Good Energy: The Surprising Connection Between Metabolism and Limitless Health

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 with depression 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

Muscle Contraction Is Medicine The reason that moving regularly is important is because a body in which muscles are contracting frequently (even at low intensities for short periods) is experiencing totally different physiology than a body where the muscles are worked in only a one- to two-hour exercise block per day (no matter how intense that block). Muscle contraction is miraculous medicine.

Eighty percent of American Farm Bill subsidies go to corn, grains, and soy oil. Amazingly, tobacco receives four times more government subsidies (2 percent) than all fruits and vegetables combined (0.45 percent).

Refined added sugar causes astronomically more deaths and disability per year than COVID-19 and fentanyl overdoses combined. We need to see refined added sugar for what it is: an addictive, dangerous drug that has been included in 74 percent of foods in the U.S. food system and for which the body needs zero grams in a lifetime. Of all the levers most damaging our cells and preventing Good Energy, I believe the worst offender may be added sugar. This substance has become a mainstay of food that we and our children eat regularly. As Dr. Robert Lustig has noted, sugar shows up on labels in fifty-six different names and sneaks in everywhere.

and I am convinced that healthy emotional boundaries—such as being clear and vocal about what you will and will not let into your life—are what make relationships functional. Your gut lining is a boundary between you and everything else in the universe that is poised to inundate and overwhelm your biology and generate unrelenting inflammation. Healing and strengthening your gut lining with food—therefore creating and strengthening this critical boundary and reducing intestinal permeability or “leaky gut”—allows you to be selective about what you want to take in from the universe on a material level. You can choose what serves you. I reflect on the fact that many of the problems in society—including violence, mental illness, developmental issues, and pain—start in humans, and humans are made by cells that become dysfunctional largely because of oxidative stress, mitochondrial dysfunction, and chronic inflammation. How miraculous that food can directly combat those things. We can’t have a healthy society without well-functioning humans. We can’t have well-functioning humans without well-functioning cells. And we can’t have well-functioning cells with mitochondrial dysfunction, oxidative stress, chronic inflammation, and cellular and hormone disruption from toxic chemicals in our food. We combat those things through nutrient-dense, unprocessed foods grown in living, thriving soil.

Triglyceride-to-HDL Ratio After assessing each of these five biomarkers, there is one more step: calculate your triglyceride-to-HDL ratio to better understand insulin sensitivity. Simply divide your triglycerides by your HDL. Interestingly, studies have shown that this value correlates well with underlying insulin resistance. So even if you are unable to access a fasting insulin test, the triglyceride-to-HDL ratio can give you a general sense of where you’re at. According to Dr. Mark Hyman, “the triglyceride-to-HDL ratio is the best way to check for insulin resistance other than the insulin response test. According to a paper published in Circulation, the most powerful test to predict your risk of a heart attack is the ratio of your triglycerides to HDL. If the ratio is high, your risk for a heart attack increases sixteen-fold—or 1,600 percent! This is because triglycerides go up and HDL (or ‘good cholesterol’) goes down with diabesity.” Dr. Robert Lustig agrees: “The triglyceride-to-HDL ratio is the best biomarker of cardiovascular disease and the best surrogate marker of insulin resistance and metabolic syndrome.” In children, higher triglyceride-to-HDL is significantly correlated with mean insulin, waist circumferences, and insulin resistance. In adults, the ratio has shown a positive association with insulin resistance across normal weight and overweight people and significantly tracks with insulin levels, insulin sensitivity, and prediabetes. Perplexingly, the triglyceride-to-HDL ratio is not a metric used in standard clinical practice. If you remember one thing from this chapter, remember this: you need to know your insulin sensitivity. It can give you lifesaving clues about early dysfunction and Bad Energy brewing in your body, and is best assessed by a fasting insulin test, discussed below. Right now, this is not a standard test offered to you at your annual physical. I implore you to find a way to get a fasting insulin test or to calculate your triglyceride-to-HDL ratio every year. Do this for your children, as well. And take the steps outlined in the following chapters to ensure it does not start creeping up. RANGES: Range considered “normal” by standard criteria: none specified in standard criteria Optimal range: Anything above a ratio of 3 is strongly suggestive of insulin resistance. You want to shoot for less than 1.5, although lower is better. I recommend aiming for less than 1.

