On Friday December 17th I interviewed Dr. Evan Hirsch, author of “Fix Your Fatigue: The Four Step Process to Resolving Chronic Fatigue, Achieving Abundant Energy and Reclaiming Your Life”, and below is the written transcript. If you would prefer to watch the interview you can access it by clicking here [1]:
Here is the transcript:
Dr. Eric Osansky:
This is Dr. Eric Osansky. And I have with me Dr. Evan Hirsch. Dr. Evan Hirsch is a world renowned fatigue expert, and he’s the founder and CEO of the International Center for Energy and Fatigue, and the Virtual MD initiative. Dr. Hirsch suffered with fatigue for five years before he achieved resolution using the Fix Your Fatigue program that he pioneered in medical practice. He also has a best-selling book, a podcast, and online programs.
And through these he’s helped thousands of people around the world optimize their energy naturally. And he’s on a mission to help one million more. I should also mention that he helps licensed functional medicine providers transition to a successful virtual practice, which is big in this day and age in 2020. Also, he’s board certified in family medicine and integrative medicine. And when he’s not at the office, you can find him singing musicals, dancing, and playing basketball with his family. How are you doing today, Dr. Hirsch?
Dr. Evan Hirsch:
Hey, Dr. Thanks so much for having me on.
Dr. Eric Osansky:
All right. Yeah, we’ll have to shoot hoops one day.
Dr. Evan Hirsch:
That’s right.
Dr. Eric Osansky:
So, you’ve dealt with fatigue for five years before you achieved resolution?
Dr. Evan Hirsch:
I did. Yeah. The story actually begins when I started my residency program back in 2004. I was in good health. I just came off of a year off after medical school and before residency. I met my wife about a month in and we fell in love. And three months later, she had chronic fatigue and couldn’t get out of bed. And that lasted for about three years. And I felt incredibly powerless. Here I was, supposed to be at the top of my game, asking everybody and their mother about how to help this person.
And all of my physician friends and whatnot, they couldn’t help. I mean, the stuff was really limited in conventional medicine. And so, she eventually got better doing a number of things from a natural perspective. And then, I came out of residency. I started my business, we got married, we had a child. And then, a couple years later, I got fatigue. And it lasted for five years and just about destroyed my life.
Just about destroyed my business. Just about destroyed my marriage, my relationship with my daughter. My brain fog was so awful that I couldn’t remember anybody’s name who I was treating. My energy was crap so I can only help people for a couple hours a day. I had to keep hiring new practitioners in order to come on to help me out. So, it was awful.
And then, I went through a process of once I realized that I had to find all of the causes, and I just dedicated myself to that and was committed to it, that’s when I found all of my causes. And I was able to get over my fatigue. And now, I’ve helped thousands at this point.
Dr. Eric Osansky:
All right. So, you helped not only yourself and thousands, but you said your wife as well?
Dr. Evan Hirsch:
Yeah, I did a little bit. I mean, at that point, she actually learned and taught me a lot about adrenal gland dysfunction, as well as toxicities. And she got mainly better by taking some adrenal support. We got a sauna. So, she was using that every day. Doing some coffee enemas. And then, the emotional work that she did was huge.
Dr. Eric Osansky:
All right. Very good. So, how does someone know that they have fatigue?
Dr. Evan Hirsch:
It’s a good question. Because a lot of people are like, they think that just because they’re getting older, and they’re getting more tired, it’s just because they’re getting older. But that’s really not the case. If somebody is getting seven to nine hours of sleep a night, and they’re still tired during the day where they need coffee, or they need Red Bull, or they need five-hour energy drink, or Coca-Cola or whatever it is that has caffeine or some stimulant in it, then there’s something not right.
And fatigue is just a harbinger. It’s just ringing the bell and saying, “Hey, there’s a problem here.” You need to pay attention, otherwise bad things are going to happen. So, that’s how you know if you have fatigue.
Dr. Eric Osansky:
As you know, my audience consists of people with thyroid and autoimmune thyroid conditions…Grave’s disease and Hashimoto’s. And so, I would say more with Hashimoto’s, even though a lot of people with Grave’s also have fatigue. Personally, I dealt with Grave’s, and I can’t say I had a lot of fatigue, but some of my patients with Grave’s disease do have fatigue. But it’s more common with Hashimoto’s hypothyroidism due to the low thyroid hormone.
So, that’s one common cause. But you also mentioned adrenals in your wife. And I also see adrenal problems a lot in my practice. So, what do you see besides thyroid, besides adrenals, what are some of the other common causes of fatigue?
Dr. Evan Hirsch:
So, what I found is that there’s actually 10 categories of causes, which can be broken down into 33 different causes. And these can really be divided up into deficiencies and toxicities. So, let’s focus on those top 10 causes. So, the deficiencies are things that aren’t in the body that are supposed to be. So, these are deficiencies and things like hormones. We talked about adrenals, thyroid, sex hormones. Deficiencies in nutrients…so vitamins and minerals.
Deficiencies in lifestyle habits, so not enough water, not enough good food, not enough sleep, not enough good movement. And deficiencies or dysfunction in mitochondria, which is the energy center of every cell in the body. Produces about 70 to 80% of our energy. And then, when we’re looking at toxicities, we’re looking at things like heavy metals. 70% of all the lipsticks that are sold off the shelf have lead in them.
100,000 pounds of mercury are being dumped into our oceans every year. Every time we bite down on a mercury filling or a silver filling, whatever you want to call it, amalgam, mercury vapor gets released into the body and we swallow it. 84,000 different chemicals we’re exposed to on a regular basis. And most of these have not been appropriately evaluated for human use. When we’re looking at something like mold, mold toxicity, about half of all the buildings in first-world countries have water damage.
