"Anything Meds Can Do, You Can Do Better" Part 11 of 12 - Mitochondrial Dysfunction

Mitochondrial Dysfunction: Why Your “Cell Power” Matters in Type 2 Diabetes

Welcome back to the Diabetes Podcast show notes. In this episode, Richie and Amber break down mitochondrial dysfunction in simple terms. We explain what mitochondria do, what goes wrong in type 2 diabetes, which meds may help, and the daily steps that power your cells back up.

If you’ve been doing “all the right things” but still feel tired, foggy, or stuck, this one is for you.

Episode Summary

• Mitochondria are the “power plants” inside your cells. They turn food into usable energy called ATP.
• In type 2 diabetes, mitochondrial dysfunction makes it hard to turn fuel into energy at the right time.
• This leads to high blood sugar, fatigue, brain fog, and slow recovery.
• The good news: mitochondria are very responsive. Movement, food, sleep, and stress care can build new mitochondria and make them work better.
• Some medicines can also help.

This is part of our 12-core-defects series on type 2 diabetes. Next week is the last one: inflammation.

What Are Mitochondria?

• Think of mitochondria like tiny engines or refineries in each cell.
• Your body brings carbs (glucose) and fats to the refinery.
• Mitochondria “refine” that fuel into ATP, your body’s energy currency.
• When demand goes up (like after a meal or during a workout), healthy mitochondria match the demand.

This fuel-switching skill is called metabolic flexibility.

What Goes Wrong in Type 2 Diabetes

• In mitochondrial dysfunction, the “refinery” gets stuck or slows down.
• Even after meals, cells keep burning fat instead of switching to glucose.
• That causes “traffic” inside muscle cells and leads to insulin resistance.
• Blood sugar stays high because glucose can’t get into the cells well.
• Your cells end up underpowered, even when fuel is available.

Amber calls this “metabolic gridlock.”

Fun (not so fun) fact: A study found people with obesity and type 2 diabetes had about 30% fewer mitochondria in muscle cells. The ones left were slow and less efficient.

How This Feels Day to Day

• Low energy and afternoon crashes
• Brain fog and low mood
• Hard time recovering after workouts
• Weight gain or stalled weight loss
• Feeling “hangry”
• High blood sugar after carb-heavy meals

Important: This is not a willpower problem. It’s a power problem.

The Analogies That Make It Click

• Refinery: You can’t use crude oil in a car. You need gas. Mitochondria turn food into usable “gas” (ATP).
• Battery/Charger: Mitochondria help “charge” your energy. If the charger is weak, everything feels harder.
• Gridlock: Fuel is everywhere, but it’s stuck in traffic. It can’t get where it needs to go on time.

Medications That May Help Mitochondrial Function

Talk to your clinician before starting or changing any medicine.

• Metformin (a biguanide)
  • May make mitochondria more efficient over time by activating AMPK, a key energy signal.
  • Common side effect: GI upset (start low, go slow up to 2000 mg/day).
• Pioglitazone/Actos (a TZD)
  • Activates PPAR-γ, improves insulin sensitivity in fat and muscle, helps lipid handling, and supports mitochondria in muscle.
  • Side effects: weight gain (often fluid and subcutaneous fat), fluid retention; CHF warning applies.
• GLP-1 receptor agonists
  • May help indirectly by improving insulin function and lowering glucose and inflammation.

Meds can help the “refinery” run better, but lifestyle is what builds more refineries.

How to Power Up Your Mitochondria (Lifestyle Wins)

You can build new mitochondria and make existing ones work better. Small steps add up fast.

Movement (your most powerful lever)

• Take a 10–15 minute walk after meals (especially dinner).
  • Helps move glucose into muscle even when insulin is not working well.
  • Signals your body to build more mitochondria.
• Strength train 2–3 days per week.
  • Builds muscle. More muscle = more “sockets” to plug in glucose and burn it.
• Sprinkle in short bouts of movement during the day.
  • Climb stairs, quick bodyweight sets, or short walks.
• Optional: brief, safe higher-intensity intervals if your doctor says it’s okay.

Tip: Movement tells your body, “We need more energy—build more power plants.”

Nutrition (feed and protect your power plants)

Focus on a fiber-rich, whole-food, plant-forward plate. These foods lower inflammation and protect mitochondria from “rust” (oxidative stress).

• Antioxidant- and polyphenol-rich foods:
  • Colorful veggies and fruits, beans, herbs, spices, tea, coffee (unsweetened o