Below are recommended optimal ranges for key metabolic blood tests. Falling outside of these ranges is an indicator that you could have brewing dysfunction. The remainder of Part 2 and the plan in Part 3 will give specific steps to increase Good Energy and improve these biomarkers: Triglycerides: Less than 80 mg/dL HDL: 50 to 90 mg/dL Fasting Glucose: 70 to 85 mg/dL Blood Pressure: Less than 120 systolic and less than 80 diastolic mmHg Waist Circumference: <80 cm (31.5 inches) for women and <90 cm (35 inches) for men (South Asian, Chinese, Japanese, and South and Central Americans) <80 cm (31.5 inches) for women and <94 cm (37 inches) for men (European, Sub-Saharan African, Middle Eastern, and Eastern Mediterranean) Triglyceride-to-HDL Ratio: Below 1.5. Above 3 is a clear sign of metabolic dysfunction. Fasting Insulin: From 2 to 5 mIU/L. Above 10 mIU/L is concerning and above 15 mIU/L is significantly elevated. HOMA-IR: Less than 2.0 High-Sensitivity CRP (hsCRP): Less than 0.3 mg/dL Hemoglobin A1c: From 5.0 to 5.4 percent Uric Acid: Less than 5 mg/dL for men, and from 2 to 4 mg/dL for women

key reason why we are chronically consuming far too much food energy is because of the wide accessibility of ultra-processed, industrially manufactured foods, which impair our body’s self-regulatory satiety mechanisms and directly trigger hunger and cravings. These ultra-processed industrial foods are chemically engineered to be addictive and make up nearly 70 percent of calories that people in the United States consume today.

nonalcoholic fatty liver disease has become the most common chronic liver disease in the world, increasing from 25 percent of the global population in 1990 to close to 40 percent by 2019. NAFLD is full-blown metabolic dysfunction in kids and adults, representing liver cells filling with fat, which worsens insulin resistance. Key contributors are processed foods, refined sugars, refined grains, sweet beverages, high-fructose corn syrup, fast food, low fiber and phytochemical intake, habitual eating close to bedtime, sedentary behavior, and oxidative stress. Liver transplants have gone up close to 50 percent in the past fifteen years, and while alcohol and hepatitis C used to be the leading causes, now NAFLD is taking the lead in women as the cause of liver failure and is a top cause for men. Fatty liver disease is now the most common cause of liver transplant in young adults in the United States. We are failing our children.

which their previous doctors have chalked up to “normal.” These symptoms often include neck pain, seasonal sinus infections or recurrent colds, eczema, itchy ear canals, lower-back pain, acne, headaches, bloating, reflux, chronic cough, a little anxiety, trouble falling asleep, low energy, and PMS symptoms like cramps and moodiness. None of this is normal. You can and should feel incredible—mentally and physically—most of the time.

Despite these trends, our culture pushes a Bad Energy world onto kids who cannot protect themselves. Our culture has normalized giving one-year-olds packaged, ultra-processed foods like cake, Goldfish, rice puffs, juice, and french fries. We slather toxic, artificially scented lotions and shampoos all over their tiny bodies as soon as their first hospital bath. We damage their livers and antioxidant capacity with too much acetaminophen (Tylenol) at the first sign of fussiness or a cold. We blast their microbiomes with heavy-duty antibiotics at the first sign of a possible ear infection. And we interrupt their sleep for unconscionably early school times, then force them to sit at desks in school for six or more hours a day. We create terror and chronic stress in their bodies from social media and overall media exposure. The world kids live in is inflammatory and metabolically disastrous unless parents staunchly go against the tide of “normal” American culture. The irony is that so many parents wish that parenting were easier—fewer infections, less colic, easier behavioral patterns—without thinking through the lens of energy production in their children’s bodies. We can do so much to make our lives and our kids’ lives easier by controlling the controllable.

The pounds of molecular information we put into our bodies daily impact our health. Every thought you have and feeling you feel comes from food. Inside your mother’s body, you were 3D printed out of food, and every item you ingest continues to print the next iteration of yourself. Bodies, neurotransmitters, hormones, nerves, and mitochondria are all made, exclusively and necessarily, from what you (or your mom) put in your (or their) mouth; we don’t arise from thin air, we arise from food.

And when small cellular disturbances happen in every cell, at every moment, the effect is outsized—rippling up into the tissues, organs, and systems of your body and negatively influencing how you feel, think, function, look, age, and even how well you combat pathogens and avoid chronic disease.

If you sit all day but get 10,000 steps over the course of one hour by going for a run, that’s less health promoting than if you space out those steps over every hour of the day (more on this in Chapter 8). Wearables

TRUST THE SYSTEM ON ACUTE ISSUES, IGNORE IT ON CHRONIC Most health care books give recommendations and end with a disclaimer to “consult your doctor.” I have a different conclusion: when it comes to preventing and managing chronic disease, you should not trust the medical system. This might sound pessimistic or even frightening, but understanding the incentives of our medical system and why it does not deserve our benefit of the doubt is the first step to becoming an empowered patient.

Obesity doctors and pediatricians are not calling to lower the recommended added sugar for children to zero; they are saying obesity is a “brain disease” and that the government should subsidize bariatric surgeries and pharmaceutical injections to manage it.

