Good Energy: The Surprising Connection Between Metabolism and Limitless Health
By Casey Means
Avery Press, 400 pages, $32.00
For many years, it has been common enough to hear the refrain that large corporations are to blame for all of the world’s problems. Big auto kills public transit; the military-industrial complex was behind the war; Silicon Valley addicts us to our phones. There’s a sense that powerful, profit-oriented forces control our fate, that the game is rigged, life unfair.
Recently, a version of this narrative focused on the American population’s worsening health has risen to prominence. The Make America Healthy Again (MAHA) movement, a hodgepodge coalition whose figurehead is Secretary of Health and Human Services Robert F. Kennedy, Jr., takes as a given that our bodies are not only not well, but actively poisoned. RFK and his followers declare that pharma peddles pills, hospitals surgeries, agribusiness corn, schools sugary drinks, television a sedentary life—all to keep us in the doom loop of disease and its profitable treatment. What was once the bastion of the alternative—reiki, thermotherapy, hallucinogens—or the idée fixes of an obsessive-compulsive—purity, nontoxicity, untainted human flesh—is increasingly the norm.
Though many physicians and scientists feature prominently in the MAHA extended universe—with several now appointed to top government roles—most prominent of all is Dr. Casey Means, who counts RFK as well as President Trump among her fans. Along with her brother Calley, Means advised RFK Jr’s transition team, and Kennedy has said he wants to appoint people like them to lead governmental agencies. According to insiders, the Means siblings have the ear of the new administration, and are helping shape the White House’s official MAHA policy.
Means is at first glance an innocuous and familiar type—an overachiever who became an iconoclastic critic of the powerful institutions out of which she emerged. President of her undergraduate class and top of her medical school (both Stanford), Means was in her fifth and final year of Otorhinolaryngology (ENT) surgical residency when she gave it all up, as she recounts, to tackle the root causes of illness. She walked into the chair’s office mere months before graduation and turned in her scalpel. Her 2024 New York Times bestseller, Good Energy, could easily be pegged as just another physician wellness book, part of a bibliography that extends from Dr. Atkins’ Diet Revolution (1972) down to Peter Attia’s Outlive (2023). Her social-media presence leans into cooking, and her newsletter is sponsored by a probiotic company. Discount codes abound.
“Means’s rhetoric is colored by a general mistrust of her fellow doctors.”
Upon closer inspection, Means’ rhetoric is colored by a general mistrust in her fellow doctors and the scientific establishment. She is the medical expert of choice for those who distrust medical expertise. (One chapter of her book is titled “Trust Yourself, Not Your Doctor,” but eight of the glowing reviews in the book’s opening pages are from MD’s, many of whom are advisers at her startup.) She gained prominence after appearing on the Tucker Carlson Show with her brother, airing grievances axiomatic among right-wing online health discourse, such as oral contraceptives and chemicals changing the sex of frogs. Calley has claimed that “body positivity” was funded by Nestlé. Naturally, the duo are skeptical of vaccines.
Means’s book usefully illustrates what MAHA gets right and what it gets wrong. What MAHA says that’s new is largely untrue, and what it says that’s true isn’t new. Gesturing at crossing the political divide by adopting the language of revolutionary change, MAHA leaves us, in the end, with hollow bromides and little else.
All MAHA discourse begins with an incantation about the increasing ubiquity of disease, and Means’ book is no exception. Heart attacks, cancer, stroke, diabetes, Alzheimer’s, PCOS non-alcoholic fatty liver, chronic pain—all on the rise. Statistics buttress these pronouncements, but anecdotal evidence often suffices. It seems like most of Casey’s friends are struggling with infertility, IBS, inexplicable fatigue, or some other condition modern medicine unhelpfully deems idiopathic. While MAHA’s exponents invoke the highly morbid (coronary artery disease, cancer), one senses that what they really care about are assaults on our focus, vitality, and peace of mind—hence the inordinate emphasis on conditions like ADHD, anxiety, and autism. “What would it feel like,” Means asks, “for your body to just be at ease enjoying this human experience, for your mind to be working clearly and creatively, and to feel that your life is established on a steady and strong source of inner power?”
“The diagnosis, according to Means, is simple: bad energy.”
