You’re Not Just Tired—You Might Be Energy Starved

📍 Insights from a new preprint on Exposure-Related Malnutrition (ERM)

In a powerful new preprint titled “The Metabolic Cost of Resilience: Bioenergetic Trade-Offs in Stress Adaptation, Aging, and Chronic Disease”, Dr. Torsak Tippairote and colleagues propose a striking reframe: what if aging and chronic diseases aren't simply a matter of wear and tear, but the cumulative metabolic cost of unresolved stress adaptation?

Drawing from systems biology, stress physiology, and immunometabolism, the authors introduce the concept of Exposure-Related Malnutrition (ERM)—a subclinical, often undetected state where the body silently reallocates its metabolic resources away from maintenance and repair, toward chronic stress responses.

The twist? This can happen without any dietary deficit. In fact, individuals with ERM often have adequate intake and normal BMI—but they present with symptoms like chronic fatigue, immune dysfunction, poor recovery, and anabolic resistance. In essence, ERM is the “invisible malnutrition” of the modern age.

🔬 Why This Matters Clinically

ERM is more than a conceptual model—it’s a practical clinical lens. It helps explain:

• Why patients with normal labs and body weight still struggle with persistent fatigue, sarcopenia, or poor healing.

• Why standard nutrition assessments miss subtle signs of under-recovery and substrate misallocation.

• How bioimpedance (BIA), adrenal reserve testing, and trade-off biomarker patterns (e.g., low prealbumin + high CRP) can help detect early-stage dysfunction.

This model opens the door to early, pattern-based diagnosis, especially in high-risk populations—those with chronic inflammatory burdens, psychosocial stress, environmental toxin exposure, or unexplained functional decline.

🧩 Translating the Model to Practice

What could “ERM-aware” clinical care look like?

• Pattern recognition: Instead of chasing isolated lab abnormalities, clinicians can monitor adaptive stress trajectories—looking for biomarker clusters that reflect metabolic triage.

• Targeted repletion: Move beyond calories—focus on protein quality, essential micronutrients (like zinc, selenium, iron), and substrates for repair.

• Adrenal and metabolic rhythm support: Monitor diurnal cortisol and DHEA trends; support circadian coherence through lifestyle and timing of intake.

• Exposome reduction: Identify and mitigate hidden environmental, infectious, and inflammatory burdens sustaining the stress response.

• Functional recovery monitoring: Use BIA phase angle, lean mass preservation, and resilience metrics to track progress over time.

🌱 Toward Resilience-Based Medicine

By identifying ERM early—before it progresses to frailty or disease—clinicians have a critical opportunity to restore bioenergetic capacity and extend healthspan.

This preprint doesn’t just diagnose a problem—it offers a systems biology roadmap for detecting and reversing decline before it becomes irreversible. It invites a fundamental shift in medicine: from managing disease endpoints to preserving adaptive capacity across the lifespan.

🔗 Read the full preprint:👉 Tippairote et al., “The Metabolic Cost of Resilience.” Preprints 2025.📄 https://www.preprints.org/manuscript/202504.1142/v1