In individuals with metabolic dysfunction, impaired mitochondria lead to poor carbohydrate tolerance, but carbohydrates are not the cause of the dysfunction.

“and a really the fascinating link is that when that cell becomes insulin resistance which again is a compensatory mechanism for mitochondrial dysfunction the insulin is going to rise in the blood because the body's insulin resistant so the body's going to turn out more insulin to try and overcome the insulin block to drive the sugar into the cells so insulin levels rise well insulin is one of the key activators of nitric oxide which is the molecule in the blood that dilates and relaxes blood vessels and so when we become insulin resistant and we're not responding to that insulin signal we end up getting less nitric oxide activity”