Chapter Content
Okay, so, Chapter Two, huh? It’s all about how bad energy, like, *really* bad energy, can be the root of a whole lotta diseases. So, let me tell you about this woman, Lucy. She was thirty-six and super frustrated, right? She had all these different health problems – acne, bloating, felt kinda down and anxious, couldn’t sleep. And, um, she and her husband were trying to have a baby for like, two years with no luck and she was dealing with PCOS, you know, polycystic ovary syndrome. Basically, she was about to drop a ton of cash on IVF.
So, she came to see me, wanting answers, in my new practice. She was just like, nothing’s working, I just wanna feel better, look better, and you know, start a family. She seemed eager, but also nervous, sitting in my office, which I made sure was, like, cozy and homey, not all sterile like a typical doctor’s office. She'd seen on my website that I focus on the root causes of issues and not the symptoms, and she really liked that.
Lucy, statistically, was just a typical American woman. She wasn't, like, dying or anything. She just didn’t feel good, you know? But isn’t that the case for everyone? Turns out, a lot of women are on antidepressants and a lot experience PCOS. Lucy thought she was "healthy" just because her conditions are so common, you know? Still, she had this feeling that something wasn't right and that things could be better.
During her first appointment, which was a long one, like, two hours, we started digging deep. She and all her other doctors thought these issues - fatigue, acne, bloating, depression, insomnia, infertility - were all separate. I told her we’re gonna look at things differently. All those issues, even though they’re happening in different parts of her body, are likely branches from the same tree. We needed to find the tree and heal it.
So, if you asked Lucy’s regular doctor how she ate and slept, she probably would’ve said “fine,” and that would've been the end of the conversation. But we really dug in. Turns out her husband was going to bed later, the cat jumped on her, and she didn't get good sleep. She was eating a ton of processed foods, like refined grains in tortillas and chips and lots of sugar in granola bars and baked goods. She'd do some yoga, go on weekend hikes, but she sat at a desk all day and didn’t do much strength training. She was also pretty stressed, feeling lonely in a new city, worried about her job, aging parents, and, well, not being able to get pregnant. Plus, her water was unfiltered, so she was getting a daily dose of chemicals. And her personal and home care products had a bunch of toxins. Oh, and she drank wine a few nights a week. And, get this, she stared at blue light from her computer all day and then from the TV at night while finishing emails. The light bulbs in her house weren’t helping either, and she wasn't getting outside.
So, we made a plan to treat food as medicine, optimize her sleep, reduce her stress, protect her gut, reduce toxins, and get more sunlight.
And guess what? Over the next six months, nearly every symptom disappeared! Her periods got regular again, the pain got way better, her mood lifted, and she had normal digestion again! She was able to get off her meds and, feeling like her hormones were back in balance, she put off that IVF appointment. Not only did she feel better, she also drastically reduced her chances of getting chronic illnesses in the future.
I saw similar turnarounds in other patients, you know, when they started making consistent lifestyle changes. It all comes down to understanding a few simple truths. First, most chronic symptoms and diseases are connected by a shared root cause: cellular malfunction, which leads to bad energy. Symptoms don’t just pop up out of nowhere; they're a result of dysfunction in our cells. And for most people, metabolic dysfunction is a huge driver of this cellular dysfunction.
Second, chronic conditions related to bad energy exist on a spectrum. Some aren't immediately life-threatening, like, you know, erectile dysfunction, fatigue, infertility, gout, or arthritis. But others are more urgent, like stroke, cancer, and heart disease.
And third, those “mild” symptoms you have today? See them as warning signs that something bigger might be coming down the line.
Now, the best way to explain how these "small" and "big" diseases are interconnected is by diving into the story of my mom and me.
So, when my mom was getting ready to have me, she was following all the nutrition advice, like, you know, eating tons of grains, bread, and low-fat snacks. Protein was an afterthought. She hated vegetables and never learned to cook, so she mostly relied on takeout. She walked, but didn’t exercise regularly, and was a total night owl. Oh, and she smoked for decades, just stopping for pregnancy.