And most of those have mold. It’s a crazy issue that causes so many things from fatigue. And what’s interesting too for your tribe is that all of these causes of fatigue are also causes of autoimmunity. So, if you’ve got Hashimoto’s, you’ve got Grave’s, those are autoimmune conditions. And the toxicities are going to be the same for them as well. And we can talk a little bit about some anecdotes that I’ve learned about those along the way.
So, that’s mold. And then, infections. CDC came out a couple years ago and said, “Actually, it’s not 30,000 new cases of Lyme every year, it’s actually 300,000.” And we see everything from Borrelia, which is Lyme, to Bartonella, to Babesia, to Epstein-Barr virus, and now we’re seeing COVID. And then there are allergies, which will be also part of that toxicity picture. And then, the mental-emotional stuff, so negative emotional patterns.
And so, that helps you categorize a little bit, simplify a little bit all those deficiencies and those toxicities Now, what’s interesting is that everybody has a different combination of those. And so, that makes treatment even more challenging. So, for me, I had about 30 different causes of fatigue. But pretty much everybody that I see has around 20 plus causes.
But the 20 plus causes that Joe Schmoe has over here is going to be different than the 20 plus causes that Sally has over here. And so that means that their treatments have to be different.
Dr. Eric Osansky:
That makes sense. And so some people just assume that they might have one cause of fatigue. So again, in the case of Hashimoto’s they might blame it on the thyroid. And that might be a big factor, but it could also be adrenals, it could be infection related, it could be environmental toxin related, it could be mold…mold toxicity is huge, nutrient deficiencies. So yes, it definitely can be challenging.
So, let’s talk about nutrient deficiencies a little bit. In your practice, do you address nutrient deficiencies primarily through food, through supplementation, a combination of both?
Dr. Evan Hirsch:
Combination of both. And I find that what’s interesting too that I should mention is that these deficiencies that we talked about, hormones, nutrients, mitochondria, lifestyle habits, except for the lifestyle habits, the other ones really can be caused by the toxicities. So, the end goal is to remove those toxicities that we talked about. And that will really help with those nutrient deficiencies. But yes, we do what we can. But there are certain nutrient deficiencies that I do like to replace like vitamin D, magnesium.
Vitamin B12 can play a huge role in energy and sleep and mood. And those are the big ones. Oh, and then iron. But one of the interesting things with iron, when you do as much work with infections as I do, iron feeds certain infections. And so, I do have to be cautious about replacing if somebody is very deficient in iron. So, if they’re around 40 or 50, it’s borderline for me. But if they’re less than that, generally, I’ll give them some replacement with herbal iron support.
Dr. Eric Osansky:
So, if they have an infection, obviously, you will want to address the infection. Will you try to do other things to help with iron absorption in the meantime, like vitamin C, increase stomach acid, or will you just focus on that infection?
Dr. Evan Hirsch:
I’m usually focused more on the infection. When there’s 20 plus different causes that people have, and they’re going to take one, sometimes two supplements for every single cause, it gets a little crazy in terms of the number of supplements. And so, we try to keep that as simple as possible. And if I think that the iron is going to be the biggest bang for the buck, then I’ll go ahead and recommend that they take it. But most of the time, it’s not going to be the case. And then, I’m going to look elsewhere for the biggest bang.
Dr. Eric Osansky:
All right, good deal. And then, you mentioned Lyme. Some of my audience knows that in 2018, I was actually diagnosed with chronic Lyme. I had more neurological symptoms. I can’t say fatigue was really bad, it was more neurological. But I think a lot of people overlook infections. I mean, maybe they’re a little bit more aware of Epstein-Barr, as there are books on both Epstein-Barr and Lyme.
But I know before I was diagnosed with Lyme in 2018, I would never have imagined that I’d have Lyme disease. And even when I was diagnosed, there was no evidence of a tick bite. There was no bull’s-eye rash. So, it’s definitely possible that for some people, I’m not saying everybody who’s experiencing fatigue, but even if you have no evidence of, again, a tick bite or bull’s-eye rash, it still could be Lyme.
I also tested positive for Bartonella. You mentioned Bartonella before. Fortunately, not Babesia. But can you talk a little bit more about infections? Do you find infections in a high percentage of your patients?
Dr. Evan Hirsch:
I do. Yeah, the people that I’m seeing who have chronic fatigue, infections are very prevalent. So, what’s interesting about the infections is that even according to the Centers for Disease Control in Atlanta, the infections really are clinical diagnoses. So, labs aren’t great. And so, what we’re looking at is conglomerations of symptoms that can determine whether or not somebody has a particular infection. And then, we can treat it using specific herbs.
And then, if we see improvement that can corroborate what we’re seeing based on the clinical picture. So for example, Borrelia, which is associated with Lyme. Borrelia, you can’t really have Borrelia unless you have the following symptoms. You have to have symptoms that move around the body. And so, we’re talking about whether it’s nerve pain, or joint pain, or muscle pain. Where one day, it’s here, and then either a couple of days, or a couple of weeks, or a couple of months later, it’s in the right knee or something like that.
So, it’s moving around the body. And then, the symptoms have to come and go, where you don’t know whether or not you can set an appointment for a certain day because you don’t know how you’re going to be feeling that day. So, some days might be okay. And other days might be crap. Usually, days aren’t great, but some days are better than others. So, you have symptoms that come and go. If you don’t have those symptoms, there’s very few things that cause that.
