[INTERVIEW]
Ronda Nelson: Well, welcome back to the podcast. I’m so glad you’re here. We’re going to be talking about mitochondria today. And, you know, I don’t know that I’ve really ever had much conversation with practitioners of late that are talking about mitochondria with every single patient. I don’t think the patients really understand what it is. And I find that most practitioners, the ones that I’ve talked to, are like, yeah, yeah, they’re the little powerhouses of the cell, right? Well, yes, they are. For sure they are.
But when they don’t function well, the patient doesn’t function well. We don’t function well. Those mitochondria absolutely have to work. So when we think mitochondria, we’re thinking like CoQ10, resveratrol, maybe some B vitamins, a magnesium. But I’m gonna say no, no, no on all of that. The bigger thing that we have to be thinking of is not just feeding the mitochondria, in other words, giving it the nutrient, giving them the nutrients that they need.
We have to think about what is driving the problem. Why are the mitochondria not working, if that’s the case? And very often the sign is fatigue, because those mitochondria are responsible for generating that ATP. When we don’t get the ATP, then we can have fatigue. So these are the patients that you work with that are tired. Doesn’t matter what you do, they’re still tired. We throw adaptogens at them, we give them licorice, we give them rehmannia, we do a cortisol test.
They’re waking up at 2 a.m. Their brain isn’t working. They’re tired. They have all the symptoms. And you think, well, of course you’re tired. You’re not sleeping. Of course you’re tired. You know, you’ve had a lot of stress. But we miss a big, big, big clinical clue. And that is that the mitochondria could literally be suffocating, so to speak. The issue isn’t so much that we need to feed them, it’s that we have to figure out what is putting them under stress. And the things that put them under stress are a poor immune system, postviral issues, mold, low oxygen delivery, infections, poor nutrients, toxicity, oxidative stress, poor digestion, nutrient unavailability, iron deficiency, adrenals for sure, hypothyroidism. There are so many things that can affect the mitochondria, but we just don’t.
For some reason we kind of don’t pull this into the clinical picture. We look at it as being fatigue, it’s an adrenal issue. But for the patients that have had long-standing fatigue, or fatigue that you’re trying the protocols and they’re not working. You’re using all of what you need to use and it’s not working. Your little Duracell batteries inside the cell are not holding the charge. And we need to get them charged back up. We’ve got to make sure that they have the nutrients that they need so that they can really support the patient.
If you think about it, if they’re like living inside a room, think about it like a room in your house and the room has all the little mitochondria in it. If the room is full of inflammation and oxidative stress and, you know, poor glucose regulation and not enough oxygen, not enough iron, the mitochondria are not gonna survive in that, they’re not gonna thrive in that environment. They’re going to adapt. And when they adapt, they lose power. They’re going to downshift their energy production. They’ll downshift their function. Oxidative stress could increase. The danger signals often will increase in the cell, outside the cell. They’ll prioritize survival over cellular performance. So it’s not that they’re failing, it’s that the environment isn’t right. So we don’t want to just be throwing supplements at them.
Here there are a few things I think we need to look at. The number one reason that mitochondria struggle is because of metabolic inefficiency. And it’s one of my top five non-negotiable clinical foundations to get blood sugar working. If the patient is skipping breakfast, living on coffee in the morning, not eating a good lunch, poor stomach acid, crashing in the afternoon, then eating a big, heavy, full meal at night, or shaky, hangry, you know, in between meals, needing an afternoon nap, or they’ve got insulin resistance. All of those symptoms mean that’s like a 911 for metabolic support. Mitochondria need glucose, they need fuel in order to function. They have to have a steady metabolic signal.
So the body has to know how to be metabolically flexible. In other words, it has to be able to flex between glucose and fat metabolism. And if the patient’s blood sugar is on a roller coaster all day long, then the cells don’t receive a nice clear signal. The mitochondria become stressed out. Then we’ve got stress. We’re addressing it as stress. We think adaptogens, we think adrenal support, but all we need to do is fix their blood sugar. That right there can reduce the way that the body is perceiving the stressful environment, because irregular, dysregulated blood sugar is a stressor.
