The Optimum Health Clinic’s Approach to Diagnose and Treat Fatigue (And The Fatigue Super Conference) with Alex Howard

Content By: Ari Whitten

The Optimum Health Clinic's Approach to Diagnose and Treat Fatigue And The Fatigue Superconference with Alex HowardIn this episode, I am talking with Alex Howard, the founder and CEO of the Optimum Health Clinic (OHC)—one of the world’s leading clinics specializing in fatigue-related conditions, about how they approach fatigue at the clinic as well as Alex’s upcoming event, The Fatigue Super Conference.

Sign up for The Fatigue Super Conference here.

In this podcast, Alex will cover:

  • The three stages to the healing and recovery process (It is not as straight forward as you may think!)
  • What are fatigue-related conditions?
  • The truth about fatigue testing (Why diagnosing fatigue-related conditions is difficult)
  • The different lifestyle and psychological traits that are most commonly affected by fatigue
  • How do I identify what the key driver of fatigue is for me?
  • The important role of psychology for people with fatigue

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The Optimum Health Clinic’s Approach to Diagnose and Treat Fatigue (And The Fatigue Superconference) with Alex Howard – Transcript 

Ari Whitten: Hey everyone. Welcome back to the Energy Blueprint Podcast. I’m your host, Ari Whitten, and today I have with me a new friend, who is named, Alex Howard, and he’s the founder and CEO of the Optimum Health Clinic, OHC – one of the world’s leading clinics specializing in fatigue-related conditions. With an award-winning team of 20 full-time practitioners supporting over a thousand patients in 40 countries at any one time. The OHC team have an unrivaled knowledge of what works in a real-world clinical environment for overcoming fatigue.

Along with founding and leading the OHC practitioner teams for the past 16 years, Alex Howard, is an immensely experienced practitioner himself, having delivered over 10,000 consultations working on the psychology side of this group of illnesses. He’s also led the therapeutic coaching practitioner program since 2005 training the next generation of psychology practitioners.

Along with his book “Why me?”, Alex has published research in a number of leading journals such as the “British Medical Journal Open” and “Psychology and Health”. Alex is currently leading the largest ever online conference dedicated to fatigue, “The Fatigue Superconference”, which has over 40 of the world’s top medical experts along with inspirational case studies and recovery stories and is free to join from June 10th through 17th. And this is something I’m going to be promoting myself and I’m honored to say that I’m one of the featured experts and speakers in the conference.

So, with that said, welcome, Alex. Such a pleasure to finally have you on the show.

Alex Howard:  Hi Ari. It’s a pleasure to be here. It’s quite fun on being the other side of the interview. I’ve spent the last four months interviewing all these people. I think it’s nice to be the one that’s being asked the questions. I’m not sure which job is harder, but yeah. Thank you for having me.

Ari Whitten: Well, yeah, I enjoy both of them. I enjoy being the interviewee and the interviewer, but I can imagine doing a span of 40 some interviews in a few weeks get pretty exhausting. Especially prepping for them and putting in the work to read somebody’s background and understand their body of knowledge so that you can engage with them sort of on their level in their area of expertise.

Alex Howard:  Yeah, that bit’s been quite… I would say the prepping for the interviews… and I mean, you know what it’s like with these kinds of things… That the prepping the interviews and doing the interviews, it’s challenging, but it’s kind of the fun bit. It’s all the kind of logistical project management and kind of marketing and kind of web stuff, that kind of goes alongside that. And it was kind of reassuring in a sense though. Obviously, I learned a lot in terms of doing the interviews. But there wasn’t that much, which was radically new to my knowledge, but there was lots of refinements and nuance and kind of upgrading of details.

And yeah. I’ve loved doing it and I don’t know what I’m going to do with my evenings all of a sudden. Game of Thrones is finishing and I’m not interviewing people every evening, let’s say, it’s been a lot of fun…

Ari Whitten: Nice. Tell me a little about your background as far as founding the OHC, the Optimum Health Clinic. Excuse me. How did that all begin? What was your story of how you conceive this approach?

Alex Howard:  I had chronic fatigue syndrome or ME – as we sometimes call it here in the UK – as a teenager. The relatively short version of the story is when I was turning 16 years old, I like to think of as a relatively normal teenager in a sense that I loved playing, I played guitar in a band, I loved playing sports. I had a girlfriend and I had a relatively normal life in that kind of sense. And then, one morning I woke up and it was, it appeared sudden, although of course one can look back and one can see kind of a kind of different jigsaw pieces that kind of lead to that. But I woke up one morning and it was kind of like if there’s a plug of energy that goes into someone’s body that had just been literally like someone had just unplugged my energy system.

And over a period of a kind of month or two, I was very severely fatigued. Unable to go out of the house for more than relatively short periods of time. And mainly that was to go to have doctor’s appointments. And improved a little bit over that time. And then this was over the summer holidays, having finished a set of exams.

And then as I started at a new school, I, within a kind of few weeks of starting that just completely and utterly crashed to the point that I was pretty much bed bound for a long period of time. And in time got diagnosed with chronic fatigue syndrome. And that was for a teenage boy that’s life revolved around kind of sports and activity. And you’re kind of, as a teenager, particularly the teenage boy, your friendships are kind of defined by the things that you can do with other people. Right?

So, you end up in a situation, you can’t do things, you just basically ended up completely isolated. To that diagnosis was quite devastating. And a couple of years passed. And I remember the doctor said to me at the time I was diagnosed, it might take six to twelve months to get back to kind of normal health and functioning. And I remember thinking like when you’re 16 years old, like six months seems like a lifetime.

And then suddenly two years of my life had passed. And like a lot of people that are experiencing fatigue in its different ways. I wasn’t tired because I was depressed. It wasn’t that my kind of met my mindset was the reason why I had fatigue. But I was starting to feel pretty fed up and miserable with my life, having spent two years getting seriously behind at school. Unable really to do anything with extreme exhaustion, dizziness, headaches, and the kind of one of the most frustrating symptoms could be feeling totally exhausted all day and then trying to sleep at night and then spending half the night kind of awake and having anxiety. And I basically reached the point where it wasn’t that I wanted to end my life, I just couldn’t see a future, continue with a life with the kind of level of suffering that I was experiencing.

And I had a conversation with my uncle who was, I don’t know if you’ve seen Lord of the Rings. It was a little bit like Gandalf in Lord of the rings that he wasn’t there very often, but he just seemed to always turn up at just the right moment, have just the right piece of advice and then he just kind of disappear back off into the, into the [distance again]. But he basically just asked me, what I now come to realize was very skillfully done. But a very simple set of coaching questions like, on a scale of naught to 10, how badly do you want to get better? And I was like, well, I’m nine and a half out of 10 because I’m not going to murder anyone and I’m not going to chop any limbs off yet.

I was like, but I do pretty much anything to get better. And then to make a list of all the things in my life that made me worse. There was already, I just put like, I wrote “life” as like a whole, just want to get through the day was, was kind of its own. But then a list of things that I thought could facilitate healing and recovery. And I was 18 years old at the time. I didn’t know much, but I’d read a few bits because I’ve been desperate. I think I had on there; things like meditation, making more changes to my diet, learning more about what I now know is functional medicine, but kind of nutrition. It was kind of talked about then. Perhaps doing a bit of gentle yoga. So, I had this fairly basic list of things I could do.

And he then said to me, “well, you’re nine and a half out of 10 that you want to get better. You’ve got a list of things that you’re doing. How many hours a day do you spend doing the things that you yourself have said could potentially help you get better?” And of course, the answer was “virtually none”.

And then the next question was, how many hours a day do you spend watching television? And the problem was because I felt so ill the whole time. I just lie on the sofa and watch soap operas all day. I think I was watching like seven hours of TV a day. So, it was like basically, you’re gonna end up with a Ph.D. In soap operas, but your life is not changing and it’s not going to change until you address this equation. So, I then set off on … this was a long answer to your question. It was supposed to be a short one.

But I sent off basically on a five-year journey of seeing 30 plus practitioners. I ended up improving to the point of being able to go to university where I studied psychology. I spent my entire student loan on supplements. I think I was taking 60 supplements a day at one point. I probably had the most expensive poo in Wales where I was at the university. A lot of things that I wouldn’t recommend that patients do now, but it was kind of just trying to do anything that I could to change my situation. I was meditating religiously for half an hour, an hour every day. I ended up reading 500 books on health and healing. And my recovery journey really became my life and there were really pros and cons to that right. In the sense that that obsessiveness around recovery was the reason why I think, ultimately, I did recover. But it also might have happened a bit more quickly if I had gone a bit more sensibly in terms of the pace and the attitude and the kind of way.

I just was so relentless in my pursuit of trying to get well. But I was in a sense creating stress in the process of trying to do that. Eventually made a full recovery. And on the other side, in the later years, it was a seven-year journey. In the later years, I’ve been studying psychology and I had done training courses in NLP and hypnotherapy and life coaching, EFT all those things.

And I wrote a book called “Why me? – My journey from ME to health and happiness” about my recovery journey and then basically set up an organization with absolutely no intention whatsoever in working with anybody with chronic fatigue, ME, and fibromyalgia. I had just spent seven years dealing with it. I just, I wanted to, do deal with kind of normal self-development kind of stuff. And basically…

We can come into more of the story of the Optimum Health Clinic. But really the Optimum Health Clinic was what happened while I was trying to do something else. I just suddenly became inundated by people that were in similar situations to what I’d been in that we’re looking for some kind of answers.

Ari Whitten: Well what was the original conception of, was it called the Optimum Health Clinic or was it called something else? And who did you have in mind to work with and what

Specific sort of health goals did you have in mind that you were trying to help people achieve?

Alex Howard:  So initially, I was just working as a practitioner on my own, just looking to work with people that had the usual, anxiety, panic attack, self-esteem, kind of issues. But it’s funny how things go because the website URL that I had was… I’d missed the chance to get So back then, this was back in late 2002, I think it was, there was a period where people used to have “.me.UK, like kind of journeymen. Of course, I hadn’t thought .me was also .ME, which is what we often call chronic fatigue syndrome in the UK. So, my website, it was… obviously… There was a wisdom that was that before. And then, and then I started getting people approaching me and for what I need to have an organization.

I spent a year working with my teachers as an apprentice. And because I didn’t want to set up a chronic fatigue clinic, I thought, well that’s called the Optimum Health Clinic. Let’s make it about health, the wellness as opposed to about disease and sickness. And it was around that time that I met, Niki Gratrix, who’s a mutual friend of ours who originally connected us. Niki was an accountant, Charleston counselor, prior to this. And she had relatively recently started this transition having done many workshops. And also read numerous books and sort of things and health and self-development. She just started training as a nutritional therapist, and she and I had had an amazing connection and so I knew lots of nutritionists, but I just thought she was the most instinctively best practitioner that I knew.

And even though, she might be saying she also qualified at the time. It was quite the spurious situation that she started working with patients or the personal training qualification that she had. But I just, we connected a lot intellectually, but I also, we connect with those people. But she just had an amazing way with clients and an amazing way to synthesize and organize and pull together information. So, she and I started working together and then I met, quite soon after that I met Anna [inaudible], who was the original director of psychology.

So, it was really the three of us. We were all very inexperienced in terms of clinical kind of backgrounds. We were all, I mean, Anna and I were in our early twenties, Niki was in her late twenties- early thirties but we were just obsessively passionate about what we were doing. Anna had also recovered from chronic fatigue herself. And now I look back, this is kind of 16 or so years ago now and I kind of look back and it was a bit crazy.

It’s like, the fact that we started this kind of clinic with the lack of business experience, the lack of, I’ve never had a job, I just have chronic fatigue recovered and started kind of seeing people. But people really resonated. And I think when we kind of formally set up the Optimum Health Clinic, I think in that first year we had something like 5,000 inquiries. And it was just, when you see practitioners try and start businesses and how hard that can be, we didn’t realize how unusual what we were experiencing was at the time. But it was an amazing time when we kind of shared this mutual understanding of this concept of integrated medicine, which people talk about, very freely and people will say, “yes, I’m a naturopath and I worked with supplements, therefore I’m addressing kind of mind, body, and spirit or I’m addressing the kind of the physical elements and the psycho-emotional elements. Because what we do with food affects everything.”

And what we said was, “well, you’ve got to work on all levels. And you’ve got to recognize that everyone is different, in terms of their experience. And yes, there are patterns in there are commonalities and understanding those are important.” But the kind of patient-centered approach wasn’t just a philosophy, it was an absolute kind of heart level passion in a sense that we had with this idea of pulling together these different approaches.

It worked. It didn’t always work, and it didn’t always work as quickly as we might have liked. And I can look back on cases we dealt with 15, 16 years ago and slightly cringe at the lack of depth of understanding that we eventually came to have. But we were providing something that was fundamentally different. And I think one of the things that people really also resonated with is we were somewhat controversially; we were talking about recovery. We weren’t talking about managing symptoms, we weren’t talking about learning to live with being ill. We were talking about people making recoveries. And that was seemingly quite controversial. But yeah, it also resonated with the people that wanted to be helped.


What are fatigue-related conditions?

Ari Whitten: Excellent. So, let’s dig into some of the specifics around your clinic or your personal approach to fatigue to helping people with these fatigue conditions. So first of all, give me like a broad overview of, one of the things in your bio was you mentioned these “fatigue-related conditions”. So, kind of give me the broad overview of how you conceptualize… what are the fatigue-related conditions?

Alex Howard:  So firstly, I think we have a fundamental problem in the lack of agreement about diagnostic criteria and about what these different conditions are. I think there’s an absolute lack of recognition and definition of different subgroups within these different conditions. So, it’s a kind of, one of the things I’m mindful of with, for example, with the naming of “The Fatigue Superconference” is I know we’re going to get push-back from certain communities around the fact we’re lumping all of these different conditions together. So that being things like chronic fatigue syndrome, fibromyalgia, Lyme disease — some of the coinfections that might go with that. Because there’s a lot of battle on a — very understandably —over the last few decades that people that suffer from these conditions, one to have because of how the psychiatric lobby has kind of hijacks a lot of the research and hijacked that kind of perceptions around that. This is a very strong kind of movement towards these being seen as using labels like Myalgic Encephalomyelitis as opposed to labels like chronic fatigue syndrome. Not because it’s a better label. What it basically means is brain inflammation. There are lots of people that have ME as it were that that isn’t their primary symptom in tabs of what’s going on.

But there’s this fight for these kinds of more medically defined forms of diagnosis on the assumption that we’re going to find one single pathogen that everyone’s got and we can find one single drug treatment for that pathogen that everyone’s going to be able to take and everyone’s going to miraculously get cured. And when you see things like the XMRV kind of thing, that happened a few years ago, so that everyone gets very excited about that.

And once or twice a year there’ll be a piece of research, and I’ll get an email that the press will kind of get over it and people said they think they found the cause of chronic fatigue or ME. I don’t even have to read the research to know what my position’s going to be on it. Which is even if it’s really good research and I really agree with the principles, it’s a subgroup of people.

And so, when I talk about fatigue related conditions, I’m talking about…

Ari Whitten: It’s a subgroup of people or it’s one small aspect of many aspects that are going on in a large portion of people.

Alex Howard:  That’s right. Yeah. That’s a good distinction. Thank you. Yeah, that’s right. And so, in a sense, much to the irritation of some people, I don’t draw much of a distinction between chronic fatigue syndrome, fibromyalgia, Lyme disease, not because I don’t think that those differentiations can’t be important. I think if someone has Lyme for example, you absolutely need to know they have Lyme and you have to deal with that specifically and directly. I just think that when you get too caught in these different labels, there’s a whole set of story and stuff that goes to those labels which become quite unhelpful when actually the principles of effective treatment still stand. Whatever label you’re using, you still need to understand the same key pieces. Now, you might be a different emphasis or different focus based upon some of the key factors that are going on. But I don’t think a distinction between chronic fatigue and fibromyalgia and Lyme is the way that the distinction needs to be done. I think it needs to be much more patient-specific in terms of understanding what’s actually the story of what’s happened with this person. Rarely is it going to be any one thing that’s going on? It’s a jigsaw. You’ve got to understand that jigsaw and put the different pieces together in the right way, in the right order. And label at the top is not going to be a thing that really helps you in doing that.


Why diagnosing fatigue-related conditions is difficult

Ari Whitten: Right. Yeah. It’s also worth mentioning for many people who may not know this, that there is no diagnostic test for chronic fatigue syndrome or fibromyalgia. There’s no blood test that they can do that says, hey, you’re positive for this biomarker, and therefore, that means you can officially be diagnosed with chronic fatigue syndrome. A lot of these diagnoses are made based on symptoms. And that lends itself I think very well to what you’re talking about, which is these… To some extent, these diagnoses are fabrications based on constellations of symptoms. And we say, “Hey, this rough constellation of symptoms, which may actually differ between different people, we’ll call it this thing even though we don’t really have a clear diagnostic test for that thing.

Alex Howard:  I think that’s absolutely right. And I think… we were trying to do some research a few years ago that that got complicated for various reasons around looking at ATP profiles and mitochondrial function as being a diagnostic criterion or biomarker for a subgroup of people. And I think you can certainly categorize looking at… there are categories where you know certain systems seem to be the driver of other systems in that case. So, you can see certain cases where you can go back through the kind of our model and look for the different kind of pieces. You can go “look at the primary place where this person’s symptoms are originating is for example in the digestive system. And until we deal with that piece, it’s going to be quite hard to be effective with other pieces”. In other cases, you might look at it and go “well, actually, the immune system is so overloaded by dealing with, with Lyme or co-infections of whatever the cases are going on there.

But until we deal with that, we’re not going to be able to address even potentially digestive function.” So, you do need to kind of make these distinctions. But there isn’t… there will never be a single biomarker. And as you said, effectively what diagnosis is a diagnosis of exclusion. It’s like you don’t have any of these other explanations of what’s happening, and you have the set of symptoms and you haven’t got a co-morbidity of something else which could be causing this; therefore, we’re going to give you this diagnosis.

Well, I would say the effective diagnosis is not a diagnosis of exclusion. Effective diagnosis is actually not, we can’t find anything else causing it. It’s the actually we can see all of these factors from a functional point of view that come into play. And that’s a very clear diagnosis. That’s then the pathway to effective treatments.


The subtypes of fatigue

Ari Whitten: take me into some of the… How you conceptualize, fatigue and kind of dig into the subtypes and identifying what are the specific causal factors or what are going to be the key needle-movers for a particular person. So, you first break things down into subtypes of fatigue, is that correct?

Alex Howard:  Yeah. So, we have a model. We have lots of different models, but in terms of the overall kind of model in terms of how we understand the process of someone getting sick with one of this kind of group of illnesses, is we look at subtypes, we look at stages and we look at systems. So, we look at subtypes as effectively predisposing factors in terms of things that were happening in someone’s life prior to them even necessarily noticing they had symptoms. That becomes a burden and become a load on the system. And we distinguish between what we call nutritional or psychological subtype. Nutritional could also be more broadly talked about those physical or a functional medicine’s kind of lens in terms of what’s happening. And some of you might have one or two of these, others… Often when I go through this, less people will say, “well, I have all of those”.

And we talk about it a little bit like being loads on a boat. The kind of analogy, it’s the final straw that breaks the camel’s back. It’s not any one of these, it’s a number of these together over a period of time, which becomes energy depleting to the body. So, for example, on the nutritional side, we talk about an Adrenal subtype, which is another way of talking about the endocrine system or the kind of nervous system kind of being overactivated, talk about an immune subtype, the digestive subtype, a toxicity overload subtype, and a structural subtype. And then on the psychological side, we talk about a helper subtype, achiever subtype, trauma subtype, and anxiety subtype.

And just to give a couple of lines on those, I think the nutritional and physical ones are a bit more self-explanatory in a sense. But particularly in terms of the psychological side, a helper subtype is somebody who has historically placed other people’s needs as being more important than their own. So, for example, they might get back from home one day long before getting symptoms of fatigue and they’re like, “oh man, I’m really tired. But that was a long day and I don’t know, long kind of weekend.” And then they get a phone call from a friend of theirs or a family member that’s in some kind of mini-crisis and it’s not, it’s not like the phone call. Well, this is like a desperate acute situation. This person really needs me right now. It’s more this person is looking for emotional support and I’m always the person that gives it and that person’s needs are more important than my needs, therefore I’m going to take care of that person.

So, they’re kind of putting other people before ourselves as a way of compensating, if I’m being blunt, compensating often for lack of self-esteem and self-worth. Achiever subtype being where we’re defining ourselves by what we do and what we achieve in the world. So, there’s a constant kind of drive to push ourselves to feel lovable and feel good about ourselves. An anxiety subtype is where we’ve just kind of historically had a sense of feeling a little bit either on edge or just like the world’s not really a safe place. Like there’s a kind of sense where we’re kind of always kind of second-guessing and questioning or wondering or worrying about what, what might be going to happen. And then a trauma subtype when we can talk about that is a kind of “big T trauma”, like a significant key traumatic events or what we would call a “small t trauma” kind of developmental trauma, where —Niki Gratrix talks very, very eloquently about this —but about even just the sense of just not being fully held and nurtured in the way that we needed for our nervous system to learn to self-regulate and adverse childhood experiences and the research around that obviously is a compelling body of research.

So, we kind of have these different factors. And just to kind of remind on the, there’s a kind of the adrenal or hormonal subtype, examples of that would be where we’re kind of constantly kind of, our system has been out of whack and out of balance for different reasons. The immune type may be Lyme cases where there have been various loads on the system, but it might also be just having lots of viruses and bugs and antibiotics and that sort of thing as a kid. The digestive subtype, I think it’s fairly obvious. History of things like IBS. Many years ago, often it would get diagnosed as Candida. These days people talk more about SIBO, but some of the different pieces that will happen there. Toxicity overload where we’ve been potentially exposed to be organophosphates, be it different kind of overloads onto the system of perhaps also a system that’s genetically not very good at handling that.