If you don’t have those symptoms, you really don’t have Borrelia. Now with Bartonella, oftentimes where people will report symptoms of headaches, or migraines, neck pain, body pain, oftentimes, these people are misdiagnosed with fibromyalgia. They’ll have problems with sleep. They’ll have anxiety and depression. They’ll have pain on the bottom of the feet.
And you may not have it now but if you’ve had it in the past, if you’ve been diagnosed with plantar fasciitis, which is a condition that can cause some of that pain or burning on the bottom of the feet, it’s very likely that you have Bartonella. Another symptom is muscle cramps. Oftentimes, in the calves, oftentimes at night. And then sometimes, people will report stretch marks. They’ll say, “Out of the blue, all of a sudden, I have this stretch mark right here.”
“And I haven’t had any weight fluctuations or anything like that.” And then, one of the biggest ones is Hashimoto’s. In fact, the only way that I’ve ever been able to get people off of their thyroid medicine is by treating Bartonella. And there seems to be some correlation there. And it happened quite serendipitously where I had just started treating somebody for Bartonella, who was on thyroid, who had Hashimoto’s.
And she calls up after hours and she’s like, “I don’t know what’s happening. I’m flipping out. I’ve got anxiety. I can’t sleep, da-da-da-da-da.” And I said, “I didn’t know what to do.” I was like, “Well, when was the last time that this happened?” And she’s like, “When I had Grave’s.” I said, “Oh crap, she’s hyperthyroid right now.” I said, “Well, let’s decrease your thyroid dose.” And so slowly, we’re able to wean her off of her thyroid medication completely.
And I find that about 50% of the time, we’re going to decrease people down to about 50 or 25% of what they were taking when they have Bartonella as well as low thyroid. Yeah, go ahead.
Dr. Eric Osansky:
You mentioned Grave’s…you meant Hashimoto’s?
Dr. Evan Hirsch:
No. So, she said, “The last time I experienced this was when I had Grave’s.” So, she had had Grave’s that then turned into Hashimoto’s. And so, she was hyperthyroid and because I couldn’t figure out what was going on. And she said that the last time she experienced it was when she was hyperthyroid.
Dr. Eric Osansky:
Okay. That’s interesting. And a few things that you mentioned, which is worth repeating. So one, you mentioned the testing. So, the testing, you’re right, especially for Lyme. I mean, I was lucky that the test showed it was clearly Lyme. But there are some people, especially if they go to a Labcorp or Quest Diagnostics, I mean, if it comes out positive, then yeah, you probably have Lyme or Bartonella, whatever you’re testing for.
But if it’s negative, it can definitely be a false negative. And so, there are other labs, there are specialty labs out there. Some doctors might argue not even using labs and just going by symptoms. And that’s another thing too. So, with Lyme, I definitely had a fluctuation of symptoms. I mean, it did move around. Again, I can’t say I had classic fatigue, as I really didn’t have it. And I wouldn’t say I had pain, but I did have electric shock sensations.
Maybe you could classify that as pain, but it definitely moved around. And some days, it felt okay, some days, it didn’t feel okay. So yeah, you are correct. Of course this is just my experience, and everybody is different. So, I didn’t have classic symptoms, and that’s why I wasn’t sure if it was Lyme. I started to have a weakness in my leg. And then, with other symptoms too, I was thinking Lyme or MS.
And the only reason I thought Lyme is due to my experience working with other patients with Lyme. But yeah, symptoms are important. I’m bringing this up because if you’re not experiencing some of the symptoms, or even any of the symptoms that Dr. Hirsch has mentioned, this doesn’t mean that you don’t have Lyme, this doesn’t mean you don’t have Bartonella. And again, I’m not trying to say everybody has Lyme or Bartonella. We all have microbes, we all have viruses in us.
A lot of us have Lyme and we don’t know it and it might not cause a problem. I mean, I might have had it in my body for years. But I just wanted to reinforce that. So, in summary…actually, before I say in conclusion, how about Epstein-Barr? Because again, most people do have Epstein-Barr. Is that a big problem in most people? Or is it with most people they just have it and you don’t really see it being problematic?
Dr. Evan Hirsch:
It can definitely be problematic as well. Oftentimes, these people are going to report a sore throat, but the symptoms are generally more vague. So, they can just have fatigue without any of the other things that I mentioned. And oftentimes, that means that there’s a virus present that we need to go after. The other infection that I didn’t mention that’s pretty prevalent is Babesia. And Babesia is considered the North American malaria.
And oftentimes, people will report getting hot and sweaty from time to time, or having night sweats on occasion, then it’s cyclical. So, sometimes, it’s once a month. And as things worsen, oftentimes, it can increase to every few days. These people generally have awful sleep. So, they’ll say, “I didn’t sleep at all last night.” And they’ll have really bad mood, where anxiety to the point of panic attacks, and depression to the point of suicidal thoughts.
And then, they’ll also have some shortness of breath, or some air hunger, can’t get a deep breath. You don’t have to have all those symptoms just like with Bartonella or Borrelia. But you just have to have some of them in order to start thinking about some of these infections.
Dr. Eric Osansky:
All right. And we will get to questions soon. We’ll spend a few minutes on questions but I just want to pick your brain for a few more minutes. But one person, Denise here, I did want to bring this up since we’re taking for granted that everybody knows what these coinfections are. And so one question Denise has is, “Bartonella, what is that?” It’s a co-infection of Lyme disease, but you can have Bartonella without having Borrelia, without having Lyme, correct?
Dr. Evan Hirsch:
Correct. Yeah. So, Bartonella is a bacteria that lives in upwards of 50% of all domestic animals. So, if you’ve ever been licked in the face by an animal, or they licked your hand, and you put it in your face, most of us have it. And I think for me and my Bartonella that I’ve had since day one, because my mom actually has it. So, if you’re seeing some symptoms that traverse from parent to child, oftentimes, it can be transmitted through the placenta.