So, even though you couldn’t see it, her metabolism was all messed up, and that transferred to me in the womb. You don’t become a nearly twelve-pound baby for no reason! And having a big baby, it increases risks for both mom and baby. Specifically, problems with insulin resistance, fat cell number and size, and inflammation.
Because I was so big, my mom’s doctor insisted on a C-section. But that meant I didn’t pass through her birth canal and didn’t get those good bacteria from her microbiome that help seed mine. Plus, it’s harder to breastfeed after a C-section, and my mom couldn’t do it. She was told not to lift too much while healing and a twelve-pound baby made breastfeeding difficult. So, I didn’t get the benefits of breast milk that shapes the infant microbiome for life.
Even when I was a kid, eating lovingly made meals with my family, I still ate the usual kid food: sugary cereal, processed snacks. The warning signs showed up pretty quickly. I had chronic ear infections and tonsillitis, and my mom was constantly at the doctor for antibiotics. She practically lived there and was on a first-name basis with the staff.
I now know that those infections were probably from a weak immune system, which is tied to our gut and microbiome. As a C-section baby, formula-fed baby, eating processed foods, and always on antibiotics, my gut was probably a disaster. This then led to a vicious cycle of worsening metabolic health, craving processed food, and weakening immune function.
By the time I was ten, I had packed on weight. By eighth grade, I weighed over two hundred pounds. I had low-grade anxiety, painful periods, acne, headaches, and tonsil infections. But I didn't see these as red flags. I thought they were normal and doctors even called me "healthy." Still, these conditions meant my biology was highly dysfunctional.
When I was fourteen, I really got passionate about getting healthy. I read tons of nutrition books and cookbooks. I dedicated a whole summer to health. I cooked my meals, went to the gym every day, and lost a bunch of weight. And guess what? My symptoms got better, too. I probably reversed the insulin resistance and chronic inflammation that had been causing my weight gain and other issues since I was a baby. I became an athlete and a chef and kept many of my symptoms at bay.
But then, ten years later, as a twenty-six-year-old doctor in a surgical residency, I fell back into cellular misery. As soon as I walked into that hospital, my world shrunk to a tunnel of chronic stress and adrenaline. My pager beeped all the time, and the hospital lights were always on. I slept terribly, ate processed food, got no exercise, drank caffeine constantly, and barely saw the sun. My body was *again* an epicenter of bad energy.
IBS, irritable bowel syndrome, was the first sign that my cells were dysfunctional. I didn’t make a solid stool for almost two years! It was painful lower abdominal gas and watery diarrhea eight to ten times a day.
Studies show reduced energy production within the gut in people with IBS. This also leads to abdominal pain. Believe it or not, IBS is strongly linked to insulin resistance and problems with bad energy. If you have IBS, you are twice as likely to have metabolic syndrome and elevated triglycerides.
Insulin resistance can mess with the gut nervous system, which some call our "second brain." It can also alter gut motility, alter gut barrier function, which then results in inflammation. Chronic inflammation from a poor gut barrier can fuel metabolic issues.
Then, I also had acne. The cysts on my face and neck when I was a new doctor were a sign that elevated glucose and insulin levels were causing hormonal changes. Studies have shown that people with acne have higher insulin levels. High insulin levels increase skin oil production and clog pores. Multiple studies have found that a low-sugar or low-carb diet can lead to significant reductions in acne. Also, people with acne have a higher burden of oxidative stress and mitochondrial damage, both signs of bad energy. Lots of skin conditions are caused by oxidative stress and mitochondrial damage, including hair loss, eczema, sun damage, and psoriasis.
And, yeah, I became depressed. The brain is super sensitive to oxidative stress and inflammation. It’s one of the most energy-hungry organs in the body. So, bad energy processes like mitochondrial dysfunction, inflammation, and oxidative stress mess with brain function and mood. It’s similar to how they affect gut function in IBS. My toxic work environment and residency lifestyle broke the energy-producing pathways of my gut and brain.