The structural type could be either postural things that have just been out of balance in different ways. It could be injuries that happened to the system.

But we have these different predisposing factors or subtypes as we talked about. Sometimes just an accumulation of all of these together, and it’s what we call a kind of gradual onset that someone gradually becomes fatigued and depleted over time. Other times you will have a trigger event. Like you will have that kind of that very clear final load or “final straw on the camel’s back” that could be a significant life stress like a divorce or exams or financial stress could be catching a bug light, Epstein Barr or even I’ve seen number of cases where someone, quote-unquote has a Lyme diagnosis but actually Lyme was the final straw. And if they hadn’t had all of these other factors going on before the impact would have been much less in terms of what happened. So that’s the kind of subtypes piece.


The different stages to fatigue and recovery

And then the stages piece is something that we tracked again, a number of years ago. And like all of these pieces of the jigsaw, it was like, it all sounds very simple when you explain it. [inaudible] sounds super simple when I explain it. But there’s, they were kind of certain cases that just did not make sense. And it was like, endless tearing of our hair out conversations… early hours of the morning of like, why is this person not getting better? And then there’s kind of recognition, for example with the stages model, but really, there are three stages to the healing and recovery process. And particularly this was emphasized in terms of the nervous system piece of recovery. But I think it also tracks to some of the more physical pieces as well.

There’s what we call “the crash stage”. And in the crash stage really it will be indicative of that if someone is needing a lot of sleep, that they have very, very low energy production. they will be low in terms of mood, and there might be a kind of nervous system reaction to it where there’s a kind of anxiety induced depressive piece that’s happening. But often the kind of primary characteristic is there’s this deep bodily exhaustion.

And then stage two is what we classify is tired but wired. And this was the kind of the irony that there were patients that we were, we felt they were making progress, but it could look like they were getting worse because what would happen was; they go from sleeping well to not sleeping. They’d go from being exhausted but kind of relatively calm to having an increase in anxiety. It was almost like their anxiety symptoms their nervous system symptoms were getting worse, but also like there was more energy. And what we started to realize was energy was coming back, but the energy was going into the nervous system. And so, you would see this kind of state of feeling exhausted but also kind of wired the at the same time. And what’s important at stage one is different from what’s important at Stage two.

Like the breakthrough at one stage becomes the limitation of the next stage.

So, Stage one, it’s very important to get as much deep rest as possible. One needs to be quite careful in terms of any kind of detoxing or any kind of heavy loads that go on the system. As one comes to stage two, energy comes back. You often need to increase activity but very carefully whilst very much listening to the body. Calming the nervous system becomes crucial. Often people need quite a lot of time outside of outside stimulation. So, time with themselves to be able to get that calm hidden state.

Stage three what you see as people start to come back more into the world. But actually, they come back into the world, their energy is back a bit more again. Systems perhaps a little bit calmer. Now the challenge is maintaining a calm nervous system whilst being around other people so that people are kind of relatively symptom-free at rest or in isolation. They may come back into the world and all the symptoms start, start kicking off. This is where learning how to what we call “bounce the boundaries” in terms of finding a baseline, not increase that because your mind says, “I need to do more”, but as the body has more energy, how to kind of navigate those transitions.

So that stage model is really helpful of understanding at what, what interventions are going to be most helpful from a kind of practitioner/coaching perspective. In terms of where the emphasis should be any kind of why, for example, you can take certain supplements at one stage and they’ll really help and that actually makes patients worse at other stages. And as a whole kind of science of that. They’re just, the final piece on my, if I give very long answers your questions, I just let you come back in.

The final piece is the systems piece and kind of recognizing that for different people, different system, most people, most systems are impacted but the different people, different systems are more crucial. So, the nervous system for example, what we would classify as a maladaptive stress response, which perhaps we can come to a bit more in a bit. The digestive system, lymphatic and immune system, endocrine system, mitochondrial function, energy production.

So again, identifying not just which systems are affected, but also which systems are, or which system is driving the impact on the other system. Because often if you try and work on lots of things at once, that becomes quite… and you’ve got very sensitive patients or very sensitive systems. You often have to go slowly, and protocols can take three or four, six months to get clarity. Choosing really carefully which tracks you go down can significantly shorten the recovery path.

And so, identifying which systems to work within which sequence it also can be very important.

So, there’s this kind of mapping of these subtypes of these stages and these systems as being really a kind of shorthand for us as a team of practitioners taking all of the kind of functional medicine models, all of the protocols that we’ve kind of created. It’s almost like a kind of metamodel of all the other models. So, before just seeing a patient and going, well that person’s got mitochondrial issues. Let’s jump in with mitochondrial supplements and detoxing kind of pathways or whatever to go, well, actually in this map, where do we need to start in this intervention to the way that’s going to be… cause the least likely to cause overload on the system, and it’s going to be the most efficient path to recovery.


The OHC approach to identifying the key drivers of fatigue in the patient

Ari Whitten: So, let’s dig more into that. And I want to talk more about the subtypes as well. How does that actually work as far as identifying which systems of the body you think are the key drivers? So, you basically running people through a battery of functional medicine tests and then if they have, let’s say a really poor microbiome analysis, you might start with gut health or you run them through an ATP profile test. You might start more with Mitochondria or what specifically are you measuring and how are you determining which are the key physiological drivers of the symptoms?

Alex Howard:  It’s a good question. And it’s a question that has an imperfect answer in a sense because it depends on the case and it depends upon the resources of the person whose case we’re dealing with. So, for example in terms of testing. Generally speaking, we’re really big fans of functional medicine testing. It can be a very helpful way, obviously, in terms of getting information. I think you can over test. I think you can cause overwhelm for both practitioners and clients by over testing. You can also under test. Sometimes financial resources are so limited that you can’t do as much testing as you want to do. We will always start with a very detailed clinical questionnaire and part of our experience as being able to take a questionnaire and see certain kind of red flags. Or see certain kind of pictures or certain kinds of patterns as it was, which will inform where we’ll start and where we’ll go.

So, in a sense of the kind of combination of an intuitive like understanding a case. And that’s often, I think intuition is just a lot of logic and rationale that’s been very well honed, that becomes kind of unconscious competence in a sense. But kind of pattern recognition process. We will then tend to use testing to confirm or test assumptions as opposed to just doing a whole massive battery of, five, 10 grand worth of tasks, which is just unreachable for most people in terms of costs. We will tend to do a few tests that may be a few hundred bucks each. If we think we need some confirmation. We will make dietary changes, almost always at the start with people. In terms of the psychology work that we do some people will start with, we have something called the 90-day program, which is an in-person program that starts with two or three days of kind of in-personal attendance and various kinds of support via conference call and video conferencing, that sort of thing.

And that will teach people the key principles of the approach. Like how to calm the nervous system, how to work with helper patterns, anxiety patterns, achiever patterns, how to deal with pacing. And so, there’s a kind of core syllabus that we will either teach through that or through one on one sessions with various support videos and kind of training resources we have. So, in a sense, everyone starts with certain fundamentals and there will be some kind of patient-specific stuff that will happen there as well. And then as we go deeper into the case and we start to… you can often get some really low hanging fruit just by putting those, those kinds of pieces in place. And then as the case unfolds and we get feedback from that, then it will tend to get increasingly nuanced and patient-specific in the process.

Ari Whitten: Gotcha. So, going back to subtypes, how does some of these, for example, psychological personality variables? If somebody is more of a, I forget the terminology used, but more of a giver type where the other…

Alex Howard:  Helper.

Ari Whitten: Helper. Yeah. Putting other people before them or, some of the other subtypes. How does that play into the type of treatment that you’re giving them?

Alex Howard:  There are a few pieces to it. So, the first thing is real people identifying and recognizing that in themselves. And sometimes it’s as simple as if you can see it, you don’t have to be it. It’s like if you can see, “hang on a second, my whole life kind of what I’m doing is I’m making everyone else more important than me. No wonder I’m burning out and burning myself out in the process of doing that.” There’s sometimes that awareness alone. It can be, it can be quite powerful. Often though what you find is that there’s a kind of awareness piece. Then there’s a habituation piece. There’s, there’s a literally a habit which someone has got trained. So, there are certain techniques NLP inspired techniques that we will use as ways of breaking certain habits. Then there’s often a layer underneath that which is there’s more fundamental self-esteem, self-worth kind of pieces that are going on, that are then informing, well, I’m not enough if I’m not helping or if I’m not achieving. Or yes, you can calm the anxiety and often you can have quite significant impacts by calming down one’s nervous system.

But then you can also get into pieces around or the reason why the nervous system was wrapped up in the first place is either unprocessed trauma or there’s just this sense of not feeling safe in the world and there are certain ways working with that psychologically to help give one that sense of grounding and stability and in a [inaudible], which will then allow the system to settle and calm through that process. So some of it is getting people information and the kind of insight happening through that absorption of that information, Some of it is giving people tools to work with themselves, and some of it is, is therapeutic one on one work that then happens as a process of taking someone on a kind of therapeutic journey.

Ari Whitten: Nice. And Are you doing the one on one work in person at the clinic or online or a combination?

Alex Howard:  A combination. At any one time, we have about a thousand people that were working within one on one sessions. I don’t have the exact stat, but probably 95% of that happens via Skype or kind of video conferencing mainly because we have patients in 40 countries. And just logistically it doesn’t work.

Ari Whitten: Sure.

Alex Howard:  With the travel. There are pros and cons to working both ways. There are actually pros to working via Skype. I think sometimes people go deeper more quick… People would ironically think you’d always get… people think that you’d go much deeper in person because more physical holding and there’s more of a sense of being in a practitioner’s presence as I kind of, there are nourishment and support that comes from that. But it’s also true to say, that when someone’s in the safety and the comfort of their own home and they’re not happy to travel to kind of get somewhere and kind of cross London or whatever it may be, that that can also, there’s less armoring that gets built up in that process. So, there’s, there are pros and cons, but we do an enormous amount of work remotely and I’m often quite stacked by how powerful that can be.


What science says about testing

Ari Whitten: Nice. I want to come back to testing for a moment. So, there’s an interesting landscape I think right now, especially when it comes to fatigue, but in health more broadly when it comes to this issue of testing, we have within the realm of fatigue their statistics specifically on standard blood testing. And people with fatigue who go to see their conventional medical doctor and get a standard blood test run. And that is the most, evidence-based the most scientifically valid test for basically everything but including fatigue conditions. They run the standard blood panel. And overall the statistics show that about 95% of the time (and these are, these are actual statistics from a research paper published in the Journal of the American family physician, which is publishing a literature review with evidence-based guidelines for physicians to practice.)

So, 95% of the time they find no detectable abnormality. Either no detectable abnormality or nothing of relevance that changes their recommendations for what that person should do. And their standard recommendations are basically 30 minutes of exercise a day. Cognitive behavioral therapy and antidepressants and stimulants as needed. Those are the four treatments they have. So, 95% of the time they do a blood test, they find nothing that changes that basic, those basic four recommendations that they have for people with fatigue. So testing is a problem there, for the reason that they don’t often find much of anything of use. On the other hand, we go into what I would say the opposite end of the spectrum, which is the functional medicine spectrum where you can run a battery of tests and show people a hundred different things that are wrong with them, and, and all the different various aspects of their physiology. And for many people looking at those tests, it’s really impressive and they say, wow, like I can’t believe I have all these things wrong with me. Yet, many of those tests are not at all scientifically validated. And in fact, many of them are totally wildly inaccurate and just junk data. So how do you, I’m just wondering if you have any sort of thoughts on that, on tests that are more or less accurate or useful,

Alex Howard:  I think it’s a great point that you raise. And I’ve got a few comments. Firstly, the kind of traditional kind of medical process. I mean, I think we will look back, I would have thought we’d be that by now, but we’re not. But I think in a few decades we will look back on the way that people have been treated with fatigue-related conditions. And I think we will be talking about malpractice and, and abuse in terms of how… I mean, I could run off dozens of cases of people whose situations have been made dramatically worse by incompetence and ignorance of traditional medical practitioners. I don’t say that really though judgment. I mean we, I have, there are some of our closest friends in our kind of social circle are traditional medics. In fact, we’re going on holiday next week with a good friend of ours who’s an [inaudible], works for trauma victims.

And basically, his job is [inaudible] people come in, hit by a bus/truck and put them asleep and deal with pain whilst butchers come along and literally save their life. And it’s incredible what he does and what they do. And we go on holiday and he sees me eating differently and taking supplements and thinks I’m insane. So, there’s just a kind of different world view that’s there that doesn’t make one better or one worse if I get hit by the bus or whatever I want him. I don’t want the nutritionist other, well the psychotherapists like it’s, there’s a very different kind of world view. And yet, what’s been done to people with this group of illnesses is fundamentally unacceptable. And so, there’s that kind of that side. And then you go to the other side, which is the, as you’re saying, you could take a basically healthy person.

And when I say a basically healthy person, I mean someone that score good energy doesn’t have any significant medical issues that are going on. And you could run functional tests and you could lead them to believe they’re going to die tomorrow by the way those results get interpreted. So, I think a note of caution is important, and I think it’s important actually on both sides of this. And one of the things that I very strongly advocate for anyone suffering from any of these conditions is you have to be the captain of the ship of your own recovery. You have to take responsibility for, and I imagine people that are in your community or in your community because they want to learn, they want to be educated, they want to take responsibilities. I’m guessing I’m somewhat preaching to the choir as they say. But there’s a sense of the… you can’t just go in and have this kind of patriarchal relationship to kind of medical experts. Be they functional medicine, be they traditional medicine, be they anyone and go, you are the all-knowing being, and I am the ignoramus that just has to follow everything that you say.

I think the place for functional tests is to confirm things that practitioners suspect may be going on. And to take those results as information, not as kind of biblical truth in terms of how things are. And we sometimes as a clinic, and I should make the assumption none of the labs we’re working with are listening to this interview, but we spot test labs sometimes. So if we see a set of results that we think are, are not right or inconsistent, or we see different labs giving wildly different interpretations of stuff, we will sometimes get a patient to do two sets of tests at the same time, send them to different labs and we will compare and contrast and we will be on the phone and say, can you please explain why we’ve done two tests at the same time and we’re getting two different things? So, there are, there is an evolution I think needs to happen in functional medicine. It saved my life and I’ve seen it impact thousands of people’s lives. And there is an enormous amount of incredible knowledge and amazing people doing amazing stuff and we need to understand that functional medicine in its current form, it’s really only a teenager. I mean, it’s not a fully-grown adult that’s been through the kind of maturation process of life. It’s still a teenager, and it’s still figuring stuff out. And that’s where, for me, clinical experience really does trump anything else. When you’ve seen the same thing hundreds of times or the benefit that we have Optimum Health Clinic, having worked with thousands of patients over the years. Sometimes you see stuff in the test that just doesn’t make sense. Other times something in a test is the bit that solves the mystery. But you have to use your own clinical wisdom. You have to cultivate your own experience, your own ability to recognize patterns. You have to dialogue with other practitioners, not be afraid to get on the phone and to dig deeper because that’s where knowledge evolves and unfolds.

