The Most Common Causes of Mitochondrial Dysfunction and 9 Tips to Improve Mitochondrial Health with Michael Chang, MD

Content By: Ari Whitten

The Most Common Causes of Mitochondrial Dysfunction and 9 Tips to Improve Mitochondrial Health with Michael Chang, MD

In this episode, I am speaking with Dr. Michael Chang—a functional medicine practitioner specializing in gut and mitochondrial health and author of Mitochondrial Dysfunction: A Functional Medicine Approach to Diagnosis and Treatment – Get Rid of Fatigue, Fat, and Brain Fog. We cover the most common causes of mitochondrial dysfunction and nine tips to improve mitochondrial health.

In this podcast, Dr.Chang will cover:

• The main causes and symptoms of mitochondrial dysfunction
• The three best supplements to support mitochondrial health
• Why the functional medicine approach is the best way to diagnose and treat mitochondrial dysfunction
• The best lifestyle habits to support mitochondria
• Best functional tests to diagnose mitochondrial dysfunction
• 3nutrition strategies to support mitochondrial health.

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The Most Common Causes of Mitochondrial Dysfunction and 9 Tips to Improve Mitochondrial Health with Michael Chang, MD – Transcript

Ari Whitten:  Everyone, welcome back to the Energy Blueprint Podcast. I am your host Ari Whitten, and today I have with me Dr. Michael Chang who is board certified in Anatomic and Clinical Pathology since 1989. And more recently, he switched from being a research pathologist, a hospital pathologist, into being a full-time functional medicine practitioner who is specializing in gut health and mitochondrial health. And he is the author of the new book, “Mitochondrial Dysfunction: A Functional Medicine Approach to Diagnosis and Treatment – Get Rid of Fatigue, Fat, and Brain Fog.” So welcome to the show Dr. Michael Chang.

Michael Chang:  Thank you very much, Ari. It is a pleasure for me. I have enjoyed watching your podcast for quite a while. It is really one of the best.

Ari Whitten:  Thank you so much. I appreciate it. So you were, we were just talking a bit about this before I started recording, but you were originally trained, you went through medical school, you got your MD. Then you went on to be a clinical pathologist working in a hospital for many, many years. And then, more recently, just in the last seven years or so, you have transitioned more into the functional medicine world. So talk to me a bit about your background and why you kind of shifted from a focus on pathology to getting into the world of mitochondrial health and gut health.

Michael Chang:  Thank you for asking me. It is quite a story. I started out in conventional medicine. In fact, many members of my family are all physicians, so I had no notion of, you know, holistic medicine or integrative medicine when I started out. I was just doing straight pathology and laboratory in a hospital setting for many years. And, so in 2012, I just kind of, as a lark, I decided to do the functional medicine university course and became certified as a functional medicine practitioner. And I was really fascinated by the topic. You know, I just felt that was really the answer for medicine, much more than conventional medicine. And, but then I didn’t really know how to go about practicing it at that time. The course was mainly theoretical. So it was a bit hard to get started.

And then in 2017, all of a sudden I just had a strong calling to really go into this field full time. And my motto was, you know, “Let’s make America HEALTHY, one person at a time.” So it is a big calling. So, I obeyed and started a clinic in Sunnyvale, California, in the middle of Silicon Valley. I thought, you know, that area kind of needed some help, you know, with mental health and physical health. And, so it was a bit slow going. It was hard to get the hang of the whole, you know, way of marketing functional medicine. But I kind of concentrated on gut health because I had some gut issues. I had, you know, gluten sensitivity issues. And then, I had my own health journey at that time that I was opening the clinic.

I had severe leg pain whenever I walked, and I had no idea what that was coming from, and eventually, I got x-rays done. I had severe degenerative disc disease. And, so I figured, okay, the whole thing is related to the [inaudible]. It wasn’t quite the classic sciatica and, but, so I just kind of kept going. It was, you know, during winter time it would get pretty bad when it got cold. It would kind of seize up, spasm, and it was hard to walk. And over the past couple of years, it got progressively worse until this past summer, uh, past winter when it was really difficult to walk. And, I started feeling severe fatigue after just doing short chores, even like just washing dishes for 10 minutes. So, it was difficult. And finally, I got the idea that the whole thing was related to basically an imbalance in the musculature in my posture from most likely sitting so much. I would sit, you know, 10 to 15 hours a day at a computer working on the book, working on my, you know, business.

