According to President Trump’s nominee for surgeon general, nearly every American is dealing with some form of metabolic dysfunction.

Dr. Casey Means, who graduated from the Stanford School of Medicine and is a former practitioner of functional medicine, faced her Senate confirmation hearing on Wednesday. As she seeks to become “America’s doctor,” her health philosophies are being closely scrutinized.

The leader of MAHA, a prominent figure on social media, and an entrepreneur, Means shared her primary objective for the role: “transitioning to a genuine healthcare system rather than just a reactive sick care system—this will significantly reduce costs and relieve the burden on American taxpayers and healthcare providers.”

Means’ critical stance on conventional medicine and big pharmaceutical companies has drawn criticism, especially regarding her views on raw milk, her unclear position on birth control and contraception, and her doubts about the safety of certain vaccines, notably the Hepatitis B vaccine for infants.

Her most fervent advocacy, which has been both criticized and praised, focuses on what she sees as the underlying cause of many prevalent and perplexing health issues in the nation, including cancers and mental health disorders.

“The truth is that most of the diseases affecting our country—and increasingly the world—are chronic illnesses stemming from lifestyle and dietary choices,” she stated on The B.rad Podcast. “These everyday choices accumulate over time, leading individuals toward chronic disease.”

She even wrote a book on the subject, “Good Energy: The Surprising Connection Between Metabolism and Limitless Health,” with her brother Calley, a White House health advisor.

In it, she claims “mitochondrial dysfunction” is the root cause of most metabolic conditions and chronic illnesses.

What is mitochondrial dysfunction?

Mitochondria are often referred to as the “powerhouses” of the cells. They create energy for cells to function, allowing our bodies to do everything from walking and breathing to thinking and feeling.

Speaking to NPR about the book, Means blamed a slew of modern health epidemics on our failing mitochondria.

Mitochondrial dysfunction, or “underpowered cells” as she calls it, is the reason why, according to a 2022 study she cited, only 6.8% of Americans have “optimal metabolic health.”

“What the science is telling us is that most of the chronic symptoms and conditions that are affecting Americans across the lifespan are rooted in metabolic dysfunction,” she told NPR, “which is a core problem in how our bodies and our cells actually make energy to power themselves.”

She offered a visual to help paint the picture: “We’re talking about the trunk of the tree of American health care being metabolic dysfunction and all the branches being the different symptoms and diseases that we’re so familiar with, [including] Type 2 diabetes, obesity, Alzheimer’s, dementia, cancer, chronic kidney disease…”

Means believes these mitochondrial disruptions are coming at us from all directions, including what we eat, how we sleep, products we use and workplace conditions. 

“A big question people might have is why now, all of a sudden, are mitochondria under siege? And the reason is our environment has been changing at such a rapid pace over the last hundred years or so,” she said.

Most people would agree that our lifestyles and environments are constructed in such a way that we don’t get enough of the right kind of movement or rest, and we don’t get enough exposure to the right kind of light or temperature. Meanwhile, we’re exposed to more toxins and chemicals, and experiencing more stress. 

Means argues this is a formula for mitochondrial dysfunction in our cells, which then puts pressure on our organs and ultimately leads to disease.

What does the research say?

Some of these theories bear out in clinical studies, like recent findings out of Europe linking disruptions to the circadian rhythm to metabolic diseases like diabetes. 

The researchers involved found that regular exposure to natural light led to “more stable blood glucose levels and an overall improvement” in the metabolic health of all 13 people who participated in the study.

There are plenty of similar one-off studies that look at a single lifestyle or environmental factor and its effects on metabolic health, but few researchers and practitioners look at the holistic impact of multiple compounding factors on a variety of biomarkers the way Means insists they should.

As far as solutions go, what Means recommends is hardly a cause for raised eyebrows.

First, have your biomarkers checked by a doctor. This includes fasting glucose, triglycerides, HDL cholesterol, hemoglobin A1C, waist circumference and blood pressure, she told NPR.

Second, eat only whole, unprocessed foods for six weeks. (Or incorporate them into your diet as much as possible.)

Third, take at least 7,000 steps per day, or go for a short (like, around-the-block short) walk every 45 minutes, also for six weeks.

Then check your biomarkers again.

While there’s room for debate about whether these steps will “transform” your mitochondrial efficacy in as little as six weeks as she suggests, it’s hard to argue with the call for fewer processed foods and more daily movement.

Though Means has denounced the medical system for trying to solve every problem with a pill or a shot, her book does seem to be selling a “silver bullet” mentality of its own, with a blurb that reads: “Nearly every health problem we face can be explained by how well the cells in our body create and use energy.” She is also the founder of at-home glucose-monitoring company Levels. 

Her confirmation hearing this week has reenergized criticism for what many in the medical field feel is her history of demonizing doctors and promoting vigilante health care.

In her conversation with NPR, she didn’t entirely deny this stance. 

“This is a controversial statement, but I feel comfortable saying it,” she said. “You don’t need to trust any health influencers. You don’t even need to trust your doctor. You actually can trust yourself.”