Dr. Molly Maloof on how energy capacity reflects cellular functioning

Dr. Molly Maloof discusses her holistic approach to energy, the markers of health, burnout, and honoring your body's dynamic cycles.


Article highlights

  • Mitochondrial health reflects overall energy capacity and resilience - healthy mitochondria allow cells to meet metabolic demands.
  • Good sleep is foundational for health because it helps reset circadian rhythm that programs our daily biology.
  • Strength training is vital to maintain muscle mass, metabolic flexibility, and physical resilience as we age.
  • Mental health directly connects to metabolic health; balancing blood sugar improves mood, focus and reduces anxiety.
  • An intuitive, personalized approach to diet and exercise that adapts to changing demands improves sustainability and enjoyment.

Molly Maloof is an original biohacker, friend of Levels, and an advisor and great partner to our team. Molly has recently released a book called The Spark Factor: The Secret to Supercharging Energy, Becoming Resilient, and Feeling Better Than Ever.

Molly and Dr. Lauren Kelley-Chew, head of Clinical Project at Levels, sat down during a recent episode of our podcast, A Whole New Level, to discuss some of the ideas in the book, which provides a roadmap and overview of a way to create balance in your own life and supercharge your energy. Below is an edited version of that conversation.

Dr. Maloof’s Path to Biohacking

Dr. Lauren Kelley-Chew: I read your book, Spark Factor, and loved it so much. I’m excited to get to share some of the key takeaways with our readers. I would encourage everybody to go out and buy it. 

I wanted to jump in with understanding your story in the health and wellness space, and specifically how you became a biohacker.

Dr. Molly Maloof: I was a biohacker as a child, because when I was hitting puberty, I thought, “Someday, I’m going to understand all of this.” I got really interested in health as a kid. I was always into science. When I got to high school and started reading magazines like Popular Science, I remember hearing about modafinil and thinking, “That’s so cool. You can take a drug that doesn’t make you have to sleep.”

At the time, I really wanted to try to avoid sleeping because I had so many things on my plate. I’ve always been a really active human. I started to take supplements, I started to exercise. I became a runner. I was extremely ambitious as a kid. I was always trying to find ways to enhance my performance.

As a kid, I didn’t have a medical education. I didn’t want to become a doctor, but I really wanted to learn how my body worked. It was a lot of trial and error. But then I became a physician. Before I became a doctor, when I was in med school, I was really struggling with my mental health. I wasn’t fully depressed or anxious. I had a lot of test anxiety and I just wasn’t happy. I thought, “I’m not really thriving here. This is really hard. What do I do?”

I went to a psychologist. He said, “There’s nothing really wrong with you. You’re just a stressed medical student who’s not taking care of herself.” And I thought, “Oh wait—this is my fault? I guess I just need to figure out how to take care of myself.” 

I started studying evidence-based lifestyle medicine, and I dramatically improved my performance—my test scores. My peers said, “What did you do? How are you doing so much better than you were nine months ago?” I told them how I changed my lifestyle and health, and how I was feeling a lot better. 

Then I designed a course called “Physician Heal Thyself: Evidence-based Lifestyle.” I got it added to the curriculum and ended up winning a bunch of awards. Then I got to my residency, and found the mainstream system to be really disenchanting. I thought, “This isn’t really about health. This is about disease. How do we fix health? How do we build health?”

I got my medical license. I started my own practice. I started working with startups. There was definitely an opportunity for early-stage companies in health, but not a lot of these companies had doctors to work with, because they didn’t have a lot of money to spend on expensive physicians. I came in as a consultant for a lot of early-stage companies and started pioneering things like blood sugar monitoring and heart rate variability testing.

I was using all these things in my practice before they were really mainstream because I had an inclination that they were important. I really felt a strong conviction. Biohacking myself and my patients was the beginning of my career and my practice. Then working with startups that were developing biohacking tools was literally part of my job. I was kind of splitting my time between taking care of patients and working with companies and becoming a biohacker that way. That’s really my path. It was a unique way to get to where I am today.

Dr. Lauren Kelley-Chew: It’s such an amazing path and, like you said, unique. A lot of people who haven’t been in medical school don’t realize that there isn’t very much education around what we would now think of as health and wellness. It is disease focused; it’s reactive. 

I had the same experience when I was in medical school. My health was at its worst, or close to its worst. We were not learning material about how to take care of ourselves despite the fact that we were literally there devoting our entire lives to learning how to take care of people. It’s a bizarre paradox for many medical students and trainees. 

A Holistic Definition of Health

Dr. Lauren Kelley-Chew: There are many different definitions of health. I’m curious how you define health, both for yourself and for your patients.

