Your Personalized Roadmap To Fixing Your Fatigue with Dr. Evan Hirsch

Content By: Ari Whitten & Dr. Evan Hirsch

In this episode, I am speaking with Evan Hirsch, MD – board-certified in family and integrative medicine. Dr. Hirsch suffered from fatigue for five years and has made it his life mission to help people recover from fatigue. We will discuss the most common causes of fatigue and how you can fix your fatigue by following his simple roadmap.

Dr. Hirsch has a new program called Fix Your Fatigue, which is a great addition to the Energy Blueprint Program as it addresses specific conditions and what you can do to recover from these. I have managed to negotiate an additional $1000 off of the price so you can get it for $997. Use the code TEB1000 upon checkout. (If you already know that this program is for you, you can purchase the program here directly!)

Table of Contents

In this podcast, Dr. Hirsch will cover:

  • The top 10 causes of chronic fatigue
  • The different types of deficiencies that trigger fatigue
  • Toxin overload – how environmental toxins enter our bodies
  • Constipation – how often you should poop and why it is essential for optimal health
  • Why balancing any deficiencies may be the best way to fix your fatigue
  • The best ways to detox

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Ari: Hey there, welcome to The Energy Blueprint podcast. I’m your host, Ari Witten. Today, I have with me for the– is the third time? I think it’s either the second or the third, I think it might be the third.

Dr. Hirsch: I think it is.

Ari: Third time, Dr. Evan Hirsch, who is an MD who specializes in chronic fatigue and he’s become a good friend of mine. He actually works with us to some extent in The Energy Blueprint and he’s also got his own brand and his own program an approach to helping people with chronic fatigue and specializing, especially in people with chronic fatigue syndrome and severe chronic fatigue. He does wonderful work and I’m amazingly grateful to have him as a partner and someone who we can work together to help everybody who needs help. With that said, obviously, there’s two other podcasts for you guys to listen to with great content but we’re going to get into even more great content in this podcast. His official bio, he suffered with fatigue for five years before he achieved a resolution using the Fix Your Fatigue Program that he pioneered in his medical practice. Through his best selling book and online programs, he saw thousands of people across the nation optimize their energy and he’s on a mission to help one million more. He’s board-certified in family medicine and integrative medicine. When he’s not at the office, you can find him singing musicals, dancing and playing basketball with his family. Welcome my friend, it’s such a pleasure to have you again.

Dr. Hirsch: Thanks so much for having me on Ari, it’s always a pleasure. 

Why many are stuck in chronic fatigue despite their recovery efforts

Ari: Talk to me kind of the big picture of– You work with a lot of people with severe chronic fatigue, as I said, and chronic fatigue syndrome. In many cases, these are people that have tried lots of other things. They’ve been to conventional doctors, they’ve been to naturopaths, they’ve been maybe in some cases to other functional medicine doctors. They’ve tried all kinds of things, they’ve tried everything from veganism to [unintelligible] to maybe even carnivore, if they’re really on it lately and they’re not getting results, they’re not getting resolution of their fatigue and getting their energy back. Why do you feel people are still struggling with this chronic fatigue problem despite trying so many different things, trying so many different diets and therapies?

Dr. Hirsch: It’s such a great question and it’s so important because I see this all the time. People are like, “I’ve tried everything. I know you can’t help me because I’ve tried everything.” And it’s like, “All right, well, what are your causes?” Because what I found is that it all comes back to the causes. When you actually know what your causes are, then you can really dive in and tailor your treatments specifically to what the causes but if you don’t know what your causes and you’re going ahead and you’re doing a number of whatever treatments that maybe are research-based, maybe or not but are supposed to be helpful, then you’re not going to be successful. If somebody doesn’t have heavy metal toxicity and you’re doing a heavy metal chelation protocol, it’s not going to help that person. Or if this person doesn’t have mold and they’re doing a mold protocol, you have to know what your causes are in order to be able to remove them and actually have success in what you’re doing.

Ari: I remember from one of our past interviews, maybe the first interview, you gave the analogy of if someone has 16 nails stuck in their foot and you only throw a more random approach, you only end up pulling out two or three of the nails or maybe even five or six of the nails while you still got 10 left in there. Again, coming back to this importance of being able to zero in on what are the unique root causes for that particular individual. With that in mind, how do you conceptualize this broad landscape of all the different potential causes that someone might have of their chronic fatigue because this is a symptom, like a fever, right? A fever can be a symptom of lots and lots of different kinds of infections, everything from a urinary tract infection to a cold, to the flu, to AIDS to Ebola, to the coronavirus. Understanding that fatigue is a symptom that’s like that, it can be caused by many different factors, how do you break down this landscape of the causes of fatigue?

Dr. Hirsch: I try to go broad, I know that if I’m looking at every single potential cause of fatigue, then I’m not going to miss anything but like you said, that’s incredibly exhaustive and so we also have to look at common. What are the most common causes of fatigue, while at the same time trying to leave no stone unturned. When we go into the causes, we’re going to talk about breaking them down into different categories but at this point, I have found there’s like 33 different causes that I want to look at. Based off of somebody’s symptoms, if we’re looking at their subjective experience and their symptoms and then we’re looking at the labs and we put those together, that’s going to help us narrow that down even more. I know that the broader that I go and this is what I saw over time, is that I would get people better to a certain point and then I would be like, “Okay, I can’t get them the rest of the way better. What am I missing?” I would learn that, I would add that into the causes list and then I would address it and then that person would get even better. Then the next person I’ll be like, okay, I can’t get this person better, what is it? I learned something else, I try it out on them. If it works, okay, great, now that’s another cause. Just trying to get as broad as possible so I’m leaving no stone unturned so that it may take longer to get there if we’re assessing all of these causes and it may be expensive in terms of looking at the labs but we’re going to get there. That’s the whole point, is that people have been suffering for three, five, ten years, who cares if they’re spending six months finding the causes, right? You’re going to find the causes, you’re going to be able to then resolve them.

The most common causes of fatigue

Ari: Obviously, 33 is a lot but maybe list out the top five or eight or ten most common causes that you found of fatigue and understanding that there might be some rare exotic infection that’s maybe the sole cause for one person. Maybe they did a trip to Africa a year ago and now they got infected with some weird parasite and that’s the cause of their symptoms. Barring those 0.1% of cases of fatigue, what do you think are the 80%, the 80/20 rule, what do you think are the main root causes for let’s say, 80% of people dealing with chronic fatigue?

Dr. Hirsch: What we’re going to talk about is I’m going to group these into 10 causes or 10 categories of causes and those are really in classifications of deficiencies or toxicities. Deficiencies are things that aren’t in the body that are supposed to be in the body and then toxicities are things that are in the body that aren’t supposed to be there so that helps to simplify it a little bit. Then in terms of the deficiencies, we’re looking at deficiencies in hormones and so that’s adrenal, thyroid, sex hormones. We’re looking at deficiencies in mitochondria which I know you know way more about than I do. We’re talking about deficiencies in nutrients like vitamins and minerals. We’re talking about deficiencies in lifestyle factors so not enough sleep, not enough exercise or movement, not enough good healthy food, not enough water. Those are the main deficiencies that we’re looking at. Then when we’re looking at toxicities, we’re looking at heavy metals that over 100,000 pounds of mercury are dumped into our oceans, Leads, arsenic, we’re talking about chemicals, 84,000 different chemicals we’re exposed to on a regular basis. Most of those haven’t been tested by the FDA. We’re talking about molds, over half of the buildings in this country have water damage and a lot of those have molds. We’re talking about infections. Over 300,000 people who have been infected with Lyme type illness according to the Centers for Disease Control. Then additional other type infections beyond just lyme or borrelia, bartonella and Babesia and Anaplasma and then bugs in the gut like certain bacteria, bacillus and yeasts, then there’s parasites and emotions. It’s like a big picture of those 10 and then–

Ari: Did you say parasites and emotions?

Dr. Hirsch: Yes, I didn’t need to group those together but– [laughs]

Ari: It was funny, we listed off so many different specific species of microbes and pathogens and then you’re like and emotions.

Dr. Hirsch: Yes, I shouldn’t gloss over it because emotions are so, so, so important of what I’ve learned and I actually didn’t think emotions were that important when I first started out because I was MD and even though I was open to it, it really wasn’t my bag. My wife is a mindfulness coach and what I’ve seen the more that she’s taught me and the more that I’ve learned about mindset, about limbic retraining, which is this part of the brain that’s responsible for emotion and memory that when we adjust those things, people are so much more successful.

Ari: Absolutely. That’s a really nice breakdown of this whole landscape. There’s a couple of ways we can go from here. I know, obviously, you have a clinical practice, you’ve been in clinical practice, for what? A decade or something like that or more?

Dr. Hirsch: 15 years.

Fix Your Fatigue Program

Ari: You have a particular protocol and system for how you go about this when you’re working one-on-one with a patient. I know also that you are about to release your new program on helping people with chronic fatigue and it’s based on the same system. I’m curious– let me ask you how you would go about helping people identify what are their unique causes, what are their unique deficiencies and toxicities of the things that you just listed in a one-on-one setting and how are you going to do it in the context of your new online program?

Dr. Hirsch: That’s a great question because that was something that I struggled with. How do I translate what I’m doing in my one-on-one into an online course? I’ll tell you exactly what I did. I created a workbook. It’s basically a 72-page workbook that takes them through the exact thought process that I do. When assessing the causes, we always want to look at the subjective, plus objective. We want to look at the symptoms plus the labs and physical exam if that’s present. What I did is I created checklists. I can actually share my screen with you if you’re interested and I can walk people through this process.

Ari: Yes, please. We’ll put this on YouTube. Anybody who wants to see it, there’ll be people who are just listening to this. Just communicate it in a way where those people can follow along if they’re just listening and not seeing the visuals, but yes, I would love for you to do that.

Dr. Hirsch: Okay, great. Okay, so this is the workbook. Step one of my process is to assess the causes. That’s what we’re talking about here. We’re going to be looking at the symptoms as well as the objective and so there’s this page here that I have on the causes of fatigue. We just talked about all the deficiencies and we talked about the toxicities. What’s really important too, is if you see these pluses and these minuses next to them, is that I found that 75% of all of these causes can be determined by symptoms. You know how imperfect labs are and so it’s really important to try to collect all the potential data that we can, and it’s great when we’re good at assessing for symptoms. The pluses are symptoms, got the key down here. The minuses are laboratory tests, and then the equals are both. That you actually know where to spend your money too because that’s the thing too. You could spend $4,000, get a whole bunch of labs, and yes, it’s going to help you, but what are the most important labs to get, and they’re going to be the ones that have the minus signs right next to them and that’s some of them over here in the toxicity section. These are all checkboxes because as we go through this process, you can come back up to the cause, and you check it off because then you know what to fix in step two through four, which it’s a four-step process. The first step is assessing which is what we’re talking about now. Step two is replacing these deficiencies. Step three is opening up the detoxification pathways so that we can do step four, which is removing the toxicities.

Ari: Got it.

Dr. Hirsch: If we’re jumping in here to the deficiencies and we’re looking for adrenal dysfunction, as you know, labs, not so good. We’re looking for what is the normal function of the adrenal gland, we know that it produces aldosterone, which is responsible for salt balance and it’s responsible for regulating blood pressure and we’ve cortisol regulating circadian rhythm and stuff like that. We know what the function of is of these hormones, and so we can look at what the dysfunction is. These are a lot of the symptoms that people will experience. Then there’s some lab tests that can be done. You and I have talked about some of these and they’re not great tests, but they’re part of what we have right now, but they are actually– [crosstalk]

Ari: I would say cortisol testing is quite accurate. The issue is it’s just arguable to what extent cortisol levels really correlate well with fatigue symptoms explicitly, but the tests for cortisol levels are quite accurate, but yes, some of the other ones DHEA, I couldn’t comment on the accuracy of that. Adrenal dysfunction it’s just a controversial one, but it does exist and as you mentioned circadian rhythm, I definitely think I did a lot of digging into that subject. I think circadian rhythm dysfunction, probably more than anything, that’s what correlates with low morning cortisol levels. If somebody has low morning cortisol levels, it’s a really good potential indicator of circadian rhythm disruption.

Dr. Hirsch: Right. For me, symptoms are so much more important than the labs anyway on so much of this stuff. I put together all of it here in the educational section. In my experience, it’s likely that someone has dysfunction if they’ve got five or more of the above symptoms, and then it can be corroborated by the labs. Someone can look at this and they can say, “Okay, so in conclusion, do I have this cause or don’t I have this cause?” If they say, yes, they mark it off here, they go back up to the causes page, and they can mark it off there so that they know, okay, I’ve got this cause and then I can move on to step two through four once we get there.

Ari: Nice. Take me through some of the other ones.

Dr. Hirsch: We’ve got mitochondrial dysfunction. A lot of these are pretty nonspecific, you can do some levels glutathione, COQ10, the 8-hydroxydeoxyguanosine or whatever, but I find that everybody who’s got fatigue requires mitochondrial support and so this would be a yes. They mark it off on the first page, and then thyroid deficiency or thyroid dysfunction. I’ve also asked strict some of the most important symptoms and when we go down to and I’ve got my–

Ari: Just for people listening who are not seeing this on YouTube, under thyroid dysfunction, he’s got a list of symptoms. For example, obviously fatigue, cold extremities so if your hands and feet are cold often, hair loss, dry skin and hair, brittle nails, difficulty losing weight, weight gain, blood sugar or blood pressure issues, depression, anxiety, there are a number of symptoms there that are potential indicators of thyroid and he’s also put an asterisk next to the ones that are specifically the best indicators of thyroid issues. Then below this list, if your symptoms match up, then you can do a particular lab test to corroborate whether those symptoms are likely coming from abnormal thyroid levels TSH T T43, and so on, and then, based on that as you’re going through this workbook, then you would mark yes or no and say, yes, thyroid deficiency, I do have that going on. This is likely a cause or contributor to my fatigue issues.

Dr. Hirsch: Absolutely. People also don’t know what labs to do. I tell them exactly, I’ve got a lab store, and I’ve got a supplement store so I can tell them exactly what labs to get. The lab will come directly to your home if it’s a kit, otherwise, it’ll be something you can just print off and take to your local blood lab. On the supplements, I tell you exactly which supplements to get and all of these– this whole workbook, I’ve divided into videos as well. I have videos going through this workbook as well so people can watch that. They can make comments below if they have questions. They can ask questions in the Facebook group and I will answer it or somebody on my team will answer it.

Ari: Excellent.

Dr. Hirsch: Go ahead?

Ari: Do you want to keep going through more of this workbook. [crosstalk] Is any other maybe some of the more remarkable pieces of this that you want to point out, obviously, I’m sure, going through this in detail, the whole thing could take up an hour or more easily. I want to make sure I’m not cutting you off, and also make sure that we can keep going.

Dr. Hirsch: Yes, absolutely. Definitely jump in and catch me because I get so excited about this stuff, and I just get on a roll. Just let me know what’s going to be the best use of our time. I’ll jump into some of the stuff that’s more significant in a minute, but I also did want to mention that I also put in exactly the range that you want on these lab tests, but I have found in 15 years of practice, that are optimal ranges, most of the ranges that you’re going to see, that are “normal ranges” are actually just population based ranges. They’re everybody who’s taken a lab test and they put them into a bell curve, chop off the top and bottom fifth percentiles and call that normal. That’s definitely not normal. We want optimal and so you get my optimal ranges with this as well. So you know exactly how to interpret the labs. If you have any questions, you can always ask and so that we can get you the data that you need so you can make the determination about having a particular cause and then how to fix it.

Ari: Excellent.

How nutrient deficiencies and hormone imbalance affects your energy levels

Dr. Hirsch: Then we talk about estrogen deficiency, estrogen dysfunction, same thing again, symptoms, asterix, how to do the laboratory testing, how to interpret the labs, and then the education and the conclusion. Same thing with progesterone. Same thing with testosterone, nutrients. I go through it for all these, I’m trying to get to the toxicities [crosstalk].

Ari: He’s got B12, he’s got vitamin D. I’m sure you have maybe magnesium in here. There you go, on the very next page.

Dr. Hirsch: Magnesium is a favorite one.

Ari: He’s specifically taking you through symptoms that are indicative of deficiencies in those vitamins or minerals as well as the tests that you can do to verify whether you have a deficiency or potentially toxicity something like iron might be toxicity and iron that you might want to test for. For some of these, the lab tests really matter. As an example, magnesium, you really want to measure intracellular magnesium inside of red blood cells, which is a very specific kind of test that you need to get done. There are some kinds of tests that you might test for certain kinds of vitamins or minerals for example or hormones or neurotransmitters that just aren’t good data and so it really matters the specific type of test that you get. Just having access to Dr. Hirsch’s list of which tests are the good ones that you want to get and which tests are a waste of money is itself extremely valuable.

Dr. Hirsch: Absolutely. Then we get into the lifestyle stuff. Sleep deficiency, a lot of people are like, “Well I think I sleep fine.” They don’t realize that if they’re not sleeping seven to nine hours of uninterrupted sleep and they’re not getting into deep sleep and they’re napping during the day and the blue light blocking and all this sort of other exposures that they might be exposed to that it’s actually an issue for them. What’s interesting is that a lot of the causes of fatigue are also causes of sleep dysfunction and that’s why they go hand in hand. Then making sure that you’re drinking the right amount of water, assessing whether or not they are in fact drinking enough. We do that. We can also look at certain labs to determine what their kidney function is because there’s a certain ratio between your BUN or your blood urea nitrogen and your creatinine will determine also if you are dehydrated. That’s a nice laboratory confirmatory marker and then what I call a good food deficiency. If people who are not eating enough good food, you know, if you’re eating too much grains– I have a little questionnaire for you here, if you’re not consuming enough organic, if you’re consuming too much gluten, dairy, corn, sugar, alcohol, stuff like that. Then there’s actually labs that we can do to look at the amount of pesticides, the amount of glyphosates, which is the main ingredient in roundup. Then I tell you exactly how to do that lab test because oftentimes with this testing, you want to provoke it. They’ll oftentimes, with a lot of this toxicity, it’s housed inside the organs and the tissues and that if you just do a blood test, if you just do a urine test, you’re not going to find these chemicals. You have to push them out of their hiding places and then assess in the urine.

Ari: I have a quick question for you to interrupt your flow here.

Dr. Hirsch: Please do.

Ari: Just taking this particular page as an example of this good food deficiency. Some of the signs that you have listed here are, I do not consume whole fruits and vegetables. I consume lots of grains and processed food. Less than 80% of the food I consume is organic. I consume gluten, dairy, corn, sugar or alcohol every one to two days. We have those. Below those you list these two lab tests that you could possibly do. Obviously, to go through this entire list of potential causes and do all the lab tests that you have listed here would be, I’m sure many, many thousands of dollars, if not well over $10,000. My question would be, do you have a system here of first you ask people to go through and check the signs and symptoms and only then if those are, if they’ve checked a lot of boxes there, then you do the lab test for confirmation? Or are you saying just, “Do the lab tests for everything?”

Dr. Hirsch: It really depends on the individual. Obviously, if you do all of the lab tests in the lab test generally costs around $4,000 to get all of them done which is still a lot of money. The sooner that you do all of those, the sooner you’re not going to miss anything. However, like I said, 75% of the causes can be determined by symptoms. Generally, I say, okay, if you’ve got a budget, do the 75% and I have all of those. That’s 75% of 33 causes. That’s still a lot of the causes that you can assess. Then if you’re fixing all of that stuff and you’re not having success, then you can go ahead and you can assess some of those other ones. You can budget out the other ones and that’ll cost you just for those is probably less than a thousand dollars.

Ari: Got it. One thing I missed as you were scrolling through, did you have one that was sleep deficiency?

Dr. Hirsch: I did.

Ari: Okay. I’m curious if you had any tests listed for that one. Are there any lab tests that you use to assess for sleep deficiency?

Dr. Hirsch: I don’t believe. What I find is that I can actually get more people to sleep at night by giving them things in the morning that they’re deficient in.

Ari: Absolutely.

Dr. Hirsch: B12, thyroid, adrenals, I don’t give them iron in the morning if they’re taking thyroid. All of those things can be incredibly helpful for resetting the circadian rhythm.

Ari: Yes. Not to mention sunlight, more sunlight in the morning.

Dr. Hirsch: Absolutely. All those things that you talk about in more detail and then an abnormal sleep study can also be helpful.

Ari: Yes. That’s true. That would be a relevant study to recommend for sleep if you actually tell him to get a sleep study where they go to the lab and have EEG monitors hooked up to their brain to check for the phases of sleep. I think there’s some kind of at-home sleep tests that there’s a company doing now as well. I don’t know if the data is really as high of quality as a more formal sleep study, but it’s an interesting idea to make that kind of test more accessible to people.

Dr. Hirsch: They’re looking at oxygen desaturations overnight and then they can put somebody up with a CPAP or BiPAP. That’s the only utility of that test really. Because most of the time when we do all this other stuff that you and I talk about for sleep, naturally their sleep is going to improve and a lot of those markers improve. It’s really only about the sleep apnea that you want them to get a CPAP for. Generally, as they do this work and as they improve their overall health and they lose weight and whatever, then they stopped snoring and they no longer need the CPAP. It can help initially.

Ari: Got it. What else do we have going on in here?

How neurotransmitter replacement can help improve your energy levels

Dr. Hirsch: Yes. It’s just about time to jump into the toxicities. Neurotransmitters, I’m still out on. Spoken to a number of different practitioners that have found that replacing neuro-transmitters is incredibly helpful in resolving fatigue. It’s hit or miss for me and so I’m still hesitant. I don’t talk about it a lot, but I do have some information in here on it for some people who may respond better to it, who do want to test their neurotransmitters.

Ari: I’m also under the impression that the urine neurotransmitter tests are not super accurate or valid data and don’t necessarily– You do get data that tells you indications of serotonin levels and glutamate and dopamine and things like that but there’s a question. I think it’s controversial as far as my understanding of how valid that data is.

Dr. Hirsch: Absolutely. Most of the time you can determine what somebody is deficient in based off of their symptoms. If they’re more depressed, then low serotonin usually, if they’re more anxious, low GABA, if they’re more angry, oftentimes that can be dopamine or if they have some addictive tendencies. Oftentimes you can treat based off of that but yes, it is hit or miss and it’s still band aids at that point too.

Ari: I want to just point out something for emphasis. There are cases, quite a lot of cases, I think, where symptoms can actually be a better indication of a problem than a lab test. This neurotransmitter example is a really good one. We know certain symptoms correlate really well with certain neurotransmitter imbalances, whether it’s serotonin or dopamine and things like that. As I said, the actual lab test, which one would think it’s intuitively you think, that’s more accurate, it’s much less crude,

it’s much more sophisticated and more advanced, more scientific, more cutting edge, that should be giving me much better data than what I could do just by looking at a checklist of symptoms, but in fact, in a case like this, the checklist of symptoms is really probably arguably better data, I would argue better data.

Dr. Hirsch: Yes, and I would agree with that for almost every single one of these causes.

Ari: Wow.

Dr. Hirsch: Even in medical school, I learned that 90% is history and symptoms, 5% is physical exam and 5% is laboratory data, and so most docs forget that, but that’s been tried and true for years and years and years.

The importance of exercise for fixing fatigue

Ari: Yes. Especially in the way functional medicine has gone. The origins of functional medicine are wonderful but there are a lot of practitioners that I see more and more today who are not on board with what you just said and who are really just– they just run a battery of lab tests and just have their cookie-cutter templates for whatever results come back negative and they’re not doing this more in-depth that you’re talking about that’s really more based on clinical expertise, and it’s about correlating the symptoms and putting even more emphasis on the symptoms and then just using the lab tests to corroborate the findings and the suspicions based on the symptoms.

Dr. Hirsch: Right. Yes, it is unfortunate. And then movement or exercise deficiency, and as most of you or a lot of you may know, that you may not be able to exercise. It’s good to always get some movement. Even if you can’t, movement is really the panacea of so many things, and it’s so important for detoxification and lymph flow and so many other things, mood. Move as you can, but don’t be put off by the fact that you can’t exercise to the nth degree because oftentimes, I see that and that just makes people– if you feel worse after you exercise, you’re exercising too much.

Ari: Yes. And this as a quick digression, but you also have listed here if your fatigue is causing your lack of exercise, then don’t start exercising until your energy improves up to a six out of ten. In other words, if you’re not at a six out of ten, maybe don’t incorporate exercise into your regimen at all. I know that there’s some mixed opinions on that among chronic fatigue syndrome experts, there’s sort of mixed opinions on whether these people should or should not be doing exercise. So what’s your take on that principle?

Dr. Hirsch: I’m a fan. I learned about hormesis from you, and I’m a fan of exercise for hormesis, but I’ve also seen that if the activity or whatever it is, stresses the body and the body can’t deal with the stress and it just makes somebody worse and they’re not able to progress, then it doesn’t make sense to do it.

Ari: Yes, 100%. Yes. The dose matters too. Some severe cases, I think there are people who just can’t tolerate any, not even a little bit of hormesis. I’ve seen even with something like red and neon-infrared light therapy, which is much more gentle than exercises, there are just really small subset of people, maybe 1% of people who will react negatively to even a minute or two of red and neon-infrared light therapy. So, yes, for sure, I agree with you.

Dr. Hirsch: Oftentimes, I tell them, like you said, dose, it’s all about decreasing the frequency, like if you’re exercising every day, go to maybe it’s once a week or three times a week and decrease the amount of time, the duration that you’re actually doing it. If you can get away with doing 15 minutes, three times a week, and you don’t crash that day or the next day, then that’s a good dose for you. Then you want to increase by maybe a minute every couple of weeks, and so you can work your way up to while you’re also doing a number of these other things that are building you up. So it’s a good combo.

The importance of proper bowel movements

Ari: Yes. Lab tests again, obviously, for physical movement, no lab tests that one can do, which is again, it’s just to point out to people, you could do a whole battery of $20,000 of all the fanciest lab tests in the world, but none of those results would give you a piece of data that would tell you this person is sedentary as opposed to not exercising, so which is a really– we know that physical movement and exercise is one of the most powerful medicines that we could possibly do for our health, and no amount of lab testing could actually clue us into whether that person is– this is a root cause of their issue or not. Just again, to point out, your approach which really puts a lot of emphasis on symptoms, which of course I agree with 100%, and then using the lab tests to confirm or rule out certain specific things where we have good lab tests to help with that.

Dr. Hirsch: Absolutely. It’s a good point. So then let’s jump into the toxicities, which are really where it’s at because all of the deficiencies that we just talked about, really, for the most part are caused by the toxicities. I tell people that we replace the deficiencies as step two because it helps you feel better faster, you’re actually able to engage more with your life, you’re feeling better, and you’re able to then go into step three and open up the detox pathways, and then go into step four, which is removing all the crap that’s in your body. You have to go through this process even though replacing those deficiencies is really a band-aid approach, even though it is more of a natural band-aid approach. The first thing is constipation because if you’re not pooping, you can’t get stuff out of the body, right? So you have to be able to get stuff out of your stool, out of your intestines. You have to be able to pee out the toxicities that your body accumulates. You want to be able to sweat it out. You want to be able to exhale it out or breathe it out. Those are like our main routes of the natural detoxification. And so if you’re constipated like I was most of my life growing up, I thought pooping once a week was normal. Oh, my gosh. If you’re not pooping every day, at least, ideally twice a day, then all you’re doing is reabsorbing all the toxins that you’re trying to get out of your body, and so you have to make sure. So we talked about constipation, and I list off the symptoms, here are the symptoms of constipation, you may have some of the symptoms, there’s no lab tests to do, there’s no laboratory data to interpret. Then in my experience, it’s likely if you have constipation, if you have the above symptoms, and basically, you’re not having a bowel movement every day. Two is ideal, one is okay as long as it’s a good one.

Ari: I usually have two before we get to noon.

Dr. Hirsch: Nice.

Ari: Yes.

Dr. Hirsch: That’s awesome.

Ari: I think this is the first time I’ve spoken publicly about my bathroom habits, so this is a first on the podcast.

Dr. Hirsch: Awesome, awesome. Your secrete– well, I was going to say your secret’s safe with me, but now it’s out.

Ari: It’s definitely not only safe with you.

Dr. Hirsch: Well, I can say also that I now stool two to three times a day, and for somebody who was once a day until I was like 22, that’s an amazing accomplishment.

Ari: I could never. I’ve never been more proud of you my friend.

How mold affects your energy levels

Dr. Hirsch: Thank you. It’s amazing. So then here’s an important one so this one is really one that– we’re talking about mold for those of you can’t see the page. It’s really important to look at. You can definitely look at the symptoms, but here’s one where the laboratory data is really helpful. So fatigue, muscle weakness or cramps, joint pain, and stiffness. Sinus issues can be pretty specific, nosebleeds, in particular, chronic sinus congestion. You can have a chronic cough. You can have itchy ears or itchy anus. Oftentimes those can be yeast or mold-related. You can have a number of neurologic things. Dizziness, disorientation, tremors, paralysis, numbness, tingling, mood swings, brain fog, and mold sensitivity, where basically you go into a moldy space and you can immediately smell mold, or you know that you react to mold. Yes, the ability to smell mold on entering a space. So those symptoms can be pretty specific, but it’s always really helpful because mold is one of those things that you don’t want to wait six to 12 months down the line and be like, “Okay, we’re not getting the success that we want. I really wish that we would have looked at mold in your home and looked at mold in your body.” Generally, we can just look at mold in your body initially. If you don’t have any mold in your body, then you’re not going to have any mold in your home. If you have mold in your body, and then you look at in your home, if it’s in your home, then that mold could have come from the current home that you’re in or could have come also from a previous home. If you’ve got it in your body, you don’t have it in your current home, then it means that you got it in a previous home.

Ari: How long does it stay in your body?

Dr. Hirsch: Forever. So you can be– you could have been exposed at the age of five, and if you weren’t taking binders and glutathione and getting a lot of this stuff out, then it’s just going to stay because it’s just a nice warm, moist environment.

Ari: The actual– so the actual mold, not the mycotoxins, but the mold itself is growing in the body?

Dr. Hirsch: Sorry, mycotoxins.

Ari: Okay. But, how could the mycotoxins stick around for years?

Dr. Hirsch: They just do. If somebody is– and it’s possible that they will be removed at some point, but the detoxification process is so slow because they’ll be somebody who, let’s say we test their home and there is no mold in their home. Granted, once again, all tests are imperfect but let’s say it’s a good test. There’s no mold in their current home. Let’s say we know that there’s no mold in their previous home, but they said, “Every year growing up, our basement flooded and it always smelled funky.” They’ve got molds in their body. I don’t know. All I know is that that seems to be the culprit. It doesn’t seem to be anything that they’ve been exposed to recently and so whether it’s the mold that is just proliferating and then producing the mycotoxins or whether it’s the mycotoxins, I don’t know, and I’m not sure that we actually really do know, but I do know that when we make sure that people are not in a moldy environment, and we remove the mold out of their bodies that amazing things happen and that you can’t– I digress a little bit, but you can’t get rid of infections if you have heavy metals, chemicals, and molds present. They just hijack the immune system. You have to have a somewhat intact immune system to work with any of the antimicrobials that you’re going to use in order to get rid of infections. There’s been several studies on this, specifically with mold and Lyme where people had both, they remove the mold, and the Lyme goes away as well because you’ve recruited that immune system to be helpful.

Stealth infections what they are how they affect your energy levels

Ari: With that in mind– We only have a little less than 10 minutes left. You just mentioned infections. I know that’s a big part of what you do. We’ve talked about it on past podcasts. Can you just briefly go over some of the key infections that are sometimes big causes for people with chronic fatigue and what tests are useful in those cases? We’re skipping over heavy metals here, various other chemicals. I’ll just list them off here as we’re going through this. Now we’re on stealth infections.

Dr. Hirsch: Right but we’re going to go into the specifics of the stealth infection. Really important stuff and even the Centers for Disease Control talk about how these infections really are clinical diagnosis. There’s a conglomeration of symptoms that you can look at that can determine whether or not you have this infection and that the western blot test and is really an epidemiologic study, it’s not for diagnosis according to the CDC. With borrelia, you cannot have borrelia unless you have symptoms that come and go. Basically, you have good days and bad days. Generally, you cannot schedule something because you don’t know whether it’s going to be a good day or a bad day.

Ari: Real quick, borrelia, just for people who don’t know, is one of the key microbes responsible for Lyme disease.

Dr. Hirsch: Correct. It’s actually what Lyme was when the– Lyme Connecticut, 1984 or whatever. They found borrelia burgdorferi, named for the pathologist Burgdorferi. That’s why it’s called Lyme but it’s really when people are talking about Lyme, they’re always talking about borrelia. Sometimes they will talk about Lyme and it’s co-infections as Lyme. We’ll talk about some of those other co-infections now. You just have to be careful about what they’re actually referring to. In this case, we’re talking about Borrelia burgdorferi. The symptoms will come and go so you have good days and bad days, and then you’ll have symptoms that will move around the body. If you have joint pain, muscle pain or nerve pain, like electric shocks or whatever, they will move around the body. Sometimes it’s within a day. Let’s say you wake up, you’ve got shoulder pain and then a couple of hours later, you’ve got knee pain, it’s moved to your knee, a couple of hours later it moves back to the shoulder or whatever. Or it may take several days or several weeks to switch. It’ll be shoulder pain for a couple of weeks, and then it switches to knee pain for a couple of weeks or whatever. If you don’t have those symptoms, then you can’t have Borrelia. There’s really not much that actually causes those sorts of symptoms. That can be really helpful. I do like the– If you are going to do a lab test, the urine PCR test, the test that are Lyme panel, as long as it’s provoked with lymph massage or 30 minutes of exercise prior, can be helpful, but the symptoms really are where it’s at. That looks at several different species and subspecies as well as, different families which can be really helpful. Then Anaplasma or ehrlichia, they’re both the same thing with a different name. You’ll have a high fever, headache, fatigue, and musculoskeletal pain but then you’ll also have some of these others that some of the others don’t have. You’ll have low white cell count less than four, you’ll have a low platelet count less than 150 and you’ll have elevated liver function tests. That helps tease that one out. That’s one where the laboratory data can be helpful. Then Babesia is a Lyme co-infection. This is Babesia microdial that we’re looking at. Sweating is a really big one where people will have day sweats or night sweats. Oftentimes, people, they’ll run hot, they’ll generally say, “I’m the hottest person in the room.” It’ll be like 20 degrees outside and they’ll be outside shoveling snow in a T-shirt. Or they noticed that they’re constantly feeling like they have to take off their clothes because it’s so hot and everybody else’s is much cooler than they are. The night sweats, they’ll soak the sheets. They’ll have lung issues that they can’t explain like sometimes it’s shortness of breath or air hunger where they feel like they can’t get enough breath. Then the sleep is usually awful, hard time falling asleep, hard time staying asleep, then the mood stuff is really bad. This is anxiety to the point of panic. Oftentimes they are crying at me on the phone, depression to the point of suicidal thoughts. Generally the people who do commit suicide usually have Babesia because it makes you feel so incredibly hopeless. Unfortunately, treatment–

Ari: Needless to say if this is one of the causes of fatigue and these other symptoms for you something like this is extremely important to address urgently because it literally could be life-altering in the truest sense of that word to address this or not address it.

