HealthyGamerGG - Why You Are Physically Exhausted All The Time

Episode Date: December 26, 2022

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So if you think about what is the feeling of tiredness, the feeling of tiredness is an amalgamation of all kinds of mental and physiologic signals. So when we're talking about tiredness, we have to remember that there are different dimensions of it, right? So tiredness can be felt sort of mentally, right? So like you can sort of feel fatigued at the thought of doing something. Like if I want to like write a book or if I want to, you know, move, for example, that's like a really good one. It's like, oh, man, I got to move. And if you really think about it, like, the thought of moving is not, doesn't actually cost a whole lot of energy. It's not like you're actually moving.

It's the very thought of it that makes you feel fatigue. But we do know that tiredness is not just in your head, right? We know that there's a lot of physiology that has to do with tiredness. We know that tiredness is a measure of energy levels. So, for example, if I haven't slept in 24 hours, I'm going to feel really, really, really tired. And that has nothing to do with, you know, whatever tasks I need to complete or things like that. If I eat a really, really heavy meal, I'm going to feel really tired afterward.

And that's actually physiologic in nature. So now what we're going to do is look at tiredness from a different angle, which is sort of the physiologic angle. And this is oftentimes what people kind of think about when they're talking about tiredness. They kind of think about, okay, there's something wrong with my energy levels. And what should I do about it? And so what I'd love to do today is share with you all kind of like how I think about

or organize looking at tiredness. like kind of within you from a physiologic angle, right? So how can we understand the physiology of tiredness? So a couple of kind of quick disclaimers or perspectives. So the first is that you'll, a lot of people will share or talk about basic science research as it relates to tiredness. Right. So people will say things like you can look at like, let's say a study that looks at eliminating, let's say, refined sugar from your diet and how that boosts energy levels. You can look at studies that correlate things like vitamin D with energy. There are all kinds of basic science studies out there that will say this stuff makes people more tired, this stuff makes people less tired.

These are primarily studies that are done in a laboratory. So the tricky thing, for any one of those studies, it may not apply to an individual person. So for all those studies that show that, let's say, eliminating refined sugar from your diet improves tiredness, it doesn't make tiredness completely go away 100% in everyone in the trial. Some people actually get no benefit from eliminating sugar. Other people get some benefit from eliminating sugar. Some people get a lot of benefit from it. And so then what we do in science is we average all those things together,

and then we kind of come up with a conclusion. So generally speaking, what I found works almost better as a clinician is when you're working with real human beings, there are a bunch of different solutions, but trying to figure out where do I, start. Should I eliminate gluten? Should I eliminate dairy? Should I eliminate eggs? Should I do keto? Should I do intermittent fasting? Should I wake up every morning at 5 a.m.? Should I do, you know, should I go swimming? Should I do resistance training? Should I do yoga? Should I do Tai Chi? Should I do

chie gong? Should I drink this special kind of coffee? Should I add this supplement to my diet? There are a thousand different things. And the answer to all of them is yes. You'll find someone out there who will talk about a paper who will say yes to all of those things. But practically as a human being, like, what do you do if you are tired all the time? So what I'd love to share with you all today is an approach to tiredness that incorporates all of that stuff. When I think about tiredness, I think about two buckets. And this is what I've learned, like working for years is a psychiatrist. There's the circadian bucket and there's the metabolic bucket.

And you may say, okay, like, what do you mean by circadian? So our body goes through various cycles throughout the day. We feel more tired at night. Some people feel tired in the morning. People have trouble getting out of bed. People have difficulty with sleep. So there's a lot of tiredness that has nothing to do with like metabolism. Has nothing to do with energy, but has to do with cycles and sleep and things like that.

By energy, I mean like, you know, ATP generation. I don't mean like the subjective feeling of energy. Because there's a lot of stuff that will subjectively make you feel tired and is kind of related to the circadian stuff. So this is where I think about things like sleep, daily cycles, you know, like afternoon crashes, difficulty waking up in the morning. So this is the circadian bucket. So we're going to talk about all that stuff.