So, a lot of this stuff, these bugs don’t become opportunistic until you get a number of hits. So, whether it’s another infection or whether it’s, for me, it was mold, and medical school, and residency and a break up, and all these other things. So, a number of stressful hits that ended up allowing some of these infections to come out in my body. I also grew up in New Jersey, so there was tick bites and stuff like that, too.
But to answer the question, Bartonella, coming from these domestic animals. But oftentimes, acutely, it’s called cat-scratch fever. Where you get scratched by a cat, you get a very large lymph node, usually in the axilla, or in the armpit, could be up here as well. But generally, in this area, just proximal or closer to the body than where the cat scratch was, whatever side of the body it was on. And oftentimes, that gets treated with antibiotics, and it goes away over time.
But what this is we’re looking at more chronic Bartonella, where the Bartonella ends up getting deeper into the body. It’ll have a couple of different phases. One phase is where it’s living in the skin, when it’s causing some of those stretch mark rashes, or what are called Bartonella striae. And the other one is where it’s living in the blood vessels.
So, anywhere that the blood goes Bartonella can go, which is why it’s so pervasive over multiple different systems in the body. Like I mentioned, going from the thyroid, to the musculature, to the joints. So hopefully, that helps explain what Bartonella is.
Dr. Eric Osansky:
Thank you for that explanation. And so, you have something called a four-step Fix Your Fatigue system. Can you discuss this and how you use this to help what causes fatigue?
Dr. Evan Hirsch:
So, my four-step process is, the takeaway from this whole talk is really, it’s all about the causes. So, the first step is figuring out the causes that you have. And so, it’s that 33 potential causes, everybody has 20 plus. So the question is, what 20 plus causes do you have? So, we take you through a process of looking at what your symptoms are first, and then what labs you need to get to confirm those symptoms and then to determine other causes.
So, what I found is that 75% of all of these causes can be determined by your symptoms alone. So, very quickly, you can start the process, print out the workbook, go through it, and within a couple of hours, you’re going to know 75% of your causes. So, the first step is determining those causes. The second step is to replace the deficiencies. Now, I should say that this process is all about step four, which is removing the toxicities. That really is the most important step.
But we have to do step two and replace the deficiencies in order to get you feeling better in order to be able to tolerate the rest of the process. So, that’s replacing the adrenals and the mitochondria and the thyroid. I call those three the big three, because they’re the fastest way to shift somebody’s energy. And then, there’s also working on your lifestyle habits, making sure you’re drinking enough water, getting enough good food, not eating crap food and food toxins.
Making sure that you’re getting enough movement and getting enough sleep. And then, replacing any vitamin and mineral deficiencies as well. So, step two is replacing those deficiencies. Then, step three is opening up the detoxification pathways. So, in order to jump into step four and grab the toxicities there and pull them into the bloodstream so that they can get out of the body, you have to make sure that those pathways, those detoxification pathways are open.
And so, that’s making sure you’re pooping one to two times a day, ideally twice a day. Making sure that the liver is open, that the kidney is open. That the lymph is open, which is the garbage system of the body. That the neural lymph is open, which is the brain length. So that it’s like these tubes, where if you’re going to grab those toxicities and pull it into the bloodstream, now they can come out. All this stuff is natural.
When I operate across state lines in these programs, I’m operating as a coach. So, that means there’s no prescribing. It’s all education and recommendations using natural stuff. So, that’s what we do for step three. And then, going into step four, it’s removing the heavy metals and the chemicals and the mold and the infections and the allergies and the negative emotional patterns. And so, that’s binding them up, it’s pulling them out.
It’s making sure along the way with all these nuances, because as you start killing off infections and removing toxicities, you’re creating a new normal. So, if you haven’t been healthy for a period of time, 20, 30, 40 years in some cases, or even just five or 10 years, we have to hit the reset button. And oftentimes, that can be a little bit bumpy. So, what we’re looking for is a five-step forward one-step back process, where you’re continuing to make forward progress. A journey of 1000 steps begins with a single step, right?
If you are doing five-step forward one-step back, you are eventually going to reach your goal. Just have to know that it can take some time in order to be able to do so and that there are some nuances to this, which is why a big part of our program is the follow-up. It’s the online community that we have. It’s the group Zoom calls that we have in order to make sure you get your questions answered, so that you can continue to make forward progress.
Dr. Eric Osansky:
That sounds great. So even though you’re a medical doctor, so you could prescribe medication for, let’s say again, getting back to Lyme, you could prescribe antibiotics. Or for toxic mold, you could prescribe cholestyramine, which binds to the mycotoxins. But you try to do as much as you can naturally, especially when you’re doing the group programs, correct? There are no prescriptions typically.
Dr. Evan Hirsch:
Exactly. Yeah, there are no prescriptions. And I’m not really using my MD so much anymore, because I’ve found really great tools naturally. And operating as a coach instead of an MD allows me to help more people across state and national lines. About a third of all of our clients right now are in the European Union and beyond. We’re actually changing the time of our group Zoom calls to better accommodate them because right now they’re at 1:00, they’re a little bit too late for the EU so we’re moving them a little bit earlier in the day.
Dr. Eric Osansky:
Yeah. There’s a good number of people from Europe in my group. So yeah, now, patients in the UK, too. So yeah, so this time, there might be people watching from the UK here or not just the UK but other areas in Europe. But what was I going to say? Oh, the deficiencies. So, going back to the deficiencies, you said that there are three main deficiencies. Did you say adrenal, thyroid and mitochondrial dysfunction?
