On RFK Jr.’s mitochondrial malaise
Glassy-eyed kids at the airport are not tired because of mitochondrial issues.
You can picture a mitochondrion, I suspect, based on how one was drawn for you in a high school textbook: It’s shaped like a kidney bean and full of squiggly lines. You might remember learning that mitochondria are “the powerhouses of the cell,” the cellular organs that provide the rest of the cell with energy to function. This is probably about as much as you know about mitochondria.
This is also probably as much as Robert F. Kennedy Jr. knows about mitochondria, but he certainly thinks about them much more than you do. He sees evidence of their dysfunction everywhere.
“I’m looking at kids while I walk through the airports today, as I walk down the street, and I see these kids that are just overburdened with mitochondrial challenges, inflammation, you can tell it from their faces, from their body movement, and from their lack of social connection,” Kennedy said Wednesday during a press briefing.
This quote reads to many as batshit crazy, and has now gone viral. People are understandably confused: What is the secretary of health and human services talking about? Is this a thing? Did he make it up? Are American children afflicted with mitochondrial malaise?
Like so much that Kennedy says, it was a statement both bizarre to the average person and entirely intelligible to his base; it was a signal to his more ardent followers that he lives in their alternate reality and a signal to everyone else that he isn’t living in ours.
The mitochondrial dysfunction claim is a typical “Make America Healthy Again” (MAHA) story for what’s gone wrong with Americans’ health. It’s an explanation rich in metaphoric potential, one that implies that illness can be resolved through living virtuously and one that challenges conventional scientific wisdom. These stories are everywhere in the MAHAverse. They offer people ways of understanding how they feel, and they’re worth being curious about.
Let’s review some Cell Biology 101: Mitochondria are abundant little energy reactors. They use oxygen to add a phosphate1 to molecules of adenosine diphosphate, which in turn creates adenosine triphosphate, or ATP, tiny packets of power that provide chemical energy to the rest of the cell. This process is called aerobic respiration (because, oxygen); when it is impaired, the cell creates energy for itself using anaerobic respiration, a less-efficient process that produces much less energy.2
OK, so: Do "mitochondrial challenges" somehow lead to … dead-eyed kids with poor social connections? Like, no. Definitely not! This is absolutely not a conventionally accepted, or even unconventionally accepted, explanatory model for how kids feel or behave.
Certain rare genetic illnesses do cause mitochondrial impairment, but these aren’t what Kennedy was referring to. The secretary was referencing secondary mitochondrial dysfunction — damage to mitochondrial integrity caused by something else — which is not a diagnostic entity that pediatricians apply to children, certainly not on sight on the street.
Mitochondrial dysfunction is, however, a preferred explanation that wellness gurus and chronic-illness advocates suggest to people with a host of otherwise unexplained, persistent symptoms throughout their bodies: fatigue, weakness, brain fog, mood swings, sleep issues, unexplained pain, headaches, changes in sensation, persistent nausea, weird food reactions, and other discomforts.
The basic hypothesis is that inflammation in the body from various causes — the presence of toxins or viruses, anything that creates “oxidative stress” — leads to mitochondrial damage, and then mitochondrial dysfunction. That dysfunction means our cells don’t work well because they don’t have enough energy, and because other mitochondrial functions become impaired.
“Our modern diets and lifestyles are synergistically ravaging our mitochondria,” writes surgeon general nominee Casey Means in her book, Good Energy, in a claim typical of people who subscribe to these ideas. Mitochondrial dysfunction is not detectable through standard laboratory testing. The belief that it might nonetheless be present and responsible for multiorgan dysfunction both subtle and severe offers a seductive explanation when people are sick in ways that elude usual diagnosis.
It is also an idea supported by some scientific studies.3 None of those studies are definitive — they’re hypothesis-generating, not hypothesis-confirming. Most of them look for evidence of mitochondrial damage in people who feel unwell, which obviously at best suggests correlation rather than causation, and much of the evidence in mitochondrial biology comes from animal and in vitro studies, not from humans. I don’t know of any high-quality studies that definitively establish that mitochondrial stress causes chronic diseases, nor do I know of any clinical trials that have demonstrated the efficacy of therapies aimed at restoring mitochondrial function as their target.
But this idea — that inflammation from bad modern living causes mitochondrial dysfunction, and that mitochondrial dysfunction causes illness — is a real hypothesis that is being studied by researchers across multiple disciplines, from exercise science to oncology. It’s just not a well-characterized clinical entity. There are other explanatory models for nonspecific, multiorgan symptoms: the idea that some chronic illness can be attributed to “microclotting” throughout the body is one; the idea that hormone disruption might be the main way inflammation does its damage is another.
None of this stuff is “real” or “fake”; it’s all just at various stages of being imagined, tested, refined, and revised. Chill, open-minded people might think of the relationship between mitochondria and chronic disease pathogenesis as potentially interesting but hazily defined and still in early days.
Kennedy is neither chill nor open-minded. He’s a very rigid thinker. He likes to draw firm conclusions from weak evidence and to extrapolate basic science to clinical science when it suits him. He, and people like him, are especially drawn to the mitochondrial hypothesis for a few reasons that are consistent with their broader project.
