Uncovering the Roots of Exhaustion—and How to Feel Like Yourself Again

Mark Hyman, MD

Dr. Mark Hyman is leading a health revolution—one focused on using food as medicine to support longevity, energy, mental clarity, happiness, and so much more. Mark Hyman, MD is a practicing family physician and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, Founder and Senior Advisor for the Cleveland Clinic Center for Functional Medicine, a fifteen-time New York Times best-selling author, and Board President for Clinical Affairs for The Institute for Functional Medicine. He is the founder and chairman of the Food Fix Campaign, dedicated to transforming our food and agriculture system through policy.

He is a co-founder and the Chief Medical Officer of Function Health. He is the host of one of the leading health podcasts, The Dr. Hyman Show with 150+ million downloads. Dr. Hyman is a regular medical contributor to several television shows and networks, including CBS This Morning, Today, Good Morning America, The View, Fox, and CNN.

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Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Izabella Wentz
And they're like, well, people tell me to exercise, but I feel worse when I exercise. People tell me to fast, but if I fast, I feel awful. I'll try to sleep for twelve hours and I'm still tired. You know, they're really stuck in that state where their body, just every little stressor can be so overwhelming.

Dr. Mark Hyman
Before we jump into today's episode, I want to share a few ways you can go deeper on your health journey. While I wish I could work with everyone one on one, there just isn't enough time in the day. So I built several tools to help you take control of your health. If you're looking for guidance, education, and community, check out my private membership, the HymanHive, for live q and a's exclusive content and direct connection. For real time lab testing and personalized insights into your biology, visit Function Health.

You can also explore my curated doctor trusted supplements and health products at doctorhymen.com. And if you prefer to listen without any breaks, don't forget you can enjoy every episode of this podcast ad free with Hyman Plus. Just open Apple Podcasts and tap try free to start your seven day free trial. Fatigue can get better. When we understand how our biology works, when we get rid of the bad stuff, we put in the good stuff, when we hunt down and root out all the causes, which are anything from toxins to allergens to microbes, microbiome, to poor diet, to stress, or lack of things we need to thrive, like the right nutrients, the right food, whole food, the right balance of hormones, light, air, water, sleep, movement, exercise, restoration, deep relaxation, community, love, meaning, purpose.

These are all the ingredients for health. When we don't have enough of those, we have too much of the bad stuff, none of the good stuff, then our bodies dysfunction. And the goal of functional medicine is to get your bodies functioning again, hence the name. So one of the things I wanna dive into today is is one of the key factors that's driving fatigue for most people. Now it all starts with your mitochondria.

So what exactly are your mitochondria and what is the meaning of these little things? And it's a big medical word, but it's really important to understand because this is the source of your energy. This is the source of all the power that drives everything in your body, including your brain, and it reflects itself in your energy levels. Now these tiny little energy factories inside our cells, and there's hundreds of thousands of them in every single cell, they have a really important job. And they basically convert the food you eat and the oxygen that you breathe into energy that your body can use in the form of ATP.

That's your gasoline. And it's so critical, this process of converting food and oxygen into energy is the fundamental process of life. Let's just sort of dive into a little bit of background on mitochondria. Now each cell has hundreds of thousands of these little energy factories. They're extremely sensitive to all kinds of insults.

So there's a lot of things that can screw them up. They exist in great numbers, especially in a lot of the active organs like your brain and your heart and also in your muscles because they need a lot of energy. Our mitochondria are where our metabolism happens. When we say metabolism, that's what we mean. Basically, metabolism is the biochemical process of running your life essentially.

And there's millions of chemical reactions in it. But the fundamental core is this process of extracting energy from food and combusting it with oxygen inside your cells in the mitochondria to make energy in the form of ATP, which is essentially the gasoline that powers all of our cellular functions. So what happens when our mitochondria become damaged? Well, that's what happened to me and it was a disaster. I just couldn't do anything.

I couldn't think, I couldn't move. I was exhausted all the time. I felt like I was walking through hair gel. It was awful. And I have deep sympathy for those who experience fatigue because I've lived a lot of my life struggling with it and I've, you know, been able to figure it out, but it's through a lot of hard work.

And I'm going to share what I've learned both on myself and with my patients so you can help understand maybe what's going on with you and why you're dragging around a little How do you get more energy? How do you protect your mitochondria? How do you either prevent yourself or actually fix the whole problem of being tired and burnt out? Well, first you gotta get to the root cause and it's different for everybody, right? So ask what could be damaging your mitochondria.

Now you need to sometimes do some digging, but if you know you're eating processed food, you're not exercising, you're smoking and drinking too much, I would start there, right? You can pretty much figure out the cause or if you're nutrient deficient or you're not taking multivitamin, there's a whole bunch of things you can do that are low hanging fruit that will help your mitochondria. But sometimes you need lab testing to figure out what's driving your symptoms and the problem is most conventional doctors don't do comprehensive testing which includes inflammatory markers, nutrient levels, heavy metals, thyroid testing, autoimmune markers and more. All of which can help you get to the root of your fatigue. And essentially that's why I co founded this company Function Health which tests over 110 biomarkers and twice a year testing and provides a comprehensive roadmap to help you find the root cause of what's happening beneath the surface.

And you can go to functionhealth.com mark, there's about 50,000 people on the membership roles now. We have about 200,000 people on the wait list, but you can jump the wait list using that code functionhealth.com forward slash mark. Now some biomarkers we test, are important, and they can help really pinpoint the cause of your fatigue. The first is HSCRP or c reactive protein. This measures inflammation.

So it can be from any source, but it tells you there's inflammation. Also, your your cellular blood count, your white cell count can give you a clue about infection. We might see Lyme disease in the testing. Heavy metals, check lead mercury. We look at cortisol for adrenal function, see if your cortisol is low or high.