Dr. Evan Hirsch:
The big three, that’s right.
Dr. Eric Osansky:
All right. And mitochondria, I mean, there’s a lot of things that could affect mitochondria. We could probably just have a separate talk just on mitochondria alone. But do you find that nutrients are the biggest factor? Or is it infections that drag down the mitochondria, toxins, or I guess all of the above?
Dr. Evan Hirsch:
Yeah, it’s always a combination of the above. So, the way that I describe it is that the mitochondria gets squashed by all these toxicities, the heavy metals, chemicals, mold, and infections. And then, you have to remove those toxicities, but then you also have to inject some love into that mitochondria in order to bring it back to life. So, it is that two-step process.
Dr. Eric Osansky:
So, as you mentioned, there’s so many potentially different causes of fatigue. How do you know when you can or cannot help someone who is experiencing fatigue?
Dr. Evan Hirsch:
So, it really depends on what’s been done before. So, if somebody has addressed all of their causes of fatigue, they should be better. So generally, if somebody has not, or if they haven’t addressed them appropriately, then that’s where I can help them. Because essentially, if you break it down as simple as possible, it’s a two-step process. You find the causes that you have, and then you fix those causes with a particular treatment that works for that cause.
So, either somebody hasn’t found the causes, or they haven’t found the right treatment for those causes. Because I’ve really never met anybody who has found all the causes, taken the appropriate treatment for them for the appropriate amount of time, and isn’t better.
Dr. Eric Osansky:
So it just comes down to that four-step process that you have? And you’re right, there’s just so many different factors. And some people might, in the case of Hashimoto’s, maybe the low thyroid is causing problems when it comes to fatigue. So, they might be taking levothyroxine or desiccated thyroid. And maybe that does help a little bit or maybe they take it and they don’t notice any difference so you have to look at adrenals and nutrient deficiencies…just so many different things.
So it really depends on the person. There are people who are able to make some changes and see dramatic improvements in their energy levels. And then, there are some people, I’m sure some people might be watching now who have had fatigue for years and it seems like no matter what they do nothing helps.
Every day in my Facebook group, or at least Monday through Friday, I create a post. And so, yesterday I put a post asking who in the group is experiencing fatigue to prepare them for this call. Just to let them know that we’re going to be talking about it. And I was looking at some of the comments, and a number of people have been experiencing it for years.
It’s bad enough for a few weeks or a few months, but experiencing severe chronic fatigue for a long time. But there’s definitely hope. It’s not always an easy process. Again, we’ll get to some questions in a minute or two, but I’m just wrapping things up. First of all, I wanted to thank you for getting together and for this interview, Dr. Hirsch. And I’d also like to thank you for the information.
So Dr. Hirsch, first of all, has a book, Fix Your Fatigue: The Four Step Process to Resolving Chronic Fatigue, Achieving Abundant Energy and Reclaiming Your Life. And even though it is available on Amazon, I’m going to put this in the chat where people could get a free copy or free PDF download of your book.
Click here [2] to get a free PDF copy of Dr. Hirsch’s book
And then also, if they’re interested, I think this also will lead to your website where they could schedule a free call as well if they wanted to chat with you or one of your coaches to learn more about how to overcome their fatigue. Is that correct?
Dr. Evan Hirsch:
Correct. Yeah, to see if they’re a good fit for any of the programs that we offer.
Dr. Eric Osansky:
Okay. Cool. But a good place to start maybe is to get that free book and then if you feel like you want to schedule a call, definitely he’s ready to help. But let’s see if anybody has questions. Well, actually, before we dive into questions, any last words? Anything else that you’d like to say Dr. Hirsch that I didn’t ask you?
Dr. Evan Hirsch:
I think there are two things. So, the first thing is I just like to give you a quick take on my take on thyroid. Where besides the Bartonella piece, what I find is that, and I’m sure you see this as well, doctors are so reliant on their labs. If I had a nickel for every person who is undertreating their thyroid, I’d be a very wealthy man, right? So, I do what’s called the subjective ramp up, where we use glandulars, which are obviously natural. And we ramp up every two weeks in order to get people up to their top dose.
Because I find that thyroid helps everything. What’s the best blood pressure lowering medication, it’s thyroid. What’s the best cholesterol lowering medication, it’s thyroid, right? But I also ramp things up in a specific format where you’ve got to replace the adrenals first and then replace the mitochondria before you go after the thyroid. Because the adrenals and the mitochondria will both make the production of thyroid better, its absorption better.
And so, you’re improving thyroid function along the way, you don’t want to ramp up on your thyroid without working on the adrenals and the mitochondria. So, that’s like my two cents on that. And then, the second thing is really about encouraging people to stay in action. Make sure that you’re moving forward, make sure that you’re working through Dr. Eric’s plan so that you are going to be successful.
If you have questions, you ask them. It seems like the hardest thing for humans, and I totally get it’s just part of our nature, if we get stuck, sometimes we don’t know what to do. So, make sure you’re asking questions. Make sure you’re staying in action, so that you can go through and you can be successful. Because we really underestimate the amount that we can get done long term in the next couple years.
We overestimate the amount that we’re going to get done in a week or two, right? So, you have to remember that baby steps and taking that five steps forward one step back will eventually get you there. And you find a good mentor like Dr. Eric or myself. And in three, six or 12 months, you’re going to have a very different life. And you think about that and it’s not a lot of your life, it’s 1/80th of your life depending on how long you live. And it can transform your life when you find that right person, that right mentor, and you take action.