Ari Whitten: Yeah, yeah. Well said. I almost want to digress so much into this lab testing topic because I think there’s much more to be discussed here, but I think there’s a number of layers to it. One is the labs themselves may not provide even reliable data. Like you said, you can split test the same blood sample, put two different names on the same exact sample of blood from the same person, taken at the same time, get different results. You could split test blood from one lab to another lab for the same kind of test, get different results. You can test this week versus next week with the same person for the same lab and get different results. You can test blood hormone levels versus urinary versus salivary and get totally different contradictory results. In addition to those issues, there’s a layer where some of the tests themselves just aren’t even valid. So, even if they are giving you consistent information about, like you can test the same blood today and tomorrow and the next day and it’s always the same or very close, that still doesn’t tell you whether it’s actually valid or meaningful data.

So, for example, like IgG food intolerance tests not really scientifically validated. Neurotransmitter tests from urinary tests not really evidence-based or scientifically validated. Many, many other examples of this. And then in addition to that layer, you also have a philosophical layer of the practitioner, which is “what do they believe in?” So, for example, if somebody has a belief in adrenal fatigue and that’s their whole narrative and their philosophy, well they can go do salivary cortisol test. And then based on this they can say, you’re in this or that stage of adrenal fatigue. But adrenal fatigue itself is a totally questionable condition that is not accepted at all within conventional medicine because the research overwhelmingly has not supported or validated the theory.

So, you can have people doing a seemingly scientific test, seemingly cutting-edge thing and finding this biochemical abnormality, which many people perceive as, “Oh wow, this is my diagnosis, this is what’s wrong with me.”

And yet it’s a fabrication largely out of the practitioner’s belief system. And I’ve seen, people basically just fabricate, layers and layers of theories and belief systems on top of a foundation of nonsense, and on top of a foundation of totally scientifically invalid tests. And then I think the last layer here is a lot of functional medicine practitioners that I see are people that substitute tests for actual knowledge. They substitute, having people do a battery of tests in place of like real deep knowledge of physiology. And you can do that like any monkey can throw somebody through a battery of… you can have somebody spend thousands of dollars on a whole range of tests. And as you said, even a healthy person will show up as having at least a dozen or so things wrong with them that they could then look at and say, “ah, here’s what’s causing my symptoms.” But if those same things are showing up as being there, even in a healthy person, are those things really causing the symptoms or is it just that anybody can do these tests and find a bunch of things wrong with them?

And then I think, a lot of these practitioners do this battery of tests and then they’re just basically following some sort of standard template of, “Oh, if this marker is off, then supplement with coq10 and B-vitamins, or if this marker’s off, supplement with vitamin E or…” I think, I totally agree that it’s a teenager. Maybe teenager might even be too generous. But there’s a lot of problems that are going on in functional medicine right now. And that’s not to say what conventional medicine is doing for people with fatigue is much better. But functional medicine, I think it’s worth being skeptical of a lot of things that go on there even though there are some, most certainly some very, very good, very knowledgeable functional medicine practitioners.

Alex Howard:  I think that’s right, and I think that that we just have to be careful not to throw the baby out with the bathwater. And that’s true on both sides of this equation. Right. So, one of the things that that also I’ve seen a lot of is people who have gone deep on the kind of naturopathic natural medicine path. On one hand, one would think more free thinking from the point of view of they’ve gone beyond the conventional traditional way of looking at things. But it becomes its own religion, it’s own world view that then restricts or has a confirmation bias and has all the things that go with certain belief structures that can actually be fundamentally unhealthy. For example, I move in my position around some of these pieces. I’ll make a statement that I may wish to attract at some point down the line, but one of the things I’m observing at the moment is certain in cases of people with Lyme are making significant progress through antibiotic treatments, they were not making, using kind of natural antibiotics. Let’s say. Or antimicrobials. And there are those in the more hardcore natural medicine, nutritional world, but have this attitude, which is fundamental if traditional medicine is not acceptable. And what we’ve always tried to do with Optimal Health Clinic, and certainly I think one of the reasons why Niki Gratrix and I connected on such a deep philosophical level when we first met, is we used to always use the word that we’re truth seekers. We didn’t really care what the model was or where it came from or whether it was convenient or politically suitable to take that perspective. What we cared about was what worked. And there were things that we were doing 15, 16 years ago that if I’m really honest with you, we didn’t know why they worked. And we could tell you a story of why they worked.

So, we could build a narrative around it. And Niki and I could both be quite persuasive when we want to be. So, it was kind of a persuasive narrative. And it wasn’t that we would sit down and go I don’t know why it works. I should invent a narrative. Like we believed the narrative at the time.

Ari Whitten:  Yeah.

Alex Howard:  But I look back now and it’s like the mechanisms of how we thought it worked, which is totally fraud. Doesn’t change the fact that it was effective, and it worked, however. And I think sometimes we can get overly fixated on subscribing to world views. Like this is the way that I belong to this model and this is how we do it. And to me, that is nearly always gonna end up in tears. And you see the same thing in the psychological world that people train as a psychotherapist.

And therefore, their attitude is that the resolution to one’s problems generally lies in understanding the past and talking about the past. And then you’ll go and talk to a life coach and they will believe that the resolution to one’s problems is creating a compelling future and building an action plan towards that future and having the motivation and drive towards fulfilling that action plan. And then you’ll go and talk to an EFT practitioner. They will tell you the resolutions one’s problems is getting in touch with someone’s emotions, tapping on acupuncture points whilst talking about those, resolving those emotions. Then you’ll go to a mindfulness teacher and they’ll say, you’ve just got to learn to be present. And if you listen to all that, you end up remarkably confused about like, “so am I going to the past? Am I going into the future? Do I just need to be more in the present?”

And the truth is that an effective psychological model, just like an effective physical or functional medicine or nutritional model, necessarily needs to include many different pieces and ingredients. And that’s problematic to a lot of practitioners. And I mean this with great respect and care to people that have given their lives to want to help others. But I think a lot of practitioners can become quite small minded that they get trained in the approach that they were trained in however many years ago and they follow it like a religious path. They follow it like one who says, well “it says it in the Bible; therefore, it must be true.” And, of course, many of us take the position. Well, we should not debate whether Jesus Christ lived, and God exists. But the Bible is as a piece of information was written a hundred years later by a committee of living human beings, not God, who sat down and wrote it. And when one takes a kind of perspective where they are, “this is how it is”, you then shut your mind off to other ways of looking at things and other perspectives and other ways of working. And I think to truly be effective as practitioners working with one of the most complicated challenging groups of illnesses, one has to kind of let go of their egoic attachment to any one way of doing things and be a student of discovery and a student of learning. And a student of what works.

And that means that most of the time, as a practitioner, you live in uncertainty rather than certainty. And I, if anything, whet many years of working with this proof of illnesses has taught me is I don’t for a second forget what I do know and I feel very solid in my depth of knowledge, but I also realize how little I know. And I get very nervous when people take strong positions with over-levels of confidence because I just think, well, you just haven’t seen the amount of clients that I have, or you haven’t read the research the way that because it’s never that simple.


The role of psychology in fatigue

Ari Whitten: Hmm. Yeah. Well said. And I agree 100%. So last thing I want to talk about is psychology and your background, actually my background too, but your background is in psychology. And I know we’ve touched on this at a few points, especially looking at some of these subtypes and personality styles, and sort of ways that people have of feeding their ego or feeling secure in the world. But talk to me about the role of psychology in these fatigue illnesses and how you conceptualize that and why you feel it’s so important.

Alex Howard:  Yeah, there are quite a few facets to this. We talked about subtypes a little bit. That’s one example where diddling with these tendencies that we have in terms of how we relate to ourselves, how we relate to others, and how we relate to the world, what I call the three relationships. That understanding the kind of way that we relate in terms of are we making what we achieve, what we do for others, more important than self-care. Then this next piece is what we would, what we classify as the maladaptive stress response. And this is something that you and I got into in a previous conversation around there’s a number of different methodologies that are out there. Ashok Gupta, who’s someone I’ve known for many years with the Gupta program. Phil Parker that wasn’t going for many years with the lightning process, Annie Hopper’s got her DNRS a system, and there are a few others that have kind of, taking systems inspired by some of these different works that each one has been doing. But different will have different ways of talking about this.

And what I kind of came to realize a number of years ago were that we don’t really kind of get that what we’re saying a little bit earlier, we don’t really know fully what the mechanism is. The fact when you and I were last talking, you were talking about, Robert Naviaux’s work, which I dived into office. I was fascinated by, by the way, so thank you for that and steering me on that. But what we would really classify as what we call a maladaptive stress response, where effectively the nervous system is maladaptive in the way that it is responding. And there’s a number of reasons why this might be. It might be because someone has a significant amount of trauma or adverse childhood experiences which have caused the system to gradually get more and more revved up. And it’s normalized and stabilized in a state of overstimulation. Often there is a significant trauma impact of being either diagnosed with a fatigue-related condition or just living with it, but even without a diagnosis. Living with symptoms where you know something is fundamentally wrong with your body, but you don’t know what’s wrong, why it’s wrong if you’re ever going to recover, should you rest, should you not rest? That just causes an enormous amount of uncertainty in one’s life and therefore a ramped up the nervous system as a result of that.

So, what we started to identify was that a lot of the people that we were working with even beyond just the kind of background of kind of anxiety and kind of being some of that tended to kind of worry a bit. That was this significantly overactive sympathetic nervous system and teaching certain tools and techniques to calm down that sympathetic overstimulation sometimes has stunningly dramatic results like within a day or two people going from being housebound to having relatively normal energy. Like kind of things that appear like kind of miracles, like literally they aren’t always sustained. And often there are more facets and pieces to that. To other people where it’s a kind of gradual, slow build, but actually, it is the thing which has the biggest impact in terms of that recovery journey and a number of others where it’s just one of the jigsaw pieces and they have to address lots of other factors. But calming down that maladapted stress response becomes crucial. And we have various tools and techniques that we’ve developed and refined over the years to help support that process. Much of that based upon core principles from NLP in terms of breaking habits and patterns and mindfulness in terms of learning to reset and to calm down the nervous system.

And then also on the psychology side, I mentioned trauma. Sometimes dealing with trauma, big t trauma or kind of more developmental kind of trauma. It can be very important. The other piece that can be crucial is we talked about earlier about this kind of model, this kind of map and the different kind of stages is that practitioners playing a role in terms of helping people identify what’s necessary and what’s important, at the next steps of the recovery process. So for example, someone to identify your stage two into Stage three and that means these are the things that are going to be important we need to work on or we classify four types of tiredness, talk about mental tiredness, emotional tiredness, physical tiredness, environmental tiredness,  and the type of tiredness you’re experiencing, will also impact in terms of what sorts of rest and restoration might be important.

So kind of helping people map where they are in that kind of healing journey and then pointing towards things that will be important whilst also establishing a baseline of activity where they are. And then what we call bouncing the boundaries in terms of gradually increasing that capacity. Not based upon not traditional pacing where one would have a kind of written routine of what you should be doing, which I think is often insanity. Like someone that doesn’t feel your body comes in and writes down what your body should be doing is just kind of madness. That one needs to learn to listen to their body and that body be that… And yes it’s a relationship with that. But just establish a solid baseline and then figuring out how to gently, gradually increase that as the body is recovering and, and has more capacity. So we kind of find the psychology team will play different roles at different parts of the process.

It might be initially, often we’ll start with calming down maladaptive stress response because many other interventions are not all that effective until you get the body into a more calm, healing state. Then we’ll tend to work more on some of the subtypes of the historical stuff will work more with the kind of coaching of kind of where you are and what’s important. We may work with those kinds of trauma pieces that are going on. And often, but not always, we will find that there are people which will, if they only come at this from a kind of physical perspective, until they deal with some of these psychological pieces, either they’ll go very slowly on the healing path or they’ll hit plateaus like glass ceilings they just kind of can get past, or they’ll have a repetitive relapse pattern where they’ll get back to recovery. They’ll get to recovery, then they’ll go and go back to being an achiever and a helper and not dealing with certain things. Then they’ll crash. Then they’ll rest. Then they’ll recover. So you kind of have these are passive relapse pattern that you don’t deal with these pieces also, you often see. Just the different ways that that impacts. But it’s, from my perspective it’s often crucial.


Alex’s 3 key takeaways for people struggling with fatigue

Ari Whitten: Excellent. So I know we’ve gone a little bit over time here. I’m wondering if you can wrap up, I know we also want to talk about The Fatigue Superconference that, that you have coming up here. But I’m wondering if you can kind of wrap up this main portion of the interview with your top three sorts of pieces of advice or key tidbits. And these can be things you’ve already said in passing, but sort of the top three things you want to leave people with who are struggling with fatigue. Your key pieces of knowledge.

Alex Howard:  Yeah. So, I think the first thing I would say if we go back to where we started in terms of, I was sharing a bit about my own healing story, that I think the first thing is you have to take responsibility. You have to be captain of the ship of your own recovery. And that’s a double-edged sword, right? Because it says it’s a burden. It’s like Holy Shit. Like I can’t just pass this over to my medical practitioner or to someone else. But it’s also very empowering because it also means that you’re not dependent upon someone else is the one that has to figure it out. And being captain the ship your own recovery doesn’t mean that you have to have more detailed knowledge necessarily than the practitioners you work with. But you need to have enough knowledge to take responsibility, know some of the right questions to ask and how to balance and weigh that alongside other people that you might be doing.

And I think programs such as yours are a great way for people to build that knowledge in that and that understanding. So I think the first thing is being the captain for your own recovery. I think the second thing is you have to understand that it’s a jigsaw and there are lots of pieces to this jigsaw and what you’ll probably find is each expert, or each practitioner, or each person will have some pieces of the jigsaw. They’ll probably think that their pieces are the whole jigsaw, or they’ll think that those pieces are more important than all the other pieces. And that’s again, with this first piece around you’ve got to be the kind of driving force or the captain of the ship, but there will be these different pieces. And part of what we really try to at the Optimum Health Clinic is we try to have as many of the pieces of that jigsaw as possible to try and simplify that process.