And, so I think all that contributed to this dysfunction. And, so I tested myself using the Organic Acids Test. And sure enough, I had mitochondrial dysfunction. And so that was quite a shock to me. But, so that kind of explained everything, you know, all the symptoms and, I think, you know, the muscles were just so out of alignment, it would, you know, go into spasm and produce lactic acidosis and causing the fatigue. So, and then, this is one area I really never got any training from in medical school. And, we are all taught about joints and, you know, but never really the muscle. And, so I search online and found this Egoscue method where they talk about, you know, doing various stretches to work out your, you know, the imbalance. And, you know, that really helped me, and I knew that was kind of getting to the root cause of my personal crisis.

And so, of course, I followed my own therapy that I do for my patients, and now I am pretty much 95% recovered. So, now I have both personal experience with mitochondrial dysfunction as well as theoretical knowledge. And surprisingly, I found more than 50% of my patients, whatever their presenting symptoms were, had mitochondrial dysfunction. So it is a very common issue, and that is why I wanted to write this book. Both for the layman who might come to see me at the clinic and for the health practitioner who may not be that familiar down to the cellular level of finding the root cause. So, yeah…

Why mitochondria are important for your health

Ari Whitten:  Got it. So this kind of shifted your focus into mitochondria, which was not a big focus for much of your practice and is not a big focus of the vast majority of MDs unless they are, you know, in a specific field where they focus on like, you know, rare genetic mitochondrial disorders, for example. So you have now delved deep in mitochondria. You have got a book coming out on mitochondrial dysfunction. So obviously you think mitochondrial dysfunction is really, really central to a lot of different chronic health problems. So the subtitle of your book specifically mentions fatigue, fat, and brain fog. So talk to me big picture now about what you see mitochondria, what you see as the role of mitochondria in human health and some of these specific symptoms that you mention in your book. So why are mitochondria so damn important?

Michael Chang:  They really are important. It is at the foundation of all chronic diseases, you know, including cancers, neurodegenerative diseases like Alzheimer’s, you know, autoimmunity, all the chronic diseases that plague our society today. And, you know, the mitochondria is the powerhouse of every cell, and that is what allows the cell to do whatever its function is supposed to be. And without that, the cell really can’t function optimally, and so your whole body cannot function optimally. And, that is why it is so critical to get down to the functional medicine or the root cause. You really have got to get down to the cellular level. Otherwise, many of the protocols, many of the treatments may not work because you don’t have the energy to make it work. For example, some of the hormone therapies or detoxification, if you don’t have the energy, those protocols just will not work. So it is really critical for both practitioners and laymen to understand about the mitochondria.

Ari Whitten:  Now, what are some of the symptoms, some of the key symptoms that would clue somebody into whether or not they have mitochondrial dysfunction?

Michael Chang:  Yeah, the key symptoms will be the main symptom that brings patients into our office. You know, fatigue is obviously a big one, but it could be anything. You know, it could be a pain, it could be brain fog, you know, mood disorders, anxiety, depression, lack of focus. And basically, through my book I have discovered, through my research, I mean pretty much all of the major chronic diseases, cardiovascular disease, you know, lung disease, are all mitochondrial based. And so, as well as the whole, and the entire aging process. So it really is at the foundation of life. And so I am now thinking kind of, you know, going into the anti-aging aspect a little bit as well. I think a lot of people are searching for that kind of answer. So, this can lead to a lot of possibilities because it is really at the foundation of all health and disease.

The main causes of mitochondrial dysfunction

Ari Whitten:  Now, what are some of the key causes of mitochondrial dysfunction from this paradigm? So what you just explained so far is mitochondria are linked with so many different kinds of symptoms and diseases and disease processes and all kinds of different systems and organs of the body. And you know, if somebody is curious, I recommend doing some, going on PubMed or Google Scholar, which is basically like Google for scientific research, and type in “mitochondria” and almost any disease you can think of. And you will probably be shocked and amazed to find out that there are studies linking mitochondrial dysfunction to almost every chronic disease imaginable. And so there is just a huge amount of research there. We also know, of course, it is linked very directly with fatigue given, you know, these are our energy generators inside of our cells that give our body most, that give most of the trillions of cells of our body most of their energy. So it makes sense that if the mitochondria are not working well, fatigue would obviously be one of the key symptoms there. Brain fog, of course, if your mitochondria in your brain are not working well, then you are probably going to have brain fog there. But it goes beyond that. Again, I mean literally, probably hundreds and pretty much all of the most chronic diseases can be linked to mitochondrial dysfunction. Given that, what do you feel are some of the main causes of mitochondrial dysfunction?

