Chapter Content
Okay, so let's talk about... well, I guess you could call it the Chapter 9 stuff. But honestly, it's more about a whole different way of looking at health than, you know, what I learned in med school.
It's kinda crazy, right? You spend all that time in medical training and what are you really doing? You're narrowing, and narrowing, and narrowing your focus. I mean, I started out, like, broadly looking at the whole body, but by the time I was finishing up, I was thinking about picking, seriously, like *one* specific body part to, uh, devote my entire professional life to.
And that's what modern medicine *is*, you know? It's all about separation. Even way back in college, when I picked my premed major, I, like, left physics and chemistry behind and just focused on biology. Then in med school, it was all about human biology and, like, totally ignoring plants and animals. And then, as a resident? Head and neck surgery. That was it. I barely thought about the rest of the body, which is bonkers, when you think about it.
I mean, if I'd stuck with it, I could've become a *rhinologist*, which is, uh, a nose specialist. Or a *laryngologist*, which is a larynx specialist. Or get this—an *otologist*! That's the inner ear, like, those three tiny bones, plus the cochlea and eardrum! Or, you know, head and neck cancer. And the whole goal was to just get better and better at treating a *smaller and smaller* part of the body.
And, you know, if you were *really* good, maybe they'd even name a disease after you! Like Dr. Lloyd B. Minor, who was the dean of Stanford Medical School. He was, like, *the* world-renowned otologist. Focused his whole career on, like, three square inches of the body. There’s even a condition named after him, Minor’s syndrome, it's about microscopic changes in the inner ear, which causes balance issues and stuff. He was like, the ultimate success story: stay focused and climb the ladder. And, well, it protects you legally too. Stay in your lane, and you don’t get sued for messing up something you weren’t supposed to be treating.
But yeah, by my fifth year, I was chief resident in otology, focused on that tiny little area around the ear, hearing and balance. And I saw patients like Sarah, this thirty-six-year-old woman. Poor thing, she came into the clinic just gripped with, like, *awful* migraines. Ten attacks a month, or more! And dizziness and auditory symptoms can be a part of all that, so they often get sent to our department as they see all kinds of doctors. Sarah's world had just shrunk down to nothing after, like, ten years of this. She was on disability, mostly stuck at home. Her life just revolved around her condition. She was so light-sensitive she wore wraparound sunglasses all the time, and she had to use a cane because of her arthritis. And she had a support dog with her all the time.
I looked through her charts...hundreds of pages of faxes. She'd seen *eight* different specialists in the past year! For all these different, persistent, painful symptoms. The neurologist gave her migraine meds, the psychiatrist gave her SSRIs for depression, the cardiologist gave her hypertension meds, the palliative care specialist gave her even *more* stuff for the pain in her joints. And she *still* wasn't getting better.
I felt stunned looking through all this. What could *I* possibly offer her that she hadn't already tried?
So, you know, I went through my routine migraine questions. I asked if she'd tried a migraine elimination diet. And she hadn't even heard of it! I was shocked. We had handouts on that right there in the clinic! But nobody thought it was important enough to mention. Instead, she was getting tests, expensive CT scans, all sorts of psychoactive drugs. And she kind of...balked when I told her about how a diet eliminating migraine triggers *could* help. Like, her body language was just saying, "If food could help, wouldn't someone have told me by now?" She just wanted another medication.
And you know what? Sarah wasn't the only one. So many patients came in with these stubborn chronic diseases, carrying stacks of paperwork. But Sarah was just so *young* to be suffering like that. And she'd been bouncing between specialists so fast. It just highlighted how the whole system was failing her. She was sick, getting sicker, had a bunch of chronic illnesses, and her lifespan was probably shortening, but she didn’t know that. And she was frustrated with her care, but she was still relying on it, clinging to it.
I tried to hide my discomfort. How could I just give her another prescription when there were, like, *simple* strategies that could make a real difference? My stomach churned at the thought of prescribing another drug that wouldn't magically fix everything. We could pretend that this new medication was going to give her hope, schedule a follow-up, and leave the meeting feeling like we'd done our best. But, deep down, we both knew that it wasn't a “medication deficiency” that was making her body sick.