The diagnosis, according to Means, is simple: bad energy. By this she intends something molecular—metabolic dysfunction arising from impaired mitochondrial ATP synthesis, chronic inflammation, and oxidative stress—though her jargon, perhaps intentionally, evokes generic millennial wellness speak. Means believes we have injured the “powerful life force from within that allows you to take on each day with pleasure, energy, gratitude, and joy.” The vibes in our bodies, one might say, are not great.
Means’ central thesis is that nearly all maladies are driven by the same process: cellular dysfunction. She posits an Occam’s Razor of pathophysiology claiming, “the biggest lie in health care is that the root cause of why we’re getting sicker, heavier, more depressed, and more infertile is complicated.” Of course, biology, unlike logic or mathematics, is messy, and it’s entirely possible that what MAHA defines as one conflagration are actually many smaller fires. I’m reminded of Hickam’s Dictum, an aphorism from medical school: “A patient can have as many diseases as he damn well pleases.”
Even if Means is correct in her unifying theory of pathogenesis, there remains the thorny question of treatment. Though she claims to share forbidden knowledge (what your doctor doesn’t want you to know so you’ll stay sick!) the advice she dispenses is hardly heresy: Don’t overeat; consume more fruits and vegetables; curtail alcohol, tobacco, and drugs; get 7-8 hours of sleep; exercise; avoid environmental toxins. In her chapter titled “Fearlessness” she borrows liberally from the pharmacopeia of New Age and Gen Z, endorsing both Rumi and JOMO (the Joy of Missing Out) as well as mindful meditation, getting a therapist, breathwork, psilocybin, aromatherapy, and self-love. “Don’t allow yourself to be separated from your source: soil, sun, water, trees, the stars, and the moon.” She adds that while “traumas crush good energy,” focusing on gratitude and cultivating community can be potent antidotes. The more outré of her prescriptions—ice baths and blue light blocking—are also common riffs on the podcaster-health circuit.
Contrary to Means’s claim that doctors don’t learn nutrition, during my time in medical school the subject was routinely discussed in our curricula. That doctors are taught to push pills in favor of healthier living is another favorite canard, even though the correct answer on all our board examinations for the first-line intervention in metabolic syndrome is “lifestyle modifications.” Of course, the healthcare system is beleaguered by perverse incentives that contribute to unnecessary testing, imaging, and procedures. But to say that doctors keep patients sick is akin to claiming that mechanics build potholes. The reason people don’t diet and exercise is not that their doctor has never revealed these concepts to them. In recounting her mother’s quest for health, Means concedes as much: “My mom tried so hard to get her health back on track. She stopped smoking. She hired a trainer. She joined a Curves gym. She read every book about nutrition … and participated in several programs, including a medical weight loss program through Stanford and WeightWatchers. She tried a whole-foods plant-based diet, and then tried a ketogenic diet through Vitra Health. She tried and tried and tried. She felt discouraged with how many different ideologies there were, all of which claimed to be the silver bullet.” Then, Means offers readers another silver bullet, her “Four Weeks to Good Energy” plan, which promises that while you have spent your whole life trying and failing to lose weight, duped by the most powerful cabal in the country, Means will make you succeed in one month.
And it is here, in identifying the true obstacle to good health, that Means and MAHA make their one major innovation. In proposing why we can’t eat well or find time to move more, they marry the left’s distrust of corporations with the right’s idolization of individualism. Means rails against pharmaceutical giants, agribusiness, soda and sugar manufacturers, plastic producers, and politicians—but her solution is to buy wearable health tech and an assortment of “approved” creams, tonics, and supplements from her online shop, a geekier version of Goop.
Decrying the vaccine manufacturers who have supposedly poisoned their children, MAHA’s adherents can feel like aggrieved victims of the system, even though Means’s intended audience consists of people who can afford to record their VO2Max. She also recommends reverse osmosis water filtration (average cost: $2,500) and interrogating restaurants on their refined seed oils. Her book concludes with nearly 60 pages of mostly vegan, California-style fare: maca smoothies, carrot harissa dip, baked jicama fries. Meanwhile, over 80 percent of American families eat fast food at least once a week, and only 24 percent get the 150 minutes of exercise recommended by the CDC.
This is ostensibly what MAHA wants to change, but not once in her book does Means mention class, poverty, or race—independent risk factors for poor health. Instead, Means zeroes in on the ailments of the worried well: “If I have anxiety, I think about whether I’ve been exercising and how much alcohol I had that week. If a pimple pops up out of the blue, I ponder whether sneaky sugar crept into a recent restaurant meal.” Although MAHA uses the language of radical social change, it evinces a genuine scorn for poor people, their toxic lives, spoiled water, processed food, plastics, and polluted inner cities plagued by asthma and obesity and concrete. It is telling that RFK’s proposals include bans on what lower-income people can consume, but say nothing about wealth redistribution, taxation, or public housing.
Means and MAHA are symptomatic of the broader absorption of anti-corporate health messaging into corporate clichés—a version of the Wall-E effect, a cute movie with an anti-corporate message produced by a colossal corporation. A recent advertisement for Hims, the direct-to-consumer pharmaceutical company valued at over $7 billion, reads: “the system wasn’t built to help us—it keeps us sick and stuck with one-size-fits-all solutions that ignore our needs. Join us in the fight for a healthier America.” This ad linked to a page that sold GLP-1 agonists. Weight loss medications are big money (not to mention paradigmatic of a one-med-fits-all approach), and though (like RFK) Means lambastes Ozempic in her book as proof of our reliance on pills, she has since called it a “life-saving” drug, only bemoaning its exorbitant price.
Meanwhile, MAHA has now tied its fate to Trump, a president who is nothing if not pro-business. “Bobby and President Trump have gone up against the largest and most powerful industries in the country and are winning,” Calley jubilantly tweeted. In reality, as Rolling Stone reported, Big Oil and Pharma both donated heavily to Trump’s inauguration, including the Pharmaceutical Research and Manufacturers of America (PhRMA), a leading lobbying group. RFK pillories drug companies, but he and the president enjoyed a private dinner with the CEOs of Pfizer and Eli Lilly. Perhaps as a test of fealty, Trump even made RFK eat McDonald’s.
Casey writes movingly about curbing environmental pollutants and endocrine-disrupting chemicals, but during Trump’s first term, more than 100 environmental regulations were slashed. Trump’s first administration blocked bans on chlorpyrifos (linked to neurological defects in kids) as well as N-methylpyrrolidone (NMP) and trichloroethylene (TCE), chemicals tied to infertility, miscarriage, and hepatic injury. He also rolled back school nutrition standards which would have required more fruits and vegetables. Casey frets frequently about microplastics, yet the plastics industry is already planning a “deregulation blitz,” under Trump 2.0, a trend that is likely to continue throughout Trump’s second term. Despite the administration’s promises to make America less toxic, on March 7, the DOJ dismissed a suit against a major manufacturer of neoprene which was charged with increasing cancer in a nearby town. On March 12, EPA administrator Lee Zeldin announced the agency’s “Biggest Deregulatory Action in US History.” Plans to revoke limits on air pollution standards, coal ash waste, and other manufactured toxins are all underway, and are likely to decrease attention span and IQ and increase stillbirths, asthma, heart disease, and stroke. It’s hard to imagine the simultaneous cuts to research in cancer, genetics, and infectious diseases being salubrious to population health either.
In medical school, we used to say that the best medicine is the one the patient actually takes. If MAHA can convince Americans to eat less and exercise more—even if that sensible pill is slathered in paranoia and mistrust—then maybe we shouldn’t complain. Couching age-old virtues like moderation, self-reliance, and appreciation for nature in an aura of forbidden truth, perhaps Means and her ilk may help Americans find some modicum of happiness and health, even as corporations continue their plunder.
But as Paracelsus warned, the dose makes the poison. Too much distrust, too much stick-it-to-the-man, and even sensible solutions may start to sound like deceptions. At one point, Means rues the fact that doctors aren’t shouting from the rooftops about the dangers of added sugar. In reality, they are, but if she and her allies succeed in damaging the credibility of medical institutions, one can imagine a future in which new health influencers gain a following by claiming the opposite, framing their pro-sugar messaging as taboo knowledge. Improvements in public health, in other words, seem unlikely to emerge from a movement that dismisses expertise only to replace it with cultish devotion to gurus with books and products to sell. Once rooted in our body politic and ingrained in the DNA of our democracy, this fusion of skepticism with credulity is remarkably difficult to extirpate—the definition of Bad Energy.