Michael Chang:  Yes. Well, you know, the mitochondria are not just making energy for the cell and for the body. I mean, they are actually very sensitive to the environment and to the toxins and infections, anything that might harm the body. And so today in today’s polluted world, I mean the toxin issue is really at the top of the list. And again, many conventional doctors are not focused on this issue at all, but it really needs to be because the toxins can easily poison the mitochondria and they shift from, you know, making energy into cell defense mode. And that is Robert Naviaux’s cell danger response. And, so once they shift out of the energy mode, I mean to defense, then you are going to be lacking the energy so you have the fatigue and a lot of the other symptoms, whether it is in the brain, whether it is in the heart or any other organ that has got a lot of mitochondria.

For my case, it was in the skeletal muscle, which is again, also an organ that has a lot of mitochondria because you need the energy for movements. So toxins are really at the top of the list. And also it is sensitive to lifestyle, to stress, psychological stress can affect the mitochondria and turn off energy production. Any kind of infection. We all know when we have a viral infection, a virus, we become really fatigued. So, any kind of… And many infections are hidden, for example, in the gut. So that is why I always look into the gut for any, pretty much for anyone that comes into my office because you would be surprised how many people have parasites and, you know, hidden infections in the gut which will certainly affect the mitochondria. So it is exquisitely sensitive to all sorts of toxins and infections.

How functional medicine is different from conventional medicine

Ari Whitten:  Now, why the functional medicine approach here? So, first of all, we should probably clarify because there is a lot of people listening to this podcast who don’t actually, maybe they have heard the term “functional medicine” but they don’t actually know really what it means. So maybe you can clarify what it means and why you think it is so useful for improving health more broadly and specifically in the context of mitochondrial dysfunction.

Michael Chang:  Right. Well, functional medicine seeks to look for the root cause of the symptoms. And we are not treating symptoms, per se, but we really want to be like a detective and dig down to the root cause. And so because of this approach, really the fundamental root cause is down at the cellular level, and it is the mitochondria. So, that is why the functional medicine approach really makes sense in this aspect where we are looking for the root cause, really down to the cellular level. And so, in functional medicine, it is a holistic approach. We are not just looking at body organs, we are looking at whole systems, and including the mind and the spirit which all play a role, which all affect the mitochondria. So it really is the perfect approach for this condition.

Ari Whitten:  Now, what specific tests do you use to assess mitochondrial dysfunction? And I know you are a fan of the Kalish method of diagnosis and treatment. So can you talk a bit about what that entails and what specific tests you think are the most useful for assessing mitochondrial health?

Michael Chang:  Yeah, the Kalish method is a validated method. They did research, they published a paper at Mayo Clinic in 2016, and so it was validated by the Mayo Clinic. And the approach is basically using laboratory testing instead of intuition or guessing or whatever other approach there might be. The main test first, we do is the salivary cortisol test. And then we always look at the gut with a stool test. I like the GI-MAP which is PCR based looking for microorganisms.

Michael Chang:  And the third major test is the Organic Acids Tests. And that one is really, really crucial because it shows 46 markers of many different aspects of the body systems. Basically, you know, you look at the metabolism of your fats, of carbohydrates, and as well as the protein and it shows you the energy production through the Krebs Cycle. Then it looks at the neurotransmitters, and it looks at your detoxification function in your liver, and it looks at the gut in a more superficial way. So, it is really; a single test can show so much about your major body systems. And…

Ari Whitten:  Now of those three tests you mentioned, it is specifically the Organic Acids Test that really speaks to mitochondrial health in particular.

Michael Chang:  Absolutely. Absolutely. The idea is you look at the first 21 markers of metabolism, and if six or more of those are low, then basically, you know, you are not making energy, you know, you are not properly metabolizing your foods into energy. And so that is metabolic dysfunction or hypometabolic states. Though it is crucial to do that test, I really would highly recommend all functional practitioners to be familiar with this test because it can give so much information and it gives a great snapshot or overall superficial view of all your body systems. So it shows you where the problem areas are and then where to zoom in with additional testing.

Ari Whitten:  Can you give maybe a specific example or two of what kinds of findings you might encounter on an Organic Acids Test and what they would tell you about a person’s mitochondrial health and how that would translate into specific interventions that are unique to that person’s findings on that test?

Michael Chang:  Yeah. In my book, I gave a couple of examples of a typical patient who presents with… It doesn’t really matter what they present with. The approach is pretty much the same. And it could be, you know, migraines. It could be fatigue. It could be, you know, can’t lose weight, hormonal imbalance. The approach is all the same. You do the same tests. And so on the Organic Acids Test, the first twenty-one markers is all about your metabolism of the foods. And then it has, it looks at the neurotransmitters which are extremely important, not only neurotransmitters but also it shows whether you have brain inflammation. And that is a big issue for brain fog. And then the detoxification section is really crucial because that would reflect on their, you know, detoxification ability and so would clue you in as to what problems there might be. And then, of course, finally the gut even though this is really metabolism of gut organisms in that test. But still, it reflects whether you have a problem with fungi, for example, candida, or other bacterial issues that you need to check out further with the stool test. So it is really good overall. It gives an overall picture of what is going on.

