Although Means' medical license has been reported inactive since the end of 2023,her career has developed such that she is considered one of the leaders of the Make America Healthy Again movement. On May 7,2025,PresidentDonald Trump nominated Means as surgeon general,following the withdrawal of his earlier Janette Nesheiwat nomination;however,inaction on the Means nomination in 2025 and the Senate adjournment on January 3,2025 triggered return of Means' nomination under a Senate rule,with the requirement that the President resubmit it (should he want its continued consideration).
Early life and education
Born Paula Casey Means on September 24,1987,[3][bettersourceneeded] Means shared her full birth name in a podcast interview,stating that she was named after St. Paul,but legally dropped her given name after graduating from medical school.[4] She is the first daughter of Grady and Gayle Means[who?];Grady served as an assistant to U.S. Vice President Nelson Rockefeller,worked on health and human welfare issues at the Department of Health,Education,and Welfare,and was a managing partner at PriceWaterhouseCoopers.[5][verification needed] Gayle died of pancreatic cancer during the COVID-19 pandemic,encouraging her children to resolve "broken health incentives" in the U.S.[6][7]
After graduating from the Madeira School in 2005,[8] Means attended Stanford University,where she graduated with honors with a bachelor's degree in human biology in 2009.[9] She then earned her Doctor of Medicine (M.D.) from the Stanford University School of Medicine in 2014 and was inducted into the Gold Humanism Honor Society.[9][10][11] According to a statement by the medical school:"during her time at Stanford,Means demonstrated a strong commitment to comprehensive patient care,published peer-reviewed articles and held a leadership role in the Arbor Free Clinic,which provides care to underserved populations".[11]
After graduating from medical school,Means started a residency in the Department of Otolaryngology-Head and Neck Surgery of Oregon Health and Science University (OHSU) with the aim of becoming an ENT surgeon.[12] During her studies,she held various research positions (at the NIH,New York University,and OHSU).[13] Six months before the end of the five-year program,she dropped out of her surgical residency,[9] due to stress and having become disillusioned with healthcare in the United States.[9][14][15][16][17]
This section needs expansionwith:any other academic teaching appointments,at Stanford during or after her training,or at other institutions. You can help by expanding it. (January 2026)
In 2022,Means served as a lecturer in courses on subjects relating to food and health at Stanford,teaching graduate and undergraduate students there.[11]
Businesses
Eventually,after leaving her surgical residency,[2][1] Means founded a company,Levels,and as of 2024 was reported as serving as its chief medical officer;the biotech company has been described as producing a health app that "offers exercise tracking and diet coaching",[2] and that it "uses continuous glucose monitors to help people track their metabolic health".[1] As of May 2025,Gregory Svirnovskiy of Politico relayed that Means' website reports that she is an investor "and/or" adviser in Truemed,a company Calley Means,her brother,founded,that "employs doctors who sign off on the medical necessity of fitness and nutrition programs and advanced health tech so customers can get a tax break".[2]
Means also has capitalized on sponsorships from dietary supplements,creams,teas,and other products appearing on her social media accounts.[20][21]
Writing
Means and her brother,Calley Means,co-wrote a medically related book directed at popular audiences,Good Energy:The Surprising Connection Between Metabolism and Limitless Health,which was published by Penquin-Random House in 2024.[22][23] As described by Blinkist,the book,which is composed of five points—the leading of which is that "[p]oor metabolic health is a leading cause of chronic disease"—presents "the connection between our lifestyle choices and our energy levels" and that it "offers actionable strategies to enhance wellness,increase vitality,and achieve a balanced,energized life...".[24] As decribed in review by physician and public health professional Joseph E. Scherger,writing for the journal of the Society of Teachers of Family Medicine:
...Means describes... all food becom[ing] energy in the body,converted by the mitochondria [of our bodies' cells] for different purposes. Good energy [comes from] food that nourishes us in positive ways. Bad energy,which occupies much of the book,[comes from] food that results in metabolic dysfunction and a variety of health problems. Good energy... from the food of the natural world... [is] unprocessed,[and] nurtures our metabolism. Bad energy comes from ultraprocessed foods,sugars,and inflammatory proteins and fats.[22]
Scherger notes that,through the book,the Meanses are "on a mission to eliminate bad energy from [the diets of] as many people as possible."[22] Overall,Scherger reviews the book positively,stating,"Good Energy is an excellent book for a lifestyle medicine book club and may be recommended for patients wanting good nutritional advice. It is well worth reading."[22]
Jessica Winter,The New Yorker family,education,and reproductive rights reporter,[25] disparaged the work, describing the Means' book as "a memoir,a quasi-anti-establishment screed,and an orthorexic diet guide" advancing core positions of the Make America Healthy Again (MAHA) movement:
The first is that Big Food and Big Pharma are incentivized to make and keep us sick. The second is that many conventional medicines and interventions do little to improve our health,and often worsen it;... And,third,that most maladies can be prevented or treated through one's own ascetic diet and life-style choices.[26][verification needed]
By January 2025,the Meanses appeared unlikely to join the Department of Health and Human Services,but remained connected to Kennedy.[34] On May 7,the Trump administration began planning to withdraw Janette Nesheiwat's nomination as surgeon general after her résuméwas questioned and Laura Loomer,a far-right social media political activist,stated that Nesheiwat was "not ideologically aligned" with Trump.[35] Hours later,Trump announced that he would nominate Means as surgeon general.[10] Trump said he did not know Means but nominated her based on Kennedy's recommendation.[36] Her scheduled confirmation hearing before the Senate Committee on Health,Education,Labor and Pensions,which was to be the first such hearing held virtually,was postponed on October 30,2025,after Means went into labor.[37]
In addition to proponents of evidence-based medicine,Means' appointment has been criticized by anti-vaccination campaigners who favored health influencer Kelly Victory,such as Americans for Health Freedom's Mary Talley Bowden,Steve Kirsch and Suzanne Humphries. Far-right activist Laura Loomer was sharply critical of Means' nomination,calling her a "total crack pot".[38] RFK Jr's 2024 running mateNicole Shanahan was also critical of the nomination,claiming there was an understanding that the Means would not play a role in the Trump administration.[28] On July 31,Politico reported that Means' nomination is currently stalled in the Senate HELP committee,pending Means' submission of financial disclosure and ethics paperwork.[39]
On January 3,2026,the Senate adjourned,triggering return of the Means' nomination to the President under Senate Rule XXXI,as "failing of confirmation",as reported in the Congressional Record'sDaily Digest.[40][41][non-primary source needed] Hence,Means nomination appears in the "Legislation and Records" information of the Senate,in its list of "Nominations Failed or Returned to the President",as of January 10,2025.[42][non-primary source needed] As a consequence,as routinely happens with nominations before the Senate that stall for any reason,the return of the nomination is accompanied by the requirement that the President resubmit it,should he want its continued consideration.[43][44]
After withdrawing from her surgical residency, Means became a practitioner of functional medicine.[46] Her efforts since have been promoted, e.g., by Stanford Medicine faculty member Andrew Huberman, who has lauded her for providing people a "sense of agency through knowlege and actionable tools".[47]:06:41
A primary focus of her efforts has been on metabolic function and dysfunction,[47]:06:54 In such a discussion, in 2024, Means stated that she believes it important for people to realize that ones "metabolism is actually the foundation of all health", indeed "the core foundational pathway that drives all other aspects of health, and ... [one] that's truly getting crushed in the modern American world," going on to state her belief that such dysfunction "underl[ies] 9 of the 10 leading causes of death in the United States today", and stating her conclusion that "the spectrum of metabolic-rooted disease is vast, and ... [therefore] relevant to most Americans", noting that "research from [the] American College of Cardiology suggests that 93% of American adults have sub-optimal metabolism".[47]:07:32[independent source needed] As to mechanism, she has argued that
When metabolism is not working properly it's essentially creating underpowered cells... [where] not having adequate power will lead to dysfunction. [With] ... over 200 cell types in the body... underpowering in different cell types ... [gives] different symptoms, because underpowering in an astrocyte is going to look different than underpowering an ovarian Theca cell or an endothelial cell".[47]:08:59[independent source needed]
From a public policy perspective, Means notes that
the biggest blind spot in Western healthcare, and ... the reason that health outcomes are ... getting worse every year in the United States, is because fundamentally we are ignoring metabolic health... We are laser-focused on the downstream symptoms that result from metabolic dysfunction in different cell types, and... focusing on those symptoms, playing "Whac-a-Mole" with them... [we are] really ignoring [the] underlying, foundational root cause... metabolic function. ... [W]hat's so facinating to me... as an ENT surgeon—is that... the more we specialize... the more we do technological innovation in all these different specialties, the sicker we're getting. ... The real nugget... [everyone] needs to understand is that we've bought into a system where we value specialization... [b]ut, while we've done that, ...we have the worst chronic disease epidemic, and the lowest life expectancy of any high income country in the world... [I]n that specialization, we're focused on the downstream manifestation of underpowering of cells, the cell-specific symptoms, and not the metabolic function itself. So... our chronic disease epidemic in this countery is a metabolic dysfunction epidemic, and underpowering epidemic, and that is the biggest blindspot in healthcare. And I think a focus on metabolic function as the center of our healthcare system—it's a completely new paradigm for health that is urgently... needed. We know we are not in the right paradigm, right now...[47]:09:44[independent source needed]