I could have done what the other doctors did, what I was expected to do: name the condition based on the symptoms, rule out anything life-threatening, write a prescription, input the billing codes, and move on. That’s respectable medicine. But cases like Sarah’s made me want to work differently, look upstream, and question *why* those symptoms were there.
So, what *does* cause disease? Well, let's talk about inflammation.
I mean, when in doubt, just start asking questions. And the obvious one in Sarah's case was: Were her conditions really so separate? Or was something connecting them that we weren't seeing?
So, I was looking through her labs, and I saw one of her inflammatory markers was high. And I remembered something from med school about that marker being high in things like diabetes and obesity. And she *did* have inflammatory arthritis. So, chronic inflammation was a factor here. And then I asked: Could inflammation have a role in causing migraines? And, surprise, a quick search showed tons of scientific papers linking the two!
I knew that inflammation is the swelling, heat, redness, pus, or pain you get when immune cells rush to an injury or infection. It’s helpful, it means your body is trying to defend itself and heal damaged tissue. Your immune system is always on the lookout for anything foreign, unwanted, or dangerous. It’ll jump into action within seconds of detecting something wrong. And then, when the problem’s gone, it turns the inflammation off. The heat, redness, swelling, and pain go away.
But Sarah? She had no injury, no infection that I could see. And it wasn't temporary. Her inflammatory response was just...on. Stuck on. To the point where it was hurting her own body. I started wondering, why was her immune system so activated? Why was it in this persistent state of alarm, causing damage to her tissues, even?
And then, thinking about my ENT stuff, it hit me. It was *all* inflammation! You know, in medicine, "-itis" means inflammation. And our practice was *full* of it! Sinusitis, tonsillitis, pharyngitis, laryngitis, otitis...I could go on and on. I was an inflammation physician and I didn't even realize it! As an ENT, my job was to put out inflammation in the ear, nose, and throat. And that usually meant anti-inflammatory medications: sprays, steroid irrigations, creams, IVs, inhaled steroids...everything to calm down the immune system.
And if the meds didn't work, like with Sophia, we'd go to surgery. We’d create holes to drain inflammatory fluid, force anatomy out of the way, insert tubes through the eardrum, drill through the skull, put a balloon to enlarge an airway.
Those things would temporarily turn the inflammation off, or minimize it, but it kept coming back. And we weren't supposed to ask *why*.
But once I started peeling back the layers, the whys just kept coming. Why were their immune systems so revved up? Why were healthy cells sending out "fear" signals? There was no obvious threat. So why were these cells so frightened on a microscopic level?
Thinking about Sarah's labs, and that inflammatory marker, it struck me: could *all* her symptoms be driven by inflammation? Was one thing driving all these different diseases? Was her whole body responding fearfully to the *same* invisible threats? Seems obvious now, but back then it was a revelation. Research shows that chronic inflammation is a major cause of all sorts of diseases, from cancer to heart disease to autoimmune diseases to neurological disorders. But it wasn't part of medical culture to focus on those connections, or to ask *why* that inflammation was there.
Then I realized how much I knew. Ever since seeing those slides in histology, I was in awe of the, like, forty trillion cells that make up the human body. I felt awe at their complexity, their tiny importance as life's foundation, and how all that we are is a collection of cells. They hold so much information inside. Each cell is a little universe of buzzing activity, and the result of all that activity is our lives.
Our cells can't talk, but if you look at things from *their* perspective, the answers are there. Complex, sure, but not as baffling or specialized as some would have you believe.
After leaving my residency, I had a chance to explore. I could fill the gaps in my conventional education. I got advanced training in nutritional biochemistry, cell biology, systems biology, and functional medicine. It totally changed how I understood health and disease. And I met doctors who'd left prestigious institutions, too, to find better ways to actually *heal* patients. It reinspired me. I opened a small practice in Portland, focusing on generating health instead of treating sickness. Instead of managing diseases as a surgeon, I'd work from the ground up, having deep conversations and creating personalized plans. My patients and I would build the foundations of a solid, healthy body. And word got out, my schedule filled up fast.