Dr. Molly Maloof: I look at health as the ability to adapt and self manage in the face of adversity: How well are you handling the challenges that come your way? Are you able to bounce back from them? For example, if you catch a cold or get COVID, did you bounce back or did you get sick? Did you end up with chronic COVID? That could be a signal you were running on a lower energy capacity before you were ill.

A lot of people don’t realize that chronic COVID is chronic fatigue syndrome. I was actually studying chronic fatigue syndrome, and have dealt with chronic fatigue myself. It was right after I left residency, and I was getting my license. I was really suffering. I had a viral infection. I was not in a good place, physically.

I’ve been on this personal journey to understand how to measure and amplify health. When I first started, I was not very healthy. Residency took a lot out of me. It takes a lot out of many people who are trying to do it. I was always asking, “What is this underlying theory of health? How do I understand it?” It took me 10 years to figure it out. It’s not like it was an overnight realization. It took me 10 years to optimize my health. It took me 10 years to get to the point where I look at health as this capacity. 

Think about capacity. Do you have enough energy to meet your demands? Do you have enough energy to handle a major stressor? Think about a person who has money in the bank, versus a person who’s completely broke. If you’re broke, you don’t have money to make repairs to the house you’re living in. But if you have extra cash lying around, you can actually make those repairs, and you can buy some new furniture and replace that fridge if you need to.

The body’s very similar. Your body needs energy currency to maintain its organ function. Your body needs energy currency so that you can maintain your brain function. When people start losing energy capacity, it’s an actual “FU” function of the physics of your cells.

I became a mitochondrial obsessor, somebody who was patently convinced that mitochondria were the seeds of health or disease. But mitochondrial dysfunction can set you up for infection. It can set you up for cancer, diabetes, dementia, heart disease. The big ones are the metabolic diseases I just mentioned. One of the things people are always asking me is, “How do you know you’ve got low energy capacity? How do you know if you’re healthy or not?” 

People go to the doctor all the time and get these labs and their doctors say, “Well, your blood pressure’s kind of borderline. Your blood sugar’s borderline. You’ve got high cholesterol, but you’re generally healthy.”

Actually, that’s not true. If you have these symptoms and signs, you’re probably on your way to getting chronic disease. It’s just going to take some time before you get diagnosed. Doctors consider “unhealthy” to be a full disease state. I consider unhealthy to be a lot of the gray area between health and disease. There are a lot of people out there who have prediabetes or pre-hypertension, and they’re on their way to getting these chronic diseases, but they don’t know it because their doctors tell them they’re healthy, and it’s not true.

If you’re broke, you don’t have money to make repairs to the house you’re living in. The body’s very similar. Your body needs energy currency to maintain its organ function. Your body needs energy currency so that you can maintain your brain function.

One in three people have prediabetes. 80% of them don’t know they have it. Most doctors are not fully testing for prediabetes because they’re not putting blood sugar monitors on. They’re not doing glucose tolerance tests. They’re looking at fasting blood sugar in hemoglobin and A1c. That’s not showing the full picture of health. This is part of the reason I’m a big believer that we should be having a different way to approach health. We should be looking at health from a different perspective.

Let’s say you wake up in the morning and are completely exhausted, and you can’t get out of bed. You are not fully healthy. This may be a circadian rhythm thing, or this could just be due to generally low cortisol. But if you really can’t get out of bed in the morning because you are so exhausted, then you have low energy capacity. If you are not sleeping soundly throughout the night—waking up in the middle of the night—that’s a good sign your health needs some work.

Sleep is a really good biomarker for health. I sleep really, really well. I love, love, love sleeping, and it’s important for me to get good rest. During the end of 2022, I was running on a bit lower energy capacity because I was overloaded a little bit this year with work. I actually took a vacation. It was game changing for me, but I noticed that my mood was becoming a bit unstable. It was chronic stress, and chronic stress can break your brain. That’s a signal.

Another big signal is difficulty focusing. If you’re chronically stressed out, you’re draining your energy capacity and you’re going to have trouble with your brain function. Stamina, endurance, strength, VO2 max—these are all markers of health.

When I was a kid, we had to take these president’s physical fitness tests. I was always really proud of getting the blue patch. But we don’t do those tests anymore for a lot of kids. Kids have no idea if they’re healthy or not. 

If you are noticing your vision changing over time, or your hearing changing over time, if you notice that your senses are dull—these are all signs. Your senses are literally part of your nervous system. Your nervous system runs on electromagnetic power, electrochemical gradients. If these aren’t functioning properly, it’s a good sign you’ve got some mitochondrial changes. Your skin should emit light. Your skin is supposed to be bright. If it doesn’t—if it’s dull and gray and green looking—it’s a pretty good sign you don’t have enough energy.

Dr. Lauren Kelley-Chew: Often people will say, “Oh, he or she’s glowing.” And we think of that as just an expression. But what you’re saying makes sense. There actually is a glow to health. There is a radiance to it you can see, and people can sense it.

Dr. Molly Maloof: My skin is a direct reflection of my overall health. When I had COVID, I was very gray looking. I looked like crap when I had COVID. All the light was gone, because it was draining my energy. I use photos to kind of track my weight and appearance. My skin health definitely waxed and waned over the last year because I was challenging myself more than I’ve ever challenged myself—starting a company, fundraising, teaching at Stanford, writing and launching and marketing a book, building a new sex therapy protocol for my company, building a team…

I love the fact I was able to do it all and not completely break down, which was great. One of the benefits about health people should understand is that you actually have more capacity. I’m the kind of person who’s always trying to test how much more I can do. What can I actually accomplish? What are my limits? I did reach my limits this year, actually. I thought, “Okay, I know what it’s like to actually challenge myself beyond comprehension.”

One of my biggest realizations of 2022 was that we should be looking at our energy capacity like money in a bank account. Just because you have a lot doesn’t mean you need to spend it all. You need to save some of it. That’s where burnout can happen. 

I got a little concerned. I was maybe close to burnout at the end of 2022 because I was overwhelming my system. Then I thought, “You know what? Just go on vacation.” So I took a trip to Puerto Rico and came back feeling like a new person. You really don’t want to overdo your voluntary challenges, because you might have some involuntary challenges that are going to pop up. If you are running on lower energy capacity, you can get sick and you can break down.

I did have a couple colds last year. That definitely wasn’t optimal. But you learn about your health through direct experience. A lot of what I write about in the book is about how you evaluate your health. Then how do you optimize it? What can you do to improve it?

Health is something you have to consistently work on. It’s a daily practice. It’s not this thing you reach one day and think, “Okay, today, I am finally optimally well.”

Last year, I needed more recovery. I started changing my lifestyle based on my cortisol tests. I had high cortisol in my labs. I thought it was time to take my own medicine. I stopped drinking as much coffee. I started doing more gentle exercises. I started using my PEMF mat. I started having more hangouts with friends that were less about going out and partying and more about staying in and hanging out and using all of the biohacking tools.

There has been a definitive shift in my thinking over the last few months. I thought, “If I don’t change my lifestyle, I will burn out.” And I didn’t. I ended up finishing the year really strong and feeling grateful I was actually able to do my audiobook myself. Listening to my audiobook constantly reminded me of all the things I could do to get healthier.

It’s not like you just remember everything every day. I actually go back to my own book regularly and think, “Remember that thing you know how to do? You should do that.” Health is something you have to consistently work on. It’s a daily practice. It’s not this thing you reach one day and think, “Okay, today, I am finally optimally well.” No, you’re constantly, dynamically interacting with your environment. That’s going to change your health. Your health practices have to change and adapt to your environment, and to your demands.

Systemic Flexibility and Wellbeing Best Practices 

Dr. Lauren Kelley-Chew: As I was reading your book, I was taking notes for myself, thinking, “I should add this into my routine, or change this.” What you said is true. Often, people get into a habitual wellness routine. They do the same workouts; they eat the same diet. There’s a comfort in that. One thinks, “I’ve decided this is the recipe for me.” But really, we need to update that recipe all the time, not just year to year, but also sometimes week to week, or even day to day.

Many people will resonate with what you described, which is that there’s something like a bank account of health. But we’re pushing it to the limit. We may be sleeping five hours a night, but think it’s okay because it’s just for this week. Meanwhile, we’re still doing interval training and all this stuff, kind of hanging in there. 

What is the line between having some times of higher exhaustion or stress, and then moving into a state—I don’t know if we’d call it pathology—where there’s real dysfunction happening at the cellular level?

Dr. Molly Maloof: November was a really tough month for me; I worked pretty much the entire month straight. I wouldn’t say that’s a healthy thing to do at all. I don’t care who you are in the world. It’s just not a sustainable lifestyle to not take time off. We need it. There is this hustle culture permeating entrepreneurship and the world.

I’m just not a believer that we should be hustling all the time. I got so close to burning out. Burnout can really creep up on people. At the end of 2020, I was isolated and alone during the pandemic. I definitely got to the edge of burnout and thought, “This is not good.”

What everyone is waking up to right now is that our hustle culture has created pathology. We are not giving our bodies what they need to thrive. We’re not spending enough time with our family and our friends. We’re overconsuming food because we’re self-medicating our stress.

It’s really hard to get exercise in if all you do is hustle all day every day. I’m not saying don’t hustle. My roommate works harder than any entrepreneur I’ve ever met. She’s extraordinarily talented and hardworking. But she’s in absolute love with what she does. She wakes up every day, and is excited about going to work. That’s pretty healthy.