We look at thyroid hormone which is key to metabolic health and mitochondrial function and if you have low thyroid which is very common, about one in ten men and one in five women, it's a big factor. We'll also look at metabolic dysfunction and insulin resistance which we measure through looking at glucose, fasting insulin which never gets measured, leptin, A1C. We also check nutritional deficiencies including omega-3s, magnesium, zinc, iron, B vitamins, vitamin D which are really critical for running your mitochondria. Now you don't have to get your testing done to start changing your health to improve your energy levels but it can help really speed up the process of figuring out what's going on and what to focus on. For example, if you have a lot of inflammation, you got to address that.

Or if you're a nutritionally efficient, you can fix that. Or if you're metabolically dysfunctional with prediabetes, you can fix that. So how do you start to unpack all this? Well, I want you to take stock of your lifestyle and your diet and your habits. Keep a diary.

What does your diet look like? You find yourself reaching for carbon and sugar throughout the day. Write down what you eat in the day and record how you feel. What does it make you feel physically, mentally? Do you have mood changes?

Do you feel more stressed? Do you feel more anxious? It'll help you get a better handle on how your diet quality affects your energy. Also, then you can start to make changes to your diet when you start figuring this stuff out, right? And see what happens.

Most people don't realize that you're just a few days away from feeling better if they address the root causes and they switch up their diet. I do these programs all over the world, these longevity programs called Young Forever. There's retreats I do in Ibiza, I do in Europe, some in America. And it's amazing in just a week or even five days, people's energy level will dramatically change just switching off their processed or their typical inflammatory diets to an anti inflammatory diet. So how do you do that?

You wanna eat real nutrient dense whole food whenever possible. Get rid of all the ultra processed food. Load up on colorful, low glycemic, polyphenol rich veggies and fruits that are rich in fiber and antioxidants. You know, these are full of these phytochemicals, which are essentially the most powerful antioxidants. They help protect your mitochondria from oxidative stress.

For example, ellagitannins, which is a polyphenol found in pomegranates, raspberries, and strawberries, are transformed by your microbiome into this super powerful active compound called urolithin A. Now most people have lost the bacteria to do this conversion, and you can actually take urolithin A as a supplement, which I do every day. Now this helps maintain, mitochondrial quality control. It regulates what we call mitophagy, which is the removal of damaged mitochondria in a recycling repair system. It also feeds your good microbes.

It helps strengthen your gut barrier and it's a really amazing compound. Other things can be helpful. Time restricted eating, eating within a eight to twelve hour window. So you can basically eat dinner at six and have breakfast at eight in the morning and that's fourteen hour fast. And that'll actually help to improve your mitochondrial function.

If you don't like the idea of cutting out ultra processed food or changing your diet, maybe just try the time restricted eating. But I'd recommend both, right? It's basically kind of a form of fasting that requires you to push the time you eat your first meal a few hours forward so you don't have this constant load of food and stress on your mitochondria. Giving them a break helps them to reset, to clean up and to repair. So maybe instead of eating right away when you wake up, wait two or three hours and eat all of your meals within a ten to twelve hour window, right?

From 8AM to 8PM or 8AM to 6PM. That's gonna give your body enough time without food to focus on cleaning up and repairing damaged neonatal mitochondria. Now you still wanna focus on keeping with the ultra processed food, right? Obviously don't don't just eat ultra processed food and be time restricted eating. It's bad idea.

What about drugs? Well, a lot of medication and drugs that we use every day affect our energy and stress. Now the most common drugs, which are nonprescription, are sugar, caffeine, and alcohol. Now obviously, tobacco, but less people are doing that. So I encourage you to cut down on these dramatically.

There's no safe level of alcohol, sugar and alcohol. I think it was recreational drugs used occasionally and sparingly and for fun, but not as a staple. Caffeine is a little different but again, if you're always tired and you're struggling to wake up, you might want to consider a caffeine holiday to see what your natural energy state is. And often people feel more energy when they stop caffeine. Now, you drink caffeine all day, that's not good.

Just try to do one or two cups in the morning, that's it. That's going to interfere with sleep, which is going to create more problems. Now, what about alcohol? If you drink every night, try to cut down to six, five, four, three, two, one, zero or occasionally. So I'll drink, but it might be once a month.

I don't drink every night. I don't drink every day. The next thing you want to do is actually lower inflammation. And the best way to do this is use food as medicine. Incorporate all these anti inflammatory foods that help to boost your energy, to strengthen your mitochondria and protects against active stress.

And that's all the colorful phytochemicals. There's tens of thousands in our food. They're incredibly powerful and they're something we don't get enough of. Now what else can you do to help your mitochondria? Well, they're made up of fat, this fat membrane around the outside and you need the right fats.

And the most important fats are the omega-three fats. So two servings of small cold water fish every week like salmon, mackerel, herring, sardine, anchovies, trout. That's really good. It'll get you a lot of omega threes. You can add more if you want.

They don't have mercury in them, so that's good or very low levels. Also, a handful of walnuts, flax seeds, chia seeds. Those are omega three containing plant foods, but they don't get converted as well to the EPA DHA that we need, so you need both. Vitamin c containing foods are great. Citrus foods, kiwis, bell peppers, vitamin e, also a great antioxidant.

They're in almonds, spinach, olive oil, sunflower seeds, hazelnuts, avocados. Zinc, really important for mitochondrial function and on the oxidative stress management. And you get that from grass fed meat, from wild caught seafood, and pumpkin seeds. So once you've tuned up your nutrition, you gotta filter processed food, cut down the sugar and starch, cut off the alcohol as much as you can and you've taken the right foods to boost your nutrient status, you might wanna start to move. Actually, we think, you know, we're spending energy when we exercise, but actually gives us more energy.

