Just a few months ago, Casey Means, MD (Casey’s Substack) took the main stage at the biggest US healthcare conference, Erin Martin and I were there and we recorded her. We’ve shared some of the highlights in the video above.

Erin ran into her, I had serious FOMO!

She is now the nominee for US Surgeon General. There is debate. There is excitement, there are naysayers.

She is a co-founder, of Levels which put continuous glucose monitors on the map for many pre-diabetics with easy access to CGMs and an easy interface to track the results. She is a NYT best seller - Good Energy: The Surprising Connection Between Metabolism and Limitless Health

To compare, our last Surgeon General was a Dr. Vivek Murthy, an internal medicine physician by training focused on youth e-cigarette use among youth, mental health stigma, the need for social connection and the opioid epidemic. Prior to Dr. Murthy we had Dr. Jerome Adams, an anesthesiologist, focused on opioid crisis, COVID-19 epidemic, health equity and community-based health initiatives and who prior to his appointment, was the Indiana State Health Commissioner.

Like I’ve said before, let’s not kill the message even if we don’t like the messenger when the message is what is needed. It’s bold and it could lead to the systemic change we write about. For most on this substack, the message is music to the ears.

As for the messenger I will let her speak for herself here. She has made her message clear over the past few years. Here are a few key quotes.

I like to stay neutral and listen, but on this one, I’m Team Casey.

“We can’t have a healthy society without well-functioning humans. We can’t have well-functioning humans without well-functioning cells. And we can’t have well-functioning cells with mitochondrial dysfunction, oxidative stress, chronic inflammation, and cellular and hormone disruption from toxic chemicals in our food. We combat those things through nutrient-dense, unprocessed foods grown in living, thriving soil.”

“More than anything, I would like to see our future White House rally Americans to be healthy and fit”

“I think about metabolic dysfunction as the trunk of the tree of all these branches that are actually quite connected... erectile dysfunction is one tree, and depression is another tree, and dementia is another tree, and heart disease is another tree... Fundamentally, they’re all linked by this core process that is totally hijacked by our modern diet and lifestyles.”

“What we know is that one of the key fundamental triggers of inflammation in the body is dysregulated blood sugar and metabolic dysfunction... And nine of the ten leading causes of death in the US are exacerbated by high blood sugar or metabolic dysfunction.”

“We’re on track this year to have more new cancer cases than any year in human history... autoimmune diseases skyrocketing, depression, anxiety, skyrocketing... And we are somehow still buying into this idea that the more money we throw at the problem with the same approach that we’ve been doing, the better it’s gonna get — and that is totally false... they’re all fundamentally metabolic driven issues.”

Quick note - I have not absconded with Carter Williams, he is simply trying to avoid becoming an ice cube after the epic ice storm his community endured resulted in a loss of power that is now going into Day 4. Please send him “warm” wishes.

I’ve been going through all of the episodes we recorded this past fall at the American College of Lifestyle Medicine Annual Conference and it dawned on me that although we talk alot about systemic redesign and the need for “health”care. We haven’t shared much about those tools and resources that exist today that could help us create actual by leveraging some of the current infrastructure/resources of the existing “Sick”care system. Even when we create actual “health”care, we will still need “sick”care. We just don’t need that to be our only option. We need both parallel paths.

Pillars of Health

There is no perfect care delivery model, there are just countless varieties and options. And in the end one of the biggest drivers to what will work in the future is cost vs. outcomes along with available resources. We often hear of things like Functional Health and Integrative Medicine but not as many folks have heard of Lifestyle Medicine. The concept is so simple it seems too good to be true. And regardless of the pillars, equally important is the concept of a framework to follow. Allopathic medicine is still delivered, but through the lens of managing the 6 pillars of “health”.

ANY clinician can add Lifestyle Medicine board certification to their current certification. It’s about 6 months of part-time learning, attendance of the conference and passing a set of exams. Most can complete it within a year and arguably less depending on timing. There is no fancy tech or expensive meds or costly devices or procedures. It is brass tacks. When you listen to the podcast you will be reminded that lifestyle is actually the basis for pretty much every clinical guidelines.