If you wake up every day and you dread work and you don’t like your colleagues and you’re struggling with your relationships, that’s going to wear you down more than somebody who’s in a flow state every time they go to work. It’s very personal. It’s important to recognize that there are going to be times and phases of your life where you’re going to work harder. And there are going to be times and phases where you’re going to work lighter.

The key is to monitor your health. I met a woman last year, and she was doing what’s called a discovery session with me. I have these people who come and answer 20 questions. Then I sit with them for an hour. I go through their health. This woman was not diabetic four years ago. She became diabetic during the last four years because she was dealing with a lawsuit and an enormous amount of extra stress on her body and her life.

Had she potentially been monitoring this, she could maybe have course corrected, but it crept up on her. This is the thing people need to realize: You might be able to handle a few sleepless nights here and there. But if that’s chronic, that’s when the system starts to break down. That’s when things start to actually fall apart. 

The body is actually designed to maintain flexibility of these systems. But it can lose system flexibility when it’s chronically stressed. The body becomes more rigid and these biomarkers start to shift into higher and higher numbers. And then they won’t come back to normal without a real lifestyle change.

Dr. Lauren Kelley-Chew: It’s a wake-up call for many people because we’ve normalized,like you said, hustle culture and feeling exhausted all the time. 

For someone who’s in that cycle of exhaustion, what is the one thing you’d advise them to do first?

Dr. Molly Maloof: One thing people don’t get about sleep that is really sad is that the better quality sleep you have, and the more sleep you get, the better performance you have during the day. The other thing they don’t understand about sleep is that the stress levels of your day will become evident in your sleep quality.

If you’re not dealing with your daytime stress, you’re not going to sleep well. But if you don’t sleep well, you’re going to actually increase your daytime stress. This is what we call circadian rhythm, your day-to-day experience. Your nightly sleep, this rhythm of your wake up and your sleep, is really important to get right because it’s programming your biology from the moment you wake up in the morning. 

You want to get sunlight in your eyes as early as possible if you can. If you don’t get it, that’s a problem, because you have these clock genes that are synchronized by light. If you don’t get that early morning sunlight, you’re not going to have the most energy during the day. And if you don’t get that good dark rest at night, you’re going to wake up with more cortisol in the morning. It’s this kind of vicious cycle where if you don’t get sleep right, everything else is not going to work. I always look at sleep first in all my clients because it’s fundamental, and there’s a lot of undiagnosed sleep apnea out there.

I definitely recommend getting a sleep study, or at least downloading some of these new programs like Resonea. You can get a home sleep study. It records your snoring if you snore. You have to look at your sleep environment. You have to look at your room, air quality, your bed, your mattress. If you have animals or a partner who snores, you have to optimize your sleep environment if you want to sleep well.

There are going to be times and phases of your life where you’re going to work harder. And there are going to be times and phases where you’re going to work lighter.

You also need to optimize your mental health—dealing with day-to-day stressors, dealing with toxic relationships, dealing with the things that are causing you the most stress, that are keeping you up at night. Those need to be addressed. 

When it comes to work, I no longer buy into the idea that sleep deprivation is necessary for optimal performance. People ask me, “How do you do everything that you do?” I say, “I sleep a lot.” That’s my secret. It’s my sleep, and I exercise and eat right.

Over time, the basics—getting really good sleep, exercising consistently, maintaining good social connection, having a good relationship with yourself, dealing with your trauma—really add up. Building metabolic flexibility, removing sugar and flour from your diet—those things change your health. But it’s about consistency.

Mitochondria: Beyond the “Powerhouses of the Cell”

Dr. Lauren Kelley-Chew: In Spark Factor, you say that mitochondria evolved to become social organelles. I would love for you to jump into that a little more, and also into the impacts of social disconnection.

Dr. Molly Maloof: Mitochondria were bacteria that were engulfed by single-cell organisms that became multicellular. These organisms were able to evolve to harness energy from the environment. The theory is that the organisms that can best harvest energy from their environment are going to be more able to thrive and reproduce. This is preserved over multiple levels of life, which is fascinating.

Mitochondria are these organelles that evolved from bacteria. But they are light sensitive. Think about chloroplasts, the mitochondria of plants. These are light-sensitive organelles. These are energetic organelles. They create energy and charge in the cell, and they create life. Without energy, you don’t have life.

They fuse together in this process called fusion, and they break apart in this process called fission. Just as people come together and share information and resources, mitochondria come together and sense whether another mitochondrion has the ability to carry a charge, or if it has enough charge left. They sort of share this knowledge. Then they break apart, and the mitochondria that don’t carry a charge get thrown out through the process of mitophagy.