Exercise is so good for your mitochondria. Why? Well, it boosts something called mitophagy. That's the clearance of these damaged mitochondria and that optimizes and strengthens mitochondrial function. It combats aging and age related diseases.

So exercise is the best therapy for your mitochondria. It produces the release of something called exarchines. Right? Those are cool. You've heard of those before.

Right? They're signaling molecules that our tissues secrete in response to exercise. So when you exercise, you're producing these beneficial compounds called exarchines that have a positive influence on our biology, including making new mitochondria. So these exarchines help you make new mitochondria. Now what kind of exercise should you do?

There's all kinds, but you need all of them. Aerobic or cardio, high intensity interval training when you're doing things like wind sprints and strength training or resistance exercise are all really important for strengthening and improving the function of our mitochondria. And also there's a lot of other things, right? It boosts our muscle strength, it boosts our metabolism, our endurance, makes us be able to do more stuff. Exercise also a form of hormesis which we've talked about.

That's a stress that doesn't kill you that makes you stronger and more resilient and it's great. And there's lots of other forms of hormesis that can help including saunas, cold plunges, all that boosts our antioxidant systems. It increases glutathione, is our master antioxidant that helps reduce inflammation. It also really protects our mitochondria from oxidative stress. It also increases NAD activity, which is really important.

It's a longevity molecule involved in energy metabolism, in signaling all kinds of molecular processes, in DNA repair. And low levels of NAD are really associated with inflammation and aging. Now exercise boosts NAD, which is good. And what else does NAD do? Now NAD activates something called the sirtuins which are part of the longevity switches that I wrote about in my book Young Forever.

Basically a family of signaling proteins that creates more and better functioning mitochondria. So basically everything that exercise does is great for your mitochondria, Right? So it makes new mitochondria, it cleans up old mitochondria, makes your mitochondria work better, it improves NAD status, in your body, it boosts your antioxidant system. So it's just all around a good thing. So what else can you do to help your mitochondria?

Well, optimizing your nutrient levels and addressing deficiencies is really important. One of the biggest deficiencies is omega-three fats. Probably ninety percent of us are deficient or insufficient and so you wanna be taking a high quality fish oil supplement. My favorite is Omega-three Rejuvenate from Big Mold Health. True to full transparency, I'm an advisor and an investor but I did that because I think it's one of the most effective products out there in terms of omega threes and how they process it.

Antioxidants are helpful to take including vitamin c, zinc, vitamin e, selenium. These can be all taken in a multivitamin. Also you want the full spectrum of b vitamins, thiamine, riboflavin, niacin, b five, b six, biotin, folate, b twelve. These are all cofactors for making energy and supporting all the processes occurring in our mitochondria. And, again, you can just take a multivitamin.

Now b vitamins are really high in animal protein, especially organ meats like liver, eggs, fish, leafy green vegetables. Now if you're a vegetarian or vegan, you want to be careful. You have to supplement the B complex. You're not going to get B12 from your food and you're often nutrient deficient. Now there's other nutrients that are important.

Magnesium, I call that the relaxation mineral. It's really important for those who are under chronic stress because stress depletes magnesium, it can lead to burnout and adrenal dysfunction and magnesium is great because you can get it in almonds, cashews, pumpkin seeds, lots of greens like spinach, kale, Swiss chard. You can get in your avocados, even dark chocolate and non GMO soy. So it's important to make sure you get a good suite of supportive nutritional supplements and I basically recommend a multivitamin, fish oil, vitamin D, magnesium, all really helpful, even probiotics. Now what else can be affecting your mitochondria that you can do something about?

Well stress, I mean we all get it, we're all exposed to it, you can't get rid of it, it's around, but it's how you respond to stress. Stress is defined as the real or imagined threat to your body or ego. So a lot of it has to do with our perception. It's a real or imagined threat to your body or ego. So it's not actually something that has to be real.

We can just think it's something that somebody said to us that they mean something bad but it actually isn't. What is it? Is it your job? Is it family stress? Is it financial stress or relationships?

Maybe social media for sure is driving more stress. Trauma, childhood trauma. So you can actually manage it, you can learn how to regulate and there's really wonderful things that are available now today that are on apps, are online, that are easy tools to integrate mindfulness into your day. It can be meditation, a walk in nature, listening to music, calling a friend, you know, getting a massage, just hanging out, just making time to be, right? Get regular date nights with your partner to connect.

Deeper relationships also or in any dose of stress. Some of these need therapy or counseling, work through deeper issues. Sometimes childhood events that are severe like divorce, trauma, abuse, addiction also affect how we deal with stress. So learning how to sort of just regulate our systems is really important and again we've covered this a lot on the podcast in the past in The Doctors Pharmacy but learning how to manage and navigate stress is really critical. Learning also how to say no is important.

Saying no to somebody else is often saying yes to yourself. There's other things you can do like just taking a digital detox. I've been without my phone for weekends or weeks sometimes and it's just like, wow, I get my life back. It's unbelievable how these little devices have captured our attention and capture our lives. There's other simple practices you can do like gratitude practices, eating a healthy diet, finding a creative outlet are all great for regulating stress.

And it's important also to set realistic goals on how you navigate your life, right? Take small steps to make lasting change in your life, right? The journey of a thousand miles begins with one step. That's from the Tao Te Ching. Starting with one or two things that you change, you know, it can be easy.

Just get more sunlight in the morning. Maybe walk, take a walk every day and then just sort of slowly add things to your life that help layer on the beneficial things you need to do to promote health. The other thing you do to manage your mitochondria is sleep. All right, get seven to nine hours of sleep a night, good quality sleep, make sure your room is dark. Get sunlight in your eyes every day in the morning.

Your mitochondria are our circadian rhythm, so they need a cycle of darkness at night. So make sure your room's blackout. It's really important because even light can get through your skin. Your body picks it up. So, you know, make sure you have blackout shades in your room or where eye shades, particularly at night, or cover your body so you're not getting any light exposure.

And then you wanna get sunlight through the day, particularly in the morning, and that'll help regulate your circadian rhythm. Certain therapies can be really helpful like red light therapy. It's called photobiomodulation. And the science around this is interesting. Basically, exposure to specific wavelengths of light, particularly the red and near infrared, spectrum can really help sort mitochondrial function through a process known as photobiomodulation or PBM or low level light therapy or LLLT.

And this process involves light absorption by something called cytochrome c oxidase which is a mitochondrial enzyme. And so basically the light, this is amazing, just like you're like photosynthesis, right? You think only plants do this, but humans do this too. They basically absorb light through the skin. It's absorbed by a mitochondrial enzyme, just like the mitochondria that are these sort of energy producing cells basically absorb light and that enhances ATP production and upregulates genes involved in healing and repair.

And what do you get when you do that with the light? Well, you get more energy metabolism, less inflammation, better tissue repair, you get protection against oxidative stress, lots of good things. Also, can just go for a walk outside if you're feeling tired during the day. That's really nice. You can do that.

Get some light. And last thing I want to focus on is some other key things you can do. There's really important mitochondrial protective and energy boosting nutrients. I use these personally. I've had mitochondrial injury.

I take good care of my mitochondria and these nutrients provide lots of additional energy and mitochondrial support along with a whole food plant rich diet. So what are the top ones that I recommend? Well, Acetyl L Carnitine. Carnitine is critical in fat metabolism, and there are lower levels of carnitine in chronic fatigue patients than in healthy people. When you take adequate carnitine, it supports the transport of fatty acids into the mitochondria for energy, so basically burning burning energy.

Another important nutrient is alpha lipoic acid. It's a powerful antioxidant, probably one of the most important ones in the body. It also promotes mitochondrial biogenesis making new mitochondria. It improves your insulin sensitivity and lots more. Another key mitochondrial nutrient is coenzyme q 10.

Low levels are associated with fatigue, with mitochondrial dysfunction, so getting out of a co ten is important. Another key nutrient is n acetylcysteine. This is a precursor to glutathione. We also call it NAC or NAC, and that can help really reduce oxidative stress and mitochondrial function. You also want to be on a B complex as I talked about before because the B vitamins are the critical cofactors for making energy and supporting all the processes in our mitochondria.

You also want take magnesium. I like magnesium glycinate. It's the relaxation mineral, helps combat stress. It boosts energy production, helps insulin sensitivity and also many other things. So the other thing I would take is a fish oil.

I mentioned the omega-three Rejuvenate from Big Bold Health, but omega-three fats are really important for the cellular membrane function of your mitochondria. Because your mitochondria also have membranes and they need the right omega-3s to regulate inflammation and many other factors.

Dr. Izabella Wentz
My issues with fatigue actually started with my first year in college. And I went from this really bubbly and bright eyed and bushy tailed person that started college to all of a sudden sleeping through my exams. Right? I slept through one of my final exams. As as you can imagine, like being a Taipei person, I was like, oh my gosh.

Why did I sleep And through my I had laid down the day before at, like, three to 4PM to just take a nap. And then following morning, my exam was supposed to start at 7AM, and I, you know, ran into the exam room at 8AM because I had just woken up. And I was on this journey of like, You're always so tired. Why are you so lazy? I had to eventually come up with accommodations to make up for my fatigue so I could study.

I figured out during my second year in undergrad and by pharmacy school, I just really had a system where I just really learned how to be very efficient in studying and getting things done and very productive in the time with the little energy that I did have. But I did require, like, twelve hours of sleep a night. And I was just like you know, I'd wake up tired. I'd be tired all day, and I had to drink, like, six cups of caffeine to get myself get, like, you know, get my brain working and get myself through the day. Finally, was diagnosed with Hashimoto's after becoming a pharmacist.

And I went to some conference, and it was like, oh, you're not supposed to sleep twelve hours a night. And I was like, is that interesting? Finally pursued additional testing. The Hashimoto's diagnosis came. I was like, this is amazing.

Finally going to get on some medications to help me. The medications helped a little bit. So I went from sleeping like twelve hours a night to eleven hours a night. Was grateful That for that, helped. And then also, but I still had the fatigue and I still had all these like digestive symptoms and acid reflux and IBS.

And so I went through a process of really discovering how to get back my own health. And part of that was the gluten free, dairy free diet that, your books were life changing for me. Was reading them when I was, listening to audio books on my way to work and getting off of those foods helped me get rid of the acid reflux. But then I still had the brain fog and the fatigue, and somebody brought up adrenal fatigue. And I was like, well, this I googled it, this was ten plus years ago.

I'm like, that doesn't exist. It's like, you know, clearly this this reputable site that says it's not a thing. So I just kind of went on and looked for other things. And finally, the fifteenth person brought up adrenal fatigue, I was like, oh, okay. Well, maybe this is a thing because I have all the symptoms, and I tried the interventions, I got better.

Holy cow. My brain works. I'm waking up early in the morning. I don't need eleven hours of sleep. I'm sleeping eight to nine hours waking up refreshed.

I don't have that anxiety. I don't have the panic attacks. I'm not hungry anymore. I'm sleeping and it's a refreshing type of sleep. And so that was over ten years ago and that was part of my healing journey where I was like, wow, I feel like myself again.

Turns out I'm actually a calm and relaxed and happy person. I'm not like anxious and exhausted all the time. Right?

Dr. Mark Hyman
So the adrenal system has an adaptive response. It doesn't just fail all at once or doesn't just kind of get dysfunctional at once. What are the stages that people go through? And how do you make people recognize that so they can actually avert the kind of final thing which I had, was chronic fatigue?

Dr. Izabella Wentz
Usually people start off with that heightened stress response where they'll release a lot of cortisol throughout the day. And typically I think of like rock stars in a hotel room. You just have all this energy and you feel like you just drink a whole bunch of Red Bull and you can't sleep. You're wired. You're on the go.

You're doing tons of things. Everybody around you is too slow, not smart enough. They just don't get it. So this is how people usually feel in the high cortisol state. Very irritable and they're kind of jumpy.

Time goes on long enough, then they'll get on what I call the cortisol roller coaster where they might start off with high cortisol in the morning. So they kinda jump out of bed and they're ready to go, but then they'll have a dip in cortisol levels maybe in the afternoon. Sometimes that's irritability. Sometimes that feels like anxiety. Sometimes that feels like getting really hungry or, you know, maybe they need to take a nap at 3PM.

And then as the day goes on, they'll have another spike of cortisol where they can't sleep at night. They get to bed, and they're like, ugh, I have a million things to do. Like, I need to do them. As this goes on long enough, then they'll go into, more of the more of the reversed cortisol curve where their total output of cortisol throughout the day will be lower, and most of the cortisol will be low early in the morning. So they'll have trouble waking up in the morning.

They'll be like a person that was an early bird and a early riser will say, holy cow. I just woke up at 09:30. I, like, I used to wake up at 6AM then go running. What what is going on with me? And then throughout the day, they'll feel tired.

But finally in the evening, they will get that surge of energy where they'll be like, oh, well, I finally feel alive now, and it's time to sleep, right? Then they'll have a hard time falling asleep. And then if this progresses long enough is where most of my clients that I've worked with end up with the chronic fatigue, with the Hashimoto's, with the autoimmune conditions, is they'll have flatlined adrenals. So these are people that are waking up tired and they're going to bed tired. And they're sleeping like I was eleven, twelve hours a night in some cases and feeling unrefreshed.

And they're like, well, people tell me to exercise, but I feel worse when I exercise. People tell me to fast, but if I fast, I feel awful. If I, you know, if I get more sleep, I just, you know I'll try to sleep for twelve hours, and I'm still tired. I sleep less, and I'm still tired. And they are just, you know, they're really stuck in that state where their body, just every little stressor can be so overwhelming.

Like, even things positive stressors can be too much for them.

Dr. Mark Hyman
Yeah. I mean, I think that's true. You know, I think the the the sense of, being exhausted in the morning is is really a big deal. It's a rush for the coffee, a sign of of, you know, just being constantly irritated. It's like it's like thinking about, you know, if you haven't slept for, you know, a while, you become more cranky and irritable.

It's not because you're a jerk. It's just because your nervous system is just fried. And so, you know, we see we're seeing this. And the question is, symptomatically, we can diagnose it. But are there tests that we can do to actually help figure out what's really going on?

Dr. Izabella Wentz
I love recommending tests. I do a lot of them myself. If I had my way, I would have everybody do various functional medicine tests. The adrenal saliva tests can be incredibly helpful for figuring out what your cortisol pattern looks like. Then there's also the Dutch profile, which goes a little bit deeper.

It's a urine test and it could look at how your body metabolizes the various stress hormones and how much it's putting out. The tricky part is I've been recommending this for ten years now and then people will say, I went to my doctor and I asked my doctor to test my adrenals. They said I don't have Addison's. And I'm like, Okay, well, you've got to go to a doctor that is an integrative practitioner. They're like, Oh, well, I found one, but they're very expensive and these tests I have to pay out of pocket for.

So it's kind of another barrier to getting the help. And then they get the tests, they get them home, and then they're like, but it's been sitting on my shelf for three months. Right? And then and then finally they do the test, and they get the results a few weeks later, sometimes couple of months. And it's like six months have gone by where I could have told you based on your symptoms that you are, you know, if you're chronically fatigued, there's a good chance that you're in that stress response.

If in that fight or flight mode and you're feeling really irritable all throughout the day and you can't sleep, I'm pretty sure you have too much cortisol. So, I do love tests and I recommend them, but I wanted to create a program and a protocol that was entirely based on symptoms and how to reverse and address the symptoms so people could work with their doctors and get the tests that they need, or they can really be empowered to take charge of their own health. I don't know if you've had the same experience, too.

Dr. Mark Hyman
Yes. I think it's so true because I think the, you know, most of the time people walk in and they come in their symptoms like a tell them what's going on and then the test will confirm it. And I think we do see stages of the test where we'll see, for example, you know, high cortisol at night and low in the morning or high cortisol all day initially, then it kind of drops in the morning and then it ends up being low all the time, of flat lining. And I think that, you know, that's something that is sort of an end stage process. And in terms of the sort of treatments and the diagnosis of it, sort of you challenge some of the traditional view of this.

You say this is sort of doctors talk about this as a bogus diagnosis and dismiss it. Why do you think that is?

Dr. Izabella Wentz
Unfortunately, I think it has to do a lot with the nomenclature where the term adrenal fatigue, it was initially coined where the person that, and the brilliant people that coined the term and started educating the world about it, the initial understanding of the mechanism of action behind it, what was going on was kinda like a mild Addison's or that the adrenals were not, capable of producing cortisol where we know it's more of an adaptive system where the adrenals are capable of producing cortisol. They're just not releasing the cortisol at the right times throughout the day. And so that's what ends up, I think kind of boggling a lot of people. And some, practitioners argue about the terminology. So they'll say adrenal fatigue doesn't exist, but then you'll look at HPA axis dysfunction or hypothalamic pituitary adrenal axis dysfunction.

And that is a real thing, and there's published literature around it. And same with, like, leaky gut ten years ago. It's like, it doesn't exist. And then it's like you go to PubMed, and there's, like, intestinal permeability. So, basically, you know, you just have to use the right terminology, I think, for them to get it.

But it's it's you could call it burnout. You can call it adrenal fatigue. You I call it adrenal dysfunction because I feel like it rolls off the tongue a little bit easier than hypothalamic pituitary adrenal axis dysfunction. It's a little bit more of an updated term to reflect the mechanism of what's going on as far as we understand it these days.

Dr. Mark Hyman
Yeah, amazing. So in your book, Adrenal Transformation Protocol, you talk about just chronic stress being a huge cause of this and how it creates a demand for high cortisol and adrenaline. But you talk about four different kinds of stress. I think this is important because it's not just psychological stress that can cause adrenal burnout as it was for me, was something else. I mean, it was physical stresses and some psychological stresses.

It was a combination of things. So I wondered for for the audience, you just sort of unpack the four types of chronic stress that can sabotage our adrenals?

Dr. Izabella Wentz
So it could be psychological stress. So you're going through graduate school, and you are waking up three times, you know, throughout the week at 5AM to go to you do your exams. That can be incredibly stressful. You have a really annoying boss who's just a jerk, that can be incredibly stressful. You have a lot of family drama, that's, currently stressful.

And people people recognize these kind of stressors. I know one of my books, somebody wrote a review that was like, didn't need to do anything that she recommended. I just quit my, you know, job, and my whole life got better. I didn't have, you know, autoimmunity anymore. And I was like, amazing.

Like, if you could recognize there's this, like, one thing in your life that's causing you stress and get rid of it, that can be a big game changer. But there's also positive stressors. So you have a beautiful baby, and that beautiful baby doesn't sleep. So I know that was a stressor for me five years ago when I got into adrenal dysfunction another time in my life. You got married and you moved across the country or you got a job promotion.

These are positive things in your life, but they can be a bit overwhelming. Then there are kind of like hidden psychological stressors. So maybe you had a history of adverse childhood events, something happened in your childhood that was traumatic. You probably don't even have a recollection of it, or maybe you do, but it has shifted your HPA axis to be more on high alert and kind of puts you in that survival mode and you've got that on your plate. So that could be something that people aren't necessarily aware of because it's not present day stress.

Their present life might be perfectly peaceful. Then we think about, like, the physiological stressors. So I'm always like, what is in your life right now that could be causing your ancient genes to think that you're under stress. Let's unpack modern life. If you are not sleeping a lot, if you are skipping meals, if you are exercising, overexercising, if you're eating foods that are inflammatory to you, your caveman or cavewoman brain is gonna say, holy cow.

We must be in a war and a famine or being chased by a, like, a herd of bears or something because why on earth would you be, eating stuff that's inflammatory? Why would you be starving yourself? You must be in a famine. So let me help you out, from an evolutionary perspective and let me shift you into this adrenal fatigue state so that we can conserve your energy, we can conserve your metabolism. So these are some of the modern day stressors, and sleep deprivation is probably the fastest way to get into this adrenal dysfunction.

Dr. Mark Hyman
Yeah. You know what's interesting is that, you know, people, don't realize that actually their diet can be a stress that actually sugar and starch when you eat it causes a flood of adrenaline and cortisol in your system, even if it's oatmeal. David literally showed this. It was really shocking years ago in a study of obese kids where he gave them oatmeal or eggs for breakfast. And the kids who ate the oatmeal had high levels of cortisol and adrenaline because of the glycemic load of the oatmeal, which we think is a healthy breakfast and cereal is even worse.

And that drives, you know, higher levels of stress hormones and that it makes you hungrier, it makes you crave sugar, it causes high blood pressure, just all kinds of issues. So I think it's important to to sort of highlight that.

Dr. Izabella Wentz
Oh my gosh. Absolutely. One of one of the key stressors is blood sugar imbalances. So just eating too many carbs and too much sugar and then not enough protein and fat, this is a really, really big stressor for many people and being micronutrient deficient. That's that's actually one of the key transformations as we focus on blood sugar balance and people will say, I thought I had anxiety.

Turns out, my blood sugar just needed to get balanced. And I thought I I had insomnia. I was waking up at 3AM, and, you know, I wasn't sleeping through the night. It turns out that it was actually my blood sugar. So this is such a really, really important stressor.

And I thank you for bringing that up because this is a core part of transforming your adrenals and transforming your stress response is like the nutritional signals, right? Figuring out how to get yourself in balance. And then there's also the hidden stressors where people might not realize them. They're not in their lifestyle. Their lifestyle might be spot on and perfect, But they might have an H.

Pylori infection or they might have a toxic exposure, perhaps mold exposure or some other kind of toxin that could just be sending their system haywire and sending them into that survival mode even though they're like, I'm doing everything right. I'm doing all the things. I'm sleeping well. I'm like, I have a good marriage, and I love my job. And all of a sudden, I just feel terrible.

Yeah. And usually, in that case, it could be could be a hidden source of inflammation in your body.

Dr. Mark Hyman
Totally. And I think that what's interesting is when I had chronic fatigue, was because I had mercury poisoning and that screwed up my adrenal. So it was some external thing or Lyme disease or mold or whatever it is. It can be anything that drives inflammation, as you said, can cause adrenal dysfunction independent of what your stress levels are psychologically. So that's really, really important.

And also rhythm. We talked about, you know, sleep. But having regular wake and sleep cycles is important. Eating at their same time is important. Your body is a biological clock.

And there's a whole system of medicine called chronobiology, which decides how to, for example, treat cancer with certain chemo drugs given at certain times of day. And I think we kind of lose track of that. And we just think we can go kind of buffing about our body with all sorts of irregular schedules. That is really not good for us. It really requires sort of a discipline of a repeated state of circadian rhythm and reducing the things that cause adrenal dysfunction kind of help you fix that.

Dr. Elizabeth Boham
The twenty to thirty percent of patients who come into their primary care doctor's office come in with the chief complaint of fatigue.

Dr. Mark Hyman
I'm tired.

Dr. Elizabeth Boham
I'm tired. And, know, so it's a lot of us. It's a lot of people that we see. A lot of people we see here at the Ultra Wellness Center. One of their main reasons they wanna come in is I'm tired and I wanna feel better.

So I think functional medicine is really well, I think it's great for whatever we're working on, but I think it works really well with fatigue. In conventional medicine, all of our training, we were really focused a lot on acute care medicine and not enough on chronic conditions. And definitely we're not often given, physicians aren't often given enough time to really delve into a topic like fatigue, which can be so complex. So one of the great things in functional medicine is we really focus on getting that timeline of the patient's history which is so important because it really helps us determine what's going on with that patient. Why do they have that fatigue?

I think that's really critical. And one of the great things about functional medicine is we talk about their timeline which just means their whole life story. What was their life like as a child? Even when they were a fetus. What kind of illnesses did they have when they were younger?

How did they feel when they were in their 20s? All of that really influences what's going on now and how we work with them when they come in saying, I have fatigue, I'm tired.

Dr. Mark Hyman
You're right. I think this is something that I sort of had the insight about decades ago with functional medicine that when we were trained in medical school, we were trained to create an exclusive history. In other words, focus on the problem. If if it doesn't seem like it's related to that problem, then you just ignore it. If someone comes in with heartburn and they also have a rash and a headache, you go, well, you go to the headache doctor, you go to the skin doctor, I'm gonna take care of your heartburn.

And we don't connect the dots. Functional medicine is an inclusive history where we look at every possible symptom, every possible exposure, where you were born, when you were born, whether you were breastfed, whether you took antibiotics, whatever it is. And we try to connect the dots and see what you call the timeline of how this all leads to the person being sick in this moment. And when you do that, you often get to see the answer. And the patient goes, oh, yeah.

When this happened, when I was 23, then I got oh, I yeah. I was in Thailand, I got sick. And I never been the same. So we begin to hear these stories and you begin to connect the dots. But when you go to a traditional doctor with fatigue, what

Dr. Elizabeth Boham
do they do? Yeah, right. They get a battery of tests. Maybe they'll do a quick physical exam, do some of the basic tests. And then a lot of times those basic tests look normal.

I mean, that's what patients come to me all the time with. Yeah, my tests were normal. And they said, maybe there's, maybe had some depression.

Dr. Mark Hyman
Right.

Dr. Elizabeth Boham
And I don't blame, I don't blame

Dr. Mark Hyman
So Prozac is treatment for depression. Mean for a fatigue.

Dr. Elizabeth Boham
Right. Maybe you've had a little depression. It's not that we're, you know, don't blame physicians for that. They're given a very short amount of time to deal with this very complex symptom.

Dr. Mark Hyman
So you're basically anemic, you have low thyroid or you are depressed, or maybe have cancer that we have to look for. But there's a short list. And if those things don't pan out, there's not a lot to offer. Or they give you Ritalin, or maybe they give you Provigil. There's drugs, but it often don't work.

Dr. Elizabeth Boham
So I mean I think what's great with functional medicine is we really, as I talked about, take that really detailed timeline and history and look to connect the dots. And we're wondering, okay, what's going on of course with that person's lifestyle? You know, of course we're paying attention to sleep and diet and exercise and stress. But we're also thinking about all the different systems in the body and how they're influencing somebody's energy level. So everything from is that person dealing with a chronic infection, right?

So chronic infections we've gotta think about and delve through.

Dr. Mark Hyman
Like Lyme disease or

Dr. Elizabeth Boham
a Absolutely, right? Yeah.

Dr. Mark Hyman
And they're not acute infections. They're these things that are lingering, smoldering things that don't make you acutely ill but that are staying That there affecting your overall

Dr. Elizabeth Boham
can happen a lot of times, right? And sometimes acute infections turn into chronic infections and sometimes people just have these smoldering infections in like the digestive system that, can really wear their body down. You know, an overgrowth of yeast or some bacteria. And the body's just chronically having to fight that and it's exhausting.

Dr. Mark Hyman
So your microbiome can make you tired it's

Dr. Elizabeth Boham
Absolutely, not if it's not healthy. We see that all the time. Yeah. Right? And then of course we're paying attention to the mitochondria, that's the powerhouse of those cells that take your food and turn it into ATP or energy.

And so there can be many reasons why those organelles aren't working well. And so we're thinking about that toxins. Sugar. Yes. Infections, just genetic variations.

And I think that's another thing that's really important that we pay attention to does this person have some variations in genetics that are influencing their energy and their requirement for certain nutrients? We of course pay attention to hormones, you know, the thyroid hormone, the adrenal hormones, the female and male hormones. We really are looking at all aspects of somebody's health. And that I think is really helpful to determine okay what is the cause for this individual person?

Dr. Mark Hyman
Yeah, because fatigue doesn't really mean a whole lot. Then I'm tired. It could be caused by so many things. For me it was mercury.

Dr. Elizabeth Boham
Yes.

Dr. Mark Hyman
It was mold. And then it was my gut. And then you know, I think I've become an expert in fatigue because I had chronic fatigue syndrome which is like the most extreme version of it where you can barely drag yourself out of bed and barely function, you have brain fog. I mean that's the extreme version of it. But it's really a continuum.

And we can really drive people to a solution by being these medical detectives that look at all these variables that people really don't look at.

Dr. Elizabeth Boham
It's so important to ask those questions of how long has this been going on? Did it just start? Has it been your life long, have you been life, your whole life been a little more tired than other people that you know? You're always feeling a little tired or is it some acute change that happened? When did it happen?

Are you tired all the time? Are you tired certain times of the day? Are you tired in certain locations, right? And not in others when you think about things like toxins and molds, So there's so interesting questions that we have to ask. And so one of the things at the Ultra Wellness Center that we do is you know, we've got one of our PAs will take a really detailed history before you even see the doctor that helps us, right?

So you know, like forty minutes or even more getting your whole story. Well first you fill out a whole patient packet which is long and extensive, then the PA gets a long history from you and then we get a lot of time with you as well. All of that really helps to put together your individual story which is really what's helpful. Right?

Dr. Mark Hyman
You see all these patterns, you connect the dots, you see how things are linked up and then you can decide to dive into different areas of testing, right? Well you know I had a tick bite when I was five years ago and I've never been right since. Or you know, like, love tuna fish and I live in Martha's Vineyard night swordfish every other week. And, you know, you always mercury or you, you know, you ask other questions related to their, for example, hormones. Well, you know, how's your libido and sex life and if you're a guy, your testosterone goes down, that could be it.

Or maybe your thyroid is not working. Or maybe we look at your nutritional status because vitamin D can cause fatigue if you're low in vitamin D. So we kind of really do a comprehensive map based on your story and that directs us to exactly what to test.

Dr. Elizabeth Boham
And

Dr. Mark Hyman
what are the kinds of things that you found are the common drivers of fatigue for patients?

Dr. Elizabeth Boham
Oh, there's so many and we can go through a few cases but nutritional deficiencies, huge. You'd think that we had adequate nutritional status, but so many of us don't, whether it's because of digestive issues and we're not absorbing well or just inadequate intake or we're dealing with some sort of chronic toxin exposure that's wearing down our body.

Dr. Mark Hyman
Or eating processed food or the soil's depleted or food stored for, I mean the average apple you eat has been stored for a year. Go pick an apple from a tree and go eat one that's been in the warehouse for very, very different experience.

Dr. Elizabeth Boham
Yeah, so I mean of course we're seeing nutritional deficiencies. I see a lot of genetic variations that influence somebody's energy level. We see digestive issues that influence energy level. We see chronic infections and of course toxins.

Dr. Mark Hyman
Heavy metals.

Dr. Elizabeth Boham
Heavy metals. You know what I think is really great. Some patients even come in with their timeline. And sometimes that's so helpful because they write down over the years when certain things happened in their health history. And then you can look at that and again you start to see some of these patterns.

Dr. Mark Hyman
Yeah. So I remember when I had chronic fatigue, went to doctor after doctor after doctor and they're like, Well, there's nothing wrong or your tests are normal or this is a little off or that's a little off but nothing really. Take some Prozac, here's some for sleep. Right. It's so frustrating as a patient to go through this litany of doctors and not really getting an answer.

And, you know, and I think that the fatigue you don't often treat directly because, you know, yeah, you can take Providual which will sort of make you more awake or you can take Ritalin or Adderall which is like a, you know, stimulant to help you have more energy. But those are sort of like beating a dead horse. You have to figure out what's really going on. And I think when I first sort of discovered what happened with me was the mercury was the thing that was driving it. And and it created a whole cascade of problems so it affected my gut.

It affected my immune system because I was chronically inflamed. I started developing all these rashes and all these sores and Yep. All these things around my eyes would look like a raccoon if I ate certain foods, I'd get bloating. And I also developed real cognitive issues and real trouble thinking and focusing and fatigue. And I realized that these insults that happen affect all the different systems in your body.

So when you're diagnosing someone with fatigue, it's all the other symptoms and all the other pieces that give you the clues about what's really going on for this person. So it's not like one treatment for fatigue. There's dozens and dozens depending on what you find with that story.

Dr. Elizabeth Boham
Right. And that mercury for you just depleted your glutathione stores that then influenced all these other aspects of your health.

Dr. Mark Hyman
Yeah. Poisoned my mitochondria. And it turned out I had a gene that affects my muscle and size, my energy cycle and my mitochondria. And at least to have an easier ability to be damaged by it, which is why I had this elevated thing called CPK which is a muscle enzyme. It was this abnormal test but it wasn't really so severe that it was a disease but it wasn't normal.

They're like, I don't know what's wrong. Can figure that out using the roadmap of functional medicine.

Dr. Elizabeth Boham
I think it's so interesting how some people just need more support than others in certain areas. And we talked about this on another podcast about supplements and I think that's what the key is is when you figure out for that individual person where they need that extra support in a personalized way, it makes all the difference in the world.

Dr. Mark Hyman
Yeah I remember I was getting a lecture at Canyon Ranch one year and I'm like, this guy's like you know I'm always tired, don't know what to do. I said how many hours you sleep? He's like six. I'm like sleep eight. That'll be $500 please.

Dr. Elizabeth Boham
Sometimes it's just that

Dr. Mark Hyman
simple, right? I was like, Sleep. So yeah, quality of sleep also matters. Sleep apnea is another cause that's often very undiagnosed in patients.

Dr. Elizabeth Boham
Often undiagnosed and something we have to look for. We look for the signs of sleep apnea from somebody snoring, not remembering their dreams, their blood pressure being elevated, they're not having a heart of gaining weight, right? Because it causes the weight gain, it causes you to gain weight around your belly, signs of insulin resistance and metabolic syndrome, that high fasting insulin, the high waist to hip ratio. You know, all those things make us think, okay, we gotta think about sleep apnea. Then when we examine them, sometimes you can see clues on exam And it's critical that we diagnose it and treat it because it makes a huge difference in not only how somebody feels, but their risk for all sorts of diseases, right?

Dr. Mark Hyman
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