Mitochondria: The Core of Exercise, Longevity, Heart Health, and Cancer Prevention

Richard Z. Cheng, M.D., Ph.D.

Introduction: From Gyms to Longevity Hubs

CrossFit and other forms of high-intensity training [1-3] have transformed fitness worldwide. Athletes in their 20s and 30s push limits, but often encounter plateaus: recovery slows, fatigue sets in, injuries take longer to heal.

At the same time, another demographic is surging - adults over 50 who seek not just fitness, but vitality, resilience, and independence [4,5]. They want energy for family, travel, and life.

The bridge between these two worlds is mitochondrial health.

Mitochondria: The Master Switch for Performance, Aging, and Disease

Mitochondria are not simply "power plants." They determine how effectively we move, recover, and resist disease.

For younger adults

• Endurance and performance: More mitochondria mean higher VO₂max, greater ATP production, and delayed fatigue. Even short-term interval training can rapidly increase mitochondrial density and oxidative enzyme activity [6-9].
• Recovery: Efficient mitochondria accelerate cellular repair, reduce soreness, and restore energy stores after exertion [9].
• Metabolic flexibility: Athletes with robust mitochondria switch smoothly between fat and carbohydrate fuels, burn less lactate, and sustain higher intensities [10-14].

For older adults

• Slowing aging: Declining mitochondrial function accelerates oxidative stress, inflammation, and tissue damage. Exercise and caloric restriction preserve mitochondrial biogenesis and delay these processes [15-18].
• Muscle preservation: Impaired mitochondria contribute to sarcopenia. High-intensity or resistance exercise helps maintain muscle quality by improving mitochondrial turnover and reducing oxidative damage [19-23].
• Cardiovascular protection: Strong mitochondrial capacity reduces the risk of heart disease and preserves cardiac output with age [24-26].
• Cancer and dementia prevention: Dysfunctional mitochondria drive genomic instability, oxidative injury, and impaired cell regulation - mechanisms linked with both cancer and neurodegeneration. Restoring mitochondrial health reduces risk [25-29].

In short:

• For the young: mitochondria = peak performance.
• For the old: mitochondria = resilience and independence.

Why Mitochondria Fail: Upstream Root Causes

In my From Mutation to Metabolism series, I outlined ten upstream categories of root causes that converge on mitochondrial dysfunction - not only in cancer, but also in atherosclerotic cardiovascular disease (ASCVD), diabetes, and aging [28,29]. Across chronic diseases, recurring upstream drivers consistently damage mitochondria:

1. Environmental and dietary toxins - pesticides, plastics, heavy metals, processed foods.
2. Nutrient deficiencies - inadequate vitamins, minerals, and antioxidants.
3. Chronic inflammation and infections - driving oxidative stress and immune imbalance.
4. Hormonal and metabolic disruption - insulin resistance, circadian rhythm disturbances.
5. Lifestyle and psychosocial stressors - poor sleep, overtraining, emotional stress.

👉 Additional note:

Bright environmental light-especially intense blue-spectrum light-can oxidize mitochondrial cytochromes in the retina because of their chromophore sensitivity, damaging mitochondrial DNA and metabolism. Prolonged exposure to bright sunlight, snow glare, or beach reflections can therefore accelerate oxidative injury to retinal mitochondria. Wearing dark or protective glasses in such conditions helps preserve mitochondrial health in the eyes and nervous system [30-33].

The Central Role of Toxins

As outlined in Part 2 of my series [29], many modern toxins are directly mitochondriotoxic:

• Plastics and pesticides disrupt mitochondrial respiratory chain enzymes.
• Heavy metals (e.g., mercury, lead) generate ROS and collapse redox balance.
• Ultra-processed foods introduce emulsifiers and additives that damage gut barriers, triggering systemic inflammation that impairs mitochondria.
• Air pollutants and endocrine disruptors accelerate cardiovascular aging, diabetes, and neurodegeneration via mitochondrial injury.

These burdens help explain why a 30-year-old athlete hits a plateau and why a 60-year-old loses vitality more rapidly.