They reproduce through mitochondrial biogenesis. When they fuse together, they will resonate with one another. That’s how they communicate. There are a lot of interesting parallels between how humans behave and how mitochondria behave. We come together. We also sense and interact with our environment. And then we share that information with other people.

We have uniquely conserved functions in society. Different people have different jobs and roles. Mitochondria have different jobs and roles in the cell. It’s a fascinating parallel that got me thinking about life itself. One of my students at Stanford told me, “Because I took your course, I’m now committing my life to studying life.” And I thought, “Whoa.” If I could go back and do it all over again, I would’ve done that, because I think the most interesting thing in existence is existence. I think the fact that we are alive and conscious is fascinating.

The question of consciousness is really fascinating, too. I believe that energy and information flow and structure is life. This makes a lot of sense to me. The mind is energy and information flow. The mind and the body connect; you can’t separate them. Mitochondria are social organelles. When they are not functioning properly, they can self-destruct. This is a process of apoptosis, programmed cell death. Humans who are not functioning properly, who are disconnected, will also experience suicide. Apoptosis is cellular suicide. 

I just bought a book by Christopher Palmer, MD called Brain Energy. The book is all about mitochondria and mental health. I just submitted a paper with some Harvard students on this relationship between mental health and metabolic health. It’s not addressed enough.

When you get your blood sugar balanced, you’re going to have better brain function because you’re going to have more consistent energy flow to the brain. You’re going to have less anxiety. You’re going to have better focus. I look at depression as the end result of a body that’s been challenged to the point where it doesn’t have enough capacity to meet its demands. The body shuts down. The brain shuts down. It’s an energy-conserving mechanism.

I look at depression as the end result of a body that’s been challenged to the point where it doesn’t have enough capacity to meet its demands. The body shuts down. The brain shuts down. It’s an energy-conserving mechanism.

People say they don’t understand depression. I’d argue that chronic stress breaks the brain. Some people are more predisposed to this than others. Some people have more malware running in the background because they have more social injury and trauma from their existence. 

When you understand mitochondria, you can understand life. You can understand health and modern, chronic diseases because they’re almost all rooted in mitochondrial dysfunction.

Dr. Lauren Kelley-Chew: I’m glad you’re bringing awareness to mental health and the way it’s connected to what people traditionally think of as health, which is more based in the physical body. 

One tragic thing I’ve noticed is that it seems there are times when someone we think of as a high-achieving person commits suicide, and everyone is surprised and shocked. We say, “That person lit up the room. That person had everything going for them.”

When are we going to stop being surprised and start becoming aware that there are things happening in people’s lives? For whatever reason, we’re not sensitive to them. This comes back to social disconnection in some ways. It’s almost like we’ve lost our ability to sense the people around us. We’ve lost our ability to sense ourselves. At least, these are some thoughts that have been going through my mind. I really appreciate you opening up the dialogue and starting that conversation, because it’s so important.

The Importance of Movement and Monitoring Markers of Health

Dr. Lauren Kelley-Chew: Something else I found really interesting in the book was that millennials are losing grip strength, a basic measure of strength. You cite that women and men under 30 have significantly weaker hand grips today than their 1985 counterparts. What is going on with that? What should we all be aware of?

Dr. Molly Maloof: It’s funny, because as you’re asking me this, I’m thinking about grip strength tools on my desk. I play with them during podcasts because I’m trying to build my grip strength since it’s such an important marker of health. I have what’s called a manometer. It’s a type of device that measures grip strength. 

In the last 30 years, exercise levels have diminished. This is contributing to obesity because modern, car-based lifestyles mean we don’t have to ride our bikes, and we don’t have to walk around. I don’t drive a car. I can drive, but I choose not to because I don’t like driving. And honestly, I don’t want to contribute to destroying the environment. Even though cars are cool, I just don’t care about cars. I rode my bike to the store today because I was going to make some steak tartare tonight for dinner, and I wanted to get some Worcestershire sauce. It was cold out, but I rode my bike all the way there. I just did a bike ride, but it’s an exercise.

In a lot of European countries, people are more active by nature, because of the ways their cities are designed. Cities are designed for mobility and for walking around, and people generally don’t need to drive cars as much in environments designed for less cars. 

Fitness is a product of a bunch of different things. But the biggest markers of fitness are things like flexibility, VO2 max, and grip strength. Another really good test of your longevity through your fitness is whether or not you can go from sitting cross-legged to standing without using your arms to get up. The more assistance you need, the less fit you are. 

I’m all about weight training, cardiovascular training. And then—yoga and tai chi and stretching, because if you don’t do these things, your body’s going to lose flexibility. It’s going to lose VO2 max. It’s going to lose muscle mass as you get older. It’s just natural. This is what happens.