Likewise, in a 2024 NPR interview, Means analogised "Type 2 diabetes, obesity, Alzheimer's [disease], dementia, cancer, [and] chronic kidney disease" to being akin to different "branches" of a tree, the trunk of which she argued is metabolic dysfunction.[1] Her views have been criticized by the M.S.-level-trained science communicator Jonathan Jarry of the McGillOffice for Science and Society, who wrote that "[Means] is not a metabolic health expert" and "theories claiming to have found a single cause for all diseases never pan out".[48][49] Means has been noted to "blam[e] the ultra-processed food system for much of the chronic disease in America",[50] and has had ascribed to her the view that the origin of most diseases lie in our exposures to ultra-processed foods and environmental factors, to a lack of sunlight, and to lack of exercise.[citation needed]
Means has spoken in support of raw milk, stating, "When it comes to a question like raw milk, I want to be free to form a relationship with a local farmer, understand his integrity, look him in the eyes, pet his cow, and then decide if I feel safe to drink the milk from his farm."[54]
References
12345Stone, Will & Means, Casey (June 14, 2024). "In 'Good Energy,' A Doctor Lays Out How to Measure and Boost Your Metabolic Health"(interview, with reporter's introduction). NPR.org. Retrieved May 7, 2025. [From the reporter's introduction:] Means, who has a medical practice in Portland, Oregon and is chief medical officer for the biotech company Levels... Ultimately she left surgery to practice functional medicine and eventually founded, Levels, which uses continuous glucose monitors to help people track their metabolic health.{{cite web}}: CS1 maint: multiple names: authors list (link)
123Stanford Medicine Staff (May 14, 2025). "Awards & Honors: Statement from Stanford School of Medicine on Alum Casey Means". Stanford University School of Medicine (Stanford Medicine). Retrieved August 5, 2025. [Subtitle and continuing:] Casey Means, MD, has been nominated to serve as the United States surgeon general. / When Casey Means entered the Stanford School of Medicine, she rapidly established herself as an outstanding student. Attending physicians recognized her clinical performance in disciplines ranging from internal medicine to general surgery to psychiatry, citing her technical skill, clinical judgment, breadth of knowledge and critical thinking abilities...
↑Blinkist staff and AI (January 9, 2026). "Good Energy summary". Blinkist.com. Retrieved January 9, 2026. Note, while the information provided here, from this source, is not within their firewall, further summary information (e.g., the remaining main four points of the book) requires a subscription for access.
↑New Yorker Staff & Winter, Jessica (January 10, 2026). "Jessica Winter"(contributor bio/autobiography). The New Yorker. Retrieved January 10, 2026.
↑Congressional Staff (January 3, 2026). "Highlights / Senate / Chamber Action / Nominations Returned to the President"(p. D2). Daily Digest (January 3, 2026). Washington, DC: U.S. Congress. Retrieved January 10, 2026– via Congress.gov. [Quote:] The Senate ...adjourned at 12:00:27 p.m. until 3 p.m. on Monday, January 5, 2026. ... The following nominations were returned to the President failing of confirmation under Senate Rule XXXI at the time of the adjournment of the First Session of the 119th Congress... [nomination of] Casey Means, of California, to be Medical Director in the Regular Corps of the Public Health Service, subject to qualifications therefor as provided by law and regulations, and to be Surgeon General of the Public Health Service for a term of four years.
↑Senate Staff (January 10, 2026). "Nominations Failed or Returned to the President". Senate.gov. Washington, DC: U.S. Senate. Retrieved January 10, 2026. [Quote:] The following Executive Nominations were returned to the President, pursuant to Senate rules, or were disapproved by the Senate during the current Congress. ... 2026-01-03 PN246-10 Public Health Service / Casey Means, of California ... [nomination content identical to the Daily Digest, see Congressional Staff (January 3, 2026), op. cit.] Returned to the President under the provisions of Senate Rule XXXI, paragraph 6 of the Standing Rules of the Senate.[non-primary source needed]
↑Greene, Michael (December 15, 2023). "Return of Nominations to the President Under Senate Rule XXXI". Congressional Research Service. Retrieved January 10, 2026– via EveryCRSReport.com. [Quote:] Nominations that have been neither confirmed nor rejected by the Senate at the time the Senate Analyst on Congress and adjourns sine die or for a period of more than 30 days are returned to the President pursuant to the Legislative Process Senate Rule XXXI... The Senate returns all nominations at the end of a Congress. If a nomination is returned to the President, it is no longer eligible for consideration by the Senate. The President may submit a new nomination, either for the previously returned nominee or for a new candidate.
↑Jarry has referred to her book[clarification needed] as an example of "scienceploitation", accusing her of using preliminary research on mitochondrial dysfunction to promote dubious products or policy. See Jarry (2024).
Svirnovskiy, Gregory (May 7, 2025). "Trump Picks Casey Means for Surgeon General". Politico. Retrieved May 7, 2025. [Means] started health app Levels, which offers exercise tracking and diet coaching, after dropping out of her surgical residency. ... Means' website says she's an investor and/or adviser in the company her brother founded, Truemed, which employs doctors who sign off on the medical necessity of fitness and nutrition programs and advanced health tech so customers can get a tax break.
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