Critique of the "Hallmarks of Aging"

The Hallmarks of Aging framework [34,35] has shaped much of modern geroscience for over a decade. First proposed in 2013 [34] with nine categories - genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication - it was expanded in 2023 [35] to twelve by adding disabled macroautophagy, chronic inflammation ("inflammaging"), and microbiome disturbance.

This framework has been valuable for organizing observations. Yet the "hallmarks" are downstream expressions, not true root causes. Many hallmarks-genomic instability, telomere attrition, epigenetic alterations, deregulated nutrient sensing, senescence, stem cell exhaustion, inflammaging-are driven by earlier mitochondrial stress (e.g., ROS, redox collapse, NAD⁺/ATP imbalance) and upstream toxins, infections, and deficiencies.

• Genomic instability is largely fueled by mitochondrial ROS, toxins, and micronutrient deficiencies.
• Telomere attrition reflects oxidative stress, inflammation, and metabolic overload - all downstream effects of mitochondrial stress.
• Epigenetic alterations mirror environmental and nutritional inputs mediated through mitochondrial metabolism.
• Nutrient sensing pathways (AMPK, mTOR, sirtuins) are set by mitochondrial NAD⁺/ATP balance.
• Senescence and stem cell exhaustion accelerate when mitochondrial energy reserves collapse.
• Inflammaging (chronic low-grade inflammation) is often initiated by mitochondrial danger signals (mtDNA fragments, ROS leakage) and perpetuated by toxin exposure.

In other words, what López-Otín and colleagues cataloged as "hallmarks" are symptoms, not origins.

From the Integrative Orthomolecular Medicine (IOM) perspective, the true root drivers of aging are the same ten categories I have outlined in my From Mutation to Metabolism series: dietary imbalance, environmental toxins, chronic infections, gut dysbiosis, oxidative stress, chronic inflammation, hormonal and metabolic dysregulation, immune dysfunction, stem cell exhaustion, and psychological stress/lifestyle imbalance.

All of these upstream drivers converge on mitochondrial dysfunction, making mitochondria the master hallmark and central integrator of aging.

Therefore:

• The "hallmarks" are descriptive signs - useful markers of damage and dysfunction.
• But they are not initiating drivers. They do not explain why mitochondria fail in the first place.
• True intervention requires moving upstream, addressing toxins, nutrient deficiencies, infections, and metabolic stress - the real starting points of aging.

This reorientation is critical for both science and practice. Focusing on superficial hallmarks risks expensive "miracle anti-aging drugs" that tweak pathways but never address root causes. By contrast, targeting upstream drivers - through diet, detoxification, orthomolecular nutrition, exercise, and lifestyle - restores mitochondria and improves multiple hallmarks simultaneously.

IOM Mitochondria Optimization: What Works

Low-Carb, Ketogenic Diet and Intermittent Fasting: Fuel for Mitochondria

One of the most powerful ways to restore mitochondrial health is through dietary strategy.

• Low-Carb and Ketogenic Diets: Restricting carbohydrates lowers blood sugar and insulin, reducing mitochondrial overload and oxidative stress. Ketones (β-hydroxybutyrate) serve as a clean fuel, generating fewer reactive oxygen species compared to glucose. Studies show ketogenic metabolism enhances mitochondrial biogenesis, improves redox balance, and increases resilience against oxidative injury [36,37,37,38].
• Intermittent Fasting: Periods of fasting activate AMPK and sirtuin pathways, stimulating autophagy and mitochondrial renewal. Fasting also lowers inflammation, improves insulin sensitivity, and promotes metabolic flexibility [39-41].
• Exercise Endurance Benefits: Both ketogenic metabolism and intermittent fasting increase reliance on fat oxidation, sparing glycogen and reducing lactate buildup. Endurance athletes often experience improved "second wind" capacity, greater stamina, and faster recovery when adapted to fat and ketones as fuel. Older adults also gain - fasting and low-carb diets preserve muscle, maintain mitochondrial biogenesis, and prevent fatigue from rapid glucose swings [42,43].
• Clinical Impact: Together, low-carb and fasting strategies have demonstrated benefits for diabetes, obesity, neurodegenerative conditions, cancer management, and longevity. For athletes, they improve fat oxidation and endurance. For older adults, they preserve function and delay age-related decline [44-47].