Ari Whitten:  Nice. So once you have identified some of those specific problem areas, and you might have some specific interventions. Let’s say there is a certain imbalance on the Organic Acids Test that suggests a deficiency in a B vitamin and that, or something to that effect. What about nutrition and lifestyle recommendations more broadly? So outside of specific interventions for those findings, what kinds of things on the nutrition and lifestyle level do you find are most helpful for people to recover from some of these symptoms like fatigue and brain fog?

Michael Chang:  Right, yeah. For lifestyle issues, I rely on the salivary cortisol test. I know you don’t quite believe in that whole adrenal fatigue issue. And I’m not sure whether I do but, you know, I thought Kalish had a nice twist to it. He says to use this test to show the patient that they have lifestyle issues because when their diurnal pattern of cortisol is out of whack, it really reflects the HPA, hypothalamic pituitary adrenal axis dysfunction or dysregulation. Whether there is true adrenal fatigue, I think that is a terminology issue. But it does show that there is a dysregulation of that HPA axis. And from that standpoint I use it to show the patient they must correct their lifestyle, whether it is more meditation, you know, more exercise in order to get back to a more normal cortisol diurnal pattern.

Ari Whitten:  Yeah. It is kind of a terminology issue and kind of not. So, the reason that I would say it is not is because the theory of adrenal fatigue is fundamentally that chronic stress, and that can be conceptualized as psychological and emotional stress or more broadly as total body allostatic load, you know, the broad range of all types of stressors, physical, psychological, chemical, spiritual, you know, every toxin, every type of stressor you can imagine. That those chronic stressors tax this stress response system, the HPA axis and the adrenals in particular, and ultimately sort of wear it out. And it sounds like a somewhat logical idea, but the research just does not support it at all. And, I mean, you can look at, and I have looked at all the research and laid it out publicly. But you look at every…

Michael Chang:  Yeah. I follow your work.

Ari Whitten:  Right. So, you can look at every type of stressor from like stress from being overworked, stress from being underworked or out of work, financial stress, relationship stress, or more broadly stresses like chronic cigarette smoking being, and they have looked at it in all of these things in relation to cortisol levels. So being a chronic heavy smoker for decades versus a moderate smoker versus a light smoker versus a nonsmoker, being a heavy drinker versus a moderate drinker versus a nondrinker. You know, every type of stress imaginable, chronic pain as well, all kinds of stress. And they can look at all of these things, and they have looked at all of these things in the context of cortisol levels, and 98 plus percent of those studies never show any sort of link or any inkling of a trajectory towards an indication that the adrenals are not able to produce enough cortisol.

That never happens. I mean, it just, it is not there anywhere in the scientific literature that has existed for the last several decades. So I think the theory that chronic stress wears out the adrenal glands and causes low cortisol levels is just total nonsense. It should be discarded. But that doesn’t mean that low morning cortisol levels do not exist. They do exist, and we know something… If somebody shows up with those things, we know that it is most likely, most likely it is circadian rhythm disruption or being a night owl chronotype or sleep-deprived specifically. It is those specific things. Not all kinds of stress. It is very specific things that can cause it. Potentially there is some weak evidence towards like chronic infections, certain types of toxins, mold exposure, and past trauma. Even in those contexts, it probably is still not any sort of real deficit in the adrenals of producing enough cortisol, but a disruption of the diurnal curve of cortisol. So that is why I say it is not really just a terminology issue. It is like, it is literally that the adrenal fatigue theory is not supported by the evidence, but, and look at, you know, sort of what the evidence does say is associated with a disruption in the diurnal curve of cortisol.

Michael Chang:  But if we look at it from a mitochondrial standpoint, all those factors do affect the mitochondria.

Ari Whitten:  One hundred percent, yeah.

Michael Chang:  So in a way, I mean that is the root cause of everything. So, you know, so in essence, it is a bit of terminology for me because ultimately those factors all affect the mitochondria. So…

Ari Whitten:  Yeah, I mean that is why I think mitochondrial health is a way more useful way of looking at it. Because you can find people with full-blown severe chronic fatigue syndrome, and many, many other kinds of chronic diseases in the context of chronic cardiovascular disease, neurological diseases, I mean almost you name it. If you look at the research on cortisol curves associated with these chronic diseases, even when it is severe, even when it has been there for a decade or two, the vast majority of almost all of those people in all of those diseases have perfectly normal cortisol levels. So I just don’t think in general a heavy focus on cortisol as a big explanatory factor in most chronic disease is all that useful.

