Podbit · The Diary Of A CEO with Steven Bartlett
The best study on chronic fatigue syndrome found a measurable deficiency in mitochondrial energy transformation capacity in muscle biopsies from patients. Their mitochondria simply cannot flux energy properly — which is why exercise makes them worse rather than better, unlike healthy people.
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At 2:25:00 · chapter starts 2:18:10
This is the most requested topic from Picard's online audience, and he addresses it with both data and compassion. The numbers are staggering: 20–24 million worldwide suffer from ME/CFS or Long COVID-related chronic fatigue, yet medicine has no reliable diagnostic biomarker and no proven treatment. The breakthrough study used muscle biopsies from the quadriceps to measure mitochondrial energy flux directly, finding a clear and measurable deficit in people with chronic fatigue syndrome — which mechanically explains why exercise triggers crashes (post-exertional malaise) rather than improvement. Unlike healthy people, whose GDF-15 dips back to baseline after exercise, in ME/CFS patients it appears to skyrocket. Picard then shares the story of a family friend who had debilitating chronic fatigue in her 20s, tried every conventional treatment unsuccessfully, and unexpectedly recovered after an emotionally transformative summer experience — never relapsing. He doesn't claim to know the mechanism, but offers it as evidence that the system can heal in ways science doesn't yet predict.
An estimated 20–24 million people worldwide suffer from ME/CFS or long COVID, with 3–5 million in the US alone, yet the medical community lacks reliable tests or treatments.
Self-help fails because people are sold one universal cure by the hyper-responders who had a transformative result from it. The real problem is context: every method works for the right person at the right time, which is almost never you just because the author says so.
Spencer Greenberg was once so socially anxious his heart pounded just approaching a stranger. His therapist gave him homework: go to a bar alone, talk to 5 strangers. Starting with asking for the time, he worked up to asking men for hugs — and his anxiety fell dramatically in 6 months.
A person who flies regularly but obsessively checks weather forecasts before every flight is not doing exposure therapy — they're teaching their brain that flying is only safe with the ritual. Safety behaviors prevent the brain from ever learning that the feared thing is actually fine.
The worry-time technique assigns all worries to one scheduled slot (e.g. 5 PM). Every time a worry surfaces, you write it down and ban yourself from engaging with it until that time. When 5 PM arrives, most worries feel trivial and the act of batch-worrying exposes how little it actually accomplishes.
In a randomized study of 20 habit techniques, 'habit reflection' stood out: recall a past habit you successfully built, write down what helped you succeed, then apply those same strategies to your new habit. It works because it's self-adapting — it uses whatever worked for YOU.
The tiny habits technique — always having a minimal version of your habit you can do when life gets in the way — keeps the mental machinery of habit formation from breaking. Paradoxically, people given a tiny-habit fallback option were MORE successful at the full habit, not less.
Fears and worries act like playground bullies — they want to ambush you. But when you deliberately seek them out and choose the time of engagement, they lose their power. The volitional act of starting the fight on your own terms is one of CBT's most underappreciated insights.
Most downtime defaults are things you regret immediately after — phone scrolling, binge TV. 'Glad you did it' activities meet the same need for rest but leave you feeling like you spent your time well. The switch from a bad screen to a documentary, a book, or a walk costs almost no extra effort but compounds into identity over time.
You rarely control your first reactive thought. But you can train your second thought — the response to the trigger — by asking whether your initial reaction is the most helpful one and replacing it with something equally true but more constructive. Over time, that second thought becomes automatic.
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