In practical terms: alternating between fasting periods and fat-based fuel sources mimics evolutionary energy cycles - giving mitochondria both rest and renewal.

Key Nutrients and Lifestyle Interventions

Exercise is the ignition. Nutrition is the fuel. Together, they upgrade mitochondria.

• Vitamin C - 3,000-10,000 mg/day in divided doses. Supports recovery, collagen formation, antioxidant defense, and vascular health [48].
• Vitamin D3 - 5,000-10,000 IU/day, adjusted to maintain blood levels of 50-100 ng/ml. Strengthens immunity, bones, and muscles [49,50].
• Niacin (B3) - 500-2,000 mg/day of instant-release niacin (titrated upward to minimize flushing). Boosts NAD⁺ and supports mitochondrial repair [51-53].
• Magnesium - 500-1,000 mg/day (glycinate or threonate forms preferred). Critical for ATP production, muscle relaxation, and energy metabolism [54,55].
• CoQ10 - 200-400 mg/day. Enhances cardiac function, endurance, and mitochondrial electron transport.
• Omega-3 - 2,000 mg/day or more of combined EPA+DHA from marine sources. Provides anti-inflammatory and neuroprotective benefits.
• L-carnitine - 1,000-3,000 mg/day. Facilitates fatty acid transport into mitochondria, improving fat burning and exercise endurance.
• Sleep, stress control, circadian rhythm - Protect mitochondrial repair cycles.
• Other supportive tools: Red-Blue therapy (NIR/PBMT + methylene blue), and additional orthomolecular nutrients.

For younger athletes: better performance and fewer injuries.

For seniors: slowing aging, preventing ASCVD and cancer, preserving independence.

Conclusion: The Mitochondrial Advantage

• For the young: mitochondria mean performance and endurance.
• For the old: mitochondria mean resilience and youthfulness.
• For all: mitochondria are the master hallmark - the central key to energy, health, and longevity.

One mitochondrion, one solution: energy for life.

I am living proof myself. For nearly two decades, I have practiced intermittent fasting, usually eating only two meals a day-the first after noon and the last before 7 p.m. In the mornings, I often play competitive badminton on an empty stomach, usually for two hours. I can still vigorously compete with players who are 10, 20, or even 30 years younger than me. I hardly experience significant low blood sugar symptoms, even if I fast for more than a day. This is because I have effectively trained my body to release, burn, and convert stored fat into energy-whereas many people cannot.

What I often see is that many younger players run out of energy and show signs of fatigue, while I'm still going strong-almost like the Energizer Bunny. People often ask me what my secret is. Half-jokingly, I reply: I'm a meat eater, while you are grass eaters (carbs). 🤣

• For young athletes: mitochondria = peak performance.
• For seniors: mitochondria = youthfulness and resilience.

About the Author

Richard Z. Cheng, M.D., Ph.D. - Editor-in-Chief, Orthomolecular Medicine News Service

Dr. Cheng is a U.S.-based, NIH-trained, board-certified physician specializing in integrative cancer therapy, orthomolecular medicine, functional & anti-aging medicine. He maintains active practices in both the United States and China.

A Fellow of the American Academy of Anti-Aging Medicine and a Hall of Fame inductee of the International Society for Orthomolecular Medicine, Dr. Cheng is a leading advocate for nutrition-based, root-cause health strategies. He also serves as an expert reviewer for the South Carolina Board of Medical Examiners, and co-founded both the China Low Carb Medicine Alliance and the Society of International Metabolic Oncology.

Dr. Cheng offers online Integrative Orthomolecular Medicine consultation services.
📰 Follow his latest insights on Substack: https://substack.com/@rzchengmd

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