There is a shell game at the heart of Robert F. Kennedy Jr’s Make America Healthy Again campaign, and it has to do with the mitochondrion. I doubt, though, that RFK Jr, who has been confirmed as Secretary of the Health and Human Services Department, even knows what a mitochondrion is.
Wellness influencers are obsessed with secret-yet-simple revolutionary knowledge that serves up one true cause for all diseases and one formidable cure-all—preferably made by Mother Nature. The boogeyman du jour? Mitochondrial dysfunction. RFK Jr’s coalition builder, Dr. Casey Means, points her finger at it in her book, the New York Times ˛ú±đ˛őłŮ˛ő±đ±ô±ô±đ°ůĚýGood Energy, which earned her interviews on massive new-media platforms.
She writes that “our modern diets and lifestyles are synergistically ravaging our mitochondria.” Essentially, if you want to explain your type 2 diabetes, cancer diagnosis, or heart problem, you have to look at your mitochondria. And salvation, of course, must likewise be focused on it.
This will not be a complete review of Means’ Good Energy (which she co-wrote with her brother, Calley Means, who holds an MBA). Rather, I want to investigate the claim that mitochondrial dysfunction lies at the heart of the chronic disease epidemic we are said to be witnessing. It’s not pure fiction, as it turns out, but the way in which it is portrayed by health influencers like the Means is a superb example of something we’ve seen before with stem cells and the microbiome: scienceploitation.
What mitochondrial dysfunction is
Living things are collections of cells and cells need energy to get work done. If a cell is visualized as an egg freshly cracked over a pan, the yolk is the nucleus of the cell. This is where the cell’s DNA is kept (although not all of it, as we shall soon see). But in the white of the egg, there are tiny structures with very specific roles, and one of these structures is known as the mitochondrion (or “mitochondria” in its plural form). Our favoured hypothesis is that way back in ancient times, mitochondria were primitive bacteria that got swallowed up by life forms that were made up of single cells, and these bacteria became symbiotic residents inside these cells. Mitochondria perform a very important function: they are power generators.
Mitochondria take molecules that are broken down from food and, through a long chain of chemical reactions, they end up transferring a phosphate group to a molecule known as ADP. When this additional phosphate binds to ADP, the molecule becomes ATP. (The “D”s and “T”s count the phosphates, so we go from adenosine diphosphate to adenosine triphosphate.) That phosphate transfer is what we refer to as “energy” in biology. Adding a phosphate to ADP loads that molecule up with energy and removing a phosphate from ATP delivers energy.
When I was studying molecular biology and human genetics, problems with mitochondria were typically restricted to mitochondrial diseases. Mitochondria have their own DNA, distinct from what’s in the nucleus. This DNA has genes, and these genes code for proteins the mitochondria need to function. When one of these genes is mutated, the protein it codes for can malfunction, thus creating a mitochondrial disease. We also see mutations in genes kept in the nucleus of the cell but that code for proteins that are critical to the mitochondria, and those mutations can also result in a mitochondrial disease. But mitochondrial disease is not what RFK Jr and the Means siblings say they’re worried about; they care about mitochondrial dysfunction.
This idea is scientific in nature but . Mitochondria are the powerhouses of the cell, yes, but they also perform other functions (like breaking down fat, acting as signalling stations, and sequestering calcium), and an abnormality in any of these activities can be called mitochondrial dysfunction. This is akin to your laptop’s monitor glitching or its operating system failing to boot or its trackpad no longer working: these are all forms of computer malfunction.
As we age, our body breaks down in various ways, and mitochondrial dysfunction is one such hallmark of ageing. In recent years, researchers have tied a plethora of diseases to mitochondria malfunctioning in some way. The list is long and it includes type 2 diabetes and cardiovascular disease, but also cancers and Parkinson’s disease. In a way, we shouldn’t be surprised. If a disease affects cells, the energy factories inside of these cells are likely to be impacted. To borrow an abused expression from the world of New Age spirituality, it’s all connected.
At this point, it is tempting to conclude the following: every noninfectious disease results from our mitochondria malfunctioning, and anything that can restore mitochondrial function will heal us from these diseases, and everything that throws a wrench in our mitochondria should be avoided. In Good Energy, there is a list of environmental factors accused of laying waste to our mitochondria: eating too much, not getting enough nutrients from the food we eat, adopting a sedentary lifestyle—even taking medications and drugs. Given how it’s phrased, you could interpret one of the book’s paragraphs as warning you against taking “several antibiotics, chemotherapy drugs, antiretroviral drugs, statins, beta-blockers, and high blood pressure medications called calcium channel blockers,” as they “hurt the function of the mitochondria,” and mitochondria are key, right?
But mitochondrial dysfunction, and how to treat it, is so much more complicated than this popular health book would have you believe.
