, and it has been on that bestseller list for months and months. They are really instrumental in starting the MAHA, the Make America Healthy Again movement. You may have listened to Dr. Casey on interviews. She’s been on Joe Rogan, on Tucker Carlson. And she is a Stanford-educated physician. She was a top resident, and she left what could have been a very successful, very lucrative career in medicine, but her passion is metabolic health.

She’s the founder of Levels, which connects people with support as they are wearing a continuous glucose monitor. And she is one of the major influencers in today’s movement to make people healthy again. And her mission resonates with our mission because health coaches are really key. If people are going to get healthy, then health coaches need to be supporting them. They need to be the new face of primary care, offering lifestyle medicine. So, let’s get started with the first clip.

Clayton: Why do we want to live longer?

Dr. Casey: Yeah, there’s a couple interesting things there. So, one is really the difference between lifespan and health span. And really the one that I think I care a lot more about is health span, which is how many years of your life are you living where you’re really thriving and healthy. That’s what we want to maximize. Unfortunately, for the average American, health span is just getting shorter and shorter. We’re starting to get chronically ill very early as Americans these days, where we’re seeing teenagers getting diseases related to diet and lifestyle like type 2 diabetes that used to be called adult onset diabetes. And now it’s being seen in children. So, this is really the health span being truncated. So, what we want to do is we want to extend those healthy years that people are living and thriving.

Dr. Sandi: What you heard was Dr. Casey talking about the importance of health span versus lifespan. Who wants a long lifespan if you’re going to be incapacitated, if you’re going to be in a nursing home, if you are going to be suffering from dementia, for example, or other chronic conditions which are compromising your ability to live fully? Who is going to help you have a health span, a long health span where you have energy and you are able to do the things that bring you joy?

Well, that person is a health coach because they are going to be helping you with those lifestyle changes that are going to be the key factors in helping you have a long health span. What are those factors? It’s diet. It is movement and exercise. It is sleep. It is having good relationships and having a way to deal with the stressors in your life so that you transform the stress. And health coaches help you with all of those lifestyle factors. That is why it is so effective at helping people live longer but healthier lives. That is the key.

Dr. Casey: That’s really what I’m passionate about is what behaviors do we have to do each day that basically create the conditions in the body for highest functioning, because when our cells are happy, our tissues are happy, when our tissues are happy, our organs are happy. And when our organs are happy, we don’t have symptoms essentially. And so it all starts at that basic level. And what we put in our mouths every day, how we sleep, how we stress, how we move, these are the things that actually connect the external world to the internal world and create the conditions in the body that make all the difference. And so that’s what I’m really passionate about.

Dr. Sandi: Health coaches help people have better cellular health. And, again how does that happen? It is through lifestyle. And they explain to people this connection. Why? What you eat, food as medicine. The biggest decision you make every day is what you put at the end of your fork. That is according to Dr. Mark Hyman, and I know Dr. Casey would agree with that. And movement that affects cellular health. How about sleep? Critical for cellular health as well as dealing with stress and having relationships that are meaningful and having joy in your life.

So, health coaches are helping you know where to start in terms of… You may have a big goal in these areas, but it can be really difficult to get started. You don’t know where to start. That is where health coaches can play a key role. And everything you do, everything you think about, every emotion you experience is related to your cellular health. You’re either creating an inflammatory response or preferably an anti-inflammatory response. So, health coaches help you have, for example, realistic thinking and not catastrophize. They help you having a sense of enjoying every day. For example, when I wake up every day as soon as my feet hit the floor, I tell myself today is going to be a good day and that kind of programming is remarkably effective at the cellular level. So, let’s hear some more of Dr. Casey.

Dr. Casey: Seventy-four percent of American adults are overweight or obese. And 128 million Americans have pre-diabetes or type 2 diabetes. So, something in this sort of like just winging it on food is not working. And people might say, “Oh, well, we’ve been eating… We’ve been around for many tens of thousands of years. Why do we need a tracker now to figure out how to eat?” The answer to that question is that we are dealing with a whole new complex ecosystem around food over the last 100 years that we have never faced before. The industrialized diet bringing food out of the ground and into a factory to transform its molecular structure into something that human bodies were never intended to see, totally changing the way that food hits our digestive system and gets into our bloodstream, putting massive chemicals in it of all types. It’s a totally different landscape and that has only been for about 50 to 100 years or so. And so that new sort of threat, that new ecosystem of food is not working for the human body at all. And that is showing up in the way our bodies are just at scale breaking down.

Dr. Sandi: Navigating our food system can be really complicated. And what health coaches do where they fit into this ecosystem of providers is that they are the ones… They’re not telling you what to eat or what not to eat, but they are helping you as that guide and can help educate you, for example, how to be a smarter consumer, how to read labels, for example. And we’re making strides. For example, you may have heard that Red 3 has been banned, but what about other additives, other chemicals that are in our food and in our other products. For example, our personal care products. Well, health coaches can help you with that. And what they are often doing so well is they are your accountability partner because you may know what to do, but it is actually carrying it out that you may have difficulty with. And so a health coach, when you have to be held accountable to somebody, that is the magic of coaching. It’s one of the elements of coaching that makes it so, so remarkably effective.

Dr. Casey: What we pay for is we wait until people develop disease and then we basically get paid for seeing those patients and prescribing a treatment plan. We get paid a lot less for taking a healthy patient and helping them avoid chronic disease. We’re in a fee for service system, so service is the name of the game. And deep dives into someone’s, an otherwise healthy person, helping them to avoid chronic disease, that’s not a service that really gets paid for. So, we are really… Brainwashed is a strong word, but we are in this culture, in this system in which we live, which is a reactionary sick care system where we wait until people get sick till we pay attention to them, makes total sense that, yeah, we would think, oh, well, we’ll only give devices to help people understand their body once they’ve gotten sick. To me, that just makes no sense.

Dr. Sandi: So, you’ve heard Dr. Casey talk about the issue that we have. It’s a big problem. And that is we have sick care. We don’t have true healthcare, which is prevention. The medical system is good at acute care. If you are having a heart attack, you don’t want to go to a health coach. You want to go to the best hospital. You want to have that procedure that is going to be life-saving.

But what happens when you get out of the hospital? Well, to prevent another heart attack or to prevent one from developing in the first place, that’s prevention. That’s what health coaches do. You are going to see your doctor. What would it be like if you saw a health coach first and then you only saw that doctor when it was critically needed? They are the diagnosticians. They are the ones who can help with that acute care, like treating you if you’re in need of a life-saving procedure, like you’re having a heart attack and they need to save your life.

But our system, as Dr. Casey says, is focused on sick care. We need true preventive care. If you are thinking of becoming a health coach, think about the crucial role you will be responsible for. You will be playing that real critical role in terms of converting the system more to the side of prevention. And that is something that we are going to see more of in the coming years because our current system, it’s unsustainable. We’ll go broke. Our medical system will collapse. We don’t even have enough doctors. There’s a critical shortage of doctors and it’s getting worse. Health coaches will fill the gap.

Dr. Casey: A lot of us, I think, are under this impression that genes are our destiny and we have this blueprint and that’s just kind of what it is. But actually, genes interacting with the environment, that is our destiny. And we have so much control over that environmental piece, like what’s going in? What are the molecules that are changing gene expression? You have complete control over that based on what you put on your fork.

That was very empowering, an empowered view of health and genetics and deterministic ideas of health. And that has, sort of, always lived within me. And as I went on through medical school, I was always trying to get more nutrition and lifestyle stuff built in and was disappointed because we don’t learn a lot about nutrition in medical school or lifestyle. We don’t become really good coaches. We become really good at labeling diseases and then figuring out what treatment procedure or pill goes along with that collection of signs and symptoms. And to me, that’s much more reactive and less empowering.

So, I was trying to shake things up. I was pissed when I was a medical student that we sit for 8 to 10 hours a day as medical students, and we’re learning that sedentary behavior is a risk factor for heart disease and yet we’re sitting all day in the classroom. So, I tried to get the Stanford Medical School administration to put standing desks in all the classrooms and cause a whole ruckus. It was always trying to do stuff like that.

Clayton: Disruptor.

Dr. Casey: But anyway, long story short, I ended up going… I became really interested in surgery and went in that direction. I always imagined I’d merge these different passions, like surgery and holistic health and nutrition and all this stuff. But the reality is when you get into the surgical world, you’re working 80 to 100 hours a week. You’re seeing 40 patients a day. You’re in the operating room all day. Your pager is going off nonstop. Literally, the last thing that you were thinking about is talking to your patient about whether dairy is involved in their sinusitis. As much as you might want to… And one, it’s not in the guidelines. We follow standard guidelines for treating most of these conditions, whether it’s cancer of the head and neck or sinusitis or laryngitis or thyroiditis or ear infections or whatever it is. There are guidelines that you follow. It’s very algorithmic. And in those guidelines, there is not counsel your patient about the triggers of what their illnesses are. And so it doesn’t get baked in and you don’t get reimbursed for having those conversations. And we’re not surfacing that research.

Dr. Sandi: This is so powerful because we hear all the time people saying, “Oh, it’s just my destiny. My mom had it, my dad had it. I have a long history, and it’s just my fate.” But in functional medicine, there’s a saying that genes load the gun, but diet and lifestyle pull the trigger. And that is the health coaching zone, diet and lifestyle. This is epigenetics. Our diet and lifestyle, it’s what washes over our genes. And this is where, again, health coaches are behavior change specialists and you’re a health coach. You are the one that is going to be playing that most critical role in helping people first, educating them that genes are not their destiny, that they have control. And in study after study of health coaching, we find that is that sense of empowerment. People are really waking up after conversations with a health coach to say, “Yeah, I guess I can make a difference. I am in charge of my health.” That’s self-efficacy, the sense that you matter and you make a difference and you can change your health status. That is a big empowering message, and health coaches are the guides that lead you to have that aha moment where you realize, “Yes, change is possible. I do not have to be a victim of my circumstances, of my genes. Just because this runs in my family doesn’t mean I have to be susceptible as well.” I have a long family history of heart disease. Everybody in my family had some form of heart disease, cardiometabolic issues. And so that’s why I have to work really hard on blood sugar, for example, on eating an anti-inflammatory diet, on getting sufficient exercise and movement and dealing with stress in an appropriate way. So, health coaches will guide people in those areas.

Dr. Casey: There’s this whole ecosystem that pushes you towards this mindset of like, “They come in with a disease, I diagnose it, I treat it.” And this ends up crescendoing into really, I think, a bit of an existential awakening for me of like, this is not how I want to be interacting with patients. I don’t want to just be waiting until they go down this road of sickness. And then I’m here at the very end of the line with my scalpel like, “Hey, let me help.” That’s not where I want to be. I want to be like many miles before that station, where I’m like, “How do we actually keep you out of the operating room?”

So, that led me on a journey towards… I was really lucky to come across a lot of the functional medicine doctors like Sara Gottfried and Terry Wahls and Mark Hyman and a lot of the nutrition-focused physicians like Michael Greger and Neal Barnard and basically just started reading their books. And so I’m walking to the hospital on a call, listening to all these audio books about really more functional medicine and thinking about more root causes approach to health. And I’m like, this is night and day, like so different from what I’m doing in a day to day, like in my day to day. And it seems so much more logical and rational and functional. And why aren’t we practicing this way?

Dr. Sandi: Well, you’ve heard Dr. Casey talk about her awakening. She discovered functional medicine. Functional medicine is root cause medicine. It is based on systems biology that we have within us, systems that are connected, they communicate with each other. It’s not just symptom based or as Dr. Jeffrey Bland, the father of functional medicine says, it’s not a pill for every ill. It is not symptom management through medication or procedures. It is why is this happening to this individual at this particular time? And a functional medicine trained health coach is on that discovery journey with their clients. What was going on? A year or six months before you got sick and all of these symptoms were then coming out. Well, what happened? What was going on in your life? And they might say, “Well, I was going through a divorce,” or, “Oh, we moved into a house and it had mold.” Aha. Well, they put the pieces together. They realized what the factor was that was perhaps creating an inflammatory state. And then functional medicine doctors address that root cause. And what happens then, 9 times out of 10, is that those symptoms will disappear or will lessen considerably.

Health coaches will play a big role helping people to tell their story, to have those aha moments where they see, “Yes, it all ties together. I get it.” And now they are becoming empowered to take charge of their health. And how does functional medicine address those root causes? Again, you guessed it with diet and lifestyle change. And again, those factors are what you’re eating, also how you’re eating, and then your movement and exercise throughout the day. It has to do with your sleep and your stress levels and your relationships, having meaning and purpose in life through our relationships and our connections. I hope you have enjoyed this interview from “What The Func?!” with Dr. Casey Means.