Significant illness represents a profound physiological stress, requiring enormous energy expenditure, such as raising body temperature and increasing cardiac output to support a systemic inflammatory response.

“I think that's such a great point and I and I don't think people fully appreciate what a physiologic stress significant illness is so you know again I I won't bore people with all of the details but if you go and do the chemistry on what it takes to raise the body's temperature from 98 Fahrenheit to 103 Fahrenheit that is an enormous energy cost when you you know when we look at cardiac patients when we look at any patients in the ICU and you look at the change in cardiac output that might be required to support um a systemic inflammatory response syndrome it it is profound”