Cellular Energy & Mitochondrial Dysfunction

In the eleventh episode of The Healing Terrain, Dr. Drew Kidder is joined by Dr. Stephanie Rimka for a conversation about mitochondrial function, cellular energy, and the everyday inputs that help shape mitochondrial health.

Dr. Rimka challenges the familiar description of mitochondria as simply the “powerhouses of the cell.” While their role in producing ATP is essential, mitochondria also respond to their environment, communicate with other parts of the cell, and help coordinate processes involved in adaptation, repair, and resilience.

Mitochondria Are More Than Powerhouses

Most people first encounter mitochondria in a biology textbook as the organelles responsible for producing cellular energy. Dr. Rimka believes that description does not fully communicate their importance.

“We’ve done [mitochondria] a great disservice by calling them an organelle, by saying they’re the powerhouse.”

Mitochondria do generate most of the ATP that fuels cellular activity. But research has also established their role as signaling organelles that communicate with the nucleus, cytoplasm, and other cellular structures.¹

“They’re talking to each other. They’re talking to the nucleus. They’re talking to the gut biome.”

Through metabolites, reactive oxygen species, proteins, mitochondrial DNA, and other signals, mitochondria help influence immune responses, gene expression, cellular stress responses, and cell fate.

“They’re coordinating everything,” Dr. Rimka said. “They decide: Are you going to repair or not? Are we safe or are we not?”

While that language simplifies a complex system, it captures her central point: mitochondria are active participants in how cells perceive and respond to their environment.

An Ancient Partnership Inside the Cell

The prevailing endosymbiotic theory holds that mitochondria descended from bacteria that entered into a mutually beneficial relationship with another early cell more than a billion years ago.²

Over time, that relationship evolved into the mitochondria found in nearly every human cell today.

“They are a community that is dependent upon relationship,” Dr. Rimka said.

Mitochondria still retain their own DNA, but they depend heavily on instructions encoded in the cell’s nucleus. This requires constant two-way communication between the mitochondria and the rest of the cell.

That biological interdependence informed one of Dr. Rimka’s larger themes: health cannot be separated into isolated parts. Cellular function is shaped by the relationships among organelles, tissues, body systems, behavior, and environment.

Structure Supports Energy Production

ATP production depends on the specialized structure of the mitochondria.

The inner mitochondrial membrane folds into structures called cristae. These folds hold components of the electron transport chain and help create the electrochemical gradient required to produce ATP.

“The structure leads to good function, leads to the voltage, which leads to the charge,” Dr. Rimka explained.

If the mitochondrial membranes or cristae are disrupted, the efficiency of energy production may be affected. Mitochondria continually adapt through fusion, fission, biogenesis, and mitophagy—the process through which damaged mitochondrial components are removed.

“They’re machinery inside there that’s so delicate,” she said. “It’s like a symphony of behavior that has to be orchestrated just right.”

Mitochondria Respond to Their Environment

Mitochondrial function is not fixed. It responds to factors including nutrient availability, physical activity, sleep-wake patterns, inflammation, oxidative stress, and exposure to certain environmental compounds.

“Mitochondria are light-sensing, sound-sensing, electromagnetic-sensing,” Dr. Rimka said. “The quality of that signal ends up creating the quality of the structure and the function.”

Some of the episode’s language reflects Dr. Rimka’s broader clinical philosophy, but the central concept is well established: mitochondria receive information about the cell’s internal and external environment and adapt their activity accordingly.

The question for practitioners becomes: Which daily inputs can patients realistically influence?

Start With Circadian Rhythm and Sleep

Dr. Rimka begins with the body’s most fundamental rhythms.

“We start with circadian biology, promoting sleep.”

Circadian clocks help coordinate mitochondrial respiration, energy metabolism, and the timing of cellular activity.³ Consistent sleep and wake times, morning light exposure, and darkness at night can help reinforce those natural rhythms.

Morning light is especially useful because it provides a strong signal to the brain’s circadian clock. That signal helps coordinate alertness during the day and the timing of sleep-related processes later at night.

Dr. Rimka favors using natural environmental cues before turning to more advanced interventions.

“Morning sunlight is a basic starter.”

Movement Sends a Mitochondrial Signal

Physical activity is another powerful input.

“The mitochondria are incredibly responsive to mechanoreception,” Dr. Rimka said. “You must exercise and move.”

Exercise stimulates mitochondrial adaptations in skeletal muscle, including increases in mitochondrial content and improvements in aerobic capacity.⁴

That movement does not need to begin with a demanding exercise program. Dr. Rimka emphasized meeting each person where they are.

“If it’s walking for someone, it’s walking. If it’s lifting their arms and legs in bed because they have chronic fatigue or fibromyalgia, asking them to go to the gym is extraordinarily difficult. We’re trying to walk to the mailbox again.”

The appropriate starting point depends on the patient’s health, mobility, energy, and medical needs. What matters is introducing a manageable signal the body can adapt to over time.

Nutrition Provides the Raw Materials

Mitochondria cannot maintain their structure or produce energy without adequate raw materials.

“I start with good nutrition because the membranes are made of phospholipids. We need fatty acids.”

Both the outer and inner mitochondrial membranes contain specialized lipids that help maintain membrane structure, flexibility, signaling, and bioenergetic function.⁵

Dr. Rimka encourages nutrient-dense whole foods that provide protein, amino acids, healthy fats, vitamins, and minerals.

“Start eating nutrient-dense foods,” she said. “It is way better than buying a pill.”

Supplementation may be appropriate when dietary intake is insufficient or a practitioner identifies a specific need. But Dr. Rimka does not see supplements as a replacement for the fundamentals of nutrition.