I reflect that the mitochondria that process energy from food to animate our tissues are inherited entirely from our mothers, passed down through millennia in an endless progression of nesting dolls along a matrilineal line. The mitochondria from the sperm essentially melt upon fertilization with an egg, while our mother’s mitochondria persist and create all the energy we need to do everything.

When our cells sense sustained danger, they divert resources to defense and alarm pathways instead of normal functions that generate sustainable health. Given this, no matter how pristine your dietary intake is, how much you’re moving, how much sunlight you’re getting, or how many hours of quality sleep you’re getting, if the cells are bathed in a stew of stress created by the way psychology translates to biochemistry (via hormones, neurotransmitters, inflammatory cytokines, and neurologic signals), all the other healthy choices will fall

Every institution that impacts your health makes more money when you are sick and less when you are healthy—from hospitals to pharma to medical schools, and even insurance companies.

With food we covered three simple rules that get you quite far: don't eat added sugar, don't eat industrially processed vegetable and seed oils, and don't eat highly processed grains. With fitness I also suggest three simple rules: 1. walk at least 7,000 steps throughout the day and space them out throughout the day; work up to 1,000 per day; 2. get your heart rate above 60% of your maximum for at least 150 minutes per week (30 minutes for 5 days per week). 3. lift heavy things multiple times per week in a way that hits every major muscle group.

Patients are being crushed by the devil’s bargain. Between the 6 trillion dollar food industry which wants to make food cheap and addictive and the 4 trillion dollar health care industry which profits off interventions on sick patients and stays silent about the reasons they are getting sick.

Thermoneutrality”: A hallmark of modern industrial life is spending most of our time indoors at relatively consistent ambient temperatures, a concept we’ll refer to as thermoneutrality. Interestingly, experiencing swings in temperature is great for mitochondrial function, as cold stimulates the body to generate more warmth by increasing mitochondrial activity and stimulates more ATP generation and use. Heat exposure has been shown to activate heat shock proteins (HSPs) within cells, which can protect mitochondria from damage and help to maintain their function. HSPs can also stimulate the production of new mitochondria and improve their efficiency in producing ATP.

About 74 percent of U.S. adults are overweight or obese, and 93.2 percent have metabolic dysfunction. These numbers sound high until you realize how many levers of modern society are stacked against our mitochondria and metabolism: 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—with trillions of dollars behind them—are causing epidemic levels of mitochondrial dysfunction and underpowered, sick, inflamed bodies.

I reflect on the fact that many of the problems in society—including violence, mental illness, developmental issues, and pain—start in humans, and humans are made by cells that become dysfunctional largely because of oxidative stress, mitochondrial dysfunction, and chronic inflammation. How miraculous that food can directly combat those things. We can’t have a healthy society without well-functioning humans. We can’t have well-functioning humans without well-functioning cells. And we can’t have well-functioning cells with mitochondrial dysfunction, oxidative stress, chronic inflammation, and cellular and hormone disruption from toxic chemicals in our food. We combat those things through nutrient-dense, unprocessed foods grown

Bad Energy Foods If you remember one food principle in this book, remember that cutting the unholy trinity of these three ingredients from your diet will completely change your health and ensure you’re making room for more Good Energy foods: Refined added sugar Refined industrial vegetable and seed oils Refined grains

The best advice I can give anyone in transforming their health is to find a way—any way—to stick with totally unprocessed, organic food for just a month or two. By the end of this time, I can guarantee that your preferences and cravings will have changed.

Six out of ten adults are living with a chronic illness. About 50 percent of Americans will deal with mental illness sometime in life. Seventy-four percent of adults are overweight or have obesity. Rates of cancer, heart disease, kidney disease, upper respiratory infections, and autoimmune conditions are all going up at the exact time we are spending more and more to treat them. In the face of these trends, American life expectancy has been declining for the most sustained period since 1860.

question that our system can produce positive results when focused on the right problem. U.S. hospitals today are filled with some of the world’s most dedicated, intelligent, and hardworking professionals. But they are operating in a system that has lost its way, one that now makes money when patients are sick and loses money when they are healthy. The modern medical system has systematically, overwhelmingly, and unequivocally let us down in preventing and reversing chronic disease. In fact, if you pull out deaths from the top eight infectious diseases (which were decreased by antibiotics) from historical data, life expectancy rates haven’t improved much in the past 120 years—despite, of course, the fact that health care is the largest and fastest-growing industry in the United States—with the vast majority of health care dollars going to chronic disease care.

Consider this: when a kid drinks one bottle of Coke, they ingest as much added sugar as they might have had in an entire year if they were living 150 years ago.

The most blatant and deadly example of the intervention-based incentives of our medical system is that medical leaders are absolutely silent on the things that are actually making us sick: food and lifestyle.