Dr. Hirsch: I feel very fortunate because the formulas that I use especially for Babesia work incredibly well. They’ve turned things around. There’s some that aren’t 90% and the one for Babesia works really well which is really nice. Then Bartonella is a big one too that I have spoken on before. Cold hands and feet that’s not related to thyroid. If the thyroid has been optimized and they’re still cold hands and feet. Oftentimes, they’ll get occasional fevers, usually at night. They’ll get pains in the bottom of the feet. This can be if you’re walking around your house barefoot and you’re like, “I wish I had slippers on,” to the point of burning on the bottom of the feet or pain in the feet. Sometimes in the bones of the feet, sometimes in the bones of the hands. Sharpshooting knife-like headaches, sometimes joint pain in a single joint. The muscle cramps are pretty typical, whether it’s a cramp in the calves, usually at night or it can be cramps in other parts. Oftentimes, those cramps can be relieved by taking potassium or drinking enough water and you’re like, “It’s just dehydration.” Well, sometimes it’s not. Then you also can get some sleep issues. You can get some anxiety and depression but they’re not as bad as Babesia. Then Epstein Barr virus is a big one and some of the other viruses cytomegalovirus, which can also cause mono. If somebody had mono, it could have been from Epstein Barr or it could have been from cytomegalovirus. People don’t realize there’s a cytomegalovirus type of mono that can occur. HHV-6 is another virus. They’re pretty nonspecific. Fever, swollen lymph nodes, fatigue, memory loss, and brain fog. There are some labs that you can get on this too. Unfortunately, the best labs for this are serology tests because looking at the immune system’s reaction to these bugs, which is highly imperfect but can be helpful at certain times. [crosstalk].

Ari: This is just awesome stuff. I know we could go on forever, but we’re pretty much nearing the end of our allotted time together. Obviously, this is just amazing what you’ve put together here to compile in a really systematic way all of t/he most common symptoms for chronic fatigue, especially for people dealing with severe fatigue. I think this is just an invaluable resource for people to go in. Let me just even add one more thing there for people that have severe fatigue, for people that feel like they’ve tried everything and nothing’s worked for them, to be able to really systematically in a surgical-precise way, go in and have the list of symptoms and the specific lab tests to get to corroborate if that’s a particular cause for you with all the major potential causes of fatigue just listed out there so someone can go through this workbook, fill out the workbook, fill out the symptom questionnaires, do the lab tests where necessary, and then come back with a map, just a guide, personalized guide, for what are the specific things that I need to address to finally fix my chronic fatigue. Stop fumbling around with the mishmash of a massive information online between all these contradictory claims of different diets and should I exercise, should not exercise? All just a mass of information and experimenting with this or that one thing, but to really just have this map of exactly what are the causes for that particular individual that they need to address, I think is invaluable. I really appreciate the work that you’re doing here. I’m super excited for your program that you have coming out. I’m super excited to promote it to my audience. Obviously, we’re doing that here in this show where we’re taking people through exactly what your method looks like. Obviously, in your program, you’re guiding people through this in the full forum, not the 45-minute forum. I know you’re about to release this program in a few weeks. I’m obviously going to help promote that for you because I want to help as many people dealing with chronic fatigue who have not had help as possible. I think you have a series of videos that you’re releasing for free that takes people through this. Do you have an option if people already know that they want this and this is for them, maybe we can set that up? If you’re open to it, we can set it up at Evan Hirsch. It’s H-I-R-S-C-H. If you go to We’ll set up a link to the master class where he has– if you want to go more in-depth, his free training on this. We’ll also set up a link if you know that you want this. We’ll set up a direct link to actually purchase the program. Evan, Dr. Hirsch, when is this program actually coming out? Is it the end of February or sometime in March?

Dr. Hirsch: It is just in the next week here.

Ari: Wonderful.

Dr. Hirsch: Likewise.

Ari: I really appreciate everything you’re doing and I’m a fan of what you’re doing. Thank you for sharing your expertise on this podcast with me. This was excellent. It was actually great to not just do a typical talking head style interview, but to have you do the actual screen share of your document and go step by step here is my list of causes of fatigue. Here are the specific symptoms for this and that cause. Here are the exact tests that I use to corroborate whether this is an issue for people. To go into that granular of detail and really give people the experience of what is actually in your program, I think is wonderful. Thank you for coming on the show again for number three. I really enjoyed it. I look forward to talking to you again very soon.

Dr. Hirsch: Thanks for having me on, Ari, it’s always a blast.

Ari: My pleasure. Again for everybody listening, go to, all one word, Evan Hirsch. We will set up a link to get access to his free training as well as the link to purchase the program. Thank you again, Dr. Hirsch. I will talk to you very soon. Thank you to everybody listening. I hope you enjoyed the show.

Show Notes

Why many are stuck in chronic fatigue despite their recovery efforts (01:47)
The most common causes of fatigue (06:26)
Fix Your Fatigue Program (10:15)
How nutrient deficiencies and hormone imbalance affects your energy levels (20:00)
How neurotransmitter replacement can help improve your energy levels (27:46)
The importance of exercise for fixing fatigue (30:26)
The importance of proper bowel movements (33:36)
How mold affects your energy levels (37:10)
Stealth infections what they are how they affect your energy levels (41:00)



Check out the program Fix Your Fatigue I have managed to negotiate an additional $1000 off of the price so you can get it for $997. Use the code TEB1000 upon checkout. (If you already know that this program is for you, you can purchase the program here directly!)

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