We don’t have all the pieces and we’re always discovering new pieces. And there are sometimes, there are other clinics that we actually think do certain pieces better than we do. And we’re busy enough that we’re more than happy to refer those people when we see that.

I think the third thing is the probably the psychology piece we’ve been talking about. And it’s a whole other conversation that maybe down the line we’ll either of, well my side or your side, one of us can host the conversation, but I’d love to go deeper into some of the psychology stuff together on particularly this piece around the maladaptive stress response. I think that could be a whole piece on it on its own. But for the body to heal has to be in a healing state.

And if your body’s not in a healing state, you can take all the right supplements, you can do everything right, and you will not recover if your nervous system is not in a healing state. And I kind of can’t emphasize enough how important it is. And I know that there are all kinds of people listening right now, which are probably wanting to… If they haven’t already, want to turn this interview off because they think that I’m saying that their physical condition is psychologically caused. And I am categorically not saying that. I’m saying that one of the key mechanisms to supporting healing is your nervous system being in a healing state. Cause all the physical processes will function and work differently as a result of that.

But just to summarize, captain the ship your own recovery. It’s a jigsaw and there are different pieces of the jigsaw. And you got to be in a healing state.

Ari Whitten: Yeah. Wonderful. I want to comment real quickly on number two, which I love what you said and I think we talked about this when you interviewed me a bit, but there is this a tendency, human psychological tendency that many people have or, most of us probably have where we look for the one thing. It’s gotta be this one thing. And we talked about some of these approaches out there specifically in the context of fatigue that are, “oh, it’s all about the brain and the nervous system where it’s all about the gut, where it’s all about diet or it’s all about, pacing or it’s all about this or that, physiological system and or lifestyle factor or something like that.” And they build an entire methodology that’s specifically around that one factor. And that’s the entire approach. And then they kind of put all their eggs in that basket and they want to insist very dogmatically that this is the only thing that’s just the key thing. Everything else is if it exists at all, is secondary to this one thing.

Alex Howard:  They also retrofit information to fit that even though it doesn’t fit it. Right?

Ari Whitten: Exactly. Yeah. And I just want to say that I really appreciate that about your work, that you are, conceptualizing many, many different factors and trying to put the pieces together and figure out what’s going on for each individual. And I just really appreciate that about the work that you’re doing. So, finally the Fatigue Superconference. So this is coming up. It’s right around the corner. We are recording this podcast towards the end of May, so I’ll be releasing it hopefully just before or right as this conference is starting up, it’s starting on June 10th and goes through June 10 through 17th. Is that correct?

Alex Howard: That’s right, yeah.

Ari Whitten:  Okay. So tell me about the conference and, who speaking, what’s it all about?

Alex Howard: So as soon as an idea that came online towards the end of last year and I’m holding Niki responsible for not talking to me out of it because she had run a conference a few years previously to the tribe. But basically, the seed of the idea… the Optimum Health Clinic approach has become what it is. Because as we’ve talked about in this interview that we’ve been inspired by many, many great thinkers and great experts that are out there. And the idea was what would happen if we could bring all of those people or many of those people together in one place and get those different jigsaw pieces kind of offered up from those different perspectives. So, it’s not that 40 plus speakers in this conference all agree. Far from it. In fact, they have some quite contradictory opinions in place.

They have a lot of sheds kind of core kind of principle opinion. But there are those that will go much deeper on certain areas because they are the pieces of the jigsaw which that the most experience with and, and see the most act clearly and, and struggling. So we have these feature interviews. But also, on the things that we felt having observed some of the excellent online summits and conferences that have been done is that sometimes you can be left with just this endless amount of information, but wondering, well how do you actually apply this? Like what is this actual actually mean when the rubber hits the road in real-life cases. So we also have each day for the eight days of the conference. In addition to having, four, five, six feature interviews. We also have sessions with the practitioner team at the Optimum Health Clinic where they’re taking real-life cases we’ve worked with and a team of sometimes two, sometimes four or five practitioners are literally walking through the case and saying, “this client came in and this is what we saw. We went down this path, this is what happened. We did this test, here’s the test result. This is what we did as a result, here’s how things change and improve.” So proper kind of, detailed, nuanced, how we work with, with cases. We also have recovery stories. So we have people telling the first person like that story of how they recovered from fatigue. We’re taking particular emphasis to those stories. So, they’re not just kind of “I did this and this and that,” but we’re theming the story. So we have one on working on the achiever subtype. One or working on the helper subtype. We have one on, which is an interesting case with one of our psychology team around how they put together the jigsaw pieces as a whole recovery story. Kind of highlighting that kind of principle.

And then we also have, each day we have meditation and Yoga sessions. We just felt also let’s, we’re going to keep a lot of mental stimulation, so let’s get them some ways also it’s kind of just calm settling some supports around that as well. So, it’s each day there’s a number of interviews or recovery story, a case study, a meditation session, and a yoga session which are free. Also, I didn’t mention we’ve got, some sessions, for carers as well. So if you’ve got, if you’re caring for someone with fatigue or you suffer from fatigue and the people around you are being impacted. We have some sessions with a former patient’s husband who’s also trained in our psychology approach to give some perspective here. It’s very much aimed at both those affected by fatigue and practitioners. So we’ve really tried to kind of go deep in places, but also make sure people can follow along in terms of the journey.

It’s free for the seven days. People can register. I’m sure you’ll give a link that people can use-

Ari Whitten: We will put it at

Alex Howard: Great. So, people could go and register there. And then if they, it’s free for the seven, eight, the eight days. And then if they want to buy the recordings and they can also do that and have ongoing access after the conference as well. But it’s I’m obviously biased in the one TV interviews. But I think is a staggeringly helpful resource in terms of, the way that you and I have been talking about this kind of complex, nuanced way of understanding it and going deep on that, but also pulling that together and helpful ways that people can also practically implement.

Ari Whitten: Yeah, absolutely. I’m really excited for it. I’m excited to share it with my audience, as well. Thank you again for, having me on as one of the speakers and this was excellent. I really enjoyed this conversation, Alex, and thank you so much for coming on the show. And thank you for the work that you’re doing. I appreciate it.

Alex Howard: Thank you, buddy. I enjoyed it. I think we have a lot of looking forward to more conversations that the two times we’ve spoken so far, I felt like they, they float paths side. I’m, yeah, I’m an admirer and respect the work that you’re doing and appreciate you. Thank you.

Ari Whitten: Yeah, thank you. And everybody listening. Please make sure to go to and sign up for this free summit. It’s going to be pretty much the most epic fatigue summit ever done. So, I’m very, very excited to share it with you all and I know that you’re going to love it.

The Optimum Health Clinic’s Approach to Diagnose and Treat Fatigue (And The Fatigue Superconference) with Alex Howard – Show Notes

What are fatigue-related conditions? (15:58)
Why diagnosing fatigue-related conditions is difficult (20:17)
The subtypes of fatigue (22:48)
The different stages to fatigue and recovery (28:55)
The OHC approach to identifying the key drivers of fatigue in the patient (34:22)
What science says about testing (41:30)
The role of psychology in fatigue (58:47)
Alex’s 3 key takeaways for people struggling with fatigue (1:06:08)


Sign up for The Fatigue Super Conference here.

Listen to the podcast with Niki Gratrix on how to heal trauma to heal fatigue

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