Michael Chang:  Yeah, absolutely. I agree with you. I agree with you. I think Kalish learned it from his mentors. This was, you know, 30, 40 years ago when this whole thing was getting started. And so he is still kind of fixing that. But, you know, today we know the real approach is obviously starting with the gut. So, you know, I think the HPA axis is kind of an issue. And it is nice to show something, you know, a piece of paper, a laboratory finding to the patient so that you show them, you know, you got to make some lifestyle changes and that, you know, serves a purpose.

Ari Whitten:  I agree. Yeah. Very useful on a pragmatic level for facilitating behavioral change.

Michael Chang:  Right. Which is the hardest thing?

Ari Whitten:  Yeah. There is genuine; I think a lot of power in just being able to show a person a printout of, “You actually have some measurable dysfunction in your body.” And then they go, “Oh wow. You know, maybe I should change something…” [crosstalk].

Michael Chang:  You know, it does make a difference.

Ari Whitten:  Yeah. The way I look at it is to a large extent; the symptoms should be doing the same thing for a person. Like if you are showing up every day with fatigue or with brain fog, those should ideally have the same effect, right? They should have it in their heads that, “Hey, this shouldn’t be happening. Maybe this is a sign of dysfunction in my body; maybe I should do something about this.”

Michael Chang:  Yeah, exactly. So from that standpoint, I think it serves its purpose, you know. But obviously, for me, it is the stool test and the Organic Acids Test that is really the foundation of the Kalish approach.

The best nutritional approach to mitochondrial health

Ari Whitten:  Got you. So talk to me about your dietary approach. What kinds of things are you doing on the nutrition level?

Michael Chang:  Nutritional levels, certainly for the mitochondria, it is, you know, I like the ketogenetic diet. That really helped me personally finally lose my belly fat, which I have had for years. And it was really pretty effortless. So I really like the ketogenic. And I like to combine that with intermittent or time-restricted feeding. And, between those two makes a huge difference for most of my patients as well as myself. So in addition to that, of course, we want lots of polyphenols which actually shows up, by the way. It is one of those rare little facts because Dr. Lord has been in the mentorship, I mean he is really the mentor of Dan Kalish, and he invented, he was like one of the original inventors of the Organic Acids Test. So it was really a blast to have him kind of share his ideas of what he was thinking, you know, back then. And, but anyways the polyphenols actually show up in some of the bacterial marker section.

So, you know, you can show patients, you know, about their dietary condition from that. And, so you know, basically, my approach is number one, remove the things that harm the mitochondria. Because, you know, if you got a toxin, no matter what you do, if you don’t get rid of the toxins the mitochondria are really not going to function properly, you know. So once you remove the things that are harmful to the mitochondria, that include infections and then stress and everything else, then you want to nourish the mitochondria with, you know, proper nutrition. The ketogenic diet is fantastic for the mitochondria, as well as fasting. You can do longer fasts, that will be recommended. I myself did the Fasting Mimicking Diet, and I enjoyed that.

It was quite easy. For first-timers, I highly recommend this. It has been said it is kind of like fasting on training wheels, you know, and it is very true because the idea of fasting can be a little daunting for people that have never done it. So that was a perfect way to really try it out, you know, and it was really pretty effortless. And we know fasting is tremendous for the mitochondria. Just, you know, really gives it a good boost. I think, you know, if you can do like a water fast for, you know, longer than a day, I mean, the benefits, can increase. The autophagy generally increases after three days. And then I really love the part about the stem cells being activated, especially when you get older that is really something very critical to healing whatever is ailing your body.

And, so all those kicks in after like three to five days. And so you probably don’t want to carry it too long. Then you start wasting some of your muscles, which was something I wanted to avoid. So, yeah, it has great benefits to the mitochondria.

Ari Whitten:  Nice. And as far as the ketogenic diet, is this something you recommend to do every day long term or are you cycling it in some way? Or are you recommending to do it for kind of short term and then, you know, get back towards a more balanced diet? Or what is your take on that?

Michael Chang:  Initially, when I did it for myself, I was doing that consistently. But then once I kind of started reading about the rotation program, I felt that makes more sense because I was really, you know, missing eating carbs and sometimes that led to overeating when the opportunity arises.

So, I think a rotating thing where you at least one day a week, you do, you know, eat some carbs. I think that is a more beneficial way to go. And so you don’t get that craving that people often have. So I think that it is more effective. And some people, you know, can handle a little more carbs. So, it differs from… And depending on like how much weight you really want to lose. But for me, once I reached my ideal weight, I didn’t need to be quite so consistent with it. So I like the program that you add in one day or at least one meal where you can have, you load up on the carbs without, you know, detriments.

