Dr. Casey Means

And I was so fascinated by this idea of like the way that we're defining the diseases we're treating in like a specialty like ENT is like I saw sinusitis day in and day out and we'd have these patients on the table.

that we'd be literally drilling into their skulls to suck out sinus pus and that's like the treatment for sinusitis and the way we diagnose the patients is we say like okay this patient has sinusitis if they have facial pressure purulent pus you know nasal discharge nasal obstruction and low sense of smell so if they have these symptoms then they have this disease

But when you actually go to the science and you actually go to the studies of like what is actually happening to create this, what you find is a lot of papers about mitochondrial dysfunction because sinusitis is in a chronic inflammatory condition where the cells are essentially sensing some threat and then they mount this immune response that creates swelling and then you get pus buildup.

But we confuse the pus buildup with the disease, which is actually happening inside the cells.

And so you start looking at PubMed as a clinician through a slightly different lens of like, what's actually happening in the cells?

And what you find for almost every chronic disease we're seeing in the US is that you will find a lot of papers on how the mitochondria are dysfunctional, lower ATP generation in a lot of these cell types.

And then what does that do?

And this gets to your question about chronic inflammation and oxidative stress.

Well, when you've got that dysfunctional mitochondria, let's say in a nasal mucosal tissue, that is a cell that can't do its job.

That is a cell that's underpowered and what could be more threatening to the body than a cell that can't do its job?

Interestingly, those cells will initiate a whole process, which is called the cell danger response.

It's work that's been done by Robert Navio at UCSD, where basically they understand the mitochondria is not working properly.

This is of course caused by the environment.

And they will actually release extracellular ATP, which is not really supposed to go outside of the cell.

And that creates a massive innate immune response saying like, I'm underpowered.

I need help.

My mitochondria is broken.

This is the cell.

Releases ATP outside of the cell.

Usually the concentration of ATP is a million times higher inside the cell.