So are they restricting carbohydrates or going on too many carbohydrates? We have to ask questions. What is their protein intake? Are they eating every four hours? You know, how much caffeine, are you hitting caffeine in the afternoon? Do you wake up at night between 2 and 4 a.m.? That’s a classic blood sugar sign. So blood sugar and restoring metabolic flexibility is absolutely essential. It is the number one thing. You want to fix mitochondria? Get metabolically flexible. Help them be able to retain and sustain nice metabolic flexibility.
The second thing that impacts mitochondria is inflammation and immune activation. If the immune system is activated, the body is not thinking, how do we make sure that Susan has amazing energy to go to Pilates and manage her inbox? No, no. The body is saying, are we safe? Is there an infection? Do we have damage to the tissue? Is there a toxic exposure? Where is the threat? Do we need to conserve resources? That’s what inflammation is doing. It’s expensive. It’s using the body’s resources to protect rather than make sure that the patient has enough energy via mitochondria to be able to get through her day.
So we have to be able to address any kind of inflammatory markers. So those would be, of course, the low-hanging fruit there is just CRP. But ask about infections. Look at elevated ferritin. Sometimes that can, or even low ferritin, you could see it in both. You want to look at blood markers like, are there liver enzymes up? Are there gut symptoms? Is there pain? You know, pressing on the gut, there should never be any pain. If there’s pain on palpation, that’s inflammation in the gut. There should never be pain. That’s a big clinical sign. So if you do physical evaluations, press on that belly, lower right quadrant, lower left quadrant, press around in there and see if there’s any pain or discomfort. That’s a good clue for you. Are they frequently ill? Do they have skin issues going on? Sinus issues, joint stiffness, you know, anything like that.
Mitochondria and inflammation are so deeply intertwined. So if we ignore inflammation in the body, then the mitochondria may not recover, which means that she’s not going to feel better. Her energy capacity is not going to show up like it needs to. The third one is oxygen delivery and microcirculation. So another one is, are those mitochondria getting enough oxygen to the cell? We think about like anemia. Where’s her red blood cells? Do we need to give some chlorophyll? You know, chlorophyll, I always describe it, they’re like the inner tubes. And chlorophyll has magnesium as the man in the middle of the inner tube. But that’s for plants, right? Chlorophyll needs magnesium in the middle. We need magnesium too. But our middleman in the inner tube is iron. And so when you have low red blood cells, then you may need to add some chlorophyll to get more red blood cells, so to speak. The chlorophyll is going to build the blood like that, and then add a little bit of iron to hook in the middle because that’s how we’re going to get that oxygen to deliver to the cells.
Now remember too that as a side note here, microcirculation is also really important. It’s one thing to get oxygen moving around in the bloodstream, but if you can’t get it out of the microcirculation into the local tissue where it can act at the cell level, then you’re dead in the water. So if you believe that there are microcirculatory issues, like it’s real easy to see it in people who are smokers, right? You know that their microcirculation is gonna be damaged and impaired. You can see it in the skin. They get that mottled kind of skin look, you know? You wanna make sure that microcirculation is working as well. So if they have sleep apnea, chronic congestion, histamine patterns sometimes, endothelial function, you know, is there some kind of blockage where blood is not moving? Sometimes hypertension can be an indication. And you can even have poor oxygen delivery, even if the patient has normal labs. That sometimes can happen as well.
So you don’t use one or two markers as a confirmation bias. Don’t do that. But if oxygen is not getting there, you’ve got to check off all those boxes, because if the oxygen is not getting to the tissue, then the mitochondria are not going to be happy. They’re not going to be able to do their jobs well. This is the patient that says, you know, my labs look normal. My doctor says they’re normal, but I feel awful. And they’re often probably right. So is there post-exercise exertion? Are they winded when they go up the stairs? You know, if they bend over and get something, or they just take a short walk and come back and they’re winded and exhausted, what do we need to do? How about you can do like a capillary bed refill? Get a pulse ox, find out what their saturation is, poor circulation in the legs, restless legs, even headaches, things that you think would be signs of poor oxygen availability.