Ari Whitten:  I’m curious, have you seen any effect on cortisol profile when it comes to ketogenic dieting? Do you notice any particular changes in cortisol levels when you put someone on it?

Michael Chang:  I have not. But, you know, it often affects the thyroid function, though, including myself when I did the FMD, I…

Ari Whitten:  For people who don’t know what FMD is, it is Fasting Mimicking Diet.

Michael Chang:  Fasting Mimicking Diet, yeah. I got into a bit of trouble with thyroid issues, kind of shut down on me, and this was like late fall when I did it. And so I felt cold like I have never felt before throughout the winter and it wasn’t pleasant, you know.

Ari Whitten:  There is some research on that you have probably seen. There is some research around how the ketogenic diet can [crosstalk]

Michael Chang:  That is something to watch out for, yeah. And certainly not everybody.

Ari Whitten:  Yeah, okay. Now, as far as supplements, you were in the nutritional supplement business for quite a long time. So I assume you know quite a lot about it. What do you find are some of the most beneficial supplements when it comes to mitochondrial health?

Michael Chang:  For mitochondrial health, you have got to go with CoQ10 and glutathione. Those are tops on my list. And glutathione, as you know, is the most powerful antioxidant in the body and so very important for detoxification. It clinches the free radicals that are produced from excessive activity in the mitochondria. And, so glutathione is just so critical for so many different functions. And besides that, the CoQ10, I highly recommend the ubiquinol form. I think that many research that shows that it is really much more effective. And lately they have newer forms like MitoQ, which I haven’t tried but I have heard good things about it, and I think that that has a lot of potentials.

Basically, it creates a charge for the CoQ10 to enter the mitochondria much easier than traditional CoQ10. So that kind of makes scientific sense in any case. And also I personally have used the PQQ. I won’t say what it is, pyrroloquinoline…

Ari Whitten:  It is much easier just to say PQQ because it is pyrroloquinoline quinone or something like that.

Michael Chang:  Yes. So, I find that in combination with CoQ10 to be quite helpful. That induces biogenesis, division of new mitochondria. And so, it turns out, you know, I did a genetic test on myself, and I had some genetic defects that involve some of the pathways of the functions of the mitochondria, the PCG-1alpha.

Ari Whitten:  Really?

Michael Chang:  Yes. So that was kind of interesting. And maybe that accounts for why I went into my mitochondrial failure, you know?

Ari Whitten:  So what exactly was the genetic…

Michael Chang:  I had a couple of them, PCG-1alpha was one, and the other one is SLG12a something or other, which has to do with the, you know, electron transport chain function.

Ari Whitten:  So your genetic variance around PGC-1alpha, which is a protein that is expressed to help facilitate mitochondrial biogenesis, the creation of mitochondria, the mutation or variation that leads to decreased expression of PGC-1alpha?

Michael Chang:  Exactly, yes. I had never heard of that, so it was kind of a surprise for me, but kind of makes sense. So PQQ would really be helpful for someone with a variance like myself. But, in any case, I think the combination of those two makes a lot of sense. But there are so many others that can really help the mitochondria. Another one that I really like is free form amino acids. Basically, these are amino acids that are extremely easily absorbable in the gut because they are not in large chains, so they are just free form. And so you want to saturate your body by taking about nine grams as a bolus, mix in some liquids, and then that gets easily absorbed. And that goes right to making these protein complexes of the electron transport chain. And so you are really just boosting up all the electron transport chain to make, to pass electrons to form ATP to form the energy. So that can be quite helpful.

Ari Whitten:  Yeah. Now, which specific amino acids are you talking about? Is it, are you talking about any particular ones or essential amino acids…?

Michael Chang:  Yeah, they are basically a mixture of the essential amino acids, including the branched-chain ones. So, and I usually add a little more of, what is it, tyrosine that kind of, it is a rate-limiting step. And so that just kind of, you know, takes away any kind of impediments to making proteins on the electron transport chain. So, yeah, and I find that that to be helpful, kind of a quick boost, you know, to the mitochondria.

Ari Whitten:  Nice. Now, what about…? So we have talked about nutrition and some of your approaches there. We have talked about supplements. What about lifestyle habits? What do you feel are some of the key things to shift in a lifestyle environment level to help facilitate mitochondria?