Sweating to death
I surveyed the recent literature on mitochondrial dysfunction and even ardent believers in our ability to prevent it—scientists like Dr. David Sinclair, who has been —a°ů±đĚývery careful when they describe the state of our knowledge in peer-reviewed publications. From , we are told than an unaddressed question is whether mitochondrial dysfunction is a cause or a consequence of chronic illness, as this issue is quite “contentious.” Multiple review articles highlight that we need to know a lot more about the molecular mechanisms that result in mitochondrial dysfunction before we can devise good therapies. And from 2022, a  co-authored by Sinclair himself: “Combatting mitochondrial dysfunction in age-associated metabolic disease has proven challenging.”
For there is a slew of dietary supplements, preexisting medications, and experimental drugs that have been suggested to help with mitochondrial dysfunction: from common vitamins and coenzyme Q10 to the diabetes drug metformin, all the way to newer compounds with names like 6j and OPC-163493. There’s also caloric restriction, often in the form of intermittent fasting, which is thought to help our mitochondria behave themselves, potentially allowing us to live longer. The problem is that just because these interventions make sense on paper doesn’t mean they will work.
In the 1930s, a drug called 2,4-dinitrophenol was used to treat obesity. It was one of many types of drugs that researchers are now interested in to potentially restore mitochondrial function. But 2,4-dinitrophenol caused some people to  which, I hope we can all agree, is no way to treat mitochondrial dysfunction.
There are antioxidants, like alpha-tocopherol and NAC, that have the potential to help mitochondria do their job, but on their own these antioxidants are , so scientists are experimenting with fusing them with other molecules that will drive them to the powerhouses of the cell. There are also molecules involved in mitochondrial function, like RIP140 and RB1, that scientists want to target… except that RB1 helps prevent cancer and when female mice lose the gene that codes for RIP140, they . Again, in a way, it’s all connected. Unintended consequences are always around the bend of our limited scientific knowledge.
There is real potential here for some pharmacological interventions to help our dysfunctional mitochondria, to the point where a phrase was coined: mitochondrial medicine. A few mitochondria-targeting drugs are being tested in humans. But, as  published in 2018 points out, the checks and balances and buffers inside of and surrounding mitochondria are such that “we are still in the infancy of a rational approach to mitochondrial medicine.” Basically, it sounds like a good idea, but finding concrete solutions is not easy, especially since the vast majority of this research was not done in humans but in rodents. A list of randomized controlled trials of drugs targeting mitochondrial dysfunction was , and many of these trials end up with negative results.
Mitochondria play a key role in metabolism, meaning the pathways our body takes to break down food and turn the resulting building blocks into cells. But metabolism is extremely complex. Have a look at a metabolic map that was presented by Dr. Peter McGuire in  on how mitochondria contribute to health and disease (the figure is also available ):
Metabolism is not a one-way sign; it’s a subway map, and metabolic dysfunction (which, according to Calley and Casey Means, ails almost all Americans) is so broad, I’m not sure it’s all that useful as a self-diagnosis.
The ends justify the Means
This is where scienceploitation rears its head to predate on a public hungry for easy health solutions. Scienceploitation is the abuse of preliminary findings in science to sell a product or intervention that has not been shown to work, moving  to create misunderstandings. It takes research findings in cultured cells and in laboratory animals, and it concludes that what we have here is a paradigm shift in our understanding of health. Everything we knew about disease is wrong; this new thing is what we should focus on now. And of course, non-experts jump on the bandwagon to sell you dietary supplements to fix this one true cause of all diseases. Like with fad diets, we will never run out of fad boogeymen. When people get sick of trying to fix their microbiome, they will turn their attention to mitochondria.
The shell game at the heart of MAHA is that RFK Jr is meant to care about metabolic diseases, like diabetes and cardiovascular issues, and to use the Means’ book, Good Energy, as a road map for how to get Americans healthy again. But the focus on mitochondrial dysfunction is a mirage; given RFK Jr’s decades-long crusade against vaccines, his obsession is not with the mitochondrion but with one of public health’s resounding successes. The platter of scienceploitation he offers Americans—stem cells, peptides, and nutraceuticals, as he highlighted in —is a distraction. He wants vaccines gone.
If you want to keep your mitochondria from getting gummed up, I’m afraid that the best advice remains as unsexy and dull as ever: eat well, get enough sleep, and exercise regularly. Your mitochondria will thank you later.
Take-home message:
- Mitochondrial dysfunction is said to be an important cause of chronic illness and age-related diseases, as in the best-selling book Good Energy by Casey and Calley Means
- Mitochondria are the energy generators inside our cells, and problems with this or any function they fulfill have indeed been tied to a long list of noninfectious diseases
- But there remain many important questions to answer before we have reliable interventions that target mitochondrial dysfunction
- To help your mitochondria do their job, the best advice remains to eat healthy, exercise regularly and get enough quality sleep