And then the last one is the nervous system. When the body is in a chronic sympathetic state, there is going to be energy depletion. But we often put this one at the top of the list. And so I intentionally left it here as number four. We can’t not look at this when we talk about mitochondria, but we make it number one. When the patient is fatigued, we think, it must be stress. But I think this should be number four. I think you have to rule out all those other things first. Metabolic flexibility, number one. Look for inflammation, number two. Make sure that the cells are getting adequate oxygen, number three. Then think about stress.
Because sometimes, you know, patients could be tired and they’ll say, I don’t know why I’m so tired. Like my life is good. I don’t really have anything super stressful going on in my life. I don’t know why it is that I’m not feeling better. I’m depleted. I just feel like someone pulled the plug on me. They sometimes will say, I get a second wind at night. Or one of the clues is they don’t tolerate fasting well because they don’t have the reserve. They don’t tolerate detox as well. They just don’t have the metabolic reserve. They don’t have the energy reserve. So, yes, it can be a stress, adrenal, cortisol, lack of adaptability. So we need some adaptogens in there. It absolutely can be, but very often, if we throw these kinds of supplements at them right in the beginning, we’re gonna miss it.
And you’ll give them, we’ve all had patients like this. Like I know I’m preaching to the choir over here. We have these patients and they say, I took all the things and I’m not better. I used to always say, well, I still say, I shouldn’t say used to. I used to say, if I give someone something for stress and they don’t respond, then that’s my clue. They say, you know, I’m maybe 20% better energy-wise, stress-wise, maybe 20% better, but I’m still just bone exhausted. Then I suspect that there’s an infection somewhere. So that would be the inflammation, infection pathway. But you have to make sure before all of that, my recommendation is that you start with blood sugar, get metabolic flexibility working. You’ve got to start there.
But ask them, you know, are you sleeping well? Do you have ruminating thoughts? Are you under-eating? That can be such a stressor. People get under stress and then they stop eating. Are you in a trauma pattern? Have you recently had a trauma? Did you lose anyone? I have a whole section on my intake form that is like psychosocial questions. I’m asking about their life, their marital relationships, their family relationships, how satisfied with their job are they? Is there financial pressure? Do they have a big high debt load that they worry about? Those are all things that will continue to keep this stress response fueling.
And then I would be wrong to not add that we have to make sure that upper digestion’s working. I mean, that really is a no-brainer. How are we gonna feed something if we’re not breaking the food down? So, yes, I guess I could add this as one of the foundational pieces, but I kind of think of it as a no-brainer. We have to make sure that the gallbladder is working, that we’re breaking down fats. We have to make sure that there’s enough hydrochloric acid in the stomach, that we’re breaking down proteins. All of that upper digestion has to be working. So those are questions that you can ask, but you’re going to be asking that anyway. And again, that is one of my five non-negotiables, is make sure upper digestion is always, always working. And metabolic blood sugar regulation has to be in there. The mitochondria have to have raw materials.
So, to circle back to what I said in the beginning, if we’re just throwing mitochondrial supplements at someone, that’s why it doesn’t work. I mean, maybe if all conditions are perfect, maybe. But when you throw mitochondrial supplements like CoQ10 and even Hawthorne, you know, Hawthorne’s so good for the heart. The heart has the largest mitochondria anywhere in the body because it has the highest energy demand. So anything that feeds a heart is going to by nature feed mitochondria. But the mitochondria need iron, they need copper and zinc and manganese and they need selenium and they need calcium and amino acids and fatty acids and sulfur and they need antioxidant support. All that has to come into play. But you’re not going to supplement your way out of that.
