In the year 2022, the average American adult is suffering at least one chronic illness. Metabolic dysfunction, by itself, accounts for much of this — according to the CDC, there are currently at least 128 million Americans who are either pre-diabetic or suffer from full-blown type 2 diabetes.

But that’s just the tip of the iceberg when it comes to how metabolic dysfunction is harming public health. 

What is metabolic dysfunction? Metabolism, in its most basic definition, is how our bodies convert food nutrients to a usable form of energy. Metabolic dysfunction therefore arises when the body is no longer able to make energy properly, and it can present as almost anything based on where it shows up in the body. 

With metabolic dysfunction, the body stops responding normally to insulin, the hormone that lets us take up sugar from the bloodstream to convert to energy. This is known as insulin resistance — which most Americans now have — and it has profound effects on our energy, weight, mental performance, mood, and longevity.   

Type 2 Diabetes is merely the most obvious sign of metabolic dysfunction — it is far from the only one. If you don’t have diabetes, it doesn’t mean you’re in the clear.  Poor metabolic health can start harming your health long before you’d likely be diagnosed with prediabetes, and can lead to diseases which on the surface may seem unrelated to the underlying metabolic dysfunction that is causing them.

As a result of this complexity, many are unaware of the degree to which preventable metabolic dysfunction both contributes to chronic disease in the long term and destroys our day-to-day energy and focus in the short term. It’s easy to overlook our metabolic dysfunction even when it's having a powerful negative impact on our lives. 

What’s more is that, in modern life, there are many quick fixes available to compensate temporarily for poor metabolic health (i.e. poor energy production) that make us feel better  — things like caffeine, sugar, and dopamine hits from social media/ email/ etc. when our energy levels are low. 

Unfortunately, these often only serve to hide and even exacerbate the underlying issues, and can lead to a vicious cycle of metabolic dysfunction > short term fixes > even more dysfunction, with our energy wildly fluctuating throughout the day —  along with our blood glucose levels. This “blood glucose roller coaster” is not only harmful for our long-term health, but impedes our short-term energy levels and cognitive performance.

Founders face a particularly acute version of this problem. Founder burnout is the sword of Damocles hanging over the head of every ambitious entrepreneur. Because the demands of founder life are extraordinary, issues stemming from poor metabolic health or inadequate emotional fitness are magnified, while the rewards of getting it right can be the 10x performance edge against your competitors that separates a successful startup outcome from a mediocre one.

This essay is for founders to not only understand how improving your metabolic health can be a competitive edge, but to give you context on how the normal modern American lifestyle became such a recipe for dysfunction — and why living a “normal” lifestyle simply isn’t good enough if you want extraordinary results in your career.

We’ll cover actionable tactics you can use to up-level your lifestyle for better metabolic health, the background on what causes metabolic health and metabolic dysfunction, and the bigger picture of the dire state of American health and why ordinary healthcare is failing us.

Setting the stakes: The dire state of American health

The first thing to understand as a founder is that if you’re on the normal treadmill of the American lifestyle, you’re more likely than not going to end up with a largely preventable chronic illness over the long term.

9 of the 10 leading causes of death in the United States are related to diet and lifestyle —  and are either directly caused by dysfunctional blood sugar, or are worsened or accelerated by dysfunctional blood sugar.

As mentioned earlier, what people don’t realize is that the process that leads to insulin resistance (i.e. metabolic dysfunction) doesn’t just affect people who have the official diagnosis of type 2 diabetes — there’s also all the people with prediabetes, and half of all American adults fall into one of those two (preventable) categories.

What’s more, there’s also all the people who aren’t yet measurably pre-diabetic, but are heading in that direction with early insulin resistance, which can start well over 10 years before a prediabetes diagnosis is made. People in this category, who already have problems with how their bodies make and use energy, are being overlooked. Yet that pre-disease state of unhealthy metabolic health practices can still result in downstream issues even in otherwise seemingly young and healthy people.

For example, overt chronic problems that are directly related to blood sugar include diseases like heart disease, stroke, Alzheimer’s and dementia (which some people are calling type 3 diabetes), chronic kidney and liver disease, cancer, and of course, type 2 diabetes.