Michael Chang:  For myself, I was using hydrogen water because I had an opportunity to try it out when I had acupuncture, and I found it really helpful afterward to recover quickly. And so I signed up for this machine through [inaudible], and it is a really good machine, and it produces about 9% hydrogen, one of the highest out there on the market. And it really helped me recover whenever I had that fatigue after a little bit of exertion; I would either inhale the hydrogen or drink the hydrogen saturated water. And within two, three minutes, the pain was gone in the legs. It really helped me recover, and it also helps my exercise abilities. I drink it before exercise and after. It just makes it so much easier, a quicker recovery.

Ari Whitten:  Now for people who have never heard about hydrogen water, talk a bit about first of all what it is. I guess that is pretty straight forward, but what the proposed mechanisms of action are as far as what it is supposed to be doing inside your body.

Michael Chang:  Yeah, well, hydrogen, as you know from the periodic table, it is the first element…

Ari Whitten:  You just triggered some past trauma from my college, high school, and college chemistry courses. Don’t say that word “periodic table.”

Michael Chang:  Yeah. Sometimes those triggers can be kind of frightening, I agree. You know, like Krebs Cycle and all that, too.

Ari Whitten:  Biochemistry is cool, but just regular organic… Maybe I had some bad teachers, but…

Michael Chang:  Yeah, must be. Well, it is the smallest molecule, you know, and it gets right through any kind of cell membrane, goes right through the cell membrane, right through the nuclear membrane, right through the mitochondrial membrane. And, in the mitochondria, it goes to work, activates the nrf2 pathway, which is involved in anti-aging and many other pathways. They are still studying it, but there is a lot of research already, maybe coming out of Asia, that shows there are so many benefits on the mitochondria. And for me I think it really helped me tremendously get over the fatigue quickly because it can, it is such a small molecule, it can go to work at whatever level immediately. And there is really no downside to this therapy. I mean, your own gut produces several gallons of hydrogen per day, so it is certainly benign, innocuous.

Ari Whitten:  Is the gut producing it in the form of hydrogen gas that gets…? I mean, are we, is it flatulence? Is it going out of our butt as gas or is it, is some of that gas getting into our bloodstream where it is acting on some of the same mechanisms that hydrogen water is acting? Can you explain a bit about that?

Michael Chang:  Yeah, I think it is both. It is both. It is also used by other bacteria. Some bacteria feed on the hydrogen gas to produce whatever they are producing. So it has got multiple uses, you know. And beside nrf2, I think there are many other pathways it activates.

Ari Whitten:  You know, what is interesting is most people talk about hydrogen water as an antioxidant itself. And if we are talking about it in the context of nrf2 then what it really is is a hormetic stressor, and probably it is a pro-oxidant in that case. So this is an interesting reframe from the way that most people talk about it. And I actually heard that aspect of the nrf2 activation around hydrogen because I am so used to people saying, “Oh, hydrogen is such a powerful antioxidant.” But I do see, I looked it up quickly, and I saw that there are a number of studies looking at hydrogen, both gas and water activating the nrf2 pathway, which ultimately, for people unfamiliar with that, translates into activating the cell’s internal antioxidant defense system. So it does indirectly create an antioxidant effect by virtue of, in most case, being initially a pro-oxidant. And then it translates into stimulating your cells to produce lots of antioxidants.

Michael Chang:  Yes. And I think that is a more precise way to produce antioxidants. Basically, when the body really needs it, it is there. So when it doesn’t, you know, it is not there. So that is very powerful.

Ari Whitten:  Yeah, I agree. I think that is a much more intelligent way of trying to affect the right [crosstalk].

Michael Chang:  Yeah. Rather than just taking tons of antioxidants because, you know, sometimes the free radicals are not all bad and they have signaling functions in the body, and so we don’t just want to quench every single free radical all the time.

The best lifestyle strategies for improving mitochondrial health

Ari Whitten:  Yeah, yeah, absolutely. So what other strategies in the lifestyle level do you find are effective for improving mitochondrial health?

Michael Chang:  Yeah, well for me, you know, the cold water therapy is very helpful. I do cold-water plunges as often as I can, a lot of baths. I love it, doing that in the Sierras in the mountain lakes where the water is maybe about 60 degrees or so, which is really perfect for that. Try to stay in there as long as you can. You can also end your showers with a quick turn off the warm water, especially in summer. I just take cold water showers, it is very refreshing. And also another thing that really helped me was the infrared saunas when I had all the stiffness and pain in the legs. Oh, that thing was a godsend. Literally, you know. I would just stay in there, and all the pain would go away and then follow that up, follow that with a cold shower.