The gut-brain axis, you know, the communication between the gut and brain, is vital in depression. The gut makes our neurotransmitters, which control our thoughts, feelings, mood, and behavior. Imbalances in neurotransmitters contribute to depression. Over 90 percent of serotonin, the happy hormone, is made in the gut. So, anything that disrupts gut function can strongly impact mental health. IBS and depression have a strong link, and IBS is even called "depression of the gut." IBS is even often treated with antidepressants.
Studies show that changes in the gut can influence depression-like behaviors. Microbiome transfer from depressed animals to healthy animals induces depression-like behaviors pretty quickly.
Problems with bad energy in our cells contributes to depression in several ways. Mitochondrial dysfunction decreases energy production in the brain. That can alter neurotransmitter signaling. Mitochondrial dysfunction can also increase oxidative stress, which leads to inflammation. Mitochondrial dysfunction can alter these processes and lead to neuronal dysfunction, contributing to depression. Oh, and also, mitochondria regulate stress response! Mitochondrial dysfunction can alter the regulation of the HPA axis and lead to altered stress response.
Unstable blood sugar can also mess with brain cells. It can cause the brain's cells to promote more stress hormones, creating a never-ending feedback loop. Even the markers from the first chapter can tell us a lot about depression risk. One study showed that every 18 mg/dL increase in fasting glucose was associated with a 37 percent increased risk of depression! Additionally, for every one-unit increase in the triglyceride-to-HDL ratio, people had an 89 percent higher likelihood of developing depression.
When I was describing my depression to my parents, I told them that it felt like my brain went from full color to black and white. My creativity, ability to synthesize concepts, and memory were gone. Looking at it through the lens of bad energy, my brain cells likely didn’t have the energy to provide me with the full spectrum of thought and emotion or the will to keep going.
There have been some associations between metabolic syndrome biomarkers and suicidal thoughts, which should be looked into.
Oh, and, um, I developed chronic neck pain when I was a young surgeon! This was also probably related to metabolic chaos. Research shows how poor mitochondrial function and insulin resistance may play a role in the development of chronic pain. Oxidative stress and inflammation in the nerves and other tissues can damage nerves. I probably didn’t get the pain from bending my neck over the operating room table, but rather from the dysfunction in my cells. Apparently I'm not alone in experiencing chronic pain — lots of people do.
Sinus infections and migraines.
I realized that the doctors in the ENT (ear, nose, and throat) department, including me, were ignoring what might be causing the head and neck issues in our patients. Take sinusitis. Doctors describe it as chronic inflammation of the tissue of the sinuses. But we never dig deeper, you know? Like, what is causing that inflammation?
The higher a person’s blood sugar, the higher the likelihood of their having sinusitis. The probability is, like, 2.7 times higher if you have type 2 diabetes!
I remember reading an article on sinusitis in the Journal of the American Medical Association. It showed a picture of the inflammatory pathways in the nasal tissue of someone with sinusitis. These are the same ones that are elevated in people with heart disease, obesity, and type 2 diabetes. I thought to myself, *Is it possible that the same problem is just showing up in different body parts as different symptoms?*
Migraines also correlate closely with poor metabolic health. Sufferers, about 12 percent of people, have higher insulin levels and insulin resistance. There are also micronutrient deficiencies in key mitochondrial cofactors. Research has suggested that migraines could be treated by restoring levels of vitamins B and D, magnesium, CoQ10, alpha lipoic acid, and L-carnitine. Also, high oxidative stress is associated with a higher risk of migraine in women. Even tension headaches are linked to high variability in blood sugar.
Hearing loss.
We’d typically tell patients that their auditory decline was inevitable, due to aging and loud concerts, and we would suggest hearing aids. Yet insulin resistance is a little-known link to hearing problems. If you have insulin resistance, you are more likely to lose hearing because of poor energy production in the delicate hearing cells.
One study showed that insulin resistance is associated with age-related hearing loss. The auditory system needs high energy for its complex signal processing, so when you have insulin resistance and disturbed glucose metabolism, it leads to decreased energy generation.
Another study showed that hearing impairment was much more common in subjects with elevated fasting glucose.
Autoimmune conditions.
Even with rarer conditions such as autoimmune diseases, like Sjögren’s syndrome and Hashimoto’s thyroiditis, research indicates a strong metabolic link. People with autoimmune diseases have a much higher rate of insulin resistance and metabolic syndrome. Bad energy can result in chronic inflammation and autoimmunity.
Dr. Terry Wahls speculates that autoimmunity could be from the body responding to the “cell danger response,” which is a biological reaction from the mitochondria because of perceived threats to the cell, like poor diet, injury, infection, and nutrient deprivation. This releases ATP outside the cell, alerting other cells of the danger. Overstimulation of the CDR can lead to an increased risk of chronic diseases such as autoimmune disorders, cardiovascular disease, and cancer.
Research has shown that people with autoimmune diseases are more likely to develop metabolic disorders like obesity and type 2 diabetes. For people with rheumatoid arthritis, the risk of diabetes is higher. Autoimmune diseases have increased in the United States over the past few decades. According to the National Institute of Environmental Health Sciences, autoimmune diseases affect a huge chunk of the population. This is because we are so biochemically fearful of our modern diet and lifestyle exposures!
Infertility.
I noticed some common discussions surrounding fertility and sex among my friend group. A lot had trouble conceiving and some experienced miscarriage. There were also whispers over cocktails about partners having problems with sexual function, libido, and erections.
PCOS is the leading cause of female infertility. A key driver is high insulin, which messes with hormones and the menstrual cycle and impedes fertility. PCOS is so tied in with metabolic health that a NIH panel proposed that the name of the disease be changed to “metabolic reproductive syndrome.”
A study in China showed that PCOS has gone up just in the past decade. Today, it is now affecting women worldwide. According to the CDC, half of women with PCOS may eventually develop type 2 diabetes. Obesity in women with PCOS in the nation is also pretty high. Weight loss, diet and lifestyle changes, and medication can all play a role in improving insulin sensitivity and reducing symptoms of PCOS. Just twelve weeks of a vegetable-filled, low-glycemic diet can improve all key biomarkers of the condition.
The fertility crisis isn’t confined to women. Sperm count has fallen—by more than 50 to 60 percent in forty years—and metabolic dysfunction is one key reason. Obese men get hit particularly hard. And “male factor” infertility contributes to a good chunk of infertility cases. This is because fat tissue contains enzymes that convert testosterone to estrogen.
Excess oxidative stress damages sensitive sperm cell membranes, impairs sperm development, and can fragment sperm DNA, causing reduced sperm quality and increased risk of miscarriage. Oxidative stress also directly decreases testosterone production. You can increase oxidative stress with alcohol, smoking, obesity, aging, psychological stress, diabetes, infection, diets high in processed foods, certain medications, chronic sleep loss, pesticides, pollution, and many industrial chemicals.
ED, erectile dysfunction, is also rising in men, and is rooted in metabolic disease. With reduced blood flow and reduced blood vessel dilation.
More than a few friends have shared that they were diagnosed with gestational diabetes when they were pregnant. Others have shared sad stories of pregnancy loss. Metabolic strain can be toxic to the placenta. Placental dysfunction is a failure of the placenta to perform its normal functions.
Assessing the data holistically, it appears that modern diet and lifestyle are sterilizing the human population in part through bad energy.
Chronic fatigue.
Doctor visits are for symptoms of fatigue, making it a super common reason for medical appointments. Lots of people experience regular fatigue at work, have chronic sleep issues, and drink caffeine daily. Reduced ATP production, unstable blood sugar levels, and hormonal imbalances contribute to persistent fatigue. This dynamic contributes to bad energy.
Bad energy among children: Normalizing unprecedented trends.
Childhood obesity and fatty liver disease.
Childhood obesity has increased dramatically in the past fifty years. According to data from the CDC, the rate of childhood obesity has more than tripled since the 1970s. Another sign of bad energy is nonalcoholic fatty liver disease (NAFLD), now the most common liver disease in kids. The prevalence of NAFLD in children is rising sharply. This prevalence should be close to zero. Historically, fatty livers were found in adults abusing alcohol. NAFLD is full-blown metabolic dysfunction in kids and adults. Transplants have gone up a lot in the past few years, and while alcohol and hepatitis C used to be the leading causes, NAFLD is now taking the lead in women as the cause of liver failure and is a top cause for men.