On top of these, there are other health problems that can affect younger populations related to insulin resistance and elevated blood sugar. Most people don’t realize these — they include things like infertility, which afflicts a growing percentage of the population. For example, the leading cause of infertility in the United States is polycystic ovarian syndrome, a metabolic condition characterized by really high insulin levels. Erectile dysfunction, which is now affecting a significant number of men under the age of 40, is, in my opinion, basically a metabolic disease until proven otherwise.

In addition, things like gout, depression, anxiety, and migraines are very much related to blood sugar, although most people don’t realize it.

So the size of the problem with American health — and in particular, chronic diseases stemming from poor metabolic health — is difficult to overstate. Life expectancy has been going down for the past five years (for the first time in centuries) and we’re getting sicker, fatter, and more depressed. How we live is killing us — a reality that is only amplified for people in startups, who often work long hours from home and lead a sedentary lifestyle.

Now that we understand the stakes and the dire state of American health, we can see why it’s so critical for founders (and really everyone) to understand the basic way metabolic health works so that we can hope to avoid the harmful consequences of a “normal” lifestyle. 

Why stable blood sugar is a founder superpower (getting off the blood glucose roller coaster)

While chronic metabolic dysfunction like hyperinsulinemia and Type 2 Diabetes develop over the long term, there are also short-term effects of blood sugar that can impact our daily lives. 

Whether you have metabolic dysfunction or you’re perfectly healthy, everyone is susceptible to acute issues stemming from not having stable blood sugar. When you eat something that causes a big spike in blood sugar, your body releases a bunch of insulin to absorb it — but if it’s a sufficiently high spike, your body often overcompensates, causing you to come crashing down.

This is what leads to the notorious post-meal crash which is what causes people to feel tired after a meal — when you have a big spike in and crash in blood sugar, research shows this can lead to decreased energy, cravings for more sugar, mood lability, and increased anxiety; it’s also been shown in even non-diabetic people to impact fact, recall, and memory retention.

In other words, being on a blood sugar roller coaster throughout the day is terrible for job performance and has a negative impact on not only energy levels but even cognitive abilities. If you’re habitually eating things that cause your blood glucose to spike and crater, you will create a roller coaster in your day of cravings, potential anxiety, fatigue, and cognitive performance. If you’re on this roller coaster, you often end up self-medicating with caffeine, sugar, and snacks, so that you’re going up and down even more frequently.

Sustainably eating in a way that keeps blood sugar stable means you’ll probably see an improvement in energy, mood, and cognitive performance — and be the best-performing version of yourself at work and in general.

The impact of this is easy to observe. At Levels, we had an experiment we called the “Coke experiment” where Levels employees could volunteer to drink a can of soda prior to a short walk, to see if a walk after a meal could help blunt the rise in blood sugar from ingesting carbs. 

Initially, we sent everyone 75 gram glucose drinks (called Glucosa) used by doctors administering an oral glucose tolerance test to all pregnant women to test for Gestational Diabetes, but the first few people who tried it felt so sick after consuming it that they had to take the rest of the day off. In our Slack channel, multiple people reported effects like intense sweating, brain fog. One reported feeling “super shaky, sweaty hands, blurred vision” and needing to lay down in bed immediately.

We then switched to a normal can of Coke, and since our employees tend not to be ingesting a lot of sugar in their diets, they found that when you’re not used to it, that much sugar can make you feel very floaty and weird. The takeaway, aside from the experimental results, was that just one sugary drink could ruin our employee’s energy and feeling of well-being so much that they had to rest, as if they had fallen seriously ill.

So not only does a sugary diet make you feel terrible, it increases your susceptibility to actual illness because of how it harms your immune system. People with Type II diabetes, for example, are 6X more likely to need hospitalization from respiratory illnesses like the flu than the general population.

Keeping blood sugar stable is therefore not only an investment in higher energy and cognitive performance, but also an investment in keeping your immune system healthy. As a founder, if we get sick with an upper respiratory infection and you’re out for like a week or 10 days, that’s a huge problem. While keeping blood sugar stable is not going to stop you from getting the flu or COVID, it is going to increase your biological resistance to all types of infections and likely minimize their severity.

