What is the Bioenergetic Model of Health?

Author: Jeffrey Wacks, MD

How we judge our state of health and the approach that we take to achieve it depends on the lens by which we use to look at health in general. The bioenergetic model of health views health from the perspective that the goal of health should be to optimize the energy supply and metabolic function of the system.

The energy supply is a function of the available of fuel coming into the system and the efficiency by which that fuel is burned into biochemical energy. The supply of energy can be thought of as a bank account that can be used to to spend on physiologic functions. Every cell, tissue, organ, and organ system requires energy to function to properly. It is thus the organism's ability to generate energy in relationship to its demands that determines how well the organism functions overall. 

Factors that are Important, But do not Define Health

• Disease prevention
• Longevity
• Weight loss
• Laboratory biomarkers out of their bioenergetic context

We discussed in the article Rethinking Healthcare Quality: Disease Management versus Health Promotion that disease prevention is an important consequence of true health promotion. Generally speaking, if one optimizes their bioenergetic function, then the risk of chronic disease will decrease. But despite its importance, disease prevention does not itself define health. For example, if we optimize the metabolic rate and function of the body, then the risk of cardiovascular disease, diabetes, and cancer will generally decrease. That being said, however, consider a medical intervention that lowers the risk of a given chronic disease, but at the expense of the patient's bioenergetic function. For example, statin medications are generally accepted to reduce the risk of cardiovascular disease, but likely have a detrimental effect on the patient's metabolic function (discussed in more detail in Volume 3 of the training manual). The serum cholesterol level is reduced, but does so in a way that does not improve the metabolic rate or energy supply, does not induce weight loss, and does not improve insulin sensitivity. We are not saying that one should not utilize statin medications in high-risk patients, but from our perspective, it is not an intervention that makes them fundamentally more healthy.

Longevity can be thought of as the pursuit of living for a long amount of time. Longevity is similarly related to health in so much as healthier individuals will generally be more likely to avoid acute and chronic diseases and the mortality risk associated with them. But most would probably agree that longevity at the expense of quality of life is not a good strategy. If one was offered a pharmaceutical that would allow them to live an additional 10 years, but the medication causes dementia and that additional time would be spent in a cognitively impaired state, most people would probably not initiate that intervention. We argue that the intrinsic function of the system is more foundational to the idea of 'health' than lifespan.

Weight loss can certainly be part of one's health journey. There are numerous reasons why it may be advantageous to lose weight. Adipose tissue secretes chemicals called adipokines, which are directly inflammatory and cause oxidative stress. It is likely for this reason that reduction of the body adipose tissue results in improvement in oxidative stress biomarkers. Additionally, because adipose tissue is estrogenic, weight loss may improve hormone balance. Weight loss also takes mechanical stress off the muscles and joints. But we argue that weight loss should not define health. Consider the scenario where weight loss is achieved in an unhealthy way. We discuss in detail in Volume 1 that long-term, constant caloric restriction actually lowers the metabolic rate. In fact, weight loss is actually by definition stressful. Stress hormones (activated by caloric restriction) are the biochemical signals that allow for mobilization and utilization of stored fat for energy. We would actually argue that it is better to be metabolically healthy obese (MHO) than it is to be a normal weight but malnourished and chronically stressed. 

Lastly, laboratory biomarkers can be helpful in so much as they reflect the metabolic function of the system; however, pursuit of optimal biomarkers outside of this context does not define health. Serum cholesterol and serum fasting insulin are two markers in particular that often fall into this category. We discussed this in detail in the article How the Term "Insulin Resistance" is Often Misused. If the fasting insulin is reduced by improving mitochondrial function, then this aligns with our perspective, but if the fasting insulin is reduced by initiating a low-carbohydrate diet, then we are sacrificing hormone balance and the long-term energy supply to achieve this result. Thus while biomarkers are helpful, they too do not define health from our perspective. 

Optimal Bioenergetic Function Defines Health

When the body is fueled properly and is efficiently burning that fuel into energy, it functions optimally. We have the subjective energy we need to complete our daily tasks and accomplish our goals. Our brain has the energy it needs to perform cognitive tasks and maintain stable mood. We fall asleep easily and stay asleep throughout the night. Our gastrointestinal system has the energy to properly digest food, transit that food through the GI tract, and optimize the microbial balance. Our immune system has the energy to mount a sufficient response to an infection and also can regulate itself such that it does not become overstimulated from potential allergens. Our gonadal/adrenal system has the energy to output the hormones that are required not only to optimize sexual and reproductive function, but also to manage stress when it is encountered. The high-energy state is essentially the "positive vitality" that most closely aligns with what is classically regarded as "health." If we accept that the energy supply is what drives function, then it is easy to see how the low-energy state forces the body to operate in a dysfunctional way.