Paying Attention to Hormones

For decades, hormone disruption was minimized, dismissed, or misunderstood.

Endocrine-disrupting chemicals. Chronic stress. Poor sleep. Processed food. Environmental exposures. Over time, these forces have reshaped hormonal health at a population level.

Now people are waking up to the reality that hormones govern far more than reproduction. They shape energy, mood, metabolism, body composition, libido, motivation, and cognitive clarity.

When hormones are balanced, life feels different. Energy becomes steadier. Recovery improves. Fat loss becomes possible. Focus sharpens. Emotional resilience increases.

The growing awareness around hormone health is not about chasing extremes or quick fixes. It’s about restoring balance and respecting how sensitive these systems are.

Understanding hormones gives people language for symptoms they were told to ignore and tools to address the root causes rather than just endure them.

Chronic Inflammation Is the Upstream Problem

Here’s why this matters beyond vague notions of “wellness”: chronic inflammation sits upstream of almost every disease that cuts healthspan short.

The connection to cardiovascular disease is now well-established.

For decades, cholesterol was framed as the main driver of heart disease. But it is only part of the picture. Inflammation is what turns plaques dangerous. It destabilizes them, makes them rupture prone, and damages the endothelium, the fragile inner lining of blood vessels, long before a heart attack ever happens. 

You can live with elevated cholesterol and never develop heart disease. Add chronic inflammation to the mix, and the math changes completely.

The metabolic connection is equally significant.

Inflammation and insulin resistance reinforce each other. Inflammatory signals disrupt insulin signaling. Insulin resistance drives visceral fat accumulation. And visceral fat actively produces inflammatory signals of its own. That’s why inflammation and metabolic dysfunction so often appear together.

Cells become energetically constrained.

Mitochondria are forced to operate under stress. Energy production becomes less efficient. More reactive byproducts are generated. Cells spend more effort maintaining basic function and less on repair, turnover, and resilience.

Inflammation reaches the brain.

The brain is not immune to systemic inflammation. Elevated inflammatory signals can activate the brain’s resident immune cells, driving neuroinflammation linked to cognitive decline and neurodegenerative disease. Inflammatory states also weaken the blood–brain barrier, allowing more inflammatory signals to reach the brain.

Inflammation increases with age.

Researchers have coined the term “inflammaging” to describe the age-related rise in baseline inflammation that occurs even in the absence of obvious disease. Your inflammatory setpoint creeps up decade by decade. This isn’t inevitable—it’s modifiable—but it’s the default trajectory if nothing intervenes.

The insidious part is that you don’t feel most of this happening. There are no pain receptors for systemic inflammation. By the time it manifests as a diagnosable condition, the underlying process has been running for years.

The gut microbiome is ground zero.

Roughly 70% of your immune system is located in and around the digestive tract. When the gut lining becomes compromised—through poor diet, stress, dysbiosis, or medications—it becomes more permeable than it should be. This allows bacterial fragments and undigested proteins to slip into the bloodstream, triggering immune responses that were never meant to be triggered. 

The result is a self-perpetuating loop: inflammation damages the gut, and a damaged gut produces more inflammation.

Check Out Our Issue On the Gut Microbiome

The vasculature suffers quietly.

Chronic inflammation gradually damages the endothelium, the thin lining that regulates blood flow and vascular tone. As this layer becomes impaired, blood vessels grow stiffer and less responsive. Circulation worsens. Blood pressure rises. Conditions for atherosclerosis take hold.

Endothelial health is now recognized as a strong marker of biological age. Inflammatory burden is one of its most powerful and persistent adversaries

Q. What’s the most effective way to use breathing before high-stress events like presentations or athletic competitions?

Q. Do you see breath as a bridge between body and consciousness? If so, what does that mean in practical terms?

Absolutely. From a physiological perspective, the state of your breath reveals the state of your body (i.e., your nervous system). So when it comes to nervous system regulation, you can create temporary shifts with the breath. 

But in order to affect long-term change, you need a steady practice, which could be with the breath or whichever form of stillness you find most delightful. It’s just like working out: doing a pull-up is hard if you’ve never trained your back muscles. Similarly, regulating the nervous system is hard if you haven’t primed it with consistent inner stillness.

Q. For parents: Beyond brushing and sometimes flossing, what actually moves the needle?

Bottom line first: cavity risk is driven more by acid exposure patterns and saliva biology than by how fancy your toothbrush is. What you do between brushings sets the trajectory.

The core idea is to control the frequency and chemistry of demineralization, then strengthen the enamel lattice.