In summary: there are 2 reasons why more stable blood sugar is a founder superpower. 

1. Stable blood sugar maximizes your day to day energy and cognitive performance. 
2. Stable blood sugar maximizes your chance of weathering an infection well.

While you can probably deduce some of the beneficial lifestyle changes you can make based on the seven pillars of metabolic health outlined earlier, we realize that a busy founder lifestyle means that there’s a premium on efficiency. In the following section, we’ll share some tactics for keeping your blood sugar stable, getting off the roller coaster, and improving your long-term metabolic health outlook.

Tactics to keep your blood sugar stable if you’re a busy person

Keeping your metabolic health up and blood sugar stable isn’t just about what it’s you eat. Food is not the only thing that leads to a blood sugar spike; lack of sleep, exercise, stress, poor micronutrient intake, environmental toxins, lack of exposure to sunlight or too much blue light at night, and microbiome abnormalities can also contribute.

1. Eliminate refined sugars and processed foods

The lowest-hanging fruit for most founders (no pun intended) is to just eliminate refined sugars and refined grains; this is one of the biggest things you can do to keep glucose spikes down.

What this means practically is don’t eat foods with added sugars, try not to eat processed grains and carbohydrates; things on this list include: soda, juice, and most packaged foods with added sugar or refined carbs. It means replacing them with whole foods.

To that end, here is a list of workplace-friendly, glucose-stabilizing snacks:

• Olive packets (Trader Joes)
• Flackers flax seed crackers
• Guacamole pods (Wholly Guacamole makes these)
• Hummus packets (Costco makes these)
• Nuts
• Seeds
• Spindrift sparkling water
• Tuna packets and cans of wild caught salmon
• Fresh fruit, especially kiwis and berries
• Roasted chickpeas/bean snacks (like Bada Bean Bada Boom)
• Unsweetened non-dairy yogurt cups (like Forager cashew or coco-June)

Another way to improve your diet as a founder with limited time is to make use of direct-to-consumer options for healthy and quick food meal kit delivery; things like Daily Harvest, HelloFresh, and Daily Dose’s keto plan. If you’re eating out, check out Levels’ recommendations for blood-sugar friendly meals at popular restaurant chains like Chipotle.

In addition, you want to swap out grains for a less refined version wherever possible — if you’re going to eat pasta, try zucchini noodles instead. If you’re going to eat rice, try cauliflower rice instead. Try eating the same meals you’d normally eat, but replace processed foods with a non-processed alternative.

2. Use food pairing 

Another helpful tactic is food pairing — i.e. eating healthy fats and proteins alongside your carbs to keep blood sugar stable. We know that adding protein, fat, and fiber to carbohydrates and not eating “naked carbohydrates” is going to balance blood sugar and prevent as much of a glucose spike. So, for example, if you’re going to eat an apple (carbs) it’s a good idea to put some almond butter (fat, protein) and sprinkle some chia seeds on it (fiber).

3. Sequence your food

Food sequencing also matters. Amazingly, even eating the same exact calories and foods in a different order can create a totally different glucose response. You want to front-load your meal with non carbohydrate foods — i.e. eat the fat, protein, and fiber before the carbohydrates (which is what the opposite of what we usually do at restaurants, where you’ll typically be served chips or bread before your meal).

For example, suppose you had a plate with mashed potatoes, asparagus, chicken, and a salad. First you’d want to eat the salad — ideally with vinegar on it, because vinegar is an insulin sensitizer which helps lower your glucose responses. Give it a few minutes, then eat the chicken (protein and fat) and asparagus (more fiber roughage), and then finally eat the mashed potatoes (carbs). That is likely to have a different effect on your blood sugar than eating the mashed potatoes first.

4. Time your meals

Meal timing is the final easy adjustment you can make to promote metabolic health. Say you have two people on the same exact diets. Person A eats all of their food between a tight feeding window of 6 hours between 8am and 2pm, and person B eats for a longer window of 12 hours between 8am and 8pm. In this scenario, person A is going to have lower 24-hour glucose and insulin levels and, therefore, more stable blood sugar.