Lots of patients came to me with clusters of chronic conditions, like Sarah and Sophia. But this time, we treated the problem from a different place: the cellular level. I focused on giving the cells what they needed and removing what was blocking them, with nutritional changes, lifestyle changes, and cellular support. And the results were different too—transformative, often. Stubborn problems like weight gain, bad sleep, pain, high cholesterol, even reproductive issues started to resolve. Sometimes in weeks, sometimes months. Inflammation disappeared, never to return. Patients reduced, or even eliminated, their medications. They regained hope. The results often came from doing *less*. Doing the opposite of what I'd always learned, which was to add another medication, another intervention.
I learned that inflammation—leading to disease, pain, suffering—takes root because core dysfunctions are happening inside our cells, impacting how they function, signal, and replicate. If we want to restore health, we have to look deeper than just inflammation, into the center of the cells themselves.
So, what *is* causing inflammation in patients like Sarah? Well, it turns out, it's pretty simple: chronic inflammation is often a response to our cells feeling threatened by being persistently underpowered, due to "Bad Energy" processes. Immune cells rush to protect cells in danger, thus producing inflammation.
An underpowered cell is struggling to make energy. It's sending out chemical alarm signals, recruiting the immune system to help. And in their efforts to help, the immune cells cause *immense* collateral damage. It’s a literal war within the body to protect itself from itself that results in worse symptoms. That's why chronic inflammation goes hand in hand with metabolic dysfunction and widespread symptoms.
Cellular biology sounds intimidating, I know, but there's one simple thing that can reframe how we understand health and disease: how well the mitochondria in the cell are making energy.
You've probably heard of mitochondria. The "powerhouse of the cell," right? They convert food energy into cellular energy. They take the stuff we eat and turn it into energy the cells can use to do their jobs. Different cells have different amounts of mitochondria inside them, depending on how much energy they need.
When we're healthy, the body breaks down fats and glucose. They enter the bloodstream and go into the cells. Glucose gets broken down further. These molecules are transported inside the mitochondria, they generate electrons, and those electrons go through specialized machinery to make ATP. And *that's* the most important molecule in the human body! It's the energy currency that pays for everything our cells do, and therefore pays for our lives!
We make *tons* of ATP. Trillions upon trillions of chemical reactions every second, bubbling up into our lives! All that runs on ATP, made by the mitochondria. Without it, we'd fall apart, literally.
Even though it's microscopic, the average human produces about eighty-eight pounds of ATP per day! Constantly making, using, and recycling it so fast we don't even notice. Each of our thirty-seven trillion cells is like a little city, bustling with action, transactions, and production. And while there are so many processes happening in our cells, the main things a cell needs to function well can be put into seven categories. And all require ATP, and therefore Good Energy, to occur.
Cells need to make proteins, which are responsible for structural, mechanical, and signalling work in the cell. They need to repair, regulate, and replicate DNA to prevent mutations that could lead to cancer and other diseases, and our cells are constantly turning over and replacing themselves, and the DNA replication and cell division processes allow for this. Also important is cell signalling. Microscopic biochemical messages are constantly being transported around the cell to give instructions about what needs to be done. Next is transport - moving molecules around the inside of the cell for everything to function correctly. Homeostasis is also key, and cells are constantly working to maintain healthy operating conditions, like pH, salt concentration, and temperature. We can’t forget cell waste cleanup and autophagy. Cells can recycle their own components to clear out damaged parts and proteins. And finally, there’s metabolism, the production of energy itself.
Every one of those activities requires ATP, made by well-functioning mitochondria. And all that trickles up to health throughout the body. Organs are aggregations of cells. Healthy, energized cells become healthy organs. Every cell has the blueprint it needs to work; it just needs the resources. But when the mitochondria don't have the right conditions, they don't produce enough ATP. This cellular problem of Bad Energy leads cells to sound an alarm: "Something's not right, we need help!" Our immune system comes running.
But the problem isn't an infection or a wound. It's a deeper problem, with how the cells function. And it's something the immune cells can't solve. The thing that is robbing the mitochondria of doing its job is outside of us. It's the environment in which our bodies now exist, an environment that—from our cells' perspective—is virtually unrecognizable from a hundred years ago.
Our modern diets and lifestyles are hurting our mitochondria. They co-evolved with our environment. Their mechanisms work with inputs and information from the outside world. Nutrients, sunlight, information from gut bacteria—all help trigger or supply the cells and their powerhouses with what they require to work. But many of those inputs have changed radically, blocking proper mitochondrial function and even damaging it.
An immune cell can’t stop you from drinking a soda, filter your water, turn off notifications on your phone, prevent you from eating pesticides and microplastics, or get you to go to sleep earlier. So the immune cell uses its tools: it recruits more immune cells, sends out more inflammatory signals, and keeps fighting until things resolve. But the problems don't resolve, because the damaging environmental inputs never resolve. This is the root of chronic inflammation.
Mitochondrial dysfunction and the immune system's overzealous response results in organ dysfunction, which manifests as a symptom. Most of the chronic symptoms we battle today are simply different expressions of this happening in other parts of the body: The mitochondria are hurt by the way we're living, a poorly powered cell becomes dysfunctional, the immune system tries to help but can't, and, in trying, it makes the issue worse.
So, how *does* the environment we live in today ravage our mitochondria? It comes down to ten main things:
Chronic overnutrition: Eating too many calories and macronutrients over time. We eat about 20 percent more calories than we did a hundred years ago, and way more fructose, which the body has to process. If you had to do 700 to 3,000 percent more work than usual, you'd collapse! The cell can't process it all, so things back up, byproducts are produced in excess, and processes in the cell get gummed up. The cell fills with toxic fats, which block signaling and activity. When mitochondria are taxed, they release free radicals. When the production of free radicals exceeds the body's capacity to handle them, oxidative stress can occur, hurting the mitochondria and surrounding cellular structures. Normally, a low level of free radicals is good, but too much leads to a chain reaction of damage. We are chronically overeating because of the wide availability of ultra-processed foods, which impair our body’s self-regulatory satiety mechanisms and directly trigger hunger and cravings. These are chemically engineered to be addictive and make up nearly 70 percent of our calories.
Nutrient deficiencies: Lack of vitamins and minerals. The final steps in making energy in the mitochondria need micronutrients to activate them. We have the most micronutrient-depleted diet we've ever had. As much as half of people are deficient in at least some micronutrients. This is partly because of soil depletion and the lack of diversity in our diets. We're mostly eating refined forms of commodity crops like wheat, soy, and corn, which are micronutrient deficient. For example, a deficiency in coenzyme Q10 (CoQ10), which is essential for the electron transport chain, leads to decreased ATP synthesis.
Microbiome issues: A healthy gut microbiome produces thousands of post-biotic chemicals that act as important signaling molecules, some of which directly affect the mitochondria. Molecules, such as short-chain fatty acids (SCFAs), are essential for the proper function of mitochondria and to protect mitochondria against oxidative stress. When microbiome imbalance takes hold, the production of these helpful chemicals gets derailed, depriving mitochondria of this signalling and support. This can be triggered by refined sugar and ultra-processed foods, pesticides, medications like NSAIDs, antibiotics, chronic stress, lack of sleep, alcohol consumption, physical inactivity, smoking, and infections, among other factors.
Sedentary lifestyle: Lack of physical activity decreases mitochondrial function and reduces the number and size of mitochondria in cells. Movement stimulates the cells to produce more energy and generate antioxidant molecules. When we're sedentary, we have less protection from free radicals, which can damage the mitochondria.
Chronic stress: Prolonged stress damages the mitochondria through cortisol. Cortisol inhibits the expression of genes involved in the production of new mitochondria and generates increased free radicals.
Medications and drugs: Many medications hurt the function of mitochondria, as well as alcohol, methamphetamines, cocaine, heroin, and ketamine.
Sleep deprivation: Poor sleep damages the mitochondria through hormonal imbalances and disrupts the expression of genes involved in the production and replication of mitochondria.
Environmental toxins and pollutants: Synthetic chemicals in our food, water, air, and products are wreaking havoc. These include pesticides, PCBs, phthalates, PFASs, BPA, dioxins, heavy metals, cigarette smoke, and vaping chemicals. Alcohol, too, can be considered a mitochondrial toxin.