Pattern over perfection. Enamel softens every time pH drops below the critical threshold. For most kids, enamel begins dissolving near pH 5.5 and dentin near 6.2. The Stephan curve tells us repeated drops matter more than one big drop. Translate that to three meals with one snack window. Water only between.

Snack engineering. Replace retentive starches and gummies with protein plus fiber that clear fast and do not feed plaque: cheese, eggs, plain yogurt, nuts or nut butter (if age-safe), meat sticks, veg and hummus, fresh fruit.

Saliva as your primary defense. Saliva provides bicarbonate, calcium, and phosphate, and carries antimicrobial peptides. Support it with hydration, electrolytes as needed, sugar-free gum after meals for older kids, cool-mist humidifier at night, and nose breathing during sleep. If a child mouth-breathes or snores, request an airway and sleep screen.

Daily remineralization. Use a hydroxyapatite paste morning and night. The particles integrate with enamel and reduce sensitivity while rebuilding crystal defects.

Interdental contact is non-negotiable. String flossing, floss picks, water flossers, or small interdental brushes make the behavior achievable. Anchor the habit to an existing nightly routine like reading books or bathing.

Target the biofilm when risk is high. Consider oral probiotics, especially during orthodontics, after antibiotics, and during illness clusters. Targeted strains help push the biofilm toward a less acidogenic state.

Nutrients matter. Prioritize vitamin D3 with K2, magnesium, calcium, phosphorus, zinc, and pre/probiotics from food first, then supplement to close gaps.Q. How would you support someone who loves desserts, snacking, croissants, and bread, etc. to make a permanent lifestyle shift to curb and reverse mitochondrial dysfunction and prevent them from developing more chronic disease?

Q. Water is great, but is brushing, flossing, and hydrating enough?

Short answer: hydration helps, but timing and chemistry matter more.

Timing beats volume. Multiple small sips of an acidic beverage can undo perfect hygiene. Keep acids limited and/or with meals only. Choose water between meals.

Know your numbers. Unstimulated saliva pH near 6.8 to 7.4 is protective. Home pH strips can teach patterns, but clinical salivary testing is better.

Fix dry-mouth drivers. Review medications, assess nasal airflow, and address airway issues. Use xylitol gum or lozenges after meals and add minerals to water if needed.

Remineralize nightly. A hydroxyapatite paste is the simplest way to push the curve back toward repair.

Q. Is it necessary to eat a clean, sugar-free diet in order to keep blood glucose stable—especially for someone with prediabetic range lab results?

Not necessarily. The keys to metabolic stability for healthy aging, including blood glucose behavior, are your dietary pattern, quality and quantity of food consumed, timing of eating, and integration of diet with regular exercise, getting good quality sleep, and stress management. 

Someone with pre-diabetes can restore their metabolic balance with plant-based foods, lean proteins, and healthy fats, while minimizing refined starches, added sugars, and ultra processed foods. It’s never too late to turn the ship around, especially with pre-diabetes. 

Importantly, one size does not fit all. Individual physiology matters, so a personalized nutrition and lifestyle intervention is the best approach for success.

Q. How would you support someone who loves desserts, snacking, croissants, and bread, etc. to make a permanent lifestyle shift to curb and reverse mitochondrial dysfunction and prevent them from developing more chronic disease?

We know from human studies that the pattern of eating a high carb diet with lots of added sugar is the road to metabolic syndrome and Type 2 diabetes, leading to the downstream pathologies associated with chronic disease. Metabolic syndrome and Type 2 diabetes are conditions associated with mitochondrial dysfunction, impaired ATP production, and lower mitochondrial density, hence the shift in energy and fatigue people experience. 

To counter this, a lifestyle shift that involves caloric restriction, low glycemic foods, and minimal carbohydrates can be a powerful lever to revert metabolism and mitochondrial dysfunction back toward a healthy set point.

Q. Besides obvious sugar/processed carbs, what other foods impact blood glucose, perhaps something that is common but most people might be unaware of??

There are some foods that are often considered “healthier” that are surprising triggers for a rapid rise in blood glucose. Some examples are sweet potatoes, beets, flavored yogurt, granola bars, and dried fruits.

Q. In functional medicine, the goal is to address root causes. But with hundreds of new biomarkers and tests available, how do we identify which ones truly matter and avoid overwhelming ourselves with irrelevant data?

More than 70% of medical decisions are based on lab results, yet the standard annual physical typically looks at just 19 biomarkers. That narrow lens leaves countless health risks undetected, fueling the rise in chronic disease, cancer diagnoses, and misdiagnoses across our healthcare system.

Function Health provides access to over 100+ tests, covering heart, hormonal, metabolic health, and more. Function also offers advanced MRI/CT scans that detect 500+ conditions, including cancers of the brain, thyroid, liver, pancreas, kidneys, and reproductive organs—as well as early signs of strokes, aneurysms, cysts, endometriosis, fatty liver, fibroids, kidney stones, and more—often before symptoms appear.

However, Function doesn’t just deliver results and leave its members with unanswered questions. It cuts through the noise by providing each member a detailed clinician’s summary of each test result, helping them understand the bigger picture, and a tailored health strategy inclusive of personalized nutrition, supplements, and lifestyle recommendations to support their health journey.

Q. So much of what preventive health promises has to do with behavior and lifestyle. What have you learned actually gets people to make lasting changes? And what doesn’t work?

Lasting change comes when people can see their progress. When biomarkers like blood sugar, inflammation, or cholesterol improve, it creates a powerful feedback loop that motivates consistency. I’ve experienced this myself. By targeting the right interventions, I was able to reduce my biological age by 20 years. The foundation is simple but essential: nutrition, movement, sleep, and stress management.

What makes the difference now is data. With tools like Function Health, we can move beyond one-size-fits-all advice to give people personalized insights tied directly to their own biology. That connection turns health into empowerment rather than discipline. What doesn’t work is handing someone a generic checklist and expecting it to stick. People need to see how their daily choices are measurably improving their own health.

Q. We’re seeing a lot of stuff enter the prevention conversation. Which emerging therapies, like peptides and regenerative medicine, do you believe will genuinely transform preventive health? And do you think any will fade away?

As the health landscape evolves, one of the most important shifts is from reactive care to proactive health. With nearly 30 million Americans living with chronic conditions like diabetes and undiagnosed cancers, it’s clear that our current system isn’t catching risks early enough.

At Function, we’re closing that gap by giving people access to advanced diagnostics and secure results through our app, empowering them to spot potential issues early and make data-driven decisions about their long-term health.

Within this shift, certain innovations stand out as game changers. Advanced imaging—MRIs and CT scans in particular—is here to stay. These tools provide a level of precision that can detect problems before symptoms ever appear, giving people peace of mind and doctors critical information to act sooner. That’s why, with the acquisition of Ezra, we launched Function Scans and introduced our standalone Heart & Lungs CT Scan—no membership required. It’s a clear example of how proactive, data-driven insights are moving preventive health from abstract promise to real-world action.

Other therapies, like peptides and regenerative medicine, are also incredibly promising for the future. Peptides can play a role in everything from immune support to tissue repair, and regenerative medicine holds potential for tackling aging and chronic conditions at their root. Still, not every trend will stand the test of time. What will last are the interventions that deliver reproducible, clinically validated outcomes—the ones that move prevention from theory into practice.

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

Q. How important is a healthy gut microbiome for a healthy vagus nerve? And does it work in reverse? Does a healthy vagus nerve improve the gut?

There is a bidirectional relationship between the gut and the brain, often called the microbiome–gut–brain axis. This axis links the brain’s emotional and cognitive centers with the gut’s functions and involves three key players:

• The central nervous system
• The enteric nervous system (sometimes called the gut’s own nervous system)
• The gut microbiome

The vagus nerve is the main communication pathway between the gut and brain. Remarkably, about 80% of vagus nerve fibers carry signals upward from the gut to the brain, while only 20% send signals downward. This highlights how important gut sensing is for brain function.

Gut bacteria produce substances such as short-chain fatty acids, serotonin, GABA, and enzymes that act on the vagus nerve. These signals influence brain activity, including appetite, emotional regulation, and even the perception of abdominal pain and discomfort. The brain, in turn, sends messages back down through the vagus nerve, influencing gut motility, the integrity of the gut lining (sometimes referred to as “leaky gut” when weakened), inflammation, and the balance of gut bacteria.

When this communication is disrupted, problems can arise. Conditions such as inflammatory bowel disease and irritable bowel syndrome are associated with reduced vagus nerve tone. Likewise, depression and anxiety often involve dysregulation in vagus–microbiome signaling. For this reason, vagus nerve stimulation (VNS) is being explored as a way to restore balance in the microbiome–gut–brain axis.

Q. The vagus nerve is usually mentioned with stress. But have you seen any practices actually make a big difference for patients in regulating their nervous systems day to day? If so, how can you measure vagus health?