So merely narrowing your feeding window can be quite effective, although this can sometimes be difficult for founders because we often use food as a comfort mechanism or to deliver a little burst of energy throughout the day.

This is why getting off the glucose craving roller coaster is such an important founder superpower. As a founder myself, I have spent time in my life being on that roller coaster — it was symptomatic of a broader problem with dopamine reward pathways and how I was stimulated.

Processed, sugar-added foods are designed to take you to your “bliss point” by tapping into the fundamental reward circuitry in your brain. So it was just another thing that contributes to an overload of dopamine, which is a major ingredient in what causes founder burnout.

By restricting those foods and loading your body with whole foods, you can create a better hormonal and neurochemical milieu in your body that makes you more resistant to the manipulative effects of food that makes it attractive to use glucose-spiking food as a comfort mechanism or something you reach for when you’re tired. 

If you are going to eat late at night as part of a very long workday, stick to the healthful snacks listed in section #1 above. I aim for a 14-hour fast per day, but find it harder to fast at night (because I’m often working late). So I tend to stop eating around 10pm, skip breakfast and just opt for coffee with unsweetened almond milk in the morning and eat my first meal at noon. 

5. Eat for metabolic flexibility

The real key piece here, though, is that when you eat for more stable blood sugar, you improve what’s called your “metabolic flexibility”.

Metabolic flexibility is the body’s ability to efficiently use glucose when it is present in the body, and to switch to burning fat for energy when it isn’t. People with high insulin levels (hyperinsulinemia) have inhibited fat burning, which lowers metabolic flexibility — but stable blood sugar over time makes your cells more sensitive to insulin, keeps your insulin levels low, and allows you to flip over to fat-burning more easily if glucose isn’t present. What this means is that your body won’t crave carbs and food as much in between meals, and your energy level can be more stable throughout the day.

Improving metabolic flexibility is about teaching the body how to burn fat appropriately. To accomplish this, do things that push your body into fat-burning mode. These might include intermittent fasting (effectively restricting glucose), fasted morning workouts, keeping glucose more stable, and things that support mitochondrial health like sleep and stress management.

For the average American who is eating snacks all day, the majority of our calories are coming from ultra-processed food — which means there is rarely or never an opportunity to push the body into a time when it needs to burn fat for energy; if you’re constantly supplying the body with energy in the form of sugar, it won’t burn fat. This is part of the reason why the keto diet has become so popular, since it forces the body to burn fat.

With cell biology, it’s use it or lose it with different metabolic pathways. If you don’t use pathways like fat oxidation and fat burning, and you slip into a low glucose situation because you’re used to snacking and you’ve been unable to eat anything for 10 hours, your body is going to be in panic mode because it’s not used to it. For a founder looking for sustained energy throughout the day, developing metabolic flexibility is key.

When you’re metabolically flexible, if you can’t get access to food, you could go a whole day and be just fine — which is important for founders whose lives often don’t fit into a stable, predictable routine.

6. Get a standing or treadmill desk

A treadmill desk is another tool you can use to efficiently keep your blood sugar stable as a founder or busy person by naturally making you less sedentary. Research shows that just taking a two minute walk every half hour is more effective at lowering glucose than taking one longer walk one time per day — one thing founders can do is to set a half hour timer and bump your meeting back by 3 minutes at each interval, and take a two minute lap around the office or use your treadmill desk.

7. Get a Continuous Glucose Monitor

Using a CGM (continuous glucose monitor), such as the one we provide our members at Levels, is one of the ultimate ways to be efficient because you can quickly learn what spikes your glucose and change those behaviors. It’s an instant feedback mechanism for whether a food is healthy or not.

For example, my colleague Sam Corcos used to eat oatmeal for breakfast for years because he was told it was healthy by his doctor and by the marketing done by oatmeal companies. He always felt lethargic in mid-morning and needed an extra cup or two of coffee, which he attributed to lack of sleep.

But the first time he ate oatmeal after using a CGM, he saw that his glucose spiked to around 180 mg/dL — much higher than you ever want to be. It then came crashing down right around the time he was used to feeling lethargic. As a result, he never ate oatmeal for breakfast again. Problem solved.

So CGMs are useful because they help us empirically test information we’re being told by the food industry and doctors that may not actually be true for our individual, unique physiologies.