Artificial light and circadian disruption: We're exposed to constant artificial blue light, which is a direct and indirect contributor to mitochondrial dysfunction. Exposure to intense light at unnatural times affects our circadian rhythms. And we spend little time outdoors, depriving ourselves of sunlight in the morning, which reinforces our natural rhythms.
“Thermoneutrality”: We spend most of our time indoors at consistent temperatures. Experiencing swings in temperature is great for mitochondrial function, as cold and heat stimulate the body to generate more ATP and protect mitochondria from damage.
Now, let's talk about blood sugar and insulin.
When mitochondria are damaged, they can't convert food energy into cellular energy properly. They become inefficient, and things back up, which is a big problem.
Normally, fat and glucose breakdown products would be transported into the mitochondria to be processed into ATP. Our energy needs would match our food intake, our mitochondria wouldn't be damaged, and the process would move seamlessly.
But with the mitochondria not working properly, the conversion of fats and glucose to ATP becomes impaired, and these raw materials are stored as damaging fats inside the cell. That's a big problem, because the normal activities get blocked. One of the signaling pathways that is blocked when a cell is filled with toxic fat is insulin signaling, which has a huge impact on the levels of blood sugar circulating in the body.
Under normal circumstances, the hormone insulin is released and signals for those cells to bring glucose channels to the cell membrane to let the glucose flow inside. But when a cell is filled with fat, this insulin signaling process is impaired, glucose channels don't get shuttled to the cell membrane, and glucose doesn't get let into the cell, it’s blocked. This blocking, called insulin resistance, is a way the cell protects itself from being overly bombarded with too much energy from food (glucose). The cell “knows” that because of mitochondrial issues, it can’t convert that raw material (glucose) to cellular energy, so it blocks the entry of glucose into the cell. Insulin resistance causes glucose to remain in excess in the bloodstream.
The body tries extra hard to encourage the cells to take it up by prompting the pancreas to produce much more insulin (leading to high insulin levels in the blood) to overcome the insulin signaling block. And it works, for a while. The body can overcompensate for its insulin resistance just by pumping out excess insulin. During this period of overcompensation, blood sugar levels can appear to be normal and healthy, when, in fact, severe dysfunction and insulin resistance are at play. Over time, the overwhelmed cell just can't keep stuffing glucose into itself. This is when we start to see individuals have sharp rises in their blood sugar levels and difficulty controlling their levels.
And therein lies the root of blood sugar problems, such as prediabetes and type 2 diabetes, conditions that affect over 50 percent of adults and nearly 30 percent of children. It's a domino effect of mitochondrial dysfunction, which leads to a backup of glucose and fatty acids that convert to toxic fats that fill the cell, thereby blocking insulin signaling, leading to a cell that struggles to take in glucose from the bloodstream. Insulin resistance ultimately leads to a rise in our day-to-day levels of blood sugar.
Rising blood sugar levels can stimulate the activation of the immune system and the generation of excess free radicals, thus contributing to a tornado of dysfunction in the cells and body. Mitochondrial dysfunction leading to inflammation and excess free radicals, and high blood sugar doing more of the same. Moreover, chronically elevated blood sugar leads to glycation. Structures that get glycated won't work properly and are considered foreign to the immune system, contributing even more to chronic inflammation.
About 74 percent of adults are overweight or obese, and 93.2 percent have metabolic dysfunction. Too much sugar, too much stress, too much sitting, too much pollution, too many pills, too many pesticides, too many screens, too little sleep, and too little micronutrients. These trends are causing epidemic levels of mitochondrial dysfunction and underpowered, sick, inflamed bodies.
The trifecta of cellular malfunction that is the root of virtually every symptom and disease plaguing modern Americans may not be the stuff of dinner table conversation. They may not be the most posted about topics on Instagram. But you need to know what they are—because when you know them, you get closer to understanding the root of the U.S. health care epidemic, more so than almost any doctor, and closer to helping yourself and your loved ones to heal, stay healthy, and be limitless during this precious lifetime. The trifecta of dysfunction inside our bodies that generates Bad Energy boils down to the following:
Mitochondrial Dysfunction: The cells can’t make energy properly because they are overburdened with so much crap from the environment that their energy factories are overtaxed and damaged, leading to less ATP production and more fat stored inside cells, which blocks normal cellular functions.