Dr. Eric Osansky:
All right, well said. And that was interesting about the thyroid and the adrenals. I talk about this sometimes too. Adrenals are a priority over the thyroid and sex hormones. Again, Hashimoto’s is this immune system condition. But I guess to make sure I understand you correctly, before giving a thyroid glandular for example, you’ll optimize adrenal and mitochondrial healthy. Is that correct?
Dr. Evan Hirsch:
Absolutely. Yeah. And then, I see it as two separate conditions, as I’m sure you do, where you have to replace adrenals in Hashimoto’s because you’ve got the low, sorry, replaced thyroid because you’ve got the low thyroid. But then, also working on the autoimmunity.
Dr. Eric Osansky:
Well, thank you for sharing that. And again, thank you for sharing all of this with everyone. And let’s see if there are any questions here. So Sheree says, “Thank you for sharing this.” And you are very welcome. And then we got Ranjeetha. “Just like me. Recent blood work shows have Hashi’s antibodies that are active.” But it looks like her issue is brain fog.
So, I don’t know if you want to say something quick, and I do have on my website some information on brain fog [3]. But what would you say for someone who is experiencing brain fog? Is there overlap with some of the causes of fatigue when it comes to brain fog as well?
Dr. Evan Hirsch:
Yeah. Unfortunately, it very much commingled. Brain fog was one of my worst issues. And the causes are the same. And generally, it’s never just one thing. I mean, sometimes, if there’s one thing predominant like mold, but it’s never just one thing. And so sometimes, it’s like you start taking adrenal and mitochondrial and thyroid support, and all of a sudden, lights come back on. And other times, it’s all about getting to a certain point and removing the mold out of the body.
Dr. Eric Osansky:
So, it really all comes down to addressing the cause of underlying imbalances. All right, let’s see. We have Michele here. So, “Interesting information. I was diagnosed with Grave’s disease a few years ago. And now, I think my thyroid is going the other way due to weight gain. So, not taking any meds at the time. I appreciate the expertise on all these issues.” Well, thank you Michele for tuning in. And let’s see. We have LaTisha here who needs a reset.
Dr. Evan Hirsch:
Amen. Hit that reset button.
Dr. Eric Osansky:
Yes. Any other questions? I know sometimes when I do these, actually, most of the time I’ll do these solo and have to encourage people to ask questions. Just going once, going twice, and then a whole flood of questions come in. But seriously, if there are any questions that you have for Dr. Hirsch, definitely let us know. And especially anything related to fatigue. We do have a question here from Norway.
So, “Dizzy all the time. So, why?” And again, there could be numerous causes, adrenals, infections. I’m sure Dr. Hirsch could expand on this as well.
Dr. Evan Hirsch:
So, one of the main sites that autoimmunity loves to go to is the cerebellum. So, it loves to attack the cerebellum, which is the balance center of the brain. So that’s one of the reasons that I see. And so, anything that can be triggering that autoimmunity, triggering the immune system to attack itself, once again comes down to those toxicities, heavy metals, chemicals, molds, infections, allergies. And so, that’s generally where I will go and have success doing so.
Dr. Eric Osansky:
Yeah, toxic mold is really big. I mean, usually, some will have more than just dizziness. I guess you answered this earlier. So, just where people don’t have just one thing, but if someone has a chronic infection, a lot of times, they also do have mold. And a lot of times, it could even be mycotoxins dragging down the immune system, potentially making them more susceptible to infection such as Lyme or Epstein-Barr.
Dr. Evan Hirsch:
Absolutely. And there’s some research to back this up, that when you remove the mold, people who have these infections get better. So, the immune system wants to bring everything into balance, right? And so, it just gets hamstrung, where basically, you’ve got heavy metals, chemicals and mold that have hijacked the immune system off into left field, and these infections are having a party. So, once you can bring that immune system back and get rid of some of those toxicities it makes a huge difference for getting rid of the infections.
Dr. Eric Osansky:
Yeah, great points. And let’s see. We’ve got Jessica here. So, “With Hashimoto’s, I’ve struggled with both exhaustion and insomnia. So, first steps to feel normal?” So again, I definitely encourage you, Jessica, to sign up for Dr. Hirsch’s to get the free book.
If you go on Amazon, you could get it. But if you want it for free as a PDF, visit that website. But besides reading your book, what’s the first steps that you would recommend?
Dr. Evan Hirsch:
So, the first step is always adjusting lifestyle habits. So, it’s making sure you’re getting seven to nine hours of sleep a night, going to bed and waking up the same time every day. So, 10:00 to 6:00 would be a good eight hours. Going to bed around 10:00 or 10:30. After 10:30, oftentimes, people get an additional wind. And so, you want to make sure that timing is as such. Want to make sure that you’re consuming enough water.
And if you’re tired, most of the times, you’ve got adrenal gland dysfunction, you want to put a little bit of sea salt in your water, okay? It shouldn’t raise your blood pressure because it’s got potassium and magnesium that also lowers blood pressure. The other thing is you want to make sure that you’re consuming mainly meat and vegetables. So, where half of your plate pretty much every time you sit down is vegetables. So, decreasing the sugars, decreasing the grains, decreasing the dairy.
So, focus on that. And if you’re not eating meat, that’s fine. Eat beans, lentils are 100% protein. So, you can vary it that way. But vegetables are the main thing. And then if you’re tired, usually, you can’t do much movement. But if you can, do five jumping jacks a day, 10 jumping jacks a day. That’s the first thing. I call that a level one problem. If you’re going to fix your fatigue by doing lifestyle habits, then that’s a level one problem.