8. Drink less to improve your sleep

Sleep has a huge impact on our energy production and metabolic health and alcohol will tank sleep — so not using alcohol as a way to relax or socialize is also a good adjustment to make if you want to be your sharpest. 

Try to kill two birds with one stone by making sure that when you do a social activity that it’s actually a physical activity; whether that’s a sport like bowling or frisbee, or some other active activity like going for a walk or meeting up with your friends outside. If you are going to drink alcohol, limit it to one drink accompanied with food, and try to space it out from bed time. 

9. Manage your stress

Stress has a huge impact on metabolic health because stress alone can raise your blood sugar levels. People wearing continuous glucose monitors will sometimes find that giving a talk or doing a podcast or responding to emails will actually raise their glucose levels — and that’s because stress hormones tell the liver to actually release stored glucose into the bloodstream to mobilize energy to address  a possible threat.

The only problem is, this is counterproductive in the modern world because most threats we face are not physical — while you may have needed that energy historically for things like escaping a predator chasing you, in today’s environment you don’t need physical energy via increased blood glucose to respond to an email.

Founders are often chronically stressed. Because of this evolutionary mismatch, it’s important to be efficient about employing evidence-based stress management practices; things like diaphragmatic breathing or box breathing (for more on stress management and breathwork, see How To Prevent Founder Burnout).

The long-term impact of poor metabolic health

So far, we’ve covered the day-to-day benefits of keeping your blood sugar stable as a founder and adopting better metabolic health practices. 

But startups are often decade-long projects, and being a multiple time startup founder means sustaining a high-level of performance over a long career. That means that your long-term health is a big input into the success and overall impact you’re going to have, especially since that impact tends to compound over time. The best ability is availability, and chronic diseases (which often result from metabolic disorders) are a huge risk factor to career longevity.

You have to be proactive about this — relying on traditional, reactive medical treatments is not a great option. To illustrate why, consider that healthcare spending is increasing even as the state of American health worsens. In other words, the more money we are putting into healthcare, the sicker people are getting. 

So there are no whitecoat-clad knights coming to save us. To understand this, we have to understand the systemic issues that make it possible for the seeming paradox of increased healthcare spending correlating with worse health outcomes. 

Why traditional healthcare isn’t making us healthier

There are three big reasons why healthcare isn’t working, irrespective of how many resources we pour into this industry. 

1. Healthcare has become a “medical-industrial billing complex”, a system which is laser focused on maximal billing, generating more profits when more people are sick.  
2. The government subsidized processed food industry is driving nearly all chronic disease and 90% of our $3.8 trillion healthcare costs, and the healthcare system has no incentive or agency to fix this.  
3. Issues with medical education that emphasize reactive treatment rather than root-cause prevention. 

The medical-industrial billing complex

I was watching the Superbowl last year when I noticed something — every commercial was either for something that either contributes to metabolic dysfunction or something that treats it. 

‍

‍

Once you start picking up on this trend in public messaging, you’ll start to see it everywhere. It seems like anything you watch on television or see in traditional advertising will inevitably conclude commercials for medication after medication, followed by commercials for processed food after processed food.

This system is perfectly constituted to promote profit for the food industry and the healthcare industry, but not to promote health.

We not only become influenced to pay for the food that makes us sick, but we then pay for the healthcare to manage the resultant diseases. And the really troubling thing is that the treatment and management options of these diet and lifestyle-based diseases don’t actually cure the disease and create health— they just manage symptoms. If you take away the medication for Type 2 Diabetes or blood pressure, you’ll see that the disease is still lurking there unresolved. 

Added to this is the fact that healthcare and pharmaceutical interventions are actually one of the leading causes of mortality worldwide. 

According to a 2018 literary review published in the National Library of Medicine, iatrogenesis — which is the adverse effects from medical interventions — is the fifth leading cause of death in the world. In many countries, adverse drug reactions to pharmaceutical treatments are a leading cause of death, and 5-8% of deaths worldwide are due to such interventions.

How is this possible, despite the individual good intentions of healthcare workers? It’s because the healthcare system isn’t incentivized to make you healthy, it’s incentivized to increase the number of procedures you’re doing and the number of medicines you’re taking. 

