Stress is inevitable; recovery is conditional: bioenergetic limits of resilience in aging and disease

Biogerontology. 2026 May 4;27(3):96. doi: 10.1007/s10522-026-10445-w.

ABSTRACT

Aging, stress-related disorders, and chronic disease are often examined across separate domains-stress physiology, nutrition, psychiatry, and geroscience-despite converging on shared phenotypes of functional decline and reduced resilience. Although adaptive responses to stress are well characterized, why comparable exposures yield sustained resilience in some individuals but progressive dysfunction in others remains insufficiently explained. We propose that the missing unifying constraint is not stress exposure itself, but the bioenergetic capacity to complete recovery. We reframe stress adaptation as a cyclical process comprising response, adaptation, and recovery, emphasizing that recovery is an active, ATP-dependent phase conditionally funded within a finite bioenergetic system. When mitochondrial processing capacity and redox flexibility are constrained, adaptive programs may persist beyond their functional window, contributing to mitochondrial congestion, epigenetic gridlock, and progressive loss of physiological plasticity-even in the absence of overt pathology. Within this perspective, we introduce Exposure-Related Malnutrition (ERM) as a proposed conceptual model describing a clinically interpretable and potentially reversible phenotype of unresolved bioenergetic triage. ERM is proposed to describe a state of relative undernutrition arising from chronic mismatch between energetic demand and recovery capacity, often occurring despite nominal intake and laboratory values within reference ranges. Distinct from frailty, sarcopenia, cachexia, metabolic syndrome, and classical malnutrition, ERM may reflect an upstream constraint in ATP-dependent recovery rather than structural loss, inflammatory wasting, metabolic thresholds, or inadequate intake. By integrating evolutionary allocation theory, developmental calibration, stress physiology, and mitochondrial mechanics, ERM is proposed to offer a unifying integrative framework for functional decline across aging and chronic disease. Clinically, this perspective shifts risk assessment from isolated thresholds toward coordinated biomarker patterns, trajectories, and recovery kinetics, potentially enabling recognition of vulnerability before incomplete resolution consolidates into irreversible pathology. We further outline translational implications of a recovery-centered approach, positioning mitochondrial processing capacity and intercellular bioenergetic support as modifiable determinants of long-term resilience.

PMID:42071106 | DOI:10.1007/s10522-026-10445-w