If you still have fatigue at that point, then you need to start in on the big three, optimizing adrenals, thyroid, mitochondria, and then some of the other ones. And if you fix your fatigue after that, then that’s a level two problem. If you still have fatigue after that, then you’re looking at removing the toxicities that we talked about in step four. But that should help give you some information to get started.
Dr. Eric Osansky:
All right, great. Well, hopefully, that helps, Jessica. So, you mentioned refined sugars. Do you find a lot of people do things for Candida overgrowth? Do you find that this also is a big factor when it comes to fatigue?
Dr. Evan Hirsch:
Yes. Once again, it’s all about the causes some people might have. In terms of percentage, a lot of people have yeast overgrowth. But it’s also about total body burden. And what is the biggest priority? So, we always go by symptoms as a guide to determine what’s going to be causing the biggest issues. Yeast, yes, it will cause some fatigue, but not as much as some of the other infections. So oftentimes, we’re addressing some of the other infections, the stealth infections first before we go after the Candida.
Unless somebody’s got really bad itching, anal itching, itching. Now, what’s interesting too is that sometimes those are fungal symptoms, which means they could be mold or yeast. So, depending on what we find in the stool, as well as what their gastrointestinal symptoms are would determine whether how high of a priority that becomes.
Dr. Eric Osansky:
All right, cool. Thank you for answering that. So Heather asked us…the person from Norway, she said she’s dizzy. Does it meaning vertigo is what she was asking?
Dr. Evan Hirsch:
I’m thinking so. I mean, there are other dizzy type symptoms that can happen. There’s postural hypotension where basically you go from a sitting to a standing position or lying down to a standing position too fast and you get lightheaded. That’s more of an adrenal issue, as opposed to the chronic vertigo. There are certain techniques that you can do, going in to see your doctor’s office or a neurologist where they can reset some of the cochlea or some of the in the inner ear.
Sometimes, the salt balance in there gets dysfunctional. When I was in residency, I remember this very clearly, there was a woman who was from Spain, and she had had vertigo for 30 years. And so, I was like, “Well, let’s try an Epley maneuver, which is something that I had just learned. Nobody had ever thought to do it on her. We did it on her a couple times, and her vertigo was gone. So sometimes, it’s simple stuff like that that can really help. And so, you want to make sure that you’re not ruling that out.
Dr. Eric Osansky:
All right. So, we have Dorinda here. So, “Hi, doctors, nice to see fellow functional practitioners giving their genius to the world. Keep up the great work. I started my career as a research immunotoxicologist in the field of autoimmunity. Then I became sick with seven autoimmune diseases myself. Now, I’m healed thanks to the latest science. Everyone, listen to these doctors. Functional medicine works.” All right, well, thanks, Dorinda. And yes, functional medicine definitely does work.
I appreciate you posting that. And okay, so Rose says, “Hi, Dr. Osansky. You probably have seen me here a few times.” Yes, I have. Thank you for showing up today as well. So, “It’s been a crazy ride trying to figure things out. I’ve been in remission with Grave’s for about three years. My new diagnosis is Hashimoto’s. I just had allergy testing and my IgE so far is high for milk, egg whites and wheat. My C1 esterase is high. And then, positive EBV, Epstein-Barr virus reactivated.”
“I’m thinking this has caused my autoimmune issues.” So as you said earlier, doc, I mean, it could be one factor with Epstein-Barr. And then also, what’s causing the Epstein-Barr because most people have Epstein-Barr in their body. So, it’s usually not just an Epstein-Barr problem. It’s usually other things affecting the immune system causing the reactivation of Epstein-Barr. I’m not sure if you want to expand on this.
Dr. Evan Hirsch:
Well, I think what’s a good reminder too is that autoimmunity is a spectrum. It starts off the immune system is reacting to something, and that’s an allergy. And then, if that thing gets inside of some tissues in the body and the immune system starts acting against it or reacting to it, that’s when you get autoimmunity where it’s actually attacking the self. And so, it’s important to remember that those allergies that you have are because of whatever is triggering the immune system.
So, whether it’s Epstein-Barr virus, or mold, or a combination of those toxicities, they’re all going to be triggering the immune system, and you’re going to have allergies. And you’re going to have autoimmunity to muscles, and you might have muscle pain, to brain, to fat to whatever it is going to then cause your symptoms. So, definitely focus on what is you know that Epstein-Barr virus. That’s definitely a good path to go down.
Just make sure that you’re addressing all of them. I think what’s important to remember is that the immune system, a lot of this testing that we’re looking at for infections is called serology testing, which is looking at the immune system’s reaction to something. If the immune system is not functioning well, guess how valuable those tests are? Not very valuable, right? If the tool that you’re trying to use is dysfunctional, then you’re not going to get great tests.
So, if you get a positive test, if you get a reactivation of Epstein-Barr virus, that is really affirmative, indicating that yes, it is highly likely that that’s an issue for you. If you don’t get one, it doesn’t necessarily mean that you don’t have it there. One of the things I like to do sometimes if there’s any question about some of these Lyme type infections is doing a urine PCR test.
So, this is looking at the DNA of the infections in urine. Unfortunately, it’s a $650 test. But that can be helpful to actually see the bug itself instead of looking at the immune system’s reaction to the bug.
Dr. Eric Osansky:
How about doing a just a separate test for a serum immunoglobulin? So, if you get negative EBV markers and doing immunoglobulin G and immunoglobulin M, and if those look good, would you say that the test is probably accurate? Or there’s still a chance that it might be a false negative?
Dr. Evan Hirsch:
Yeah, that can definitely help to determine. But I also think that we’re really at the early stages of testing. We rely very heavily on blood testing. And most of the active stuff that we’re looking at is actually inside the cell. And that’s not what we’re testing for. We’re testing for what’s floating around outside the cell, which could be 30% of actually what’s happening. So, it’s just not the best representation.