On the flip side, the food that you’re eating has no incentive to make you healthy — it just has the incentive to keep you coming back for more (i.e. being addictive and highly palatable, regardless of the long-term health consequences). Food companies spend millions of dollars funding food scientists to take customers to their bliss point and bypass our natural satiety mechanisms. 

On top of this, patients are kept in the dark about how their body works; our healthcare system today tends to be very infantilizing and dismissive of the idea that patients can make good decisions when provided with the proper information, often flying under the guise of patient privacy. 

Irrespective of the intent of medical privacy practices, the net effect is that it's very hard for patients to get access to their data and to use that data in an easy and understandable way. As a result, as a patient you’re constantly at the mercy and at the teat of the healthcare system for any scrap of information about your own body.

While there is innovation happening in healthcare at scale — things like consumer lab testing — it’s not enough. And while we wait for a notoriously backward and slow-to-innovate industry to get its act together, American lifespans continue to slide downwards, while our rates of chronic disease continue to mount. 

Broken incentives in healthcare

Adding to this, the business model for healthcare practitioners itself is set up in a poor way. 

Doctors, for example, are primarily paid for the volume of patients they see and the number of interventions they do, like surgeries.

This means that their incentives are not aligned with patient health. The quickest way to get a patient out of your office is a very brief conversation; and it takes a lot longer to do a really thorough, deep dive into a patient’s diet and lifestyle than to prescribe a medication.

This fee-for-service system in healthcare, where doctors bill on the basis of services they’ve done and patients they’ve seen, is the root cause of many of the issues we see today in the healthcare system, and that system itself is the downstream result of the broken incentive structure mentioned earlier. 

The good news is that there has been a recent movement towards Value-Based Care business models, which incentivizes better outcomes over lower cost — but this is still a nascent movement and has yet to move the needle.   

Medical education is deeply flawed

Beyond broken incentives, the way doctors are taught to understand disease is a problem.

Doctors are trained in a siloed, reductionist view of health. We’re basically taught to see diseases as separate conditions because of the disparate symptoms — cancer is seen as totally different from type 2 diabetes, which is totally different from Alzheimer’s dementia, etc.

If you focus on the symptoms, i.e. the downstream manifestation of these diseases, then they all appear to be different and unconnected phenomena. But if you focus on the root cause that is actually leading to the disease in the first place — the cellular dysfunction that leads to many such conditions — you can start to see very interesting links between them.

One of those links is blood sugar dysregulation and insulin resistance. As we’ve learned more about how disease works through things like whole genome sequencing, proteomics, and other big data methodologies to help understand disease, we’re starting to see that diseases which seem very different in terms of surface level symptoms may actually be closely connected in terms of root cause physiology.

The modern areas of systems and network biology embody this approach, and these fields  have helped underline these connections between most chronic diseases. Unfortunately, research shows that it can take up to 17 years for research advances to make it into clinical practice, meaning that despite our improved understanding, doctors are not treating diseases as linked in their root causes, when we know that they are.

All this helps explain why public awareness about the implications of metabolic dysfunction — which often arises from preventable lifestyle issues — is so low. By the time you’re sitting in a doctor’s office dealing with a resulting chronic disease, it’s often too late to deal with the underlying root cause that has led you there; but even if it weren’t, many doctors are not trained to connect the dots. 

Understanding metabolic health and metabolic dysfunction

There are a lot of misconceptions about what metabolism means. When people think about metabolism, they tend to think about fast metabolism or slow metabolism as related to weight.

But actually, as previously mentioned, metabolism is how we convert food nutrients to a usable form of energy in the body. Metabolic dysfunction is therefore a body not making energy properly, and it can present as almost anything based on where it shows up in the body.

We have around 37 trillion cells on average in the human body. Every single one of those cells has to have copious amounts of a usable form of cellular energy to do anything; for its cell membranes to allow things in and out, for all of the machinery inside the cell to work, and for DNA to be replicated.

This requires a currency that results from a conversion process from food to energy, and that currency is called ATP — the molecule of life. ATP metabolism converts food to a form of energy we can use.

