How to Fix Your Fatigue with Dr. Evan Hirsch: Rational Wellness Podcast 076

Dr. Evan Hirsch discusses how to fix your fatigue with Dr. Ben Weitz.

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Podcast Highlights

2:51  What distinguishes fatigue from chronic fatigue is that fatigue is generally relieved by a good night of sleep and chronic fatigue goes no for an extended period of time, usually longer than 6 months. Dr. Hirsch has found 15 different causes of fatigue: 1. not drinking enough water, 2. not getting enough good sleep, 3. deficiency in adrenals, 4. deficiency in thyroid, 5. deficiencies in sex hormones, 6. nutrient deficiencies like B12, vitamin D, magnesium, 7. heavy metals, 8. chemicals, 9. molds, 10. infections, 11. allergies, 12. negative emotions, 13. EMFs, 14. hidden dental infections, 15. parasites.  One of the founders of Functional Medicine, Dr. David Jones once said that the key to health is finding what we don’t have enough of and providing it and finding what we have too much of getting rid of that.

8:45  Adrenal fatigue or dysfunction can be a common cause of fatigue.  While testing for adrenals can be helpful, you can tell from symptoms if there are adrenal problems. Dr. Hirsch likes to start by using Adrenal Px from Restorative Formulations, which he’ll have patients take every 3 hours until 4 pm and if they need to he will recommend up to 3 capsules per dose.  In addition, make sure they are sleeping well, eating healthy, drinking water, etc. Dr. Hirsch mentioned that one doctor analysed all the studies on cortisol levels and fatigue and there was no correlation at all. If his patients need more support, he’ll recommend Adrenal Px syrup and he may add in some licorice root.  If that hasn’t taken care of the problem, he’ll use a product called Adrenal Para-NS from Byron White formulas. And finally, that hasn’t helped enough, then he will recommend hydrocortisone. 

16:40  Thyroid is another important gland that affects energy levels. Low thyroid is really two conditions: 1. low thyroid prodicution by the thyroid gland and 2. an autoimmune condition in which the immune system is attacking the thyroid. And this is usually because of either heavy metals, chemicals, molds, infections, allergies, emotions, or EMFs. One infection that Dr. Hirsch sometimes finds is involved is Bartonella and getting rid of Bartonella with the Byron White formulas can sometimes completely reverse low thyroid.  To support the thyroid Dr. Hirsch may start with some thyroid glandulars or iodine or kelp, but he generally finds that prescription thyroid is the most effective.  He does not like using Armour or Nature-throid because some patients may bneed more T4 and some may need T3 and we have to figure out the right dose for that individual. You also need to support the thyroid by supporting the adrenals and there’s this beautiful dance between thyroid, adrenals, and the sex hormones.                                               

19:45  Gluten, dairy, soy, and genetically modified corn can all play a role in the causation of thyroid autoimmunity.

24:04  Dr. Hirsch will sometimes use 20,000 IU vitamin D if a patient’s levels are below optimal, since vitamin D will stimulate T regulatory cells, which can help autoimmunity.  Most of his clients take 10,000 IU for maintenance.

27:42  Balancing sex hormones can help with fatigue. He finds that a lot of times when he finds younger men with mold, which results in low testosterone levels and low libido and once we get rid of the mold, their testosterone and libido comes back.  He will test for mold with urine testing from Great Plains or Real Time Labs after taking 500 mg of liposomal glutathione twice per day for seven days. For heavy metals he will use the Doctor’s Data provoked urine test using DMSA and test before provocation for baseline and then test after DMSA provocation.  To screen for other chemicals besides heavy metals he will use the Great Plains Lab GPL-TOX urine test also with glutathione provocation. To get rid of metals and other toxins he will recommend saunas, coffee enemas and cilantro and chlorella and modified citrus pectin. Dr. Hirsch likes to use a combination of products by Byron White that open up the liver and kidney pathways and helps to open the lymph and the neurolymph. He finds that most of his patients require at least 6 months to a year of treatment and sometimes as long as 36 months.

39:45  To support mitochondria, which are the organelles in the cells that produce energy, and they produce 70-80% of our energy.  Our mitochondria can get damaged by heavy metals, chemicals, molds, infections, allergies, emotions, and EMFs.  Not only do we have to remove that crap off of the mitochondria but we also have to inject the mitochondria with some good love in the form of like Acetyl-L-carnitine, L-carnitine and D-Ribose, CoQ10.  Dr. Hirsch likes to recommend a product from Research Nutritionals called ATP Fuel for supporting the mitochondria and he sees a boost in energy from using it.  Dr. Hirsch is on a mission to help a million people resolve their chronic fatigue!



Dr. Evan Hirsch is an MD who is practicing Functional Medicine with a focus on treating patients with chronic fatigue.  His website Fix Your Fatigue  offers a free download of his best selling book, Fix Your Fatigue.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.


Podcast Transcripts


Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.  Hey Rational Wellness Podcasters. Thank you so much for joining me again today, Dr. Ben Weitz here. For those of you who are enjoying the Rational Wellness Podcast, please go to iTunes and give us a ratings and review, that way more people will find out about the Rational Wellness Podcast. Our topic for today is fatigue and what do we do about fatigue. Today we have Dr. Evan Hirsch, who’s a medical doctor who practices in Olympia, Washington, using a Functional Medicine approach and his practice is really focused on treating patients with various forms of chronic fatigue. He’s written a best-selling book, Fix Your Fatigue. Dr. Hirsch, thank you so much for joining us today.

Dr. Hirsch:           Thank you so much for having me on Dr. Ben.

Dr. Weitz:            So since you’re a conventionally trained MD, how did you veer off the path into functional medicine?

Dr. Hirsch:           So, when I grew up, my mom was really into natural stuff. So, I think I was about 10 when she first started down her path, and she had very high cholesterol genetically, and she was able to reverse it using oat bran. We went on this six months of oat bran muffins, oat bran this, oat bran that. I remember just being really disgusted by oat bran at the end of it, but she brought her cholesterol down significantly and I thought that was very interesting, and then when I went through medical school, I just am very curious, I ask a lot of questions, and I wasn’t happy with the answers that I was getting from all of my professors and doctors-

Dr. Weitz:            Just put people on statins, right?

Dr. Hirsch:           Exactly, and so I was saying, “Well what’s the cause of the cholesterol issue? What’s the cause of the high blood pressure?” And getting to the root, and I didn’t like the answers I was getting so I went off into holistic medicine. I got board-certified in holistic medicine, went into integrative medicine, functional medicine, environmental medicine and that kind of led me down that path and then my wife got chronic fatigue and then a couple of years later I got chronic fatigue, and so it was working through all that that I really became so in tune with what the causes were for fatigue and how to resolve them.

Dr. Weitz:            Great, so what are some of the most common causes of chronic fatigue? And by the way, what distinguishes chronic fatigue from other forms of fatigue?

Dr. Hirsch:           It’s a great question. So fatigue in general just means that you’re tired and it’s not resolved with rest, because theoretically you should be able to work out hard and then you sleep well and then the next day if you’re not well rested you sleep well the next night and then you’re fine, so it may take a couple days to recover depending on whether you ran a marathon or not but you should recover. Fatigue is when you don’t recover and then chronic fatigue is when it’s been going on for a extended period of time. Conventionally it’s usually longer than six months or so but usually if somebody is having an issue after just a couple of weeks I say don’t wait because there’s things that are happening that your body should be recovering and at that point you need to start going after it.

So that’s the answer to your second question there, and then the first one and around the causes, so I have found that there’s 15 different causes of fatigue but to be brief on it, and we can definitely get into those, generally I put them into two categories, one is things that need to be replaced or deficiencies, and so that’s things like not drinking enough water, not getting enough good sleep, deficiencies in hormones, adrenal, thyroids, sex hormones, deficiencies in nutrients like B12, vitamin D, magnesium. And then the second part is excesses, so we’re talking about things that need to be removed, the crap that’s in the body that needs to be removed out that’s causing problems, so we’re talking about heavy metals, chemicals, molds infections, allergies, negative emotions, electromagnetic frequencies, hidden dental infections, parasites, so a bunch of that crap that’s not supposed to be in the body that’s just draining the body and causing all these deficiencies.

Dr. Weitz:            Yeah, a famous Functional Medicine doctor basically said, “It’s pretty simple, what do I not have enough of and add that and what do I have too much of and get rid of some of that.” I think that was Dr. David Jones.

Dr. Hirsch:           Yeah, that’s exactly right. What I find with a lot of docs, they have that theory but they’re not looking enough at molds. They don’t have enough knowledge around mold illness, how to diagnose it in a person, how to diagnose it in a home to make sure they’re not living in a home, what that process looks like and then infections. You really have to dive in there in order to get that knowledge beyond just what Dr. Jones said.

Dr. Weitz:            Yeah, absolutely, and the tricky part is that you could spend a lifetime just studying mold, you could spend a lifetime just studying heavy metals, and so each time you get into one of these specific topics as a functional medicine practitioner it’s like jumping down a new hole of a whole new set of things to learn about, and that’s the tricky part. You tend to find what you’re familiar with, so if you’re really comfortable dealing with heavy metals it’s easy to find heavy metals, and most people have heavy metals so you fix those and you’re gonna get some improvement.

Dr. Hirsch:           Right, exactly, and that is a problem with being a clinician is we always have to catch ourselves and make sure that we’re just not leaning on what we enjoy treating or what some of these old patterns are and really trying to be as expansive as possible. And so for me what I have people do when they first come to see me is I have them run a whole bunch of labs because I know my clinical suspicion and I can diagnose some things clinically but neuropathy, fatigue, I mean a lot of these things it could be multiple things. And in fact, with everybody that I see I tell them, “There are 15 potential causes, you have multiple causes of fatigue and the causes that you have are different than the person in the next room.”  So we all have different multiple causes and they’re all different from each other which makes it so hard to treat, so it’s really important to get all of those things assessed, the heavy metals, chemicals, molds and infections, looking inside the body, making sure and seeing whether or not they’re there, putting them together with the symptoms and then coming up with a plan and having the right tools in order to treat them effectively.

Dr. Weitz:            And one of the things that I find challenging in Functional Medicine is when patients come in with the conventional mold, they’re realizing, “Well of course I realize it’s gonna be a little bit different,” but basically they want to take the test, they want to be told it’s this, they want to take those pills and that’s it, I’ll see you, and the problem is these are a lot of times complex cases and there are levels of dysfunction. So if the person has mold but they also have a leaky gut and they also have nutritional deficiencies, and you can’t address all these at one time so you sort of have to prioritize, deal with some of the most significant ones first and it’s a different model than you’re used to going to their medical doctor.

Dr. Hirsch:           Absolutely. I tell people this is a marathon, it’s not a sprint. This is a long-term proposition and it’s gonna require a lot of information or a lot of buy-in from them, and the people who come to see me have already seen 20, 30 doctors and so they’re probably different maybe than the people who come to see you but they’re usually a lot more bought in than when I was just practicing functional medicine now that I’ve ditched myself in this way and people are coming to me for chronic fatigue.

Dr. Weitz:            I see, interesting. I was reading your book which is an excellent read, lots of good information, easy to read and you talk a lot about adrenals in one of the first chapters, can you talk about how important adrenals are to fatigue? And how do we assess adrenals? And what do we do about adrenals if they’re burned out or not functioning optimally?

Dr. Hirsch:           Absolutely, and this is one of the things that I do at the first visit. Generally even without labs I can tell whether or not someone has the symptoms of adrenal dysfunction, and to answer your question-

Dr. Weitz:            Do you ever have patients do a series of labs before they even come in?

Dr. Hirsch:           I don’t.

Dr. Weitz:            Okay.

Dr. Hirsch:           Yeah, they could. A lot of people come with their own labs but I don’t because I want to make the assessment and I want to make sure that I’m ordering the correct labs for them, but the adrenals are really a universal problem. The adrenal gland produces lots and lots of hormones, cortisol is the big one that we talk about a lot that manages stress, it manages the immune system, it manages inflammation, everybody’s heard of prednisolone and cortisone, well guess what? They come from cortisol and that’s our body’s natural anti-inflammatory. So whenever there’s inflammation in the body like from eating gluten or eating dairy or having an infection or having mold, cortisol goes and some of the other adrenal hormones go and try to put out that fire, and as a consequence those hormones coming from the adrenal gland end up going down and people will have low blood pressure, they will crave salty and sweet things.  Generally they’ll say, “I can’t walk past a bag of potato chips without having to stop to eat it.” And then with the low blood pressure they’ll kind of have dizziness when they go from a sitting to a standing position too quickly. They will have low energy throughout the day, but typically they’ll crash usually at around eleven o’clock or at around three o’clock. Three o’clock is the big one where people are like, “Man, between 2:00 and 4:00 I have to take a nap. I have to get some chocolate, pick me up, caffeine, 5-hour energy.” Whatever it is, that’s really when they’re crashing, or they exercise and they have exercise intolerance where they exercise and then they’re crashed out for two days and they’re like, “I thought exercise was supposed to be good for me.” It’s like, “Yeah, but if your adrenals aren’t working well your body can’t manage the stress of that exercise.”

For those of you who don’t know, the adrenal gland is a little triangular gland, sits on top of the kidneys, produces cortisol and some of these other hormones which regulate so many parts of the body, so important and really the sentinel gland. As the adrenal gland goes, so goes the thyroid, so goes the sex hormones, so its really so pivotal, so important. So that’s the anatomy of the adrenal gland, the symptoms that you’ll get with it, and then in terms of testing like I said, I can tell really based off of their symptoms but sometimes you’re looking at a morning cortisol level which is what I do in blood but you can also look at saliva to look at four times a day, but those are kind of the big ones.

Urine can be helpful looking at urine metabolites from the adrenals, so all of those can kind of give you a glance. I do believe that looking at the symptoms are most important. And then in terms of treatment, I’ve tried lots of things over the last 10 years and I’ve dumped all of my protocols into the book, you can read more about this but I found that there’s this one product called Adrenal Px by Restorative Formulations that’s Eleuthero root, Hawthorn root, but mainly the Eleuthero root that’s super smooth and super strong that I have people take every three hours until 4:00 PM and it makes a world of difference in their overall function. It’s really the first thing that I do when you talked about the common causes, one of the most common causes is adrenal dysfunction, maybe it’s cortisol, maybe it’s some other components of the adrenal gland.  But starting to work on that adrenal gland, starting to work on sleep, behavior, food, those are kind of a lot of the big things that I do initially that can make a huge difference in people’s lives.

Dr. Weitz:            Cool, there’s a lot of discussion these days about checking the cortisol within like the first 30 minutes of waking up, it’s called the cortisol wakening response, and so now some saliva tests. You actually spit into a tube before you even get out of bed and apparently you get the most accurate assessment of cortisol apparently using that test now.

Dr. Hirsch:           Interesting. I’ve got a free Facebook group with almost 1,000 people in it and I just did a Facebook live review of some of the work that Ari Whitten did at the Energy Blueprint. He basically looked at all of the research on cortisol and its association with fatigue, and I think most of the research was on blood and on salivary, probably wasn’t on this new technology, but what he found, and time and time again, I mean he went over like, I don’t know, almost 100 different papers and meta analyses and there’s really no correlation between low cortisol levels and fatigue.

Dr. Weitz:            Interesting.

Dr. Hirsch:           Yeah, and so what I really think is happening is that there’s a number of these different components, these different hormones that are being produced by the adrenal gland, epinephrine and norepinephrine which are like the adrenaline hormones, maybe they’re playing a bigger role but utilizing just cortisol to determine someone’s adrenal function really hasn’t been proved and has been disproved in the research to be effective and functional. So we need some better tools but in the meantime I do use it and I combine it with symptoms, making sure that … Because those symptoms can be very specific for the adrenals.

Dr. Weitz:            How often do you actually prescribe cortisol itself?

Dr. Hirsch:           Great question, so like hydrocortisone, Cortef , some of those prescriptive agents?

Dr. Weitz:            Yes.

Dr. Hirsch:           So I have a tiered approach where I’ll start off with giving people Adrenal Px and then if they need I’ll ramp up to three capsules per dose, four capsules per dose. If they need more support I will put them on the Adrenal Px syrup which is a little bit stronger, and then if they need more support beyond that oftentimes and they have low blood pressure I’ll add in a little bit of licorice root and then I’ll move into a product called Adrenal Para-NS by Byron White Formulas, and then I’ll get into hydrocortisone. So there are problems with hydrocortisone, it is a steroid. I mean cortisol is also a steroid, we’re making our natural steroids but it can cause people to put on weight.  They get a little bit of this chipmunk appearance with the jowls and often times they may get a bit of a hump on the back and they do put on the weight and they do start craving a lot more food which causes them put on the weight. So it’s not perfect, there is a book called Safe Uses of Cortisol by William Jeffries where he did use it long term, and I have used it long term with some people but the goal is that it really is just a band-aid, because when we figure out what’s causing stress on the body and that could be a mental, emotional stress or it could be physical stressors like all that crap that’s in the body that I talked about before, once we remove those it allows the adrenal gland to relax. It doesn’t have to produce all these hormones and you shouldn’t need as much of the adrenal support.

Dr. Weitz:            Cool, now another important gland that affects energy levels is thyroid, can you talk about that a little bit? And how often is that playing a role?

Dr. Hirsch:           Absolutely. Thyroid dysfunction is huge and part of that has to do with the fact that low thyroid is really two conditions, it’s low thyroid production by the thyroid gland and then it’s also an autoimmune condition. So the immune system is attacking the thyroid, and usually it’s because one of those crap things, what I call the usual suspects, heavy metals, chemicals, molds, infections, allergies, emotions, EMFs, they’re all in the thyroid and so the immune system is trying to get rid of the stuff in the body that’s not supposed to be there. So it goes on over to the thyroid, calls its friend, starts attacking the thyroid to get at what’s in the thyroid, usually it’s mercury, maybe it’s Bartonella which is this particular kind of infection.

It grabs at it, tries to pull it out, oftentimes not successful because they’re so sinister but that’s kind of the process and in that process you’re destroying the thyroid and you get lower levels of thyroid.  So in order to fix it you have to remove the crap that’s in the thyroid, that’ll slow down the destruction of the thyroid or stop it.  Immune system is no longer gonna react to it and consequently you’re not decreasing your thyroid levels. Now, I do like to use prescription grade thyroid when I am replacing the thyroid.  I’ll start off with some natural things, some thyroid glandular or some iodine or kelp or some of these other things, but generally I find that I get the biggest shifts when I dive into using the prescription agents.

Sometimes people need more T4, sometimes people need more T3.  People who just use Armour or Nature-Throid or Westhroid, they’re missing the boat, that’s basically like a combination of T4 and T3 but everyone’s an individual and most of the time those people who come to me on Nature-Throid or Armour, they need more T4 or they need more T3. We have to figure out the right dose for that individual, and this combination product is not a one-size-fits-all, but thyroid plays a huge role. You also support the thyroid with the adrenals, and there’s this beautiful dance that happens between thyroid, adrenals and sex hormones, and they really all have to be present and accounted for in order for the whole system to work.  So somebody steps out of the dance like when you have stress with the adrenal gland and that’s gonna tax the thyroid and the sex hormones or you get above 50 and all of a sudden the gonads start to shut down and sex hormones start to go down. If the adrenals aren’t robust enough, they’re supposed to take over production of the sex hormones, but if they’re not robust enough, then both the adrenals and the thyroid will start to decrease their function as well, as they try to scramble and compensate for each other.

Dr. Weitz:            Do you find that gluten is sometimes playing a role where the body immune system attacks the gluten and then you get this cross reactivity with the thyroid?

Dr. Hirsch:           Yes, gluten definitely plays a huge role, gluten-

Dr. Weitz:            Soy.

Dr. Hirsch:           … dairy, soy, corn, genetically modified corn, those are kind of the big ones that I see but the only time I’ve ever been able to really reverse thyroid and to get people off of their thyroid medication has been going after infections and heavy metals. There’s one particular infection called Bartonella, this is a funny, serendipitous story where I had a patient who I had just put on a treatment for Bartonella. Now Bartonella is this infection that causes a combination of symptoms usually a combination of headaches, neck pain, problem sleeping, anxiety, depression, pain on the bottom of the feet, muscle cramps in the calves, stretch marks sort of rash on the body and thyroid issues, and so you don’t have to have all those you just have to have some of those. The big ones are like pain on the bottom of the feet usually misdiagnosed as plantar fasciitis and the muscle cramps.

But I put somebody on treatment for Bartonella and she comes back in like the next day and she’s in a thyroid storm. So she was on thyroid medication, I started her on this path and now she’s got too much thyroid, she’s like hyper thyroid. Her heart is beating out of her chest, she’s got tremors, she can’t sleep, she’s anxious, agitated, I said, “I don’t know what’s going on but we got to decrease your thyroid because you’re hyperthyroid.” So we decreased her thyroid and over time as we ramped up on treating her Bartonella we were able to wean her completely off of her thyroid medicine, which I’d never been able to do before.  I never heard of anybody being able to do this before, so it was very exciting.  And so I find that about 50% of people who have thyroid issues who also have Bartonella, I’m able to get them off or wean down off of their thyroid medication, maybe not all the way but a significant way down off of their meds.

Dr. Weitz:            Very cool. What kind of treatment did you use for the Bartonella?

Dr. Hirsch:           So I’m a big fan of Byron White Formulas. He’s just done an amazing job with his herbal complexes, and so A-BART is really one of my favorite formulas which has neem in it and poke root and a number of other things to break up biofilm, to kill the infection, to push it out of its hiding form.  It’s incredibly potent, so even just one drop can send people into a die-off or a Herxheimer reaction where you’re killing the bug and you feel worse, and so sometimes I even start people off topically, just rubbing it into their hands can make a huge difference for folks, but his formulas are really genius and I love to use them.

Dr. Weitz:            Interesting, yeah. I interviewed Darin Ingels who’s an expert on Lyme disease and he mentioned the Byron White Formulas as one of the formulas that he’ll use, and I guess Bartonella is often talked about as a Lyme co-infection.

Dr. Hirsch:           Exactly, yeah. Acutely it’s cat scratch fever, where people get big lymph nodes and they get fevers but chronically, yes it can exist in ticks and fleas and mosquitoes and all these things that transfer Lyme.  And I find that I don’t have to treat Lyme or Borellia as much when I’m going after these co-infections, whether it’s Bartonella, whether it’s Babesia that will cause people spontaneous sweating, shortness of breath, cough, awful panic and anxiety as well as depression and suicidal thoughts. I go after those guys and I don’t have to really go after the Lyme, Borellia as much because then the immune system will come back on board.  I get rid of the molds and the heavy metals that brings the immune system back even more, because you really can’t treat these infections until you get rid of the heavy metals, chemicals and molds that have distracted the immune system. So you got to bring that immune system back in order to bring these bugs back into check.

Dr. Weitz:            Cool, I noticed you were talking about using 20,000 units of vitamin D sometimes for patients with thyroid problems, that’s pretty high dosage, do you find that to be necessary to go that high?

Dr. Hirsch:           Yes, and it really depends on what we’re doing, but when we’re looking at the thyroid and we talked about it being an autoimmune disorder, one of the ways in order to modify the immune system and what’s called the Th1/Th2 balance. One of the aspects of the immune system is causing this autoimmune component, and you can adjust that by dealing with the T regulatory helper cells and you can do that with high dose vitamin D, you can do that with glutathione, you can do that with low dose Naltrexone.  So there’s a number of different strategies that we can use to bring that seesaw back into balance and decrease the amount of autoimmunity that’s happening to the thyroid.  And there’s been lots of studies on vitamin D and I know doctors who try to get people’s levels up to 100 or 150 units on the blood and I’m really looking for more 60 to 100 but people are so deficient that you can give them 20,000 and oftentimes it’s not gonna put them into excess of 100. Most people live at around 10,000 but yeah, 20,000 is also really great for colds, boosting that immune system so that it’s able to function at a higher level.

Dr. Weitz:            Yeah, you probably noticed patients who’ve been to their medical doctor who tested their vitamin D and they said, “Oh yeah, I’m taking plenty of vitamin D. I’m taking 1,000 units a day.

Dr. Hirsch:           Right, yeah it’s almost comical. And the levels when we’re looking at those labs, normal range is not a normal range. It’s not an optimal range, it’s a population-based range, so I’m always telling people … Because a lot of those labs say yeah, less than 20 is low for vitamin D and I’m saying less than 60.

Dr. Weitz:            Yeah, exactly. There was just a study that showed that women who got their vitamin D above 60 had the lowest risk for breast cancer. I noticed you mentioned PEMF which is a kind of electrical machine, right?  And you sometimes use that for patients with thyroid issues.

Dr. Hirsch:           I did. I was experimenting it for a while, probably around that time that I was writing the book. I don’t use it a lot, in part, because some of the ones that I’ve used have just been too strong for a lot of my patients. It opens up the capillaries where you’re able to absorb things a lot better and you’re able to detoxify and I really need more control over detoxification because a lot of my patients were feeling worse. It was also very dehydrating for them and when you have adrenal issues you don’t maintain your salt balance well and so consequently you’re chronically dehydrated, and so it was just a little bit too much. I was using the BEMER technology and some of those and it was just too strong on people.

Dr. Weitz:            You might look into using cold laser. There’s a research group out of Brazil that’s published several studies using cold laser directly over the thyroid, there’s a certain protocol and they’ve actually been able to show changes in the cells and actually reverse Hashimoto’s in some cases.

Dr. Hirsch:           Wow, I’m writing that down right now.

Dr. Weitz:            Yeah, I’ll send you a copy of one of the papers afterwards.

Dr. Hirsch:           Great, thank you.

Dr. Weitz:            So you also talk about trying to balance the sex hormones as something to look at when patients are suffering with chronic fatigue, maybe you could talk about that.

Dr. Hirsch:           Sure, so sex hormones, generally I’m looking at that for people who are over the age of 50, but when mold is introduced it’s incredibly common in any age, especially scratched my head for a while, I’ve had all these men that had low testosterone levels, low libido, stuff like that, turns out that most of those had mold and once we got rid of the mold then the libido came back, the testosterone levels came back up. So it really is about where’s the stress on the organism? How are the adrenal thyroid sex hormones playing a role? Can we do it with herbs? Sometimes I’ll use maca and different forms of maca to boost estrogen, progesterone, testosterone, but sometimes I’ll need to go …

I had a patient today in my office who I needed to give bioidentical hormones. So she’s 47 years old, she’s moving into menopause, she’s got hot flashes and sometimes in the interest of time and in the interest of helping somebody resolve their symptoms I’m like, “Okay, we’re gonna boost your adrenals and while we’re boosting those I’m also going to give you this symptom relief because this is gonna make everything work better as we remove these toxins out of your body.”

Dr. Weitz:            Cool, yeah. One of the problems I think is all these endocrine disrupting substances in the environment.

Dr. Hirsch:           Yeah, we tested her for toxins and we found that there were a bunch of organophosphates, so pesticides that were found in her urine in addition to some mycotoxins or mold toxins that were there too.

Dr. Weitz:            Yeah, I’ve tested hormones on about 20 men in the last several months and like 17 of them were low, especially in their free testosterone, even called up the lab and said, “Is there something wrong?” But I think it’s getting to be really common that these endocrine disrupting substances and potentially mold and heavy metals as well are interfering with testosterone production.

Dr. Hirsch:           You got it right there. Yeah, and they’re all stressing out the hormone system which is really … When it comes to options in the body, I tell people, “Does your body want to survive or does it want to procreate?” And right now it just wants to survive. It’s dealing with all that crap coming at it, it’s stressed out of its gourd and it’s gonna send as many of its resources as possible over to the adrenals, to the thyroid, and it’s not going to worry about the production of testosterone. You can actually see that also when you’re looking at the steroid hormone pathway, that half of it is kind of like adrenals and the other half is sex hormones and you can see how it would be diverted.

Dr. Weitz:            So let’s say you have a patient with chronic fatigue and you’ve looked at the thyroid and adrenal and maybe even addressed the sex hormones, and now you’re starting to think, “Okay, could there be an infection or maybe heavy metals or mold,” and there’s nothing really clear in their history, how do you decide which way to go?

Dr. Hirsch:           So that’s where the labs come into play, because I’ve definitely been proven wrong. And actually another person I had today, I was like, “Well there is no history of known mold exposure.” Now most people don’t ever think that they’ve had mold exposure unless it’s been on the wall, and so I have to ask them, “Okay, have you ever lived in a place that had a leak in the roof or had a flood in the basement or had a broken pipe?” And then people say no and then inevitably they’ll come back the next time and say, “You know what? I think I did.” But it’s so nebulous and it could be that it was a place that they were growing up when they were five and they don’t remember. And so it’s all about the testing, it’s all about having good tests in the urine mycotoxin which is looking at the mold toxins is really the best test out there.  Now you have to propagate it with glutathione so you have to make sure that somebody’s taking glutathione so that they can push all of the micro toxins out and make sure you get a good test.

Dr. Weitz:            Oh, interesting. How much and how long do they have to take the glutathione for before you do the urine test?

Dr. Hirsch:           So seven days, 500 milligrams of liposomal glutathione twice a day, so that’s like a teaspoon twice a day of the ReadiSorb glutathione or the Tri-Fortify liposomal glutathione by Research Nutritionals, and so either one of those should work but seven days or however long. If they can’t take it for seven days because they start to feel like crap because they’re mobilizing all this crap that’s in their body, then just have them take it on that day so that they don’t have to suffer, but generally seven days, twice a day, 500 milligrams and then they do that test but that’s the urine test for the mycotoxins, the urine provocated test for heavy metals utilizing DMSA, really the best ways to get these things out of the body so that you can test them and determine what’s going on.  The PCR tests are basically a DNA test for a lot of these Lyme type infections in the urine through DNA connections is the best test out there. So there are a number of different tests but you got to make sure you’re looking at the right one.

Dr. Weitz:            Which test do you use for the mold? Do you use the Great Plains mycotoxin test?

Dr. Hirsch:           I’ll use both of them, the Great Plains or the RealTime Labs but Great Plains, less expensive, does a great job, I really like what they’re doing. RealTime Labs is covered by Medicare, they also do a great job and they’re expanding their panel a little bit more but I’ll use either one but the Great Plains is less expensive.

Dr. Weitz:            Cool, and then how do you assess for heavy metals?

Dr. Hirsch:           So I’ll use Doctor’s Data, looking at the DMSA provocation test where people take 10 milligrams per pound of body weight, so if they’re 200 pounds or over they’ll take 2,000 milligrams. But I do a pre and a post, so you wake up in the morning and you check your urine and that’s the pretest and that tells you what’s floating around in the bloodstream, and then you take 2,000 milligrams or whatever your weight is of the DMSA and then that’s gonna start pulling out the heavy metals from the tissues, from the organs, because that’s where the heavy metals live. They don’t live in the bloodstream, that’s why when you do a blood test for lead it’s really worthless, blood test for mercury, worthless.

You have to pull it out from the tissues and then you check it in the urine, you collect the urine for the next six hours and then you compare the two and that can give you some really good information as to whether or not someone has a heavy metal. And then there’s a lot of nuances to it because if they’re detoxification pathways are really clogged up with molds or chemicals then they’re not going to have a very positive results or if you detoxify them for a period of time then all of a sudden they’re gonna be releasing a lot more mercury, so they’re going to be like, “Why is my mercury getting worse?” Well it’s not getting worse it’s just that when you were detoxifying initially you could only get rid of up to this amount of mercury, but now that your detoxification pathways are so much open now you’re able to get rid of so much more mercury out of your body. So there’s a lot of nuances to that and I do talk about some of that in my book.

Dr. Weitz:            Interesting. Is there a way to screen for some of the other chemicals besides heavy metals, like the endocrine disrupting substances.

Dr. Hirsch:           So I use the Great Plains Lab, they’re GPL-TOX tests which looks at kind of a hundred different chemicals and that’s a really great test as well, and also should be provocated with the glutathione.

Dr. Weitz:            Okay, great. And then how do you get rid of heavy metals?

Dr. Hirsch:           So that is a great question too, so there are some more aggressive techniques or some more gentle ones. You can use things like saunas and coffee enemas and cilantro and chlorella and modified citrus pectin. I use a combination of products by Byron White. A combination that opens up the liver and kidney pathways, helps open up lymph neurolymph so basically lymph that’s in the brain, and our lymph system is really our garbage can or trash system that really helps to move things through, and then a product that he’s got called Envi-Rad which helps to get the metals out as well as the chemicals.  And in a study that Byron White did on his patients, he found that over a 10-day period when he combined all of these products he saw a 300% increase in excretion of metals in the urine which is pretty darn equivalent to doing it with DMSA which has a lot more side effects and consequences, and you have to make sure that you’re replacing a lot of the minerals and a number of other things. You have to protect the liver and the kidneys while you’re doing that so it has a lot more nuances to it, and so I’ve been very pleased with using this Byron White protocol.

Dr. Weitz:            Cool, how long does that protocol typically take?

Dr. Hirsch:           So it depends on the person, generally the people who are coming to see me need to do it for sometimes six months, sometimes 36 months, so it really depends. I tell people, I say, “I’d like to get you better in a year but depending on the number of causes you have and your ability to tolerate these supplements that I recommend will determine on whether it’s a year or whether it’s three years.”

Dr. Weitz:            Now, do you look at the guy to make sure that they are not constipated, so they’re actually excreting these toxins to make sure they don’t have a leaky gut so they don’t get reabsorbed.

Dr. Hirsch:           That’s a very important point. Nobody should ever be doing any sort of detoxification unless they can get things out of the body, and that means that you’re peeing regularly, you’re pooping regularly, that you’re sweating regularly, that you’re able to exhale. Those are the ways that we detoxify our bodies and so you have to be able to be stooling on a regular basis, once or twice a day. And so I’ll use magnesium to bowel tolerance, but a lot of times when … Constipation has a cause, it could be thyroid and I kind of have a chapter, I’ll dedicate it to this in the book. It could be thyroid, it could be parasites, it could be yeast, it could be a number of these infections that I test.  I really like that GI-Map stool test, really works well.

Dr. Weitz:            Yeah, we’ve been using that a lot too.

Dr. Hirsch:           Yeah, and it gives you a lot of good data and then you can determine whether or not you need to fix it, but everybody that I see has got a leaky gut because they have all these causes of fatigue which also all damage the gut, so there has to be some leaky gut repair. But I found that I’m just wasting time and money to try to heal leaky gut when someone’s got heavy metals, chemicals and molds. I can heal the gut at the same time as going after the fatigue by going after parasites or yeast, but it just doesn’t make a lot of sense for me when I’m treating these really sick people to go after that leaky gut and spending a lot of time there.

Dr. Weitz:            Yeah, especially if their primary symptom is not gut related so you have to prioritize.

Dr. Hirsch:           Exactly.

Dr. Weitz:            Yeah, so the final topic I want to touch on is mitochondria which is that part of the cell that’s truly responsible for producing energy, can you talk about how we think about the mitochondria with respect to fatigue?

Dr. Hirsch:           Absolutely, so the mitochondria like you said is the energy center of every cell in the body except for red blood cells, they don’t have them, but it produces about 70 to 80% of our energy, our ATP as it is. And so the mitochondria comes from a bacterial ancestor, it has this very important mitochondrial membrane which can get damaged by heavy metals, chemicals, molds, infections, allergies, emotions, EMFs, like all these things are going to damage that mitochondria, and so not only do we have to remove that crap off of the mitochondria but we also have to inject the mitochondria with some good love in the form of like Acetyl-L-carnitine, L-carnitine and D-Ribose, CoQ10.

There’s a number of things that I really like to use but the most important thing I think is also to heal that mitochondrial membrane, because what people forget sometimes is that around that cell, that membrane, is the communication tool for other cells, so there’s these ion channels, there’s these messengers that need to be working, and so one of my favorite products is ATP Fuel by Research Nutritionals which does wonderful things for healing the mitochondria and then repairing that mitochondrial membrane. And they did a study on 58 people, and after the saturation you’ve got to boost it up, taking it twice a day for the first two months but after the first two months they saw a 30% average increase in energy.  So just a really nice bump of one or two points of someone’s energy just from doing that, now imagine if you’re also boosting the adrenals, boosting the thyroid, B12, vitamin D, magnesium and then also removing the crap out of the body, you’re gonna get a lot better energy and a lot better function.

Dr. Weitz:            Cool, I feel more energetic already doc. So thanks for the interview Evan, this is really good. How can listeners get a hold of you?

Dr. Hirsch:           So you can find me at fixyourfatigue.org, F-I-X-Y-O-U-R-F-A-T-I-G-U-E.org. You can also check out my free Facebook group which is Fix Your Fatigue With Dr. Evan, you can find that from my website as well. I do have a free download on my website of my book, so if you want to get it on Kindle or on Amazon as Kindle or paperback you’re more than welcome, but you can also download the PDF for free, and I’ve really dumped all of my protocols into there so you can figure out how to solve your fatigue. And I do have about 10 spots available for one-on-one and group coaching right now, so if people are interested I’ll be filling that up in the next month or so. But otherwise, I’m on a mission to help a million people resolve their chronic fatigue so thanks so much for having me on and helping me with my mission.

Dr. Weitz:            Cool, that’s great, that’s a great mission doc. Talk to you soon.

Dr. Hirsch:           Thanks so much.


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