In essence Lifestyle Medicine is the foundation of healthcare. Not the other way around. It just so happens we have created an educational system that does it in reverse and an economic model that has the economic alignment backwards.

Not long ago, Lifestyle Medicine had a stigma due to it’s initial conviction to exclusive plant-based eating but it has evolved, so has it’s acceptance of dietary diversity. Still however, whole food, plant heavy - which is the diet associated most with longevity regardless of specialty.

So imaging adding the actual nutrient dense food to this approach and we are talking a true paradigm shift. This also lays out the basics for N of 1 / personalized medicine.

The Unexpected Epicenter of a “Health”care System - Tulsa

Most everyone reading our substack knows Erin Martin and FreshRx Oklahoma. If you aren’t familiar, go now and learn more! She was on a previous episode of our podcast and it’s a great listen. Her program has become a national model for partnering with local regenerative farmers and using food as a true clinical intervention that improves health outcomes. She’s the only program in the country with a health plan contract that has outcomes incentives, an actual value-based care contract.

Unbeknownst to Erin, Dr. Ajay Joseph, (an interventional cardiologist who carves out one day a week as a lifestyle medicine doctor) also in Tulsa, was busy at the same time she was building FreshRX, building an Intensive Therapeutic Lifestyle Change (ITLC) program over at St. Francis - one of the major health systems in Tulsa. He has built a wildly impactful Lifestyle Medicine clinic and program that has eliminated cardiometabolic disease for the majority of his program participants. It’s an 8-week program that teaches nutrition (including hands-on in a teaching kitchen), stress management, sleep hygiene, exercise/movement, importance of relationships and avoiding risky susbtances.

As you would imagine once they met it was an immediate “synergy for the ages”. Let’s just say you are going to see some pretty exciting outcomes coming out of Tulsa in the next 12-18 months… It’s been so fulfulling to get to work with those two to create a sustainable economic model!

The Podcast Recording with Dr. Joseph

I figured no better way to explain his program than for you to hear it from Dr. Joseph himself. This is the brief interview we did with him last fall at the ACLM conference. We need to get Dr. Joseph onto The Food Is Health Revolution for a full episode!

There has been quite a bit of chatter lately around front-of-package nutrition, the need to understand nutritional density and whether the FDA is doing enough in general. Especially in light of the fact that 75% of the “food” in grocery stores isn’t actually food at all by definition.

FOOD (noun) - any substance consumed by an organism for nutritional support and energy

Well what better a way to ponder the FDA’s vision than to hear it directly from the proverbial “horses mouth”.

Late 2024, Erin Martin (FreshRX Oklahoma), Justin Politi (one of partners at BP2 Health) and I had the chance to sit down with the FDA’s Deptuty Deputy Commissioner for Human Foods - Jim Jones. In this role, which reports directly to the FDA Commissioner, Jones leads the unified Human Foods Program (HFP), overseeing all FDA food safety and nutrition activities. He is actually the first person to hold this role that was created in 2023.

When you read his background, you realize he might be a bit of a secret weapon for Making America Healthy Again #MAHA. He spent most of his career as a federal regulator of pesticides, toxic substances, chemical safety, and pollution prevention at the U.S. Environmental Protection Agency (EPA) and spent much of his tenure involved in leadership and decision-making related to food safety. As a principal architect of the 2016 overhaul of the Toxic Substances Control Act, Jones led discussions with members of Congress, industry and environmental groups that resulted in a law reshaping how chemical safety is managed in the U.S. And these are just a few of the highlights.