Our modern diet and lifestyle over the past 100 years or so has totally and utterly hijacked the process of converting food to cellular energy — a process which is multifactorial. Elevated excess sugar consumption is one big contributing variable as it overwhelms the cell’s metabolic machinery to make energy, generates damaging byproducts and causes the excess to be stored as fat which further disturbs the cell and body’s function.

The mitochondria is the energy factory of the cell. Interestingly, almost all elements of modern life hurt the mitochondria by simultaneously compromising all of the 7 pillars of metabolic health, which are: 

1. Unprocessed, micronutrient-rich food
2. Exercise
3. Sleep
4. Stress management
5. Microbiome (i.e gut health)
6. Avoidance of environmental toxins
7. Exposure to adequate sunlight 

Basically, all seven of these are screwed up by modern life — especially for highly-stressed startup founders working long hours sitting at a desk and with little time to think about their diets. Among other negative effects, this is highly damaging to the mitochondria.

Take excess sugar, for example. In 1820, we were eating about five pounds of added sugar per year. We are now eating, on average, 150 pounds of added sugar per year — a 30x increase.

All that sugar must be metabolized by our mitochondria — which, as mentioned before, is the energy factory of the cell. 

Imagine a cheese factory that suddenly has 30x more raw material like milk to process, and can’t process it fast enough. What will happen is that there will be nowhere to store all the excess, and it goes bad. Meanwhile all the machines in the factory are working on overdrive, the workers are working around the clock, and maybe they eventually go on strike and the whole factory just ends up breaking down.

That’s what’s happening in the body by driving so much sugar through the mitochondria to make ATP —  it’s just totally screwing up the machinery of the cell.

The body has been able to process sugar forever, but when you ask it to process 30x the amount, the dose is what makes the poison. Think about sugar like a substrate flowing through the system — at a trickle, the body is equipped to clean up the waste products that are created as a byproduct of metabolizing sugar, and there’s no excess that needs to be stored.

But when the body’s trillions of mitochondria are simultaneously overloaded by excess sugar consumption, you end up shuttling your excess glucose to your fat cells for storage, and overworked cells simultaneously creates an insulin block to stop more glucose from being taken into the cell from the bloodstream, which is what leads to insulin resistance.

Insulin is the hormone that lets sugar be taken up by cells from the bloodstream. When there’s a block, it creates a negative feedback loop because high blood sugar causes the body to release even more insulin.

The other role of insulin is to block fat burning. Fat can also be used for energy, but if your blood glucose and insulin are high, it stops the body from tapping into fat and instead makes it switch over to burning glucose to relieve the excess.

74% of American adults are overweigh or obese; part of the reason for this is that if you’re constantly driving up your insulin from excess sugar, you can’t effectively burn fat, and it’s going to promote fat storage.

Sedentary behavior (habitual lack of exercise) is another contributor to metabolic dysfunction  — 150 years ago, we weren’t sitting down for 12-14 hours a day, we were moving around all the time. A sedentary lifestyle hurts mitochondrial biogenesis, because extra exercise stimulates three things that are important: 

1. Exercise stimulates your cells to make more mitochondria (factories which can process sugar) 
2. Using your muscles allows you to use more glucose without having to store the excess
3. Exercise increases insulin sensitivity and the movement of glucose channels to the cell membrane

So you can see how much less exercise combined with 30x more sugar consumption creates a compounding issue.  

The next contributor to metabolic dysfunction is chronic sleep deprivation — we are sleeping well over an hour less than we historically did, and sleep deprivation can cause insulin resistance almost immediately because it’s such a huge stress on the body. If you take young healthy men and subject them to sleep deprivation where they can only sleep four hours a night for six nights in a row, that alone can make them pre-diabetic (although you can reverse it when they get more sleep).

Lack of adequate micronutrients is another problem resulting from modern lifestyles. Micronutrients are the vitamins, minerals, trace metals, and antioxidants that help our cellular machinery function and regulate metabolism, and micronutrient deficiency has been linked to insulin resistance.

The way it works is that within mitochondrial membranes is an electron transport chain, which is a set of proteins that convert food to energy. These enzymes require specific vitamins and minerals like B vitamins, zinc, vitamin C and others to act as lock and key cofactors to make the proteins work well.