Brain disorders among children.
We are reaching epidemic levels of childhood mental illness. According to the CDC, by the time they reach age eighteen, a good amount of children will meet the criteria for mental health disorders! The prevalence has risen dramatically over the decades. Also, the number of children with an anxiety or depression diagnosis increased over only a few years.
Suicide is now the second leading cause of death for young adults. Among local leaders, there was little talk of whether metabolic factors could have contributed to these trends.
Cases of developmental conditions are also rising rapidly in youth, with autism and ADHD rates climbing yearly. Children's brains don’t escape from issues with bad energy! A developing brain is particularly susceptible. In a rational health care environment, a key public health priority would be to support maternal and early childhood metabolic health as a high-leverage approach to support a thriving population.
Other childhood metabolic conditions.
Epidemic levels of obesity, liver dysfunction, and brain dysfunction demonstrate a cellular energy epidemic. And our children’s small, not fully developed bodies are being set up to fail at an early age because our culture and daily lives have been co-opted by processed foods.
A sampling of health conditions that are increasing in children and are known to be related to poor cellular energy production, mitochondrial dysfunction, or oxidative stress include ADHD, autism spectrum disorder, type 2 diabetes, NAFLD, depression, anxiety, high blood pressure, allergies, acne, psoriasis, and eczema.
Many parents have complained about taking their kids to the doctor for infections. Few, if any, understood that the way their kids’ bodies were producing energy had a significant impact on the propensity for illness, given that immune cell function is regulated by energy.
Kids with metabolic dysfunction are at a higher risk for infections than kids without metabolic dysfunction or who are a healthy weight. For instance, the odds of streptococcal pharyngitis were higher in kids with obesity. The antibiotics we throw at these kids are in no way harmless. One of the most alarming research findings I’ve ever come across is that antibiotics in childhood increased the risk of mental health issues.
It’s this simple: kids’ bodies, just like adult bodies, are made of cells that need energy to function. Our children are living in disastrous metabolic conditions, and their bodies are paying the price.
Our culture pushes a bad energy world onto kids who cannot protect themselves. The world kids live in is inflammatory and metabolically disastrous unless parents staunchly go against the tide of normal American culture.
Fifty and beyond: The rise of life-threatening chronic conditions.
Many of us have watched as our parents develop chronic illnesses as they get older. All the common conditions like high blood pressure, heart disease, stroke, dementia, arthritis, cancer, or upper respiratory conditions are rooted in bad energy.
Stroke.
The relationship between high blood glucose and the risk of stroke is well established. Patients end up being unaware of their condition. Insulin resistance leads to problems with blood vessels that contribute to stroke, including excess clotting, reduced nitric oxide production, and increased atherosclerosis.
Dementia.
Early-onset dementia and other cognitive diseases are also charging through our population. The brain uses more energy and glucose than any other organ, so it is particularly vulnerable to the effects of bad energy. The impaired glucose uptake caused by insulin resistance may starve brain cell mitochondria of the energy they need to function.
Alzheimer’s disease has been dubbed “type 3 diabetes” because of its higher prevalence among people with insulin resistance. It’s predicted to more than double in the coming years. Finding ways to prevent, treat, cure, or simply slow the progression of dementia has become an urgent global challenge.
Fortunately, recent research shows that Alzheimer’s cases are related to modifiable risk factors. And we should be ambitious about prevention.
Heart disease.
The heart is the organ that causes more deaths than any other part of the body. Heart disease is directly rooted in bad energy.
One of the first studies demonstrated that metabolic dysfunction is a risk factor for developing heart disease. High blood sugar leads to oxidative stress, which causes inflammation and damages both large and small blood vessels. In response, fatty deposits build up inside blood vessels, causing them to harden and narrow.
Respiratory disease.
The leading type of chronic respiratory disease is chronic obstructive pulmonary disease (COPD). Cigarette smoke contains toxins, which can directly damage the mitochondria within our cells. The damage to the mitochondria leads to decreased energy production, which can then lead to health problems. Multiple studies support the concept that improving blood glucose control leads to better outcomes. Consumption of sugar-sweetened beverages is strongly linked to COPD risk.
Arthritis.
One of the saddest things that many people experience as they age is that their bodies just don’t feel as good. The aches, pains, and stiffness have a direct metabolic link. Arthritis may be more of a metabolic disease than a structural one. People with osteoarthritis have a much higher risk of having cardiovascular disease and a higher risk of having type 2 diabetes.
One metabolic factor that has been linked to arthritis is chronic inflammation, which can damage joint tissues and cause the release of pain-causing chemicals. Another is chronic oxidative stress, which can lead to cellular damage. Obesity has been shown to increase the risk of developing osteoarthritis. Exercise can do wonders to minimize joint pain.
COVID-19.
As I continued through my journey of discovering the metabolic links to common conditions, around the bend came COVID-19. I had recently joined forces with my cofounders to launch Levels, a health technology company. The connections between bad energy and nearly every chronic disease and symptom were becoming clear to us in metabolic research and medicine, and we viewed the fast-moving viral phenomenon through metabolic glasses.
The COVID-19 crisis was one of the most dramatic examples of conventional medicine’s metabolic blind spot.
In many studies on COVID-19 mortality, a good chunk of the people who died had other chronic health problems, such as type 2 diabetes and high blood pressure. Experts around the world were trying to yell it from the rooftops, yet the message did not get out.
Society missed the opportunity to teach people about the connections between severity of illness and diet, exercise, and other modifiable factors.
COVID-19 is not the first pathogen to biologically discriminate against people with diabetes. In fact, people with diabetes are more likely to need hospitalization during influenza epidemics.
The cruel cost of missing the signs.
We accept conditions such as obesity, acne, fatigue, depression, infertility, high cholesterol, or prediabetes as common for generally "healthy" adults as they get older.
This is the largest blind spot in medicine. These “small” conditions are invitations to become curious about the metabolic dysfunction. Bad energy will almost certainly result in more serious conditions down the road if left unaddressed.
In medicine, we call conditions that tend to go together comorbidities. In medical school, the conclusion of these co-occurrences generally elicited a shrug. This normalization has, in a sense, reinforced our blind spots and has led to untold missed opportunities to help millions of people turn things around before their health gets worse and harder to heal. This is exactly what happened with my mom.
My mom did not know that the extra fat on her body was a sign of cells that were overwhelmed. She didn’t know that her comorbidities were the definition of metabolic dysfunction. They were telling a story and raising a warning that was ignored.
My mom tried hard to get her health back on track. She stopped smoking. She hired a trainer. She joined a Curves gym. She read every book. She felt discouraged with how many ideologies there were. But unfortunately, she didn’t have the framework to look at her body through the lens of cellular energy production, she didn’t have the resources to make sense of her biomarkers, and she didn’t make progress.
She was let down by the siloed medical system, which saw every health issue she faced as an isolated incident. She didn’t have the support of practitioners who could teach her that the large baby, inability to lose weight, high blood pressure and cholesterol, prediabetes, and, ultimately, pancreatic cancer were all branches of the same tree.
The conditions that have affected me, my friends, our children, and our aging parents show that we are all starting to become entrenched on the bad energy spectrum. Our siloed approach to seeing these conditions as separate is fatally misguided. We don’t have fifty different conditions to treat.
Consistent pathways inside our bodies must be nurtured and healed: the function and quantity of mitochondria, the prevalence of chronic inflammation, the levels of oxidative stress, the health of our microbiome, and all the ways they interact.
We’ve lost our way, but we can change course quickly. Our cells have an incredible capacity for adaptability and regeneration.
This information applies to people of all ages. I have seen people gain back their health, confidence, self-esteem, and happiness by starting with a foundation of protecting their cells’ energy-making capacity.