Chronic Inflammation: Mitochondrial dysfunction and low cellular energy production are perceived as a threat, so the body revs up a fighting response. This response becomes chronic because the perceived threat doesn’t go away unless the environment changes.
Oxidative Stress: The cells create damaging, reactive waste in the form of free radicals while trying to process all the junk being thrown at them from the environment and from damaged mitochondria. These free radicals cause damage to cells, leading to dysfunction.
Okay, so how do you even *know* if all this is happening inside you?
Well, we've got some good answers. Simple markers can show us "check engine" alerts. The most basic way to see if you have a reasonable level of metabolic health is by checking five markers that are almost always tested at your annual checkup: blood sugar, triglycerides, HDL cholesterol, blood pressure, and waist circumference. When these markers fall into an optimal range, you can deduce that your cellular energy production is doing okay. Typically, you will feel vibrant, healthy, and pain-free.
But when several of those markers fall outside the optimal range, it's a different story. The markers are signposts to the opposite state: metabolic syndrome. Metabolic syndrome means cells are struggling to get their jobs done because of problems in their energy production system. It's clinically defined as having three or more of the following:
Fasting glucose of 100 mg/dL or higher
A waistline of more than 35 inches for women and 40 inches for men
HDL cholesterol less than 40 mg/dL for men and 50 mg/dL for women
Triglycerides of 150 mg/dL or higher
Blood pressure of 130/85 mmHg or higher
The reason you want to know is that it's a clue that the Bad Energy processes are happening inside the cells. And that needs to be corrected to prevent or reverse the problems that can result from an underpowered machine.
We’ve been taught that disease is often random, and my claim that preventing some of the country’s largest killers is within your control probably sounds surprising. But when you dig into the scientific literature, you can see a phenomenal picture: People with Good Energy have a drastically lower risk of heart disease, cancer, stroke, Alzheimer’s disease, type 2 diabetes, and liver disease. People with Good Energy will be much more likely to recover from pneumonia, COVID-19, and chronic lower respiratory diseases. Studies show that 70 percent of people with heart disease and 80 percent of those with Alzheimer’s have dysfunctional blood glucose levels.
Poor energy metabolism is a target on your back for a slow and painful journey toward death, a shorter life, symptoms, and higher costs. Even if you currently have more “minor” symptoms, such as fatigue, infertility, and foggy thinking, you can improve these issues by understanding the science of how your body processes energy, by treating food as the information to optimize this machine, and by utilizing some very simple behaviors in your daily life as high-level biochemical information your cells require to thrive. You can feel limitless, positive, sharp, powerful, and free.
But if you don’t heed the warnings these “minor” conditions are trying to tell you, our Good Energy machinery will get worse over time, leading to more serious symptoms. This is why it is tragic that patients are told conditions like type 2 diabetes, heart disease, and obesity are totally separate conditions. They are all warning signs of Bad Energy and can be improved or reversed the same way.
Exiting the separatist, reductionist framework of medicine to take on unifying cellular perspectives of health and disease felt like a sea change to me. But now I feel like I have a solid gold key in hand that opens what seemed like an impenetrable lock. This key unlocks the possibility of your feeling and functioning better, even when you’ve gotten stuck in long-standing, challenging, or even defeating circumstances. This key holds a kind of superpower: one that can help all of us, young and old alike, avert chronic diseases and symptoms of the mind and body that have become tragically normalized today, and for people of shockingly young ages. It is not normal for 74 percent of the country to be overweight or obese, for fifty million people to have autoimmune diseases, or for 25 percent of young adults to have fatty liver disease. It is not normal for the leading cause of visits to the doctor to be vague feelings of “being tired.”
You now have a powerful understanding of how nearly every common symptom of the Western world is connected and how one of the biggest misconceptions in medicine is that people in their twenties, thirties, and forties are “healthy”—simply because they’re not overtly or egregiously sick or overweight. This superpower is priceless in a world where the deck is stacked against us, and where our animating life force is being systematically and dramatically dimmed.
To understand why exactly that is, we need to zoom out from looking at the interior of our cells to looking at something wide and far-reaching: the metabolic spectrum of disease.