Modern diets are highly processed, which depletes nutrients from many of the calories we eat — and because of modern farming practices like mono-cropping and industrial pesticide use which have depleted soil nutrients, even whole foods have less nutrients.

The combined effect we are seeing of all the factors above is that the modern world is hijacking the process of converting food to energy, and if your cells can’t make energy properly, they become dysfunctional — leading to disease. And oftentimes we conflate symptoms with the underlying disease, for example thinking that depression is lack of motivation or sadness. This is not the case — depression is cellular dysfunction in the gut and brain that leads to symptoms like lack of motivation or sadness.

Because energy production is table stakes for optimal cellular function, metabolic dysfunction can show up as almost anything based on where it is most prominently showing up in the body. Insulin resistance leading to endothelial (blood vessel cell) dysfunction can look like heart disease, retinopathy, kidney disease, or erectile dysfunction (all related to blood vessel problems). Insulin resistance in the brain looks like Alzheimer’s dementia or depression. And insulin resistance in an ovary cell shows up as polycystic ovarian syndrome.

While I’m not making the case that the only thing leading to disease is metabolic dysfunction, it is very clear that we have a widespread crisis in metabolic health as indicated by diabetes rates, and many diseases and symptoms that stem from this root cause.

Inflammation compounds the issue. There’s a bidirectional relationship between high blood sugar and inflammation; high blood sugar can cause inflammation, and inflammation can in turn play a part in creating insulin resistance. Basically, high blood sugar causes inflammation, inflammation worsens insulin resistance, and high blood sugar hurts the way immune cells  function. It’s a vicious cycle.

For example, there are much higher rates of infection in people with diabetes, who are particularly susceptible to bad infection because their immune systems aren’t working properly. 

But this doesn’t just apply to people with Type 2 Diabetes. Everything in metabolic health is a spectrum — it’s not like one day you don't have diabetes, and the next day you’re diabetic (at least with type II diabetes). Instead, it’s a condition that develops over time, and we are constantly shifting back and forth on that spectrum. If someone is stressed, sleep deprived, and eating poorly, they could very easily pop into the pre-diabetic category, and then pop back out again when they resume a healthier lifestyle. 

The problem is that, the way most of us are living (especially in the startup world)  — year after year of sedentary behavior, poor interrupted sleep, unmanaged stress, and ultra-processed foods — the problem builds over the course of years and decades.

You therefore don’t have to have type 2 diabetes or prediabetes for metabolic health to be causing you issues. Even totally “healthy” people with normal fasting blood sugar can have significant issues due to metabolic dysfunction, partially because fasting blood sugar which is what you might get checked in your yearly doctor visit is an imperfect, lagging indicator of the state of your metabolic health. 

(For what it’s worth, everyone would benefit by asking their doctor for a fasting insulin test along with their fasting glucose, which can start increasing (hyperinsulinemia) years before glucose shows issues as insulin resistance takes hold. We want it to be between ~2-6 uIU/mL).

How metabolic health can help founders have real energy

Although your morning coffee or your afternoon sugary snack may make you feel better whenever you notice a dip in energy throughout the workday , none of that is real energy. Real energy comes from optimal metabolism. 

Because founders are often young, generally healthy people, you can compensate for poor metabolic health practices for a while, but this is a suboptimal solution.

But, at the end of the day, you’re not building the foundational metabolic health practices that will prevent problems from developing down the road after the body has been compensating for suboptimal metabolic health.

And even in the short-term, poor metabolic health likely means you’re not performing optimally in the moment. There’s only so much that you can fix this with bandaids like an energy drink or a pack of chips. 

A body that’s really functioning properly with respect to its metabolism can’t be simulated — but once you get back to metabolic health, you’ll notice a real and lasting improvement in how much you can do and how well you can think. 

Many founders will neglect this step by telling themselves that they’re “too busy” or they’ll “deal with it later”, falling into the classic trap of prioritizing what’s urgent over what’s important. If you can have the discipline and clarity to avoid this, you’ll have a definitive edge — which is why good metabolic health practices are such a founder superpower.