Yes. There are many ways to regulate the nervous system. The key is consistency — choosing practices that are enjoyable and sustainable, rather than something that feels like a chore.

One of the most practical ways to measure vagus nerve health is by looking at heart rate variability (HRV), which is the variation in time between heartbeats. Higher HRV is linked with better vagal tone and stress resilience. Many wearables now make this easy to track.

There are both invasive and non-invasive ways to support vagus nerve function. Focusing on non-invasive methods, HRV biofeedback is especially effective. It pairs slow breathing with real-time HRV feedback, training the nervous system toward healthier patterns.

Even without biofeedback, slow, deep breathing is powerful. For example, the 4-7-8 breath, or any breathing exercise that slows the breath to about 6–8 breaths per minute, can increase vagal tone and help manage stress. I often recommend, as taught by Dr. Andrew Weil, beginning with just four breath cycles at a time. A word of caution: some people may feel lightheaded when starting, so it’s best to do less breath cycles or pause if that happens. This practice can be especially helpful during stressful moments, between tasks, after emotional events, or as part of a morning or evening routine.

Lifestyle habits also influence vagal tone and HRV. Aerobic exercise, yoga, dance, meditation, listening to music (such as Mozart), spending time in nature, or interacting with pets (especially dogs) all help. Social engagement—activities that build connection—is another powerful way to boost vagal health.

Q. Can vagus nerve training be a meaningful complement to therapy or medication for anxiety and depression? How would you recommend integrating it?

Yes. Practices that activate the vagus nerve can meaningfully support treatment for anxiety and depression, and they can be combined with medications, therapy, or lifestyle approaches.

There is no one-size-fits-all approach. When I work with patients, I start by asking: What supportive practices are they already doing? What are they willing or able to add? And what do they actually enjoy?

For example, meditation twice a day may work for some, but for others, it isn’t realistic or may even trigger more anxiety. The key is to find practices that strengthen vagal tone and fit the individual’s life.

A person might begin with slow deep breathing, such as the 4-7-8 breath twice daily, and later add biofeedback, exercise, or yoga. The practices can evolve over time, and the best results come when they are personalized.

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

Q. Have you personally seen evidence linking mitochondrial dysfunction to mental health disorders like depression or anxiety? How do you determine that? And how do you treat that?

There is a substantial and growing body of scientific evidence linking mitochondrial dysfunction to mental health disorders, such as depression and anxiety. For example, brain imaging studies show elevated lactate and reduced high-energy metabolites, suggesting inefficient energy production. Postmortem analyses of the brains of people with depression and many other mental health conditions reveal reduced mitochondrial density, altered structure, and changes in mitochondrial DNA, while blood studies consistently find impaired mitochondrial respiration, lower acetyl-L-carnitine, and increased oxidative stress. Genetic and transcriptomic studies identify mitochondrial pathways as among the most dysregulated in depression and other mental
health conditions. Animal models confirm that disrupting mitochondrial function produces depression-like behaviors, while treatments that enhance mitochondrial health can improve mood.

In clinical practice, however, most of these studies aren’t readily available, so we measure things that can be easily and inexpensively measured and look for behavioral manifestations of impaired mitochondrial function. These can include signs and symptoms like fatigue, exercise intolerance, brain fog, insulin resistance, abnormal lipids (high triglycerides and low HDL), high blood pressure, elevated inflammatory biomarkers, increased levels of visceral fat, etc.

Treating mitochondrial dysfunction is complex, as there can be many different biological,
psychological, social, and environmental causes of it. The first step is trying to determine the root causes and addressing them directly.

In some people, this could include addressing an unhealthy diet, improving sleep quality, optimizing nutrients, or reducing harmful substance use, such as tobacco or alcohol. All of these lifestyle factors are known to directly impact mitochondrial function. For others, the root causes can be more complicated, such as the lingering effects of an infection, as we see in some cases of Lyme disease or Long COVID. In
these situations, we might use anti-inflammatory diets, supplements, and specific vitamins to improve mitochondrial health.

Q. Do you encourage proactive mitochondrial health? If so, what does sustained mitochondrial health look like?

Yes. Prevention is always easier than trying to fix problems once they’ve taken root. Sustained mitochondrial health shows up in many tangible ways of good health: stable blood sugar and blood pressure, strong cardiorespiratory fitness, and preserved muscle strength. It also includes consistent, restorative sleep; a well-regulated circadian rhythm; and resilience in the face of stress—meaning the ability to recover and adapt effectively.

