We are not a serious country

MAHA's health crusade embarrassment continues

Casey Means, RFK Jr’s pick for surgeon general, gave many non-answers during her congressional hearing last week. The questioning expectedly went along party lines, with Democrats actually trying to hold her accountable for her wellness grifting and Republicans lobbing softballs. Senator Bill Cassidy, the man who could have stopped Kennedy’s appointment as HHS Secretary (but didn’t) pretended to play rough, though it was more performative than real.

Ironically, even though Cassidy was the deciding vote that installed Kennedy, MAHA PAC, Kennedy’s fundraising arm, is donating $1 million to defeat Cassidy in a Republican primary this year. It’ll be interesting to see how he votes on Means’s nomination, but I’m certainly not holding my breath that he’ll do the right thing.

While the reason for her nomination likely involves her brother Calley’s role as senior advisor to Kennedy, their collective star rose with the publication of their 2024 bestseller, Good Energy: The Surprising Connection Between Metabolism and Limitless Health. You probably won’t be surprised to learn that neither Means sibling is trained in endocrinology; telling people not to trust experts is kinda their thing.

Lack of training didn’t stop the Meanses from claiming expertise on the subject, and being rewarded with a high-profile book filled with misinformation and misleading information.

From a meta perspective, Good Energy greatly oversimplifies the causes of chronic diseases and health conditions by attributing them primarily to metabolic dysfunction—the specter they term “bad energy.” Heavy on anecdotes and bad data, the book is driven by affect, not science.

The thesis of the book:

Nearly every health problem we face can be explained by how well the cells in our body create and use energy.” The Meanses posit that bad mitochondrial/metabolic function is “the root of virtually every symptom and disease plaguing modern Americans.

Classic fallacy of a single cause, a cognitive bias that has repeatedly failed throughout the history of medicine. The scientific and medical literature does not support the idea that poor metabolic health is either a necessary or sufficient cause of most chronic diseases. In fact, many diseases they cite may cause poor metabolic function, not the other way around.

A few examples:

• Autoimmune diseases like multiple sclerosis, type 1 diabetes, and lupus, are driven by genetic susceptibility and environmental triggers, such as viral infections, particularly Epstein-Barr virus for MS. While metabolic dysfunction can exacerbate autoimmunity, the primary drivers are immunological and genetic.

• Many cancers have predominant non-metabolic causes: tobacco smoking (lung cancer), H. pylori infection (gastric cancer), HPV (cervical cancer), BRCA1/2 mutations (breast/ovarian cancer), UV radiation (melanoma), radon (lung cancer), and alcohol (several GI cancers).

• Infectious diseases (pneumonia, COVID-19, upper respiratory infections) are caused by pathogens, not metabolic dysfunction. While metabolic health influences susceptibility and severity, the claim that these diseases are “rooted in Bad Energy” conflates modifiable risk factors with root cause. This gets very religious and terrain theory-esque quickly in the book.

• Genetic diseases like Huntington’s, cystic fibrosis, and sickle cell disease are caused by specific gene mutations, not by how well the mitochondria are functioning in response to modern diet.

• The field of psychiatric genetics has identified hundreds of common and rare genetic variants associated with schizophrenia, bipolar disorder, major depression, and autism. These have no simple metabolic explanation, but the Meanses pretend they do.

Why then reduce all these diseases to a single cause?

Casey co-founded Levels, which sells CGMs to non-diabetics, often through marketing that posits slight fluctuations in metabolic signals are really telling you about undiagnosed issues. Calley partners with hundreds of alt-med and supplements companies that sell supposed solutions to such problems.

Good Energy makes a lot more sense as a marketing vehicle for their main businesses.

The Meanses credit their health awakening with the death of their mother, who sadly died from pancreatic cancer. Even the dedication of the book features misinformation:

For Gayle Means / Born 1949, died 2021 of pancreatic cancer (a preventable metabolic condition).

Pancreatic cancer has a 5-year survival rate of just 11–12%. It’s one of the most lethal cancers precisely because it’s so difficult to prevent and detect early. While type 2 diabetes and obesity are associated with a modestly increased risk of pancreatic cancer, these are risk factors, not causes. Most people with obesity and diabetes do not get pancreatic cancer, and many people who get pancreatic cancer have no metabolic dysfunction.

Plus, we know the dominant genetic driver of this cancer is a gene mutation present in >90% of cases. This mutation is not metabolic in origin. Calling the death of a specific person from pancreatic cancer “preventable,” implying that better metabolic choices would have saved them, is not supported by decades of evidence.

The Meanses also claim that 93.2% of people have metabolic dysfunction. This figure comes from a single study that defined “optimal metabolic health” using very stringent criteria: simultaneously having optimal levels of fasting glucose, triglycerides, HDL, blood pressure, and waist circumference. These levels must all be maintained without medication. The study found only 6.8% of U.S. adults met all five criteria simultaneously.

This definition is not the same as “having metabolic disease.” Good Energy repeats this statistic to suggest nearly the entire population is sick in a clinically meaningful way, which is not what the study’s authors intended or what the data show.

Robert Lustig has been on social media supporting Casey’s nomination, which makes sense given how heavily Good Energy relies on his health propaganda. Per Lustig, the book advises readers to “throw [total cholesterol] in the garbage,” downplays LDL-C as a risk factor, and implies statins are largely ineffective or that they target the wrong LDL particles. All of these are false or misleading.

LDL-cholesterol is a causal driver of cardiovascular disease, not merely a correlate. The evidence base includes decades of randomized studies, clinical trials, and mechanistic data. People with genetically lower LDL have proportionally lower lifetime cardiovascular risk.

The Meanses falsely claim that statins only reduce “large buoyant” LDL and not small dense LDL. In reality, statins reduce all LDL particles. The clinical trial evidence for statins is extremely well-studied and among the strongest claims in medicine.

They also claim that “more than 50 percent of people who show up in the emergency room with heart attacks have normal cholesterol.” Where do they get this from? Mark Hyman, who also wrote a blurb for the book. “Normal” by conventional guidelines is a very low bar; most such patients have LDL well above the levels associated with minimal risk, and many have other cardiovascular risk factors including metabolic syndrome itself.

Speaking of Hyman, the Meanses present the fictional diagnosis, leaky gut, as solid science. Intestinal permeability is a real problem implicated in celiac disease, IBD, and some infections; leaky gut is a functional medicine marketing term designed to sell you supplements.

Then they claim poor metabolic health is the root cause of depression, when most evidence points to depression contributing to metabolic dysfunction. The most powerful predictors of depression are stressful life events, early childhood adversity, and genetic predisposition. These factors dwarf the effect size of metabolic health on depression risk. But the Meanses have vibes on their side.

The wellness world (and the Meanses) has latched on to the term “Type 3 diabetes” to describe Alzheimer’s disease. This term was coined by Suzanne de la Monte in 2005 as a hypothesis, not a consensus diagnostic category. It has not been adopted by the scientific mainstream, the DSM, or any clinical guidelines. The evidence for insulin resistance causing Alzheimer’s is associational.

I mentioned earlier that Casey cofounded Levels, and yes, continuous glucose monitors (CGMs) are presented as “the most powerful technology for generating the data and awareness to rectify our Bad Energy crisis” and are strongly recommended for healthy, non-diabetic individuals. CGMs were developed and validated for use in people with type 1 and type 2 diabetes who need to manage blood glucose for medical reasons. Their clinical utility in metabolically healthy individuals without diabetes is not established. That doesn’t stop the Meanses from recommending unnecessary lab work done by Mark Hyman’s company, Function Health, where the results of your unnecessary CGM will likely land you in an unnecessary supplements downline.

I could go on and break down how the Meanses get optimal ranges for biomarkers wrong, and how they source imprecise data to say we consume 3,000% more sugar than our ancestors. They rage against seed oils despite extensive research to the contrary. They wrongly implicate metabolic dysfunction as a cause of autism and ADHD, which is better than vaccines? Still, completely unfounded. They rail against SSRIs like they do statins, which, again, is based on vibes.

Back to the title of Chapter 3, shared above: Trust Yourself, Not Your Doctor. The book advises readers not to accept pushback from their doctors on tests like fasting insulin, and frames the medical system as primarily a profit-driven obstacle to health. The irony: the Meanses accuse doctors of over-prescribing statins, SSRIs, and metformin while simultaneously recommending a lengthy list of tests and, implicitly, supplements, many sold by companies the Meanses are affiliated with.

America’s for-profit healthcare system is fucked. There are so many problems with putting profits over people. Ironically, Casey didn’t once mention socialized medicine as a solution during her congressional hearing, or, to my knowledge, ever.

The fact that she drops the ball on the biggest “root cause” of America’s health problems makes her unqualified for the position as Surgeon General. Good Energy provides dozens of more reasons, should any senator care to look.