Most women in their forties are told that whatever has changed is "probably hormonal". Dr Mayoni Gooneratne, a former NHS surgeon who now practises longevity medicine, thinks that answer is incomplete. In the first episode of the Sanno Health cellular health podcast series, she explains why energy through the day starts several layers beneath hormones, and offers a plain-language framework anyone can use.
Why do we talk about cells when we mean energy?
Dr Gooneratne's starting point is that a cell never works alone. "Our cells only thrive when they are in community," she says. A cell sits inside an organ, the organ inside a system, and the system inside a life that has its own story. That is why she resists the idea that a single number on a hormone test explains how someone feels at four in the afternoon.
It also explains why so many people are looked after in pieces. "You might see a neurologist about one thing, an endocrinologist about your thyroid, your GP about your cycle. Yet they are all different leaves of the same tree." The tree, in her telling, is the whole person, and its trunk is how well the body's cells are supplied, powered and rested.
What is the house model?
The most useful idea in the episode is an analogy. Think of your health as a house.
- The soil is what you were born with: your genes and the environment your parents brought to the moment you were conceived.
- The foundations are your gut, your nutrition and the community of microbes that lives with you. "If we just stay in the soil and the foundations forever, we are doing a really good job," she says.
- The walls are your relationships, starting with the one you have with yourself.
- The roof is your immune system.
- The heating is your metabolism and your hormones.
- The light switch is your mitochondria, the part of every cell that turns food and oxygen into usable energy. "How do we power our house through the day? Can we keep the lights on? Are we exhausted by 4 p.m.?"
- The windows are your body clock: whether you obey day and night.
Every house also produces waste, so how the body clears it matters, and every house is exposed to weather: the things we breathe, drink, apply to our skin and live through. Hormones, in this picture, are one system among many. "There are so many other parts of someone's house to unpack and understand before we start looking at hormones."
Why does midlife feel different?
Women's lives run on rhythms, Dr Gooneratne points out: a daily rhythm, a monthly one, an annual one, and a slower one across the decades. Perimenopause, which can last for years, is a stretch where several of those rhythms change at once, often while work, children and ageing parents are all asking for more. Her argument is not that the change is a problem to be fixed, but that it is a moment to pay attention to the foundations, because the habits built in this window carry forward for decades.
Her one caution is to take the change seriously rather than push through it. "Until very recently, women were just white-knuckling through this time."
What does she actually tell people to do?
Before any test result comes back, almost everyone she sees leaves with the same three foundations. None of them costs anything.
1. Claim the first fifteen minutes of the day
Get up a little before the rest of the household, make a hot drink, and take it outside or to a window with real daylight. "That retinal information is such important data for resetting the circadian rhythm." For a body clock that has been set by screens and indoor lighting, morning daylight is the strongest signal available, and it is free.
2. Eat in the morning, and eat enough
This is where she is bluntest. "When women first come to me they are often not eating enough. Missing breakfast and not eating until two in the afternoon is not fasting. I would argue it is self-neglect." Her advice is to eat within an hour or so of waking so the body gets the message that there is plenty, and to save deliberate fasting for an occasional, planned day rather than every morning by default.
3. Half the plate is protein
Her rule of thumb needs no scales. Half the plate protein, the rest split between vegetables in as many colours as possible and complex carbohydrates that occur in nature: sweet potato, wild rice, brown rice. "Carbohydrates are not the enemy." The point of the protein is structural: the body rebuilds itself constantly, and it cannot do that without the raw material.
Only after those three does her method move through the layers of the house in order: gut and nutrition first, then how the body clears waste, then metabolism and hormones, then the nervous system, and finally the mitochondria. "It gives both my team and that client a real process to hang their whole journey on."
Where do supplements fit?
Dr Gooneratne's framework is deliberately food and routine first, and we would say the same. Where a supplement can help is in covering specific nutrients the body uses to turn food into energy, particularly when appetite, time or diet variety are limited.
Magnesium contributes to normal energy-yielding metabolism and to a reduction of tiredness and fatigue, and also contributes to normal psychological function. B vitamins, including riboflavin (B2), vitamin B6 and vitamin B12, contribute to normal energy-yielding metabolism and to the reduction of tiredness and fatigue. Iron contributes to normal energy-yielding metabolism and to normal oxygen transport in the body, which is one reason an iron check is a sensible conversation with your GP if tiredness is persistent.
For the cell membranes that the whole podcast series is about, choline is the nutrient with authorised claims: it contributes to normal lipid metabolism and to the maintenance of normal liver function. Phosphatidylcholine supplements are one source of choline, and the Supplement Hub range includes BodyBio PC alongside liposomal and softgel alternatives.
As always, the form and dose on the label matter more than the marketing, and we select every product in the range against our standards for purity, form and transparency. If you are pregnant, breastfeeding, taking medication or under medical care, talk to your practitioner before adding anything.
Frequently asked questions
What is cell function?
Cell function describes how well the body's cells are supplied with nutrients, powered by their mitochondria, protected from damage and able to clear waste. Because every organ is made of cells, it is a way of talking about health at the most basic level rather than symptom by symptom.
What are mitochondria?
Mitochondria are structures inside almost every cell that convert food and oxygen into the energy the cell uses. Dr Gooneratne calls them the light switch of the house: the part that decides whether the lights stay on through the day.
Is skipping breakfast the same as intermittent fasting?
Not according to Dr Gooneratne. Deliberate, planned fasting is different from habitually not eating until the afternoon. Her advice for most women in midlife is to eat within an hour or so of waking and to keep any fasting occasional and intentional.
Which nutrients are linked to energy metabolism?
Magnesium, thiamine (B1), riboflavin (B2), niacin (B3), vitamin B6, pantothenic acid, biotin, vitamin B12, vitamin C, iron, iodine, copper and manganese all carry authorised EU claims for contributing to normal energy-yielding metabolism. Several of them, including magnesium, B2, B6, B12, folate and vitamin C, also contribute to the reduction of tiredness and fatigue.
Where can I hear the full episode?
The Sanno Health Podcast cellular health series is produced with Amrita Nutrition Global and BodyBio. Episode 1 with Dr Mayoni Gooneratne is available on the Sanno Health channels. Episodes with Daniela Lawler and Dr Monisha Bhanote follow on 29 September and 14 October.
Shop the range: Magnesium · Energy and B vitamins
Written by Kris Barnes for Supplement Hub. Reviewed for compliance with Regulation (EC) 1924/2006 by Keren Tamasial, 22 September 2026. Dr Mayoni Gooneratne appears in an educational capacity; she has not reviewed or endorsed any product mentioned. Quotes are from the Sanno Health Podcast, Episode 1 of the cellular health series, lightly edited for clarity.