Why Minerals Matter for Cellular Energy

Minerals serve as cofactors for many of the enzymatic reactions involved in energy metabolism.

“There are minerals required for cofactors inside the mitochondria,” Dr. Rimka explained. “Your functions are not going to work without them.”

Magnesium is one example. ATP is typically used by the body in a magnesium-bound form, and magnesium is involved in mitochondrial respiration, ATP synthesis, and many other energy-dependent reactions.⁶

“The magnesium isn’t making you calm magically,” she said. “It’s directly involved in the electron transport chain.”

The goal is not to assume that every patient needs more of every mineral. It is to recognize that cellular energy production depends on adequate nutritional building blocks and to evaluate those needs within the patient’s complete clinical picture.

Healthy Cell Membranes Support Exchange

Dr. Kidder connected the discussion of dietary fats to the larger function of cellular membranes.

“How do we get good nutrients into the cell? How do we get unwanted compounds out of the cell if we don’t have a healthy cell membrane?”

Cellular and mitochondrial membranes regulate what enters, what leaves, and how signals move between compartments. Their composition affects membrane fluidity, protein activity, mitochondrial respiration, and communication throughout the cell.

Dr. Rimka therefore considers fats and phospholipids part of the foundation rather than an optional addition.

“Those membranes—outer and inner mitochondrial, in every cell—it’s all about the fats.”

More Intensity Is Not Always Better

Advanced interventions are sometimes promoted as shortcuts to mitochondrial health. Dr. Rimka cautioned that increasing the intensity of a stimulus too quickly may not be appropriate for every patient.

“There’s an order to this that I like to teach clinicians. So we slow it down.”

She used prolonged red-light exposure and hyperbaric oxygen therapy as examples of interventions that require consideration of dose, timing, and the individual’s current capacity.

“I don’t jump to extreme things in the beginning. That’s not where you start.”

The same principle applies to exercise, fasting, supplementation, and other forms of physiological stress. A stimulus that is beneficial at one dose may be poorly tolerated at another.

Stress Is Part of the Mitochondrial Environment

Dr. Rimka also connected mitochondrial support to the nervous system.

“You cannot repair anything if you’re constantly in fight-or-flight, stressed out.”

Psychological stress and mitochondrial function influence one another through interconnected neuroendocrine, immune, metabolic, and cellular pathways. Supporting nervous system regulation may therefore be an important part of helping a patient build greater physiological capacity.

Dr. Rimka may begin with breathing, restorative movement, sleep, and other foundational practices before introducing more demanding interventions.

“We might have to spend 30 to 60 days just dealing with vagal tone and breathing before bringing in [more].”

This reflects a broader systems-based principle: the body’s response to an intervention depends not only on the intervention itself, but also on the state in which it is received.

Health Should Not Become Another Source of Stress

Although Dr. Rimka encourages patients to reduce exposures and improve their daily habits, she does not expect perfection.

“I don’t want anyone to turn being healthy into a stressful event as well.”

That perspective is especially relevant for patients who feel overwhelmed by extensive lists of foods, products, technologies, or environmental factors to avoid.

The more sustainable goal is to identify the changes most likely to make a meaningful difference and introduce them at a pace the patient can maintain.

Return to the Foundations

For Dr. Rimka, mitochondrial health begins with accessible actions rather than advanced technology.

“Go for some walks. Do some breath work. Get some sunlight. Do some basic stretching. All of these things are free.”

Her foundational approach includes:

• Consistent sleep and circadian rhythms
• Appropriate morning light exposure
• Regular movement at a tolerable level
• Nutrient-dense foods
• Adequate protein, healthy fats, and minerals
• Clean water
• Breathing and nervous system support
• A gradual, individualized approach

Supplements and clinical modalities can be layered in when appropriate, but they are not substitutes for the signals and building blocks mitochondria receive every day.

“I don’t bring in molecules and modalities” at the beginning, Dr. Rimka said. “Low-tech [strategies] are really the most important.”

Listen to the Full Episode

Cellular Energy & Mitochondrial Dysfunction is available on DrTalks, Apple Podcasts, Spotify, and YouTube.

References

1.    Chakrabarty RP, Chandel NS. Beyond ATP, new roles of mitochondria. Biochem (Lond). 2022;44(4):2-8. doi:10.1042/BIO_2022_119

2.    Roger AJ, Muñoz-Gómez SA, Kamikawa R. The origin and diversification of mitochondria. Curr Biol. 2017;27(21):R1177-R1192. doi:10.1016/j.cub.2017.09.015

3.    de Goede P, Wefers J, Brombacher EC, Schrauwen P, Kalsbeek A. Circadian rhythms in mitochondrial respiration. J Mol Endocrinol. 2018;60(3):R115-R130. doi:10.1530/JME-17-0196

4.    Mølmen KS, Almquist NW, Skattebo Ø. Effects of exercise training on mitochondrial and capillary growth in human skeletal muscle: a systematic review and meta-regression. Sports Med. 2025;55(1):115-144. doi:10.1007/s40279-024-02120-2

5.    Acoba MG, Senoo N, Claypool SM. Setting the curve: the biophysical properties of lipids in mitochondrial form and function. Trends Biochem Sci. 2024;49(12):1066-1080. doi:10.1016/j.tibs.2024.08.008

6.    Huang CW, Wen CY, Tsai AP, et al. Magnesium as a bioenergetic checkpoint linking mitochondrial function, metabolic disease, and aging. Aging Cell. 2026;25(6):e70578. doi:10.1111/acel.70578

This content is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment.