In this episode, Dr. Evan Hirsch talks about how his approach to chronic fatigue and ME/CFS has evolved over the years and how he’s now working with patients who have long COVID. He also describes what he calls “The Toxic 5” and how these are at the root of many fatigue issues.
Table of Contents
In this podcast, Dr. Hirsch and I discuss:
- The “Toxic 5” primary reasons Dr. Hirsch believes people struggle with chronic fatigue
- The crucial importance of addressing toxicity, protocol simplification, and brain retraining in ME/CFS
- How long-term infections—now, including COVID—contribute to fatigue and their interplay with other root causes
- The usefulness of testing and how much weight you should (or shouldn’t!) place on certain test results
- Dr. Hirsch’s experience with ozone therapy, hyperbaric therapy, and IV vitamin C and why his stance has shifted over the years
- One very surprising (and scary) statistic on mold and two key ways to get mycotoxins out of your body
- The safest way to rid the body of heavy metals and the dire consequences people suffer if they aren’t ready to detox properly
- The most problematic heavy metal and Dr. Hirsch’s recommendations for how to avoid it
- His approach to long COVID and the problem with COVID persistence, i.e., spike proteins remaining in the body in a latent state
- “Brain retraining” (a technique Dr. Hirsch learned about from his patients!) and the powerful combination of addressing the mind AND body for people with chronic fatigue
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Transcript
Ari: Hey, this is Ari. Welcome back to The Energy Blueprint Podcast. With me today for I believe the third time, is my friend, Dr. Evan Hirsch, who is a world-renowned fatigue expert, best-selling author, and professional speaker. He’s the creator of the EnergyMD Method, the science-backed and clinically proven four-step process to resolving chronic fatigue, ME/CFS, and long COVID naturally. Through his best-selling book, podcast, and 100% online practice, he’s helped thousands of people around the world.
In this episode, we are going to be talking all about his approach to resolving chronic fatigue, ME/CFS, and long COVID, as well as reflecting back on years ago when I met him, I think five or six years ago, and some of the initial podcasts that we did at that time, and some of the things that he and I talked about in private conversations about his approach to dealing with ME/CFS, and how his views and how his approach to certain things, to the treatment of ME/CFS and chronic fatigue has changed over that time and differences in how he sees different therapies based on how he’s seen hundreds or thousands of patients respond to different things and what’s worked and what hasn’t, and what’s worked consistently, and what maybe leads to variable results and unpredictable results, and so on.
A lot of good insights here. I think if you are dealing with severe chronic fatigue or complex chronic illness or Long COVID, I think that you’ll glean a lot of great insights from this. Without any further ado, enjoy this episode, I think number three with Dr. Evan Hirsch. Dr. Hirsch, welcome back to the show.
Dr. Evan Hirsch: All right. Thanks so much for having me on. At this point, you can call me Evan.
Ari: Awesome. I do in person but in the podcast, I always like to make sure– Some people have a thing where, “Yes, we’re on a first-name basis outside of podcasts, but–” Some people have actually told me, “Okay, but during the podcast, I don’t want you to call me by my first name. I want you to call me Dr. So-and-so.” I always assume that’s the case.
Evan: You’re smart.
Ari: On the side of caution rather than coming across disrespectfully to somebody who wants to be addressed by their professional credential. Evan, it’s been, what, at least four years, maybe six years since I had you on the podcast for the first time. I think we met in person at Mindshare Summit, maybe six years ago, five, six years ago, something along those lines. We’ve since had a really nice friendship ever since then. We’ve had a lot of really nice discussions on and offline. I’ve also interviewed you for the Superhuman Energy Summit I did several years back.
You’ve been in the trenches treating ME/CFS, treating people with chronic fatigue for many, many years now. I’m curious about the big picture, and then we can zero in on more specific things to talk about, but in the big picture, how has your approach and your thinking, your paradigm, your understanding of the causes and best treatments for people with chronic fatigue changed over the last five or six years since we met?
Evan: When I first started, it was all about finding all the causes that an individual had. I knew from my functional medicine, and environmental medicine training, that was going to be really important. What I didn’t realize was that they weren’t all weighed equally. When somebody had deficiencies, I categorized the causes into deficiencies and toxicities. At this moment, we were looking at about 38 of those, but really, the most important ones are what I now call the Toxic 5, which are a combination of the heavy metals, chemicals, molds, infections, and nervous system dysfunction or trauma.
Before those were in there, but they weren’t as important and I didn’t see them as like the root cause of all this stuff, is like, what is actually causing the hormones to be deficient? What’s causing the mitochondrial dysfunction? What’s causing vitamins to be deficient? The lifestyle habits I put as deficiencies, like not enough good food, not enough good water, not enough good movement, and not enough good sleep, but those other deficiencies, I didn’t realize were so dependent on how severe these toxicities were. That was probably the biggest thing that I’ve moved towards.
Then the other thing is just trying to simplify things as much as possible, because when you’re addressing a lot of different causes it can cost a lot of money, for people, especially with the amount of supplements. Oftentimes they’re spending more on supplements than they are for my time. Just trying to figure out how to optimize things as much as possible.
Then I guess the last thing, the third thing I’ll say is I didn’t realize how important nervous system dysfunction was and brain retraining was. I personally have gone down that path and seen the results, not just for me, but for my clients as well. When they join the program, I talk to them about doing some nervous system retraining. We have some components in our program and we’re incorporating more all the time. Then we also work in tandem with some of the other brain retrainings that are out there. When people are working on their mindset and when they’re doing the brain training they get better faster.
Ari: Okay. I’m overflowing with questions, but let’s start with chronic infections. I know that many years ago when we spoke, this was sort of the foremost thing in your mind that was affecting people. This was one of the biggest causes. Is that something that you still consider to be one of the dominant things going on with people with ME/CFS and I guess you could say chronic fatigue more broadly?
Evan: It is, but I didn’t understand the interplay between the heavy metals, the chemicals, the molds, and then also the nervous system dysfunction. I definitely improved my understanding around that. Now I see all these toxins as like a toxic ball where when you start to pull one thing out of your ball, they’re all kind of attached to each other, they’re feeding off of each other. They’re, swapping DNA with each other, at least the infections are. When you start to pull mold out or heavy metals or chemicals and the infections are attached, all of a sudden the infections are released. I used to go after one thing at a time. Now what I found is that I kind of have to have a little bit of everything on board in terms of treatments so that when mold is released, there’s a binder on board to bind it up, when certain infections are released, that there’s something on board in order to grab that and take it out of the body. I’m seeing it more holistically when it comes to some of those toxins, but definitely, the infections play a big role.
Then now we’ve got the newest comer on the block, which is COVID.
Is chronic infections the root cause of chronic fatigue?
Ari: Yes. I know that in our discussion prior to recording today, you wanted to flag long COVID as something to get into. I know that’s an area of specialization in recent years since COVID. We’ll get into that. I want to touch a bit more on chronic infection. It’s interesting that you said that because my observation over the years is that certain people that I observed who got a diagnosis of some particular chronic infection, whether cytomegalovirus or Epstein-Barr virus or Borrelia or something like that, I saw so many people. this pattern became very clear to me that there were people who were insisting that this was their diagnosis, that this was the cause of their problems, that they had this infection and that this was the driving force for all their symptoms.
I saw them just chase after it for years in many cases, just with one, looking for the magical chemical substance or magical supplement cocktail that’s going to remove this infection and cure all their symptoms. I have to say, I just almost never saw it actually be successful. It seemed to me that it was like chasing a ghost, like, yes, okay, I took this chemical, this antiviral drug or this supplement, this herbal concoction and it seemed to work, it seemed to help me for a period of time, and then my infection came back and I had another flare of this infection and another, period of time where I was debilitated with chronic fatigue.
Is that something that you’ve observed as well? It seems to mesh with the new paradigm that you’re presenting, which is that that’s just sort of one piece of the puzzle. Is it really a part of this larger toxic ball that you have to address in its entirety rather than just this one piece?
Evan: Absolutely. Yes. That’s definitely a good observation. I’ve seen the same thing. You can’t get rid of infections if you have heavy metals, chemicals, and molds on board. You just can’t. You need a somewhat intact immune system in order to be able to help you get rid of that infection. You can’t just go after the infection, and slam it with whatever. The immune system has to help you. The immune system can’t help you if it’s being distracted by heavy metals, chemicals, molds, whatever, or nervous system dysfunction, which leads to immune system dysfunction. Those things will not allow you to get rid of the infection.
Are tests for root cause of fatigue money well spent?
The other thing, too, that I wanted to mention that’s really changed a lot is that I test so much less now. The reality is that when I used to do testing, I would test people for all of these different causes every three or six months. What I found is that over the course of about a year or so, pretty much everybody had all of the Toxic 5 or Toxic 4 at that point coming out, the heavy metals, chemicals, molds, and infections. They all came out at some point.
At this point, I’m like, “We need to treat all of these things. A better use of your time, energy, and money is to put that money towards the supplements that are going to do that. Then we can test later and see how much is left.” That’s been a really interesting shift for me, too. A lot of that comes from the idea or the fact that all testing is imperfect. I think we talk a lot about this.
Ari: I was just going to say this is something that I’ve touched on in a number of podcasts. Maybe some people listening are sick of hearing me talk about it. My experience is there is this really big gap. I’m really glad you brought this subject up. There’s this gap between the people’s perception of these tests as being extremely cutting edge and sciencey versus the reality, which is that when you dig into the actual evidence and the research that underlies many of these tests that exist in the market. You realize that a lot of them are just being created by these for-profit companies to sell tests to practitioners and ultimately patients that really have very weak underlying evidence to support their clinical validity, to support even that they are accurate, even that they are legitimately measuring the thing that they claim to be measuring.
I could tell you many, many stories. There are lots of examples that I’ve either experienced personally or read from other practitioners and friends who have done split testing and things like that. Food intolerance testing, you can take two samples from the same person literally at the same time, write different names on them, send them off to the lab, and get two totally different sets of results. You can get saliva hormone testing and compare it to blood testing from the same person to urine testing from the same person, all the samples taken at the same time, and these different tests show huge disparities in the levels of different hormones. One will show high, one will show low levels of the same hormone from the same person taken at the same time.
I’ve done microbiome tests. I’ve done multiple microbiome tests with my own stool samples that are the same stool sample, but using different microbiome technologies and I get reports with radically different levels of the same species of bacteria. When you get a report of, let’s say, all these tests with 10 or 20 or 50 pages of reports of all these different markers that have been measured in you, our brains go, “Wow, this is really amazing data. They’ve figured out exactly what’s going on in my body. Now I know exactly what to do about all these specific problems that are the cause of my symptoms.” Except when you start to do this split testing that I’m describing and you start to look at the evidence underlying these tests, you realize actually, this is 50 pages of data that I don’t even know if I can trust if it’s accurate or not.
Obviously, I’m painting with broad brushstrokes here. There are many types of tests that are accurate with data that you can trust, but a lot of the landscape of functional medicine tests are questionable validity, questionable accuracy, and whether you can actually trust that data or not.
Evan: I agree. In medical school, we learned that 90% of your diagnosis is going to be history and symptoms, and 10% is going to be physical exam and labs, right? We forget that. when I lecture to physicians, I tell them, “If you lean too hard on your laboratory tests, you’re going to fall over,” right? They’re just not a place to stick your pole in the sand and say, “Okay, this is the hell I’m going to die on.” You’re going to die very quickly, unfortunately. I found that actually, it’s more beneficial to just treat these things because of that information. I do find that 90% of the 38 different causes that we’re looking at can actually be determined by history and symptoms. Then it’s always about, what’s most important to treat. Let’s focus on those things. Yes, I agree.
Is ozone good for CFS?
Ari: Okay. One other thing that I wanted to ask you about is ozone. This is something that I know when we first met, you were really raving to me about the benefits of ozone. Then I remember speaking to you maybe two or three years later, and you were already starting to change your view on ozone if I remember correctly, you correct me if I’m wrong, but I think what I remember you telling me was that you found the response to be very unpredictable. Some people would benefit greatly from it. Other people would react in a very negative way. I’m curious what your latest take is on the benefits of ozone and if you use it in your practice.
Evan: Ozone, hyperbaric, these are all pro-oxygenation techniques where you’re basically trying to increase oxygenation in the body. High-dose IV vitamin C is also like this. What ends up happening is that you can increase mitochondria significantly, which can be beneficial for increasing energy, but it also is a bit of an indiscriminate antimicrobial. The main reason why I stopped using it was because, as they say in South America, no vale la pena, like it’s not worth it. A lot of that had to do with the fact that as I started getting better in my functional medicine practice, I started seeing sicker and sicker patients and started getting more into ME/CF, chronic fatigue syndrome, and seeing more people with infections, more and more people got a lot of die-off and they got a lot worse when I would give them IV ozone. This is ozone that’s mixed with the blood and then injected back into the body.
I had one person who almost had like a psychotic break because there are certain infections that are associated with different moods, and can cause different symptoms. There were studies years ago, people with schizophrenia who responded really well to doxycycline, there is this association between mood and infection, and that really gave me pause. I found that with a number of people. I was not preparing them appropriately for the die-off that was potentially going to occur, and it was very unpredictable. Then there’s the cost associated. Thousands of dollars of getting these IVs or the hyperbaric oxygen and not knowing whether or not it’s going to work. For some people, it potentially could be helpful, but it was only usually marginally effective. For other people, they really didn’t notice anything at all, and oftentimes they got worse.
The big role mold plays in chronic fatigue
Ari: Yes, interesting. Let’s talk about mold a little bit. The source of mold exposure for most people you’re finding is the home environment, is, previous water damage, or living in certain climates where the home gets moldy and then people get exposed that way, or are you finding other roots of exposure as well?
Evan: Yes, it’s mainly home environment. Sometimes it can be work. The adage is that upwards of 50% of all buildings in first-world countries have water damage, and most of those have mold. It doesn’t always have to be in damp climates, though mold does grow at greater than 55% humidity. the joke is when people say, “I’m going to move to Arizona because there’s no mold there,” the joke is, “Are you going to have indoor plumbing?” If you live in a home that has ever had any sort of water damage, whether it’s a roof leak, a flood in the basement, or a busted pipe, you have the potential to get mold from that place, or if you had exposure when you were like five years old, if you weren’t taking a binder and glutathione for a significant time after that, or N-acetylcysteine if you can’t tolerate glutathione, then you still have that mold in your body even 50 years later.
Plus, the amount of times that people move. I got my mold when I was in medical school. There were cats that peed on cardboard boxes in the basement, and then I put those boxes unbeknownst to me in my car and drove across country. That’s one of the ways that I got it. We move around so much and it’s just so common to get it.
One of the most important tests that I do recommend that people get is to make sure they’re not living in a moldy environment and this test is also imperfect, right? Most challenges that I have in getting people better is when they’re living in a moldy environment. We try to always do our best to make sure that that’s not an issue for them.
Ari: Yes, if mold is being stored in the body for many years, where in the body is it being stored?
Evan: It’s in the tissues, oftentimes organs, fat in general and so it does require more of a binder in order to catch it because otherwise it’s just getting recirculated.
Ari: Okay. Even over years, the body doesn’t really have the capacity to remove some of these mycotoxins. When you say mold is in the body, we’re referring to mycotoxins, right? Rather than the living mold.
Evan: Yes. Sometimes there are the actual spores, the DNA, but more often than not, it’s the mycotoxins that we’re talking about, the toxins that are produced by the molds. I forgot your question.
Ari: As far as removing those from the body, basically the body has limited capacity to do it on its own and we have to rely on external binders, basically?
Evan: For the most part, but if you are sweating on a regular basis and you are drinking 3 liters of water a day, there are certain habits that can definitely help. If you’re consuming a lot of vegetables, oftentimes you are going to have some benefit, but for the people that I see, you have to remember that I’ve got a tainted population because all of these people have chronic fatigue, chronic fatigue syndrome or long COVID, right? There have been significant cases where we start to remove mold out of the body and that’s really the lever that makes such a significant difference for these people. Oftentimes when you start to feel bad, that’s really when you stop moving around, you stop exercising, you stop sweating.
My wife believes that a lot of the reason why she got sick is when she moved from Texas where she was sweating all the time as soon as you’re walking out the front door to Olympia, Washington where the temperature is between 40 and 70 degrees all year round and so she wasn’t sweating anymore. She thinks that was a big reason why she got sick. There are some of those things that can help, but the people that I see all have significant mold exposure.
Ari: Several years ago, this was, actually I remember, it was just before the COVID outbreak, which is probably the worst timing possible, I discovered that there was water damage from the bathroom right next to my master bedroom in the house that I was living in. When we went into the walk-in closet and we pushed aside a bunch of our jackets and stuff that we rarely touched, you looked at the wall behind it, and the whole wall was covered in mold.
Evan: Wow.
Ari: It had been there for months, growing definitely for at least a few months. That was 8 feet away from where I was sleeping each night. I was inhaling all of these mold spores for months. Around that time, I got a respiratory tract infection, which I think was right at the beginning of COVID. It was one of the most severe infections that I’ve ever had. For over a month I had very, very low energy levels and a really severe cough. Then we got news of COVID a month or two later. That’s when I put the pieces together that that’s what it probably was. I think that I had this mold exposure that I was getting for months that was weakening me and then I got exposed to COVID. That was not a very good combination.
When I was dealing with that mold toxicity, the physician that I was working with prescribed me cholestyramine, which is a prescription medication. I forget, is it used for– it’s treating cholesterol or treating bile or something like that? What’s the previous use for it?
Evan: Exactly, yes. It’s an old– it’s not really used so much anymore, but it’s a bile sequestrant. The way that it was removing cholesterol out of the body is it was binding up the cholesterol, the fat in the bile, and taking it out of the body.
Ari: Okay. That’s what that physician prescribed to me. I think it was relatively effective, bar there are some questionable results from some of these mycotoxin tests. Some showed high or low levels depending on which one we did. Definitely, the levels went down over time and my body got rid of most of these mycotoxins. I’m curious what you found to be really effective in terms of binders for treating mold. What do you typically use with patients?
Evan: I’ll comment on the cholestyramine and then I’ll go into that. Cholestyramine, if you can get a doctor to prescribe it for you, and I don’t prescribe anymore, I work online as a coach now so I can help people across state and national lines, it can be helpful. It usually tastes awful. Oftentimes it has to be compounded and combined with sugar in order to get rid of the taste.
Ari: I can confirm it does taste awful. The texture is actually worse than the taste. I got an unflavored one, but it’s really grainy. It’s almost like drinking sand and it stays in your throat and it’s an awful texture.
Evan: Yes, and oftentimes it’s really constipating or cause stomach aches. A lot of people can’t tolerate it. I’m glad you did, because if you can, then it’s a good treatment. 95% of the mycotoxins can be addressed with the following combination; bentonite clay, activated charcoal, and chlorella. That’s what studies have shown. That’s a combination that we use. Oftentimes we’re also using humic and fulvic acid or we’re using zeolite, and that seems to work well.
Heavy metals and CFS
Ari: Excellent. As far as heavy metals, which is another component of this toxic ball, I guess two questions. One is related to binders. I suspect it’s some of those same binders that you just mentioned that sort of have that dual purpose maybe of addressing mycotoxins as well as addressing heavy metals. I’m curious also if you have more general thoughts on heavy metals and the role that they’re playing in chronic fatigue and what you’ve found over the years with your patients.
Evan: We’re also using a combination of natural substances in order to remove the heavy metals from the body. A combination of things like chlorella and cilantro and [unintelligible 00:27:41], which is like a seaweed. What I used to do was utilizing things, prescriptions like DMSA back when I prescribed. What I found was that there was a lot of redistribution happening.
That means that the heavy metals were being moved from one part of the body to another. Oftentimes it would end up in the brain and then people would have memory issues and it wasn’t pretty. I go a lot slower now. I’m often talking about removing these toxins at a rate that people can tolerate. I spent a lot of time in Step 3 of my Step 4 process, which is opening up drainage pathways or exit pathways to make sure that we can get rid of this crap so that it doesn’t get redistributed. That’s the really big thing. If you’re going to go and you’re trying to remove heavy metals with IVs or with prescriptions, I’ve seen too many side effects from those things so I no longer recommend it.
Ari: Interesting. It’s been several years since I explored the whole topic of detoxification in depth. It’s not something that’s been a great area of interest to me. What I recall was a lot of controversy among experts who specialize in that area among which of these binders are best. Sort of some of these people are saying that things like chlorella and cilantro and alpha lipoic acid are, I think they use the term reversible binders, if I remember, or they’re sort of temporary binders, I guess you could think of them as, where they sort of grab these toxins, these heavy metals, but they only hold on to them more weakly for a shorter period of time. Therefore there is a higher risk of them grabbing the chemicals from the cell, going into the blood and redistributing them to somewhere else. Some of these people were advocating the use of DMSA. What’s the other one? E?
Evan: There’s EDTA-
Ari: ETA, yes.
Evan: -and DMPS.
Ari: And DMPS, thank you. Some people are advocating the use of those as being much stronger binders that decrease the risk of redistribution. It sounds like your take is a bit different, that you think that those chemicals are actually problematic and that you found that those increase the risk of redistribution. Did I understand that correctly?
Evan: Yes. That’s what I’ve seen. Plus, also, I think that with our approach, where we also have people drinking 3 liters of water a day, and then we also have the other binders, yes, they are reversible, but it’s less likely to be an issue. It’s also a lot lower dose. They’re more likely to come out with the other things that we’re doing and not get redistributed, in my experience.
Ari: Are there particular heavy metals that you found to be uniquely problematic, whether it’s mercury, or aluminum, or cadmium, or lead, or something like that? Is there some sort of pattern that you’re finding with those? Anything that you can tell people that is related to roots of exposure to those metals that they may not be aware of?
Evan: I would say that mercury, I saw come out most of the time. What’s important to remember with these tests is they’re really excretion tests. Depending on the binder that you use, or the chelating agent that’s going to bind to that, it’s going to come out disproportionately. These chelators, like DMSA, or DMPS, or EDTA, they have a binding coefficient, which means that they bind preferentially to different metals. Consequently, you may see, when you do this test, that there’s a whole bunch of lead coming out.
Then if you continue to do the testing, you see then the lead goes away as you’re removing the heavy metals. Then the next thing that comes out is mercury. Then after that, maybe it’s cadmium. These different chelating agents aren’t particularly good at removing aluminum so generally, you don’t see those. You have to do something like silica in order to do it. Then there are concerns about that testing, too, because if you’re going to give a chelating agent, which is a treatment x 10, generally, it’s going to be just a very high dose. If you’re going to give this to a sick person, they’re not going to be able to clear those heavy metals. That’s another place where I have changed what I’m doing is because I’ve seen a number of untoward effects from that.
Ari: Interesting.
Evan: I think I answered the first part of the question, but what was the second part? Roots? You were talking about roots.
Ari: If there’s anything related to roots of exposure to these heavy metals that people could be more aware of so that they don’t accumulate some of these things in the first place?
Evan: Yes. With mercury, it really is about amalgams. They call them silver fillings because it sounds bad to call them mercury fillings. They really are half silver and half mercury, right? Every time you bite down, you release mercury vapor. This is one of the reasons why I got chronic fatigue is from my mercury fillings. Then a big one that a lot of people don’t want to talk about is fish because they talk about fish as brain food and Omega-3s are so important, and that’s true. Unfortunately, I feel like you got to get them in supplements these days that have actually been tested to make sure they don’t have mercury because we have way too much mercury right now that’s in the oceans. That, unfortunately, is now in the fish. The bigger the fish, the more mercury. Consequently, if you are going to eat fish, eating smaller fish like anchovies or sardines is going to be recommended. Those are some of the big reasons why people end up with more mercury. Did you want to say something?
Ari: Living up in Seattle, I know salmon consumption is big up there. Do you find that even salmon is problematic?
Evan: I do.
Ari: My understanding was that most of the salmon from the Pacific Northwest and Alaska is largely without concern. Is that not true?
Evan: That’s not true. That’s not what the testing shows.
Ari: Interesting.
Evan: Even wild-caught, unfortunately. Now, I was just up in Iceland, and I did eat fish because I don’t normally, but I figured it was far away from most things. Their energy is 80% geothermal so I figured that there were not going to be– The mercury that gets in the oceans comes from coal plants. Even if it’s from across the seas in Asia, it’s still getting into our–. I was in the North Atlantic. I figured that it would be more of an option. My daughter loves sushi. Once a year for New Year’s, we get sushi, and I give her binders. That’s the trade-off. She gets binders also if she wants to eat something that’s gluten or dairy. That’s how we deal with some of those things so that she can still feel included and still have experiences.
Ari: Just a random thought I had as you were speaking there that just related to the proportion. If we consume a small portion of fish, and even that has a significant enough amount of heavy metals to be toxic to us, given that we are maybe somewhere between, let’s say, 10 to, I don’t know, 50 or 100 times the size of the actual fish itself, you’ve got to believe that amount of mercury in the fish is even way, way more toxic to the fish than it is to us. Do you follow what I’m saying here?
Evan: Yes. I would agree.
Ari: I wonder if these fish are just swimming around with barely functional brains because of all the heavy metals that they’re getting exposed to.
Evan: We’re seeing all sorts of interesting trends with fish. I just saw something recently that was blaming it on climate change. We don’t know whether or not there’s also this issue.
Chemical overload can contribute to fatigue
Ari: Interesting. Okay, so mycotoxins, heavy metals, chronic infections. I know I want to get into some of the brain retraining stuff with you, but was there anything else that I’m missing in that toxic ball?
Evan: I put chemicals in there as well. Just in terms of the exposures, what is it now? 90,000 different chemicals we’re exposed to on a regular basis; pesticides, herbicides, et cetera.
Ari: As far as getting rid of those? Obviously minimizing routes of exposure and then using some of the same binders that also apply to mycotoxins and heavy metals also covers some of those chemicals or is there some other approach that is also recommended?
Evan: No, it’s more of the same. What ends up happening is that you reach a critical mass where you really start to excrete a lot of these different toxins at the same time. Part of that has to do with the fact that they are bound to each other. When you’re starting to release more and we’re focused on the Step 3 and we’re opening up the exit pathways and we’re drinking enough water, a lot of that ends up coming out with the rest of it. It’s more of the same, the binders and some of the other heavy metal natural chelators that we use.
Overcoming Long COVID
Ari: Okay. I want to get into brain retraining, but maybe before we go there, I know that you flagged long COVID as something to talk about. This is something that early on in the pandemic when there started to be some increasing awareness of this situation, some subset of people were getting these longer-term symptoms, you took a deep interest in that and sort of specialized in helping those people very early on.
Now, thankfully, all the COVID mess is largely behind us, what are your thoughts on this landscape of long COVID? I know that there was some controversy, there was some research that was considered flawed, that maybe overestimated how prevalent this long COVID actually was. What are you finding with regard to sort of the reality of it and how to help people overcome it?
Evan: The research that the CDC did came out with 20%, 1 in 5. I think that’s probably accurate. It might be a little bit higher than that, just because a lot of people don’t realize. They get a new symptom and they don’t know where it comes from. The challenge is that it really is very sneaky. The idea is that the more symptoms that you get when you have a cold, but the milder the symptoms are, the more likely you are to get persistent symptoms. Since 2019, if somebody gets a viral illness and then they end up with persistent symptoms. Now, sometimes those symptoms go away. When we get them, they go away for a couple of months and then they come back and you’ve got a bunch of weird symptoms, whether it’s fatigue or brain fog or muscle pain, joint pain, neurologic symptoms, heart palpitations. A lot of these things that are typically weird for most people to experience all of a sudden out of the blue, we have to start considering that.
What’s interesting is that a lot of the people who got sick with COVID, well, I don’t know if this is true or not, but it seemed like I have more interest now in my practice with long COVID than I have the last several years.
Ari: Really?
Evan: Oh yes. I think a lot of it has to do with the fact that a lot of people went to their university’s COVID clinic and they tried to go the conventional route. Then they started looking outside the box after that didn’t help them, maybe a year or two later.
Ari: Sorry, the conventional route for treating long COVID, like seeing a regular doctor saying, “I have these strange symptoms long after COVID. Can you help me?” Basically, those doctors are saying, “We don’t have any treatment for that. We don’t know what to do”?
Evan: Yes, or they went to a COVID clinic at their local university hospital where they had a bunch of specialists there where their heart symptoms were being treated by the cardiologist and their lung symptoms were being treated by the pulmonologist and their gut symptoms were being treated by the GI. They were all being just treated by symptoms. They’re getting all this polypharmacy where they’re getting all these different medications and they weren’t getting [unintelligible 00:41:33] [crosstalk]
Ari: It cured them all.
Evan: Yes, right. I know. They’ve just kept on getting worse, unfortunately, right? Then they started looking outside the box and they’re like, “Okay.” Then they go to their local naturopath or they go to their local integrative doc or their local functional medicine doc and maybe they get a little bit better. Then they start looking outside that and then outside of the local area. That’s when they’re starting to find me and they’re starting to look for people who specialize in long COVID. They’re realizing that it’s really a whole new ball of wax and that we have to have different tools. It takes them a long journey.
I have one guy right now who’s doing really well in my program for about nine months, and all of a sudden his energy came back. He’s in Hollywood. He started working again, producing stuff or whatever he does. His wife had a call with me two years ago and he wouldn’t get on the phone. He’s like, “I don’t want to talk to that quack,” right? It took him those years for her to eventually convince him, “We have to do something else. We have to think differently. We have to look at a different paradigm. We have to look at different causes.” That’s been very interesting to see.
Because I thought in 2020 or 2021, when we’re seeing all this happening, I’m like, “Okay, long COVID, I can help these people because it’s so similar to chronic fatigue syndrome.” Then nobody showed up, It just seemed like they just wanted to go. They’re like, “I’m just going to go to my COVID clinic and I’m going to get better.” Unfortunately, that didn’t happen. That’s the first thing that’s been really interesting.
The other thing is that I’ve seen people who come to see us who have long COVID and we treat them with natural antivirals and they get better. I’ve seen people who come to see us and they have mold along with their long COVID and we treat the mold. Before we even get to antivirals, they’re getting better. It turns out, at least what I’m seeing, is that it really is that combination of the heavy metals, chemicals, molds, and other infections that are present, and then the nervous system dysfunction that all need to be addressed when it comes to long COVID or whether it’s chronic fatigue syndrome or whatever. long COVID is just another infection, right?
There are other things that we do in order to mitigate the microclots that people are seeing. We already do this when we’re addressing hypercoagulation with the chronic fatigue stuff. A lot of it is part and parcel, the same as the other work that we’ve been doing, but we definitely need different tools in order to address the spike protein, in order to have different antivirals to go after the COVID. We are seeing now viral persistence, which previously was thought to not be the case, but the virus is persisting. The spike protein is persisting. We’re getting immune system dysfunction and inflammation so we need to address this [crosstalk]
Ari: Just to be clear for listeners who might not understand that persistence that you’re referring to, is this something analogous to let’s say Epstein-Barr virus staying in a latent state in the body, going into hiding, if you will, or going into dormancy for a period of time, and then when maybe you’re under stress or when there’s a chemical exposure, when your immune system is suppressed from some other causes in your life, now all of a sudden the virus can pop back up again?
Evan: Absolutely. [unintelligible 00:45:05] [crosstalk]
Ari: That’s basically what you’re saying, is there some evidence that COVID is behaving like that?
Evan: Correct. Yes, it is persisting in the body. It is hiding. It’s been found in every cell in the body and that’s why it can cause over 200 different symptoms. That’s what we’re seeing. Go ahead.
Ari: Is there something we can do to help clear this out? Meaning is there also evidence that, okay, it persists in some people, but it is possible to clear it out of the body. If we use something to clear the spike proteins or anything along those lines, is that possible?
Evan: Yes. Yes, we’re seeing that all the time in our clients. Absolutely. One, I guess, public health notice I would say is that if you’re taking things to treat any sort of virus, I recommend that you treat it for four weeks, even after your symptoms resolve after the first week or so because you don’t know because the testing is so poor about whether or not you have COVID. You just have to assume that any virus that you get is COVID. Then you have to treat it aggressively with antivirals. natural antivirals are what I’m talking about. Vitamins; high-dose vitamin D, vitamin C, vitamin A, et cetera, quercetin, zinc, in order to make sure that it’s not going to persist, so they don’t end up with long COVID.
Ari: Got it. I want to ask you a very controversial question that’s highly polarized, which is that there’s also quite a bit of evidence showing harms from the COVID vaccine now. While this was disputed very early on and people tried to suppress it and say that anybody who questioned whether it was safe and effective was some kind of crazy conspiracy theorist nut job. Now the evidence is pretty clear that a certain subset of people absolutely have been harmed by COVID vaccines. There is also something some people have termed long vaccine, but the official name in the literature is long post-COVID vaccination syndrome. Is this something that you’ve also worked with people on, people who have long-term side effects from getting the COVID vaccines as well?
Evan: Yes. I agree with you. the research is definitely clear. I’ve seen a number of studies and presentations on the subject. The vaccine was helpful for some people with some really severe illness and hospitalization initially, but, it was definitely overused and caused more harm than good, unfortunately, I believe.
Brain retraining for healing
Ari: Yes. Agreed. We’ll leave it there in the hopes that this episode doesn’t get censored. One last thing that I wanted to ask you about is the brain retraining stuff. There’s this term, brain retraining, and this has become its own phrase. It’s interesting. How should I describe this? It’s almost a term that is specific to the ME/CFS community. The people in that community have been told about this “brain retraining.” There are specific people like Ashok Gupta and there are now, I would imagine, at least four or five, probably more different methodologies, specific methodologies that have the paradigm of looking at chronic fatigue and ME/CFS through this lens that it is primarily driven by one’s mindset and belief system and the way that their brain operates as a result of maybe early life trauma and chronic stress and things of that nature and that the key treatment to recover from ME/CFS that is, in their view, vastly more important than anything else, vastly more important than nutrition or lifestyle or anything one might do with regards to toxins and infections and things like that. A lot of these people’s frames, and I’m sure some of them are more nuanced, but in general, my experience is that most of them look at ME/CFS through this lens of, “It’s all about what’s going on in the brain. We have to do this brain retraining. That’s the big key to recovery.”
I think like you, I’ve also seen that certain people have benefited tremendously from doing this work. I think you and I agree that it is not solely what’s going on in the brain and that there are obviously deeper physiological layers of what’s going on here. It sounds like you’ve come to see this brain-retraining piece of the puzzle as being very important. Tell me about your experience with that.
Evan: The body will heal better when it spends more time in the parasympathetic state, right? There are two aspects to the autonomic nervous system; the sympathetic and the parasympathetic. Sympathetic is fight, flight, or freeze. The parasympathetic is rest, digest, and recover to simplify it. Whether it is from heavy metals or chemicals or molds or infections from trauma or things that happened in your past, all of those things can cause dysfunction in the autonomic nervous system, in the vagus nerve. Consequently, that puts people into a sympathetic state and it’s very hard for them to heal.
A lot of the techniques that are being used, whether it’s mindset, whether it is breath work, whether it is cognitive therapy, or catching and retraining your different thoughts, all of those things are working to put people more into their parasympathetic. I didn’t know much about it until I saw the people who were doing it in my program get significantly better faster, right? Then it’s like, “Okay, I have to look at this,” right? It’s definitely been a game-changer for the people in my program.
The question is always just when to introduce it. You never know whether or not it’s going to be 10% of their issue or whether it’s going to be 70%, right? Oftentimes when somebody comes to me, they’re like, “I’ve done a brain retraining program for the last year and I’m not better.” I’m like, “Oh, yes, this is going to really help you.” They continue to use those techniques and then they just work better when we’re starting to remove these toxins out.
Ari: Just to clarify for listeners. The way that your brain interprets that is, okay, you’ve ruled out the extent to which the mindset is the big thing causing your issues. Now essentially based on that, we have eliminated that variable or we know that that’s not the main cause of your symptoms so therefore we know that it’s mostly mediated physiologically by things like toxins and infections and mold and that sort of thing. Is that correct?
Evan: That’s correct. That’s what I’m saying. Yes. Having that combination, people are always going to get better. The question is just about how much, and how much is it going to be. That’s why we continue to incorporate more of that into our program. There is a learning curve. It’s challenging for people to do both our program and somebody else’s. Generally, we recommend that if they’re very sensitive, like they’ve got MCAS so that they’re reacting to everything and they can’t tolerate any supplements, then we recommend that they do a brain retraining first or nervous system retraining, whatever you want to call it. If they do not have that sensitivity, then oftentimes we introduce it about three or six months in, depending on how much they can hold because it is such an important component.
Ari: Given that I said that this is a phrase that means something rather specific within the ME/CFS community specifically, there is this specific approach to “brain retraining” that exists in that community. Whereas the term brain retraining might mean lots of other things outside of that. It could be post-brain injury, recoveries, and things like that with lots of different methodologies. Here we’re talking about something that is from what I’ve seen, very cognitive in its approach, very much about helping people with specific techniques that help them control their thoughts and emotions better. This would be largely under the umbrella of what’s called top-down control, which is using your prefrontal cortex to respond better to how your body is thinking, feeling, and physiologically reacting to certain things and basically gaining that skillset of being able to better regulate your thoughts and emotions.
Evan: I think that’s somewhat accurate. I think there are a couple of different levers that are being pulled. I think the most important one is mindfulness. This is also where I found psychedelics to be supportive. Having that mindfulness so that you can experience the sensations that are happening in your body, then allows you to do something about it cognitively. I think that there is the thinking and the feeling, but oftentimes we spend so much time cognitively and so much time in the thinking. Most of, I think, what heals people is actually feeling and getting in touch with the sensations that are in the body and practicing that mindfulness, whether it’s meditation or something in that realm, so that you can experience it.
Then you can do some of these techniques if you’re feeling your nervous system gets dysfunctioned. Like, I was in a conversation with my wife, we were actually having an argument. I was just so overwhelmed by the sensation in my body. I could have very easily started blaming her and being upset with her, as I had done in the past. In this particular situation, I was just like, “Whoa, my body is just going crazy right now with sensation.” Some of the interpretations are about inner child work. Putting my hand on my chest and being like, “Okay, you’re safe, you’re loved, you’re enough,” like, “You’re safe.” This conversation does not indicate that you’re not safe, right?
I think feeling it and then being able to cognitively provide some sort of support for the sensation allows the sensation to disperse. That ends up helping to retrain the nervous system. I’m not an expert in this, I’m still learning about it. That is my understanding of what’s happening. When you’re doing something like the breath work, that is not cognitive also. That’s just, you’re doing box breathing because that helps to move you into parasympathetic or you’re doing some sort of yogic breathing that helps to move you into parasympathetic.
Ari: This is bottom-up basically, how the breath interfaces with the nervous system. The breath is this link between something that is under non-conscious control, but we can also consciously control it. By virtue of that bi-directional effect, we can modulate the breath to modulate the nervous system.
Evan: That’s right. I forgot you’re a breath expert. Yes. I’m glad you put some terms to it. Top-down versus bottom-up. That’s helpful. I would definitely say bottom-up is what I recommend and what I see to be super helpful in my own life and in talking with our clients. I think that there is this mindset cognitive component, but I think that you have to incorporate the other as well.
Ari: Some of the methods that I’ve seen in the CFS community around brain retraining are very much like NLP-based specific techniques that would, I think, largely be categorized as cognitive behavioral-type therapies that are about thought-stopping. Noticing if you’re having negative thoughts and really having a specific technique to notice when that’s happening and to catch yourself and interrupt it and replace it with positive thoughts and helping learn the cognitive technique of just regulating your own thoughts, getting yourself out of these patterns of spiraling out of control of negative thoughts and emotions.
Some of these techniques, to be honest, don’t resonate with me so much, but I have seen a number of people who report really tremendous benefits from it. I would say that in general, my bias is also like yours, I think, towards some of the bottom-up approaches. There are some people that seem to have this catastrophic– I think catastrophizing is the word that would be used in psychological circles where some little thing happens and then all of a sudden they spiral out of control with just this series of negative thoughts and emotional patterns and catastrophizing around every little event. When you do that around every little event, it’s like your whole life becomes dominated by just this constant state of stress and catastrophizing over every little thing. I’ve seen people in that state and I think it’s definitely. the case that they can use some specific cognitive techniques to interrupt that pattern.
Evan: I have found personally that mindfulness ends up leading to that. I like to combine them both because mindfulness allows me to stop and see what I’m thinking and then catch myself. I talk to myself a lot more these days than I ever have because I’ll stop and I’ll be like, “That thought really doesn’t serve me right now,” scarcity around whatever, right? It’d be like, “Let’s choose a different thought that feels good.” That’s how I work with it in my beginner journey. That’s been helpful for me.
Ari: Yes, beautiful. Evan, this has been a really fun conversation. It’s been great to catch up with you. Let people know where they can find you, follow you, work with you, anything else you want to leave people with.
Evan: They can find me at energymdmethod.com and there’s a little button in the bottom right-hand corner where they can text me and we can start a conversation. I’ve got free 20-minute calls if they’re interested in getting on a call and seeing whether I can help them. I’ll go through a little bit of their history and let them know whether I feel like I can and if not, I will send them elsewhere.
Ari: Awesome. Thank you so much for coming on the show again. It was awesome to reconnect with you. Let me know if you want to come on again soon and talk about anything else. It was an absolute pleasure. Thank you so much for sharing your knowledge and your wisdom, your accumulated experience over many years of in-the-trenches clinical experience with ME/CFS with my audience. I really appreciate it.
Evan: Thanks for having me on. I really appreciate it.
Show Notes
00:00 – Intro
00:46 – Guest intro – Dr. Evan Hirsch
08:33 – Is chronic infections the root cause of chronic fatigue?
11:13 – Are tests for root cause of fatigue money well spent?
16:28 – Is ozone good for CFS?
19:12 – The big role mold plays in chronic fatigue
27:40 – Heavy metals and CFS
37:37 – Chemical overload can contribute to fatigue
39:08 – Overcoming Long COVID
48:42 – Brain retraining for healing
Links
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