But that is one way to determine whether or not somebody has normal immune system function. Though, if they do have autoimmunity, by definition, they just wouldn’t have normal immune system function. So if you’ve got a number of the immunoglobulins present, that’s great. But they still could be reacting, there still could be autoimmune in their activity.
Dr. Eric Osansky:
All right. We got Rose with the follow-up, “Thank you, I’m going to get IgeneX test to rule out all Lyme disease.” So yeah, IgeneX, you’re probably familiar with IgeneX, a specialty lab that focuses on Lyme.
Dr. Evan Hirsch:
I’m not a fan, just because of what I said…it’s a serology test. It’s looking at the immune system’s response. And it’s very hard. You can have all those symptoms that I mentioned of Bartonella, and it may still show up as not having Bartonella. And then, somebody doesn’t get treated for Bartonella. And then, guess what, they continue to have problems with those symptoms from Bartonella.
The lab is such a small part. Even in conventional medical school, I was taught that history and symptoms are 90%. And then, labs and physical exam are 10% of your diagnosis. And so you have to always remember that. And so make sure that you’re looking at those symptoms more than you are at the labs.
Dr. Eric Osansky:
All right, sticking to the topic of labs, doing a complete blood count with differential. Obviously, this alone is usually not going to give you everything you need. But how much do you pay attention, like if someone does have persistently low white blood cell counts? Or if they have elevated lymphocytes, or just imbalance of the neutrophils, lymphocytes?
I know you can’t just go about it and say, “Oh, that person doesn’t have an infection.” But if there are imbalances, does that perhaps give you some clues, or you don’t really even look at that?
Dr. Evan Hirsch:
It’s confirmatory. So, it can be helpful. But once again, it’s not the cause, it’s more of a consequence. So yes, the immune system is going to be off and the levels are going to be lower or higher based off of what other infections are present. Now, the main thing that I’ll use the CBC for is going to be MCV. So, mean corpuscular volume, looking at the size of the red blood cells to determine whether you’re looking at iron deficiency, or whether you’re looking at B12 or folate deficiency.
Dr. Eric Osansky:
RDW as well if that’s usually an iron deficiency, you’ll see that higher? Or maybe you look at MCV more?
Dr. Evan Hirsch:
Yeah, I don’t really look at RDW. If I’m looking for iron, I’ll also combine the MCV with ferritin, as well as the TIBC. I think the TIBC is the most accurate marker, total iron binding capacity. And so, that’s inversely proportional to the ferritin. And so, that’s going to be elevated when the ferritin is low. Ferritin can also be an acute phase reactant, as you know. So oftentimes, if you’ve got inflammation and ferritin is 150, all bets are off.
So, I’ll combine some of those. What’s really like a two out of three, if TIBC is high, and MCV is low, and ferritin is off the charts, then I’ll still say, “Well, yeah, your iron is on the lower side of things.” And I’ll try to do it with diet first, depending on how low it is, and then I’ll use some of the herbal iron supplements like we talked about.
Dr. Eric Osansky:
All right. And this will be, I think, the last question because we’re almost at 3:00. So, Benita, “Just had my gallbladder removed. How does that relate to Hashimoto’s?” So, I do have an article on this topic Benita, on my website. We’ll see what Dr. Hirsch has to say. But I do have an article on bile metabolism [4], talking about the gallbladder.
Obviously getting the gallbladder removed, sometimes it is necessary. So, it definitely might have been necessary but it doesn’t take care of the cause why the gallbladder needed to be removed. But do you want to expand on that?
Dr. Evan Hirsch:
Sure. So, what I’ve found is that upwards of 95% of all gallbladder issues are allergy related. So, the gallbladder is spasming because it’s reacting to usually a food that you’re consuming, whether it’s gluten or dairy or sugar or whatever. And so, the way that correlates is that Hashimoto’s is an autoimmune condition. Autoimmunity is also going to be exacerbated by anything that you consume that you have an allergy to, or anything that you come in contact that you have an allergy to.
So, that’s where I would say that there’s a correlation there. If you’ve got both of those things going on, gallbladder issues, you had that removed as well as Hashimoto’s, once again, it comes back to those toxicities. And there’s something that’s triggering your immune system to have allergy and autoimmunity to the gallbladder, to the thyroid, and I’m sure to other parts of the body. And so, it’s find the cause and remove it.
Dr. Eric Osansky:
All right. So Jacki just wants to say, “Thank you for this information.” Thank you, Jacki. Thank you for tuning in. And thank you, everyone, for attending, for tuning in to this call. And I appreciate Dr. Hirsch taking time out of his schedule. And don’t forget, you could download a free PDF copy of his book. Again, this is in the Facebook comments section.
And I also plan on sending an email out as well, because I know some people weren’t able to attend this live. And Tanya says, “Thank you, have a good night.” Thank you. And Benita, “Thanks so much.” And Rose says, “Thank you.” Again, thank you everyone. Just again, this probably will be the last Facebook Live this year. Yeah, I guess the New Year is two weeks away. And I usually do these on Fridays, so I definitely won’t be having one next Friday for obvious reasons, being it is Christmas Day.
So, first of all, I want to just again, thank Dr. Hirsch one more time for taking the time. I appreciate all the advice you gave. And again, make sure you visit his website, download his book, and I just want to wish everybody a happy holiday season and a Happy New Year. And I will catch you again in early 2021. Well, take care everyone. And thanks again for attending.
Click here [2] to get a free PDF copy of Dr. Hirsch’s book