First, they love when basic science corresponds to intuitive metaphors that accord with their general worldview. The idea that the “powerhouse of the cell” might be taken down by toxic exposure to the byproducts of ultra-processed foods is kind of a perfect story for them; it’s easy to grasp, it sounds plausible, it accommodates their anxiety about vitality, and it is capacious enough to explain any feeling of unease, any deviation from perfect health.
Second, it suggests that there are lifestyle interventions that one can pursue today to reverse the damage: Eating an anti-inflammatory diet rich in antioxidants is something that’s often suggested, along with supplements and spending a lot of time doing “Zone 2 exercise,” which is when your heart rate stays at 60-70% of your maximum heart rate.
Third, the mitochondria story is very science-y. Kennedy and his compatriots in the wellness and functional medicine realms love to draw straight lines from these types of recommendations to specific biological processes. Everyone knows we should eat well and exercise, but the Kennedy shtick presents this advice as more than just generally accepted wisdom." Getting people to live more healthily is only part of his project; the bigger, more important aim is to imply that the conventional stories about health that Americans have been sold are all lies, that establishment scientists have ignored inconvenient truths, and that you have been poisoning yourself and your children without even realizing it.
Kennedy’s mitochondria mention inspired snorts of derision from liberals and scientists. “Maybe it’s the brain worms, but Health Secretary Robert F. Kennedy Jr. claims he can look at a child and diagnose them with cellular difficulties,” began a response article in The New Republic. “This is wacky, flat-earth, voodoo stuff people,” tweeted Ashish Jha, former Biden COVID-19 czar.
But voodoo stuff isn’t quite right, and this type of response isn’t quite right, either. While Kennedy shouldn’t be seriously engaged around his self-serving read of the science, I think it’s a mistake to treat everything this camp thinks and advocates as outlandish pseudoscience. Rather, I think we should be curious about MAHA science and MAHA mythology — to take it seriously, if not literally.
There is a scientific reason for this, and a political one. The scientific reason is that it’s counterproductive to ignore or deride ideas you don’t like. The political reason is that a growing number of Americans do believe these things — that mitochondrial dysfunction is at the heart of the chronic disease epidemic, that SSRIs make kids violent, that mRNA vaccines kill people.
These theories shouldn’t be validated, but they can’t be suppressed. They didn’t originate with RFK Jr., and fact-checking him won’t make them go away. We should try to understand where they’re coming from and why they have such influence — you can’t counter an idea you barely deign to acknowledge.
A world of people ranging from the celebrity doctor Peter Attia to functional-medicine followers to patients with chronic disease believe that mitochondrial dysfunction plays a prominent role in poor health. They know that there’s some evidence to support this idea, and they’ve read the studies and listened to their authors on podcasts.
These people feel that they cannot trust health information from establishment sources, and that they’re locked into a dynamic where they’re always speaking truth to the indifferent powers that be. They hear Kennedy’s mitochondria reference in a press conference as a signal that he shares their perspective. This dynamic is how Kennedy builds power with his followers and deepens divides between them and the rest of us: first, by affirming their ideas, and second, by daring us to overstep our bounds when we rush to shoot them down.
This isn’t a plea for civility or restraint; it’s a suggestion that responding to Kennedy’s dubious claims with total derision is counterproductive to our larger aim of undermining his authority. I think it’s important that we become familiar with MAHA’s science and the way that they’re thinking about health. We can acknowledge and even take fringe ideas seriously without affirming them, and we should — not immediately in response to every statement Kennedy makes, but as a regular practice of crossing partisan lines and getting to know what others are worried and thinking about.
We risk seeming closed to challenging new ideas when we roll our eyes at everything MAHA believes, and we risk alienating people who are seeking available solutions for problems they feel abandoned to. I know without a doubt that Kennedy cannot detect mitochondrial dysfunction based on the way a tired kid stumbles through the airport. But I don’t know for certain much else about why so many people have lost faith in public health and science, or what they’ve turned to instead. I think that, as a good doctor, it’s incumbent upon me to find out.
A phosphate is a compound containing phosphorus and oxygen.
Mitochondria also do other necessary things. They’re important in building fatty acid chains; they’re important to regulating how calcium is used and stored in the cell; they play a role in cell metabolic regulation; they play a role in signaling cell death; they’re implicated in a host of pathways for various cell functions. When they don’t work well, our cells don’t work well. Mitochondria are in nearly every type of cell in the body, so they are also in every organ in the body. Notably, mitochondria actually also have their own DNA, separate from the regular DNA in the cell nucleus that encodes our genes. This is a simplified explanation for what’s up with mitochondria, of course; but presuming you’re not about to cite this brief opinion piece in your cell biology paper, it’s enough.
There are studies that look at how damage to mitochondrial membranes inhibits normal cell function and activates inappropriate immune responses. Evidence of this kind of disruption is present in autopsied bodies of people who had severe COVID-19 and who have symptoms of long COVID. There are studies that associate disruptions in mitochondrial function with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). There are also studies that suggest that mitochondrial dysfunction might play a role in cancers, autoimmune diseases, and cardiovascular disease.