“My view is that we have 330 million Americans that we really want to improve their nutrition, and I want to do it for everybody. - Jim Jones

Call me a pollyanna, but after our power-packed 15 minutes where Jim shared a few of the highlights of what the FDA has planned, I felt it wasn’t all doom and gloom:

* A rule that will describe the parameters for when a food can say that it's healthy. And the development of a logo so that consumers can start to see on packaging some consistency around how they can be able to recognize the healthy designation. This will identify products designated as healthy across product categories and within product categories

* Taking comment from all stakeholders right now, what we refer to as Phase II of sodium reduction goals. Phase I just ended last April and with a 2.5 year goal to achieve a 13% reduction in average sodium consumption by Americans. The early data that we have indicates about 40% of the categories meeting or close to meeting the first reduction

* Planning to propose bringing three nutrients from the back of the label to the front of the label, in a way that's very easily understood by the consumer (Sodium, added sugar and saturated fat). Putting that on the front of the label with some descriptor related to it. (This was actually announced by the FDA a few weeks ago)

* We discussed whether there is a universe where there are fewer chemicals in our foods

* We talked about Eric J. Smith and Edacious and the need for nutritional density

* We talked about work that includes Instacart to help them help their customers quickly understand what foods they are buying through Instacart that are good for them

“At the FDA we have a lot of knowledge around nutrition, chemical safety, how that can then be translated in new technologies in the private sector to help consumers buy and get healthier food, and I think that that can play a huge role in how people get healthier” - Jim Jones

Despite all of this promise, we seem to all find ways to pick things apart. We all seem to say it isn’t enough and that the evil empire of food/pharam/chemicals will find a way around.

Which brings me to the question I started with…

Is incremental change better than no change at all?

This episode features a conversation between Ellen Brown and Carter Williams about the systemic issues within the food and health industries. They discuss the interconnectedness of the food system, from soil to cell, and argue for a more holistic approach to improving health outcomes. Their conversation explores the need for systemic redesign, drawing parallels to engineering and aircraft accident investigations, to create a more nutritious and affordable food system. They highlight examples of companies successfully integrating various stages of the food chain and emphasize the potential of data-driven approaches to improve both individual and population health. Ultimately, they advocate for a comprehensive, systems-level approach to address the current health crisis.

Our co-hosts Katie Stebbins, Carter Williams, and Ellen Brown reflect on the past year and discussing the interconnectedness of the food and healthcare systems. They analyze the food supply chain ("soil to cell"), exploring challenges and opportunities in farming, manufacturing, distribution, and consumer behavior. The discussion highlights the need for systems thinking, addressing issues like regenerative agriculture, food safety recalls, and the evolving relationship between food companies and healthcare. They emphasize the potential for innovation and collaboration to improve health outcomes and economic efficiency. Finally, they predict future trends and identify key areas for change in 2025.

We recently brought together a multidisciplinary panel of experts sharing practical strategies to address critical issues at the intersection of healthcare and food policy. Drawing on perspectives from healthcare to agriculture, the discussion focuses on actionable approaches to Make America Healthy Again.

The diverse expertise of the speakers provides a comprehensive view of the challenges and opportunities in transforming healthcare through a more nutritious and affordable food system. This session offers valuable insights for policymakers, healthcare providers, and stakeholders seeking pragmatic solutions.

Our hosts Katie Stebbins, Ellen Brown, and Carter Williams are joined by Dr. Joseph Pizzorno, an internationally acclaimed expert on science-based naturopathic medicine, to explore the intersection of nutrition, healthcare, and environmental factors influencing public health.

Erin Martin runs a program called FreshRx Oklahoma, which prescribes fresh, locally grown produce to individuals with type 2 diabetes. This program is aimed at addressing both food insecurity and chronic illness, showing remarkable results in reducing patients’ A1C levels, weight, and healthcare costs. The conversation emphasizes the importance of aligning economic, agricultural, and health systems to improve outcomes for individuals and communities.

Our hosts Katie Stebbins, Ellen Brown, and Carter Williams are joined by guest Matt Moreland of Moreland Farms. The group discusses current agricultural trends and challenges, including the integration of the supply chain and the tension between overproduction of commodity crops and the growing demand for specialized, higher-quality agricultural products. They explore the potential role of food in improving public health, especially in light of rising health care costs and the increasing use of GLP-1 medications for obesity. The podcast also covers the need for innovation in farming practices, such as integrating livestock, and the broader impact of these practices on climate and health systems. The conversation emphasizes how changes in the food system can drive better health outcomes and create new economic opportunities.