In recognition of her biomedical research, she was awarded the first-place award for Excellence in Basic Science from Dr. Mark Wax and Dr. Paul Flint, chairman and program director of the residency program, in June 2017.

During her residency, Means also published Pediatric primary Sjögren syndrome presenting with bilateral ranulas: A case report and systematic review of the literature, for which she was the first author.

As her residency progressed, however, Means grew increasingly disillusioned with the reactive “sick care” model she encountered in her clinical practice. This shift in perspective led her to take time away from her surgical training to explore the intersection of holistic health and surgery. Extensive documents and emails from this period show a prolonged effort to merge her surgical work with a holistic and “root cause” approach, securing meetings with the Chief Wellness Officer at Cleveland Clinic, faculty from National University of Natural Medicine, the Casey Health Institute (which has developed an integrated approach to healthcare blending complementary and conventional therapies), and many other experts for guidance on opportunities to design and foster a more proactive and holistic practice within the surgical ecosystem. Ultimately, she felt so disillusioned with the practice and incentives of surgical care that she chose to resign and work on reform from outside the “system.”

She summarizes this in her book Good Energy, 

“I deeply respect doctors, but I want to be very clear on something: at every hospital in the United States, many doctors are doing the wrong things, pushing pills and interventions when an ultra-aggressive stance on diet and behavior would do far more for the patient in front of them. Suicide and burnout rates are astronomical in health care, with approximately four hundred doctors per year killing themselves. (That’s equivalent to about four medical school graduating classes just dropping dead every year by their own hand.) Doctors have twice the rate of suicide as the general population. Based on my own experience as a young surgeon, I think a contributor to this phenomenon is an insidious spiritual crisis about the efficacy of our work and a sense of being trapped in a system that is not working but seems too big to change or escape.” 

Two weeks after resigning from residency, Means participated in a business retreat for physicians with Dr. Pamela Wible focused on designing an “Ideal Medical Practice,” beginning on October 14th, 2018. In December 2018, she obtained her unrestricted medical license with the state of Oregon, and incorporated her medical practice, “Means Health,” in January 2019, to implement a holistic and functional medicine approach in clinical practice. She began training with the Institute for Functional Medicine (IFM), completing the foundational “Applying Functional Medicine in Clinical Practice” on March 8th, 2019 and completing further coursework with IFM, and started giving talks on Functional Medicine and “food as medicine” in Portland, Oregon. 

Levels

As Means began seeing more patients in her private practice in Portland, Oregon, she started thinking about ways to scale functional medicine principles and accessibility to a wider population. This led her to conceptualize a company that would use existing lab information from routine blood work as an educational biofeedback tool to empower patients to understand their health. While circulating this concept, called “Labracadabra,” within her close network in July 2019, she was introduced to the co-founders of an emerging startup called Levels working on a overlapping concept. After getting to know the team, she began consulting for the company, helping develop early strategy and content on metabolic health—an area largely underserved in the online content ecosystem at the time. After several months of both consulting with Levels while also maintaining her private practice, she joined Levels full-time as a co-founder in March 2020, gradually phasing out her medical practice to focus on the company’s rapid growth.

At Levels, she initiated the company’s content arm—including the blog Metabolic Insights—and began recruiting the medical advisory board while supporting initial academic research collaborations between the company and academic advisors. The process of building this content operation is discussed in a two-part series on the Levels podcast A Whole New Level (“Building the Levels Content Engine, Part 1” and “Building the Levels Content Engine, Part 2”). Advisors to Levels have included preeminent metabolic researchers and clinicians including:

• Gerald I. Shulman, M.D., Ph.D., MACP, MACE, FRCP – The George R. Cowgill Professor of Medicine and Professor of Cellular and Molecular Physiology at Yale School of Medicine, internationally recognized for research on insulin resistance and type 2 diabetes.

• Robert H. Lustig, M.D., M.S.L. – Professor Emeritus of Pediatrics in the Division of Endocrinology at the University of California, San Francisco; neuroendocrinologist specializing in childhood obesity and metabolic health; and Director Emeritus of UCSF’s WATCH Program.

• Sara Szal, M.D. – Harvard-trained physician, Director of the Precision Medicine Program at the Marcus Institute of Integrative Health, Clinical Assistant Professor at Thomas Jefferson University, and four-time New York Times bestselling author in functional and integrative medicine.

• David A. Sinclair, Ph.D., A.O. – Professor of Genetics at Harvard Medical School, co-director of the Paul F. Glenn Center for Biology of Aging Research, and internationally recognized researcher on aging and epigenetics.

• Ben Bikman, Ph.D. – Associate Professor of Physiology and Developmental Biology at Brigham Young University, researching insulin resistance, metabolic disorders, and mitochondrial function.

• Dominic D’Agostino, Ph.D. – Tenured Associate Professor in the Department of Molecular Pharmacology and Physiology at the University of South Florida Morsani College of Medicine and Research Scientist at the Institute for Human and Machine Cognition, focusing on ketogenic metabolic therapies.

• Mark Hyman, M.D. – Founder and Director of The UltraWellness Center, Senior Advisor for the Cleveland Clinic Center for Functional Medicine, and internationally recognized leader in functional medicine and nutrition.

• David Perlmutter, M.D., FACN, ABIHM – Board-Certified Neurologist, Fellow of the American College of Nutrition, member of its Board of Directors, and multiple-time New York Times bestselling author specializing in brain health and the gut–microbiome connection.

Many of these advisors also conducted academic-affiliated research with the company to better understand the transition from health to disease in metabolic syndrome. The company was founded on the principle that since most type 2 diabetes and pre-diabetes cases are preventable, it is unacceptable that these conditions are skyrocketing, and the public health response is failing, as evidenced by rates going up every year. Given that accessible tools already exist to understand blood sugar levels before they reach clinical thresholds, like direct to consumer lab testing and continuous glucose monitors, Levels saw an opportunity to empower people with personal health data to track the trajectory of their metabolic biomarkers and the environmental factors influencing blood sugar well before a clinical diagnosis, and in doing so shift the greater healthcare ecosystem towards a proactive approach to metabolic diseases rather than reaction.