It is absolutely fantastic. And those are all hormesis, as you know, hormetic things to do which is… Hormesis is basically a mild stressor of short duration that invigorates the mitochondria without going too far and draining the mitochondria. So, it is fantastic. And of course, I love the red light. I learned about the red light through your book, Ari, which is fantastic. And I do that every day now. I really rely on that. I just can, I do it in the morning and it just kind of energizes the whole body, you know. And then, of course, if you have specific areas of pain, muscle pain or joint pain, then that really helps that as well.

Ari Whitten:  Wonderful. Yeah, I saw in your book, I was happy to see that the number three reference on the list of citations was my Energy Blueprint Program. So that put a nice smile on my face.

Michael Chang:  Absolutely, yeah. Great.

Ari Whitten:  Okay. So awesome. And it turns out actually all of the things you mentioned thus far are actually forms of hormesis – cold, red light therapy, hydrogen water. You are also a big fan of high-intensity interval training because you talk about it in your book. Do you want to talk about your preferred approach to that?

Michael Chang:  Yeah, absolutely. I think that is really the way to go. So what it is is you do, you know, high intensity of whatever form of exercise, but just really intense for short durations, 30 seconds to a minute. And then just intersperse that with a short period of rest, about a minute. And so I do it on the treadmill or whatever machine I’m working on. And so basically in about 10 minutes, you are done. Instead of doing half an hour, an hour of aerobic training on the treadmill or something, which by the way, if you go longer than 30 minutes actually, you know, inhibits your cortisol and it is damaging to the body to do those long aerobic exercises.

So this way, this is the best. It really stimulates the mitochondria the best, just short bursts of energy followed by a short period of rest and also just plain movement. My problem was, you know, I had to sit so much at a computer studying, you know, working on my business and working on the book and that really I want to warn the public about this issue as well because we all sit, you know, most of our day at work. And as you know, sitting is the new smoking, right? It is going to take years off of your life, and it takes a toll on your body, you know, especially when your posture is not correct. I mean my back and hips just really got all distorted, and that led to the leg distortion, which would, you know, manifest through your ankles into your feet.

So the first thing you look at is your feet and your shoes, for example. If it shows uneven wear, then that tells you you got an issue. And the issue may not be at the feet level, you know, it could be way up, you know, it could be in the neck, you know, everything is all connected. So that is one thing I learned through this Egoscue method of posture retraining really. And it took a little bit of work, but it is well worth it, you know. You can do these posture exercises anywhere, you know, I mean at your desk sitting down, even. I do it in the car. A little bit, you know, throughout the day is absolutely fantastic. And I love to do, you know, bouncing on the mini-trampoline. When I want a short break, I just go bounce for five, 10 minutes and just move your body, move your arms, you know, and it is very invigorating.

Ari Whitten:  Yeah. Movement is definitely something we have lost in the modern world, and it is absolutely vital, and people don’t realize how powerful it is to just incorporate simple movement rituals throughout your day. Dr. Chang, I want to thank you for your time today. It has been a pleasure and really a privilege to do this interview with you. For everybody listening, I highly recommend picking up a copy of Dr. Chang’s new book, “Mitochondrial Dysfunction: A Functional Medicine Approach to Diagnosis and Treatment – How to Get Rid of Fatigue, Fat and Brain Fog.” I have had a chance to read an advanced copy of it in preparation for this interview. It is excellent. I highly recommend it. And Dr. Chang, if somebody wants to work with you one-on-one, how can they get ahold of you?

Michael Chang:  My website is That is one word. My clinic’s name is Healed and Whole Clinic located in Sunnyvale. But also I do Zoom consults from anywhere in the country, in the world. And so check on my website, get the free ebook that is in there to start the whole process of working with me. And…

Ari Whitten:  And what if somebody already knows they want to work with you? Do you have an email that you can give for them to reach out to you directly?

Michael Chang:  Yeah. My email is drchang, d-r-c-h-a-n-g, one word,

Ari Whitten:  Excellent. Dr. Chang, thank you so much. Really, really enjoyed this and have a wonderful rest of your day.

Michael Chang:  Thank you, Ari. You too. Appreciate it.

The Most Common Causes of Mitochondrial Dysfunction and 9 Tips to Improve Mitochondrial Health with Michael Chang, MD – Transcript

Why mitochondria are important for your health (6:54)
The main causes of mitochondrial dysfunction (10:30)
How functional medicine is different from conventional medicine (14:34)
The best nutritional approach to mitochondrial health (29:15)
The best lifestyle strategies for improving mitochondrial health (47:24)


Visit Dr. Chang’s website to learn more about his work

Contact Dr. Chang via E-mail if you want to work with him at: [email protected]

If you want to learn more about mitochondria, listen to the podcast with Dr. Martin Picard on the stress- mitochondria link.

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