In the metabolic bucket, we've got different stuff. Okay, so like let's not worry about the sleep and stuff. But the other big dimension of tiredness and energy levels is what you put into your body and how your body responds to that. So this is stuff like, let's say, homeosteatial. balance and like blood sugar, nutrition, things like nutrient deficiencies. But there's other stuff going on with metabolism as well, like inflammation. And so this is where all the stuff of like, what should I eat, when should I eat it, and what effect does the food that I put into my body

have? That's the metabolic stuff. That's completely different from like the circadian stuff. And so as a clinician, when someone comes into my office and says, I'm tired, there's also a psychological component or spiritual component. You may say, like, what do you mean? There's a psychological component in terms of, there's some tasks that just make you feel tired. It's up here. You just don't want to do it. And spiritually, like, some people come into my office and they say, I'm tired. And what they really mean is, like, I have no zest for life. Everything just feels like a chore. And then what happens is if they try to, you know, fix their sleep schedule, like, that's not the problem. The problem is that, like, they've got nothing to look forward to during the day. They can take as many

supplements as they want to, but that's not going to fix it because it's not a metabolic problem. So this approach is almost like from a differential diagnosis standpoint. What's the differential diagnosis of feeling tired? So it can be physiological, psychological, or spiritual. And then in the physiology of it, there's the circadian branch and the metabolic branch. So let's talk about the circadian branch. Let's start with simple stuff, and that is the pathology. There are all kinds of things that can mess with your sleep.

So at the top of the list is sleep apnea. So sleep apnea is a condition that probably affects somewhere around 5 to 8% of people in the world, shockingly high, results in periods of cessation of breathing during sleep. So essentially what you do is drown or choke in the middle of your sleep. As you drown or choke, you don't get oxygen in. Then what happens is you start to drown physiologically. That's the best word, right? So you're not getting oxygen.

So for 60 seconds, you're going to have like no oxygen. And then what it does is triggers a survival response. Rush of adrenaline, you kind of reset your breathing apparatus and you start breathing again. But the problem is that the rush of adrenaline and physiologic response is going to make you feel exhausted when you wake up in the morning, right? Because think about what's happening. Like imagine like, if you were to get thrown overboard and we're underwater for 60 seconds before you came up without a brain, Imagine how exhausted you would feel after that. People will have 20, 30, 50, 60, 100, 120 apnic episodes per night.

And so physiologically, when you wake up, your body is ragged. That's sleep apnea. There are other things that we'll kind of talk about. There are other diagnoses that you can have. But circadian rhythm disorders are other examples. You can also have stuff like narcolepsy and stuff like that. But we're not going to talk about that. So circadian rhythm disorders, I think the other really, really big one that I think is

actually quite common. And so what this, what these kind of mean is if we think about a regular day, right? So let's say there's midnight, there's 6 a.m. There's noon, 6 p.m., and then midnight. If we think about the activity level over time, right? So most human beings, their activity level is kind of like this, right? So you wake up at maybe six, you go to work by nine, kind of work until 6 p.m. You kind of wind down and you're asleep by midnight. Now the problem is that some people, their circadian rhythm, is actually more like this. And so what that means is that they're very exhausted when the rest of the world is working.

They're just, when everyone else goes home for the day, I'm just getting started. And between 12 and 4 a.m. is actually my maximum productivity. And so if your body's clock, which is what a circadian rhythm is, is off center from the rest of the world, and you force yourself to wake up at 6 a.m.

like everyone else, this is your experience of life. Right? So like, I want you all to think about, let's use calculus, and calculate area under the curve. For someone with circadian, this is the total amount of energy that they have during the day. Compared to a normal person, this is the total amount of energy that they have during the day. And so you look at quote unquote normal people and you're like, wow, they're able to do so much. And you look at yourself and you're like, I'm exhausted all the time, I can't do shit. And that's because you've got a circadian rhythm disorder.

And you can actually do the same amount. It's just you're jet lagged compared to society. So this is a circadian rhythm disorder. There's also all kinds of really interesting research. For example, the circadian rhythm of teenagers shifts later. So there's data that shows that if you start school at 9 a.m. or even 10 a.m., instead of, let's say, like, 8 a.m., that teenagers will do a lot better because their circadian rhythm changes. Why does their circadian rhythm change?

Because they're going through puberty and growth spurts. and our body physically grows while we're asleep. And I don't know if you all have noticed this, but our body does a lot of growing when we're teenagers, right? So there's even data that shows that schools that start super early for teenagers, those kids do worse in all kinds of different ways. Okay? So there can be circadian rhythm disorders.

Part of the problem with circadian rhythm stuff. Okay, so let's talk about solutions for a second. One is if you've got sleep apnea, the solution is actually medical care, right? So there are these things called CPAPs, continuous positive airway pressure. There are different like medical devices that you can use that will keep you from having apnic episodes overnight. And so like you just have to get medical care for that. Like if you're worried about, okay, how do I know if I have sleep apnea?

I can't sort of diagnose you all over the internet, unfortunately. But a really, really common sign of sleep apnea is waking up in the morning despite sleeping enough. So if you went to bed and you got like eight or nine hours of sleep, but you wake up and you're exhausted and it feels like you didn't get any sleep at all. You need 12 hours of sleep, 13 hours of sleep. That, you should probably talk to a doctor about that. Another really common sign of sleep apnea is snoring. So part of the reason that we'll become apnick is sometimes we have our soft palate and our epiglottis and like some of the stuff in our oropharynx literally like

clamps down and prevents us from breathing. So it'll like block our airways from like this oropharynx area. And we also know that, for example, having a lot of, like, mass around here. So if you've got, like, a really thick neck or obesity can increase the risk of sleep apnea. So even weight loss can be a treatment for sleep apnea, depending on what the physiology is. Okay? So if you snore a lot and if you feel very tired in the morning, despite getting a full night sleep, public service announcement, talk to your doctor about it. And in the case of circadian rhythm disorders, things are a little bit more complicated.

So part of the reason that I think we have circadian rhythm disorders increasing in our society is because we aren't quite as bound to the sun and the moon as we used to be. This doesn't mean like we're druids or we're no longer druids. This means that like literally we have, you know, this is where all the blue light kind of stuff comes in. So blue light suppresses melatonin production. Actually, this is the right symbol from the pineal gland. And then melatonin helps us sleep and keeps us on schedule, which is why people will use melatonin to adjust for jet lag. So what we've got is like, we'll take melatonin to help us get on a good sleep schedule. But here we are using blue light and technology that actually does the opposite of taking a melatonin tablet.

It shuts off melatonin production. And so this kind of stuff, the availability of the internet, you may say, well, what do you mean by that? It means that at midnight, you know, I want you all to imagine 10,000 years ago, what could you do if you were a human between the hours of midnight and 4 a.m.? What can you do? You can't do anything. There's nothing to do. Everyone's asleep. But now we have all kinds of stuff to do.

Stuff is available all the time. They're 24-hour eateries. We can get food brought to our doorstep. There are going to be some degenerate nobs that are queuing at 3 a.m. for whatever game you want to play. And so there's all kinds of crap that you can do. And that all interferes with your circadian rhythm. It allows you to get circadian rhythm.

You can become an absolute degenerate when it comes to your circadian rhythm. But it turns out that aside from these kinds of things, there are a couple of other things which people don't realize about circadian rhythm. so we're going to talk about that. The first is that your circadian rhythm is a natural cycle and that there are particular times of the day where you're good at particular things. So this isn't actually what the circadian rhythm looks like.

What the actual circadian rhythm looks like, it's not like this, but probably like this. So this maybe is like 9 to 10 a.m. This is noonish, noon to 3. This is like 4 to 7. And sometimes this is like 9 to 11. So if you actually look,

at our activity, and this should be flat, by the way, but if you actually look at our activity, we actually have like fluctuations in our activity. And this is conserved throughout the mammalian kingdom. So if you look at like the idea of a siesta or a nap in the afternoon, like even in some countries in Europe, like things will shut down around like 2 p.m. and they'll like open up again in the afternoon, late afternoon. So if you look at most mammals, like you look at monkeys, monkeys are awake at like, you know, 5 a.m. or even earlier. And then they kind of chill out around 10 and then they're like quiet during the hottest part of the day and then around dusk they become active again. Same is true of like gazelle and Impala. So humans are probably the same way. There's

even some evidence that for example cognitive activity between the hours of four and six a.m. is very, very like productive. So if you look at religious traditions across the world, they all wake up and pray or meditate at like 5 a.m. And why do all the religious traditions do that? It turns out that there's probably a circadian rhythm. There's like something about our mind is more at peace. at that time. And the other really interesting thing is I'll work with some people who think they're night owls.

And then I'll ask them, what do you mean? So help me understand the details of what do you mean by your night owl. Well, I get started kind of sometimes around midnight and at 4 a.m., sometimes I'll, like, do my best creative work. I'll write music. You know, like I'll write prose,

poetry, inspiration. Like it comes at like three in the morning, four in the morning, which is actually consistent with our circadian rhythm. So it's not that they're night owls, it's that they're like mourning people, like really, really mourning people, early morning people, which is consistent with most of the mammalian kingdom. Another consideration for circadian rhythm, which a lot of people forget, is that we have

these things called sleep cycles. So if you look at sleep, it's stage one to four sleep, and then we have REM sleep after that. But what people don't understand about sleep architecture, and so you basically go through these five stages, okay? The problem is that different stages of sleep do different things for us. So at the beginning of the night, let's say this is stage one sleep, this is stage two sleep, this is stage three sleep, this is stage four sleep, this is REM sleep. And at the end of the night, stage one is short, stage two is short, stage three is short, stage four, let's say, is a little bit shorter, and REM sleep is actually really long. So the more, the longer you sleep, the more your brain changes, what stages it spends its time in.

So you'll actually go through a sleep cycle, where you'll go through a sleep cycle, where you'll go through all five of these, and then you go through them again. Then you go back to stage one sleep. Now, one thing that people don't realize is that if you wake up in the middle of a sleep cycle, you will feel really groggy. And I don't know if this has ever happened to you all, but you may find that it's kind of weird, but like, if I sleep eight hours, I will feel tired when I wake up. If I sleep eight and a half to nine, I'll feel really good.

Or if I sleep four hours or six hours, I'll feel really good. It's easier for me to wake up with six hours of sleep than it is for me to wake up with seven to eight hours of sleep. If y'all ever observe that? Like, it's really weird. Like, I'm actually getting less sleep. But I feel more rested when I wake up. And it's because you have to wake up during the right time of your sleep cycle. Then you won't feel groggy.

But if you wake up during like the middle of your sleep cycle, it's going to be a mess. This is also why, and the progression of sleep staging is actually really, really important. Because we know that, for example, a lot of the good stuff in sleep happens in REM. and to this day, if anyone tells you they know exactly what's going on in our brain and sleep, they don't know what they're talking about because no one really knows. Pay attention to your sleep cycles and recognize that you may not need eight. How did we get the number eight? Eight hours of sleep a night is what the doctors recommend.

What they did is they took a thousand people and they took these thousand people and they asked, okay, who here is healthy? And these four people raised their hands. And then they asked them, how much do you sleep at night? One person said 10, one person said 8, one person says. said seven. One person said 7.5. They averaged all these numbers together and they decided, okay, 7.5 is the healthy amount of sleep that you need. So this is really weird. If we use the system to make clothing recommendations, everyone would wear gray smocks that were like medium to

large. We're like, okay, doctor, what should I wear today? And they're like, well, let me ask 10 people what they're wearing, average their sizes, average their colors, average their cuts. And that's the answer. This is how we do medicine. This is how we do basic science research. We just average a bunch of people together, right? So when we look at daily caloric intake, how did we get that number? We got it the same way. Why is it 2,000 calories a day?

Well, we just asked people who are healthy how much they ate. And now you have papers that come out that show that mild calorie restriction, like 1,800 calories a day, actually leads to better health outcomes over the long term. So it turns out that that number that we got by just averaging all the crap together turned out to actually not lead to the best health. Fascinating. Who would have thought that if you'd have? that if you just ask 10 people what works for them and average it altogether, that that's not actually

the right answer of what works for you. Okay. So be aware of waking up in the middle of your sleep cycle and remember that one of the reasons that you may not be, you could be like tired from a circadian standpoint is if you're not getting enough sleep progression throughout the night. So we don't want to just sleep, you know, with a low amount of REM sleep, but we can't, it's not like it's, the first two hours of sleep in the last two hours of sleep give us different benefits. Now, way to transition to metabolism is by talking about caffeine. So what does caffeine do? Caffeine, the simplest way to describe what caffeine does is it suppresses adenosine receptors in the brain. So we have this thing called ATP, which is our basic unit of energy in our cells. And when you use up an ATP,

you end up with an adenosine byproduct. So this is like when we have very high levels of ADNASA ATP, this means that we have lots of energy. And we have high levels of of adenosine, this means that we've got low energy. And then what we have is we have something that measures this. So we're measuring our adenosine to ATP. It doesn't, I'm oversimplifying. And so what caffeine does is it blocks the signal of low energy. It does not actually give us energy. It just makes our body numb to energy, or the lack of energy, right? So it's like, it's like the equivalent of like, if we were taking medication that suppressed our hunger, our suppressed our thirst, that's analogous to what caffeine does. So it numbs our body's ability to

detect fatigue, which is why we feel more energized. But we're not actually energized, right? It also does other things like suppress appetite and things like that, which gets really interesting. The key thing about caffeine is as we use caffeine, it's going to make us feel more energy without actually having more energy. Now, there are other effects of caffeine as well. So like it increases heart rate, for example. So it increases our pulse. So we get kind of amped up. You can sort of get the jitters with caffeine, right? So it does like all kinds of other things. But this is where a lot of people will combat this kind of stuff, like sleep apnea with things like caffeine. So when I have patients who have sleep apnea, sometimes I ask them, do you feel tired in the morning? They'll be like,

yeah, absolutely. And then I'll ask them, okay, what do you do when you wake up? It starts with two cups of coffee. I'm like, wow, okay. So now this person has two things going on. Not only do they have sleep apnea, but now they're blocking all of their energy signals. And then what happens is they don't actually take rest when they need to. So then like, then they start running, their car starts running on empty, which creates all these other problems. So generally speaking, a lot of people like caffeine, there's some evidence that shows that a moderate amount of caffeine, which may have more to do actually with the other things in caffeinated beverages. So if you look at things like green tea or coffee, there are all kinds of like phenols and like other things that probably have positive health

benefits, that a moderate amount of caffeine intake per day actually can be fine or even healthy. But what you've got to be really careful about is if you're tired and you're drinking caffeine, especially if you're drinking a lot of caffeine, chances are what's happening is that the caffeine is suppressing your body's ability to detect fatigue, and so you can't take care of it the way that you should. So as an example, caffeine also suppresses appetite. One of the reasons why people like it if they're doing intermittent fasting. If I'm using an appetite suppressant and I'm running on a caloric deficiency, that's going to cause my energy to crash. So we use caffeine to feel less

tired and we end up making ourselves more tired because of all kinds of other things. So let's move on to the next thing on metabolism, which is glucose balance. So remember, it's an appetite suppressor, right? So now here's what we got to understand about glucose balance. We've got two hormones, insulin and glucagon. There's basically a balance between these two things. Insulin is an anabolic hormone. What does anabolic mean? Anabolic means it builds things up. So when we have high levels of insulin, we've got a lot of available energy,

and we're going to use that as storage or building stuff, like cellular machinery. So generally speaking, when we're doing this process, our energy is not there to be used for activity. It's there to store away and build up machinery. If you all play games like RTSs or, you know, turn-based strategy games, insulin is like your expand hormone. It's like, okay, we're not going to build military units.

We're going to boost up our economy. So we're going to invest our resources and having more resources later. But what this actually does is makes us feel tired. So insulin makes us feel tired and actually activates the parasympathetic nervous system. And what does the parasympathetic nervous system do? It rests and digests. This is also responsible for food comas. And now we're going to see a very common thing that we're seeing more and more with the digital generation,

which is I'm a starve myself for a while because I'm drinking caffeine and I get distracted by technology. And then I'm going to get so, so, so hungry that I feel super, super hungry. I'm going to eat a ton of food. I'm going to eat like 1,500 calories in one meal. It's going to lead to a surge of insulin and the surge of insulin is going to put me into a food coma. And then I'm going to feel really, really, really, really tired. And now we understand how improper sugar balance can lead to feeling tired. Now there are all kinds of other things to keep in mind here. Now we get to see a lot of why a lot of the healthy things that people are touting, like how they work. So the first thing is a low carb diet leads to low insulin levels. So the trigger for insulin is carbohydrates. So you can

eat a ton of fat and protein and your insulin levels will still be low. What this sort of means is that if we don't have activation of the parasympathetic nervous system, people are going to feel less tired. So if you talk to people who are on ketogenic diets, they'll say like, yeah, at the beginning it was rough, but now I have so much energy throughout the day. My energy level is actually way higher and I feel way better. And why is that? It's all mediated through insulin. So now we can see why low carb or keto is pretty good. Next thing that we're going to talk a little bit about is, let's say, like intermittent fasting. So if you look at things like fasting, fasting has its own whole situation going on, but let's talk about that very quickly. So the first thing,

first thing to understand is that we have glycogen, which is essentially our sugar stores, and they last about eight hours. After we run out of glycogen, then we start burning fat, even breaking down protein, and then we're going to turn this, we're going to use these to generate glucose. We're going to make sugar because we've run out of our sugar stores. So, for example, the brain requires sugar or ketones. It can't use other forms of like, it can't use fats. So we have to make glucose. The thing is converting sugar to fat is very efficient.

Converting fat to sugar is very inefficient. It's like the efficiency of this process is, I'd say, less than 10%. One 16th or whatever that is. So it's like 6% efficiency or 5% efficiency, let's say. 6% efficiency. And so what that means is that when people like we are living such a calorie dense society that in order to be healthy, what we need to do is start really inefficiently burning calories. Like imagine for a moment what your life would be like if instead of eating 2,000 calories a day,

you needed 12,000 calories a day, right? Like there's like if you were really, really inefficient, then you could eat all the hamburgers and crap that you want to. The problem is that we're not that inefficient. We're actually quite efficient, which means that when we eat 2,000 calories, we're going to gain weight, 21. 100 calories, 2,500 calories, we're going to gain weight. So in order to counter that, what we need is some of these things like intermittent fasting. The reason that intermittent fasting is

so good is because we run out of our sugar stores. And then for the next eight hours, we're in this state, which is actually the first state of starvation. We're in the early stage of starvation. And we're burning fat very, very inefficiently to maintain our glucose levels. But this causes us to lose weight. And then we get to the third thing, which is inflammation. So when it comes to what to eat in your energy level, there tends to be all kinds of crap that causes low-grade inflammation. So examples of things that cause low-grade information. Obesity, gluten, dairy, eggs, all kinds of minor food allergies.

Now, note that this is not celiac disease. Celiac disease is a true allergy to gluten. But there's even like very, very interesting cases that I've worked with people who are like this, who will feel really, really bad if there's a very. eating gluten, they cut out gluten. And then they start to feel more energetic and they start to feel better. They have like more energy, their mood is improved, things like that. The really interesting thing is that there is one guy in Austin, Texas, who uses a strain of wheat that is a thousand years old. So he's like somehow found some kind of wheat that is grown somewhere or he

grows in himself. And so this strain of wheat has not been modified or been selectively bred for the last thousand years. I know people who have gluten sensitivities who can eat wheat from his bread and be totally fine. So something about the way that, because if we look at it like gluten sensitivity is increasing, why is that? So what else is happening? Like, why are human beings suddenly becoming so? And we talk about sensitivity. What we're talking about is there's actually particular proteins in gluten that trigger an immune reaction. So what's changed over the last thousand years? We've selectively bred wheat. Even the discovery of dwarf wheat is a Nobel Prize winning discovery because we conquered world hunger with the discovery of dwarf wheat. And so there's probably some

kind of chemical change there that triggers some kind of immune reaction in some percentage of the population. So this low levels of inflammation also come from things like processed foods. And there's all kinds of other stuff. So like refined sugars will cause inflammation. All kinds of stuff causes inflammation, like the crap that we eat. Data is really unclear on how much stuff causes what percentage of inflammation and what percentage of human beings. So you've got some people who are like super, super into natural and anti-GMO and stuff like that. I think that GMO is the worst things in the world, right? Natural is better. And there's probably some evidence that some of that's true. Paster raised is better than farm raised and this and that. Like, there's probably some benefit to

that. But we don't really know how much. But when it comes to the metabolic stuff, reducing these low levels of inflammation. So there are other things that we also know, like eating fresh fruits and vegetables, reduces inflammation. You may say, how does this reduce inflammation? It all has to do with gut bacteria. So the kinds of, so this is what's happened, okay? In a quick summary, two-minute summary. So here's a human being, let's say 50,000 years ago. The human being has a certain diet.

This is the diet of the human being 50,000 years ago. The human being develops a symbiotic relationship with bacteria. And we developed this relationship for 50,000 years because the bacteria helps us digest these things. And since we've lived with this bacteria for a very long time, our immune system thinks that this bacteria is a good dude. They're like, hey, these are friendly bacteria. We do not need to kill them. They're not threatening. Meanwhile, over here, there's another bacteria.

And this bacteria causes, let's say this is anthrax. And anthrax hurts us. So when the immune system sees this, this is like, this is a bad dude, let's kill it. Now, as our diet changes to, let's say, just circles, we start to select for a different kind of bacteria. Because that's the bacteria that can digest, just the circles is going to grow in our gut. Now, the problem is that this bacteria is different from this bacteria. And our immune system looks at this and it's like, well, it's not really bad, but it's not very good. It's not a friend.

It's like kind of suss. And then this leads to inflammation. So what we see is when people eat foods that we've been eating for a long time, it tends to reduce the inflammation in the gut. And so what this kind of comes down to, oh, there's also other things. So exercise is not something that we talked about. But exercise affects insulin metabolism in a very positive way, sugar metabolism. So it sort of fixes this.

It also affects the kind of food that we crave. Right? So I'll ask you all a question. You know, who here likes to have a milkshake with a burger and fries? If you enjoy having a milkshake with a burger and fries, raise your hand. Who here, whenever they exercise for an hour, craves a milkshake at the end of the hour, right? When you exercise, what kind of stuff do you crave? You can feel really, really, really hungry.

Most people just want to drink water. So exercise helps with all this stuff too. So if y'all are tired, a couple things like what do we do if we do? like, what do we do if we're tired? The first thing is pay attention. So this is also where like complex carbohydrates, so eating a cookie and eating like a piece of fruit is going to be different. Because complex carbohydrates have something called the lower glycemic index, which is the amount of insulin that is released in response to this food. So if I eat an apple, this is actually not going to lead to a very big insulin spike. If I eat a grape, that's going to lead to more insulin

release. If I eat a cookie, that's going to release even more insulin. And if I eat a white flour cracker, like not whole wheat flour cracker, that'll lead to more insulin. So generally speaking, the higher the glycemic index your diet is, the more tired you will feel, number one. So you can also do intermittent fasting or ketogenic diet. Sometimes people will do both, whatever. And now we understand why these things will make people less tired. Other thing is like, eat fruits and veggies. because fruits and veggies have a really interesting thing when you eat high fiber diets, what ends up happening is,

I don't know if this kind of makes sense, but if you're starving and you eat an apple, you're no longer starving, but you're still kind of hungry, but you can't really gorge yourself, right? So like if I'm really, really starving, and I don't know if this kind of makes sense to you all, if I'm starving, if you give me 1,500 calories

that is packed very densely, I can eat them if I'm like really, really hungry. But if you give me an apple first, and let's say an apple is, let's say like 180 calorie, let's call it 200 calorie. After eating the apple, I'm not going to eat a 1,300 calorie meal. I'm going to eat like a 700 calorie meal. Does that make sense? Oh, Gah RL is raiding with a party of 279.

Thanks for the, thanks for the raid, girl. We're talking about metabolism. I don't know if it's the most exciting topic. Is it 200? So that's a good question. So this is another thing. There's so much to learn. So that's because our hunger, so people are asking,

okay, why does an apple make you feel full if it's not only, calories. So our perception of hunger is an integration of all kinds of circuits. So it's an integration of our blood sugar, but it's also an integration of things like mass in the stomach. This is via stretch receptors. So even like how much our belly is stretched and how much weight is in there correlates with our hunger. So this is why people will like, you know, talk about rice cakes is pretty filling. They're super low calorie, but they have some volume. I don't don't know how much they actually create stretch in your stomach, so I'm not really sure if this is a great example. But like, if you eat some low calorie dense food that has a lot of volume,

you can't eat very much of it. Like, you can eat 1,500 calories in one burger. But I don't know that you can eat like 1,500 calories of broccoli, right? Like, you just can't do, like, physically, like, you're not going to feel hungry. It'll be like eight heads, like, you're just going to, the stretch receptors are going to be like enough. Does that make sense? There are also different kinds of hormones at play here, like ghrelin and leptin. So if you're, tired, pay attention to the glycemic index of stuff. By all means, reduce your carbohydrate intake, or be careful when you eat. So another thing going back to this, and I'll kind of integrate this. So let's kind of like integrate all this stuff. So let's say that you wake up at 5 a.m. So usually when I

wake up first thing in the morning, I don't eat something because I find that if I eat something right away, I get an insulin spike and I'm not very productive. So if I wake