The only way you can ensure that those things are getting in the body for the body to use to feed, fuel, nourish, and replenish that mitochondrial activity is to make sure that we’re getting it in the diet and that the upper digestive function is working. So the nutrients, I would not start with them. I would get them from the diet, improve the upper digestion, and then start with diet and metabolic function. So if you have a patient that is tired, start with fuel. Make sure that their diet is good, their metabolic activity is good. Then put out the fire. Make sure there’s no inflammation, no infection. Third, make sure that you’ve got oxygen flowing to the tissue, got good oxygenation. And then finally, make sure that they’re sleeping, recovery, downtime, that nervous system has time to settle so that they can rest appropriately at night. They’re not working every day of the week, nonstop.
I mean, moms with kids in certain phases and times of your life, there’s going to be more fatigue just because life is busy, but that doesn’t mean that that fatigue has to define her. You know, it doesn’t have to define her. We can come along and give the support that we need to. So the next time that you have a patient that has fatigue, they come to you and they say, I am just so tired. I just want you to remember this. Mitochondrial dysfunction is real. It doesn’t necessarily mean that it is the root cause. Often the mitochondria are like the victims in a drive-by shooting. Like they just got caught in the crossfire. They are just innocent bystanders that got caught with poor glucose handling and an infection and high stress and nutrient unavailability, poor digestion, whatever it is. They just got caught in the crossfire. And then they have to adapt.
So feeding them isn’t necessarily always the right thing to do, but understanding that there could be some other things that are driving this. And when we want to get the patient’s energy back up, if what you’re doing is not working, you have to stop and think about the mitochondria. You just have to. This is a do not pass go, do not collect $200, right? You gotta stop and think, okay, what is it that really does produce energy in the body? Yes, cortisol plays a role. But at the cellular level, those little babies, those little mitochondria, they’re cranking out that ATP like crazy, or at least they want to. If the environment is right, we’ve got to clean out the room.
So just put this in a mental checklist. Blood sugar, infection, inflammation, oxygen delivery, make sure they’re recovering and sleeping well, the nervous system is working well, and upper digestion is working well. It all kind of comes back to all the basics, doesn’t it? You know, really, if you think about it, that’s why I created the clinical non-negotiables.
[CLOSING]
Ronda Nelson: Go to rondanelson.com/nonnegotiables. Go download it, and you’ll read about my five favorite clinical, they are my non-negotiables. And if I were gonna add a sixth one, it would be microcirculation. That’s kind of my sixth one. It’s not in the handout, but it’s there. If I was gonna redo it, I would make it my six non-negotiables.
But that’s why it all comes back to the basics. We sometimes reach for the designer tests and we want to do a Dutch test or we want to do a saliva test or a stool test or this test or that test. I’m not saying don’t do them. I’m not a big tester person, but a lot of people are. I’m just not a fan of spending $2,000 on a bunch of tests only to find out, yeah, no, you just have some stress. Could have saved them $2,000. That $2,000 would have gone a long way towards food, supplements, and appointments with me. Rather than a test that’s a one-off.
So, all of that to say, don’t forget about the tiny little baby mitochondria, because they need somebody in their corner and no one thinks about them. The poor little things are creating all the energy in the body, but no one is talking about them. So let’s make mitochondria a dinner table conversation, shall we? Let’s just start making it more of a conversation with patients. Explain to them, show them a picture. Explain to them how they work and why you’re doing what you’re doing. And you can’t go wrong by giving more metabolic flexibility. You’re never gonna be wrong. The patient’s always gonna feel better.
So I hope this was helpful for you. I should make a t-shirt. Make mitochondria a dinner table conversation. It’s not very catchy, but you get my point. So let’s do that. This week, think about it with your patients. Think about what mitochondrial involvement there might be with this patient that has fatigue that’s just not operating on full cylinders. How can I make sure that the mitochondria have an environment that they’re going to thrive in? That’s our job. All right, friends, if you like this, subscribe, come back, and don’t forget about the five clinical non-negotiables. Go to rondanelson.com/nonnegotiables. You can download it. I’ll see you next week.
[END]