These markers not only signify healthy mitochondrial function but also actively support and reinforce it over time.

Q. What’s the connection between mitochondria and longevity? If someone wants to invest in their mitochondrial health now for better aging later, where should they start?

Mitochondrial dysfunction has long been recognized as one of the hallmarks of aging. Recent work even suggests it may be central to the entire aging process, because mitochondrial impairment can help explain and connect the other pillars of aging—from genomic instability and telomere attrition to inflammation and cellular senescence. Processes like mitochondrial biogenesis, mitophagy, and dynamic remodeling are essential for maintaining cellular vitality.

When these systems falter, damaged mitochondria accumulate, fueling chronic inflammation (“inflammaging”) and organ decline. Interventions that enhance mitochondrial turnover and efficiency are increasingly being studied as strategies to extend both lifespan and healthspan.

From my perspective as a psychiatrist, this biology is especially relevant. People with mental illnesses are known to age prematurely and die far earlier than the general population. A recent meta-analysis found that individuals with mental disorders lose nearly 15 years of life, on average. My hope is that by integrating mitochondrial health into mental health care, we can help close this mortality gap—supporting not only longer lives, but healthier and more fulfilling ones.

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Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

Q. How do psychedelics actually work in the brain? What are they doing up there?

There are four primary categories of psychedelic substances:

• Phenethylamines (e.g,. MDMA/Mescaline)
• Tryptamines (e.g., LSD, DMT, Ayahuasca, Psilocybin)
• Ketamine
• Cannabinoids (e.g., delta9-THC)

Psychedelic substances are neurocatalytic substances—meaning that they do quite a lot in the brain to enhance brain functioning. Amongst other things, they enhance neuroplasticity/learning, provide perspective, and accelerate brain function. They do so by activating neural networks involved in expanding awareness.

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Q. Is microdosing a legit mental health tool or just a low-dose placebo effect?

Microdosing the correct kind of psychedelics (tryptamines) has been found to be effective in the most recent clinical trials for enhancing energy and motivation; learning and memory; and focus and cognition. There is some early evidence of supporting mood enhancement.

There are few to no large studies of microdosing that qualify it as a tool to effectively treat mental illness. However, the use of psychedelics (microdosing or macrodosing) is known to worsen mental health in people with a history of psychotic disorders, delusional disorders, bipolar disorder, or personality disorder.

Q. Do psychedelics work differently depending on your personality or past trauma?

The psychedelics themselves work in the same way. However, the outcomes and experiences you have may be different from those others have.

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Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

Q. What’s one non-obvious use case for wearables that excites you the most?

Early pattern detection for emotional dysregulation.

As someone who has navigated depression and poor sleep, I’ve seen firsthand how powerful the nervous system can be in shaping health. Wearables are evolving beyond performance metrics. They are beginning to decode signals like low HRV, irregular breath, and prolonged freeze states. Soon they will prompt real-time interventions like breathwork or vagal activation.

That shift from passive tracking to active regulation is where the future lives.

Q. I wear a Whoop and an Oura Ring, and I have an Eight Sleep mattress. Why is the sleep data (especially deep sleep and HRV) so variable among the three? And how should we think about sleep data from wearables overall? Is it accurate enough to act on?

As someone who tests multiple wearables myself, I’ve experienced this variation directly.

Each device uses a different method:

• Whoop uses continuous HRV sampling from the wrist
• Oura captures HRV from a deep-sleep window via the finger
• Eight Sleep uses mattress-based tracking, strong for temperature but less precise for HRV

None of them are wrong. They are just offering different perspectives on the same night. Look for consistent patterns, not single-night spikes or dips.

Sleep data from wearables is worth acting on, but only if you focus on the trends.

As a biochemist, dietitian, and long-time biohacker, I’ve learned not to fixate on one night’s score. Instead, I look at changes over time—like declining deep sleep, reduced HRV, or shifting sleep latency. These patterns tell the story. Wearables give directional truth, not lab-grade precision, and that is more than enough to adjust behavior with confidence.

Q. Continuous glucose monitors are getting mainstream attention. What other biometrics will become continuous in the next 3–5 years?

Here’s what I foresee:

• Lactate for metabolic flexibility and fatigue threshold
• Ketones to monitor fat adaptation and cognitive fuel
• Cortisol for stress and circadian alignment
• Electrolytes like sodium and potassium for hydration and cramping
• Core temperature for recovery, illness detection, and fertility
• Neurochemical proxies via sweat or saliva for focus and mood

The next frontier is metabolic clarity.

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Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.