Fitness is a product of a bunch of different things. But the biggest markers of fitness are things like flexibility, VO2 max, and grip strength.

We have to maintain that muscle mass. We need to feed those muscles. We need to send the signal to those muscles to make more muscles. And that’s eating and lifting. Our heart’s a muscle. We need to exercise that heart because that’s where we get our oxygen-carrying capacity.

I didn’t do as much cardio last year. I just decided I was going to start adding cardio back in. I actually did a fair amount of cardio, but for a couple months I did less cardio. Then I thought, “Shoot, I need to start adding this back in.” I started adding it back in. I fluctuate between the kind of exercises I do. 

The key point here is that your muscles are power packs filled with mitochondria. The more you exercise them, the bigger they get, the more they become insulin sensitive, the more they can process glucose effectively, the more that you can lower your post-meal glucose, and the more you can prophylactically fight frailty. The best way to deal with frailty is not to wait until you’re frail to start weightlifting; it’s to build muscle strength so you never become frail.

Dr. Lauren Kelley-Chew: It’s clear that everyone should be moving much more than we think we need to. If we forget about jobs and all those things, is it optimal that we move in some way throughout most of the day?

Dr. Molly Maloof: That would be ideal. We’re all knowledge workers at this point. We’re sitting in front of computers, which is part of the reason high-carb diets don’t really work for everybody these days; people aren’t using carbs as effectively because they’re not using their bodies.

In between podcasts today, I did 10 squats in the kitchen. I did some laundry in between calls. I try to get as much non-exercise activity thermogenesis (NEAT) in. And I try to use my Oura Ring to keep tabs on my activity levels. What do I need to do by the end of the day? I got a solid 27 minutes of high-intensity exercise today, which is actually the equivalent of quite a lot of moderate-intensity exercise. You’re supposed to get about no more than 150 minutes of high-intensity exercise per week. I’ve already gotten about an hour this week, which is pretty cool. 

There are ways to fit exercise in. But the key is that you don’t want to be sedentary all day long. I try to break up calls by going to the kitchen to make tea. I try to walk around and get extra movement in, and I try to get a walk in here and there.

One of my friends, Katrine, does a 30-minute walk every morning and evening. She’s really fit and strong. She does an hour of yoga every morning. You’ve got to find a way to fit exercise and movement into your life that works for you. It’s not going to happen overnight.

When I started my fitness journey about 10 years ago, I was basically in bed with chronic fatigue. I knew I had to change. The only thing I could do was walk across the street to the YMCA. I did the Feldenkrais Method, which is probably the easiest exercise anyone could ever do. It involves lying on the ground and barely moving. It’s really effective.

It got me through the psychological barrier of movement, which is what a lot of people struggle with. They’re overwhelmed by going from completely sedentary to high-activity. It’s really scary for people because they don’t know what that looks like. They don’t want to get super sore. Maybe they’re not motivated.

One of my mentors from medical school said, “For some people, getting to the mailbox and back is an accomplishment.” It’s important for people to realize that you have to just start somewhere. Maybe it’s increasing the number of steps you do per day. 

I had a discovery session with a guy who had chronic migraines. I asked him how much he was moving. I told him to open up his phone and show me how much he was moving, because our phones track our steps. He had 2000 steps. I told him, “You’re not moving your body enough, and your brain probably has some blood sugar dysregulation as a result.”

Blood sugar dysregulation is a big cause of migraines a lot of people don’t know about. One of this patient’s biggest takeaways was that he needed to move more. But if you’re only moving 2000 steps a day, it can take a bit of time to move up. Maybe it’s adding 500, 2000 steps here and there. 

When I first started weightlifting, I just bought kettlebells. It was an $18 kettlebell. I started doing kettlebell swings. Simple and achievable is always better than hard and unachievable. Start where you’re at and just do your best to start getting more movement. Slowly, over time, you’ll find you can actually do more and more with your body.

But I also recommend getting coaching if you need it. I’m about to start doing jiu jitsu because I’m kind of obsessed with learning how to fight. One of my friends messaged me today and asked if I wanted to join a jiu jitsu group. I thought, “Yes! Thank God somebody can organize this for me, because I’ve been wanting to do this, and I didn’t even know where to start.”

I love when things like that manifest. I’m not going to just start doing jiu jitsu without training. You need to get a trainer. I once had a partner who taught me how to lift weights in a gym. If you don’t know how to lift weights with good form, you need to get a trainer and learn how to lift because form is the most important thing when you start a fitness regimen so you don’t injure yourself. If you injure yourself, you’re going to completely negate the purpose of exercising, and you’re going to end up getting more deconditioned from not being able to move.

Dr. Lauren Kelley-Chew: I completely agree. It’s encouraging how the conversation around exercise is divorcing itself from always being within the context of weight loss. When that’s the framing, it gets difficult because you are forcing yourself to do something that maybe you don’t want to do, and then the scale isn’t moving right away. It becomes very difficult for people to feel the results.

But when you focus on how you feel in your body regardless of the number on the scale, you feel better. Especially on days when I don’t feel like exercising and then I do something—even if it’s minor, like stretching—I feel better.

Dr. Molly Maloof: By the end of this year, I was really struggling with exercise because I was running on empty. November took a lot out of me. When December came, I thought, “This is really tough. I’m struggling to get to the gym.” I made it to the gym maybe five times in two weeks, which is not as much as I normally do.

But when I got to Puerto Rico for a vacation, I decided to do whatever felt good. If I felt like working outside in my friend’s farm, I worked outside. If I felt like taking a long walk, I took a long walk. Once I recovered from the stress I was under, I came back to Austin. 

I went to the gym yesterday, lifted weights for 45 minutes. I went on a bike ride today and two days ago. It’s almost like exercise is medicine, and if I don’t take my medicine, I’m not going to be happy. I’m looking at exercising like taking my medicine.

Simple and achievable is always better than hard and unachievable. Start where you’re at and just do your best to start getting more movement. Slowly, over time, you’ll find you can actually do more and more with your body.

It makes a massive difference in my mood if I exercise, because exercise increases your energy capacity directly by sending the signal to your cells to make more energy. I told myself that cutting back on exercise in December was what helped me recover. But what I really needed was vacation. When I got back and I felt recovered, I realized getting back into the gym was what I needed to feel great. I know this is what’s important for me to feel really good.

Your body and your lifestyle are going to wax and wane. That’s okay. I’m going to be traveling a bit over the next few weeks. But the goal is to try to find something you can do in whatever environment you’re in.

Dr. Lauren Kelley-Chew: I agree. I’m very privileged to be able to do this. But I have the flexibility to cancel a meeting if that’s what I need to do to get exercise in, if that feels right for my body, because I just know if I don’t do that, it creates a backlog of issues for me. And then, even if I was in that meeting, it wouldn’t be good for anyone involved. I’ve prioritized it much higher than I have ever felt I could in the past. 

Beyond Weight: Establishing a More Complete Picture of Health 

Dr. Lauren Kelley-Chew: How are weight management or even weight loss related to energy capacity? If someone reaches optimal mitochondrial health, will their body naturally be at the weight it’s meant to be for its healthiest self?

Dr. Molly Maloof: Weight is not the best biomarker of health. You want to understand your visceral fat because your visceral fat is a much bigger predictor of whether or not you’re metabolically unhealthy or healthy. A lot of people out there are skinny fat—they have high amounts of visceral fat but are not overweight or obese. Yet they are just as much at risk for diabetes, cancer, heart disease, and dementia than somebody who’s obese. And not everybody who’s obese is metabolically unhealthy. It’s not as many people; it’s definitely a smaller percentage. 

Generally speaking, you don’t want to be under fat, either. Having too low body fat is not good for longevity. But high body fat and too much visceral fat is what causes metabolic inflexibility and non-alcoholic fatty liver disease. Your organs getting infiltrated with fat is not going to help them function properly.

That fat around the organs is the most toxic. When you drink soda and eat fast food and ultra-processed foods, you’re eating a lot of fuel that gets burned, but it also causes metabolic gridlock in the cell. When you over-consume packaged, processed foods and fast foods, these foods are not easily metabolized because they’re Franken-foods. They’ve got all sorts of crappy preservatives and they’re highly refined. You can’t easily metabolize carbs and fats at the same time. Your body wants to switch back and forth.

When you give it lots of fat and carbohydrates at the same time, it can be problematic for metabolic health. This can create a gridlock in the cell. It can also cause the mitochondria and the microbiome to become inflamed. Ultra-processed foods are inflammatory by nature, and eating them is kind of like overheating the body, or overheating the engine. And you’re getting all this exhaust blowing off of it because it’s overheating the fuel. That’s what oxidative stress is.

Oxidative stress is that bad exhaust polluting your cells and your blood vessels. This is one of the biggest reasons blood sugar spikes are problematic for health. It’s because they cause a lot of exhaust in the blood vessels. When I figured this model out, I thought, “Why does everyone make this all so hard and complicated?”

Sedentary behavior is like having your car in the garage all day long. Even if you drove it for a half an hour, that doesn’t mean it’s not going to fill the garage with smoke if it’s still sitting there all day.

If you have a car in the garage and you’re revving its engine with tons of fuel, it’s going to overheat, and it’s also going to produce a lot of exhaust. That exhaust is going to poison you if you don’t move that car out of the garage. This is why you need to move your body. If you don’t move your body, you’re not going to be healthy. Sedentary behavior is like having your car in the garage all day long. Even if you drove it for a half an hour, that doesn’t mean it’s not going to fill the garage with smoke if it’s still sitting there all day.

That’s why I want people to realize that mitochondria really are the engines of the cells, the power plants. They create energy. They store charge. They’re like hybrid engines that have battery power as backup power. But in order to access that backup power, you need to be able to turn off the gas metabolism. This is why it’s important to occasionally lower your carbohydrate intake, to occasionally do a bit of fasting. It’s helpful for metabolic flexibility.

Dr. Maloof’s Personal Health Routine and Philosophy

Dr. Lauren Kelley-Chew: What diet and exercise routine do you follow?

Dr. Molly Maloof: I follow Dr. Casey Means. And I love Casey’s diet. But I definitely still eat meat. I don’t see myself stopping anytime soon. She’s definitely more plant-based than I am, although I do eat a lot of plants. Most of my diet is meat, vegetables, nuts, seeds, and fruits. 

I’m really interested in teas and adaptogens and polyphenols. I go in and out of drinking coffee versus MUD\WTR. I feel okay on coffee right now, but I didn’t feel as well on it a few weeks ago. I go back and forth on whether I’m going to consume coffee or not.

Nutrient density is the key. I try to eat as local as I can. In Texas, I have friends with farms, and they bring me wild game and really lean, delicious beef. I use that in my cooking. But as I get older and as I go through menopause, when I don’t bleed as much, I’ll probably cut back on the red meat and focus more on lighter meats. But because I run lower on iron, I feel better when I eat some red meat. I try to avoid the processed meats as much as I can, and then focus on limiting sugar if I can.

Although, my roommate brought home some sugar last year, and I started eating jelly beans for the first time. My blood sugar was going crazy. When I saw it, I thought, “Oh crap. I really can’t eat these.” It’d been so long since I’d eaten sugar. I do try to limit it. I occasionally do a little bit of honey, but not very often.

One of the things I’m aiming to do this month is to continue to remove the sugar again. I ate a fair amount of sugar in December, because of my roommate’s candy situation. I was sent an enormous amount of chocolate by Hu Kitchen. That’s a bit of an issue, too—companies send me this amazing chocolate, but most of what I focus on is nutrient-dense food at home. I cook a lot. I can count on two hands the number of times I’ve eaten out in Austin since I moved here. I love to cook, and cooking is far more affordable.

We’ve got a great grocery store here called Central Market. And I love the farmer’s market. My preference is to always get local meats. I love local fish, too. I had some lobster on vacation in Puerto Rico. That was quite fun. I love eating Mediterranean food, Paleo style. I wax and wane with ketosis, less so when I’m under a lot of stress, and more when we’re heading out of winter and I’m trying to lose a little weight.

My diet is, generally speaking, Paleo, low carb. I occasionally eat some beans and grains, but most of the time I don’t. I’m not a big grain person. Grains don’t agree with me, so I don’t do a lot of them. But I don’t really outlaw any food except wheat. Wheat doesn’t agree with me at all. 

I used to not eat dairy. Then I reintroduced a little bit of dairy. But I’m kind of phasing dairy out again. If I’m going to do any dairy, it’ll be butter and ghee and maybe a little cheese, but I’m trying to remove the cheese. I do consume some cottage cheese, though, for protein. It’s a lot less dogmatic as it was when I was in the Bay Area. At the same time, the pandemic taught me that I need to be more of a human and a little less crazy.

Dr. Lauren Kelley-Chew: I appreciate that. I often feel the same, because life ebbs and flows, and different things come in and out of our lives. There will be times when I know I just won’t be able to micromanage my diet.

Dr. Molly Maloof: I went from really optimal metabolic health, and then the pandemic hit. I spent some time in the Midwest and I was really challenged by the lack of food that was up to my caliber of what I typically would be eating. It really brought me down to earth. 

I also gained 10 pounds during the pandemic. And then I lost it, and then I gained five pounds last year. I lost five pounds, gained five pounds. I look at my body as an interplay with my stress levels and my environment.

I look at my body as an interplay with my stress levels and my environment.

My goal for next year is to slowly get back into the kind of shape I was in while living in San Francisco. That means being more stringent with how I eat and live. It’s okay during times of high stress to be a little less rigid. But the goal is, when those stresses diminish, to get back onto the saddle and onto the kind of dietary lifestyle that works for you.

Dr. Lauren Kelley-Chew: Very inspiring for everyone looking forward to making changes to their health. Where can people find you?

Dr. Molly Maloof: Please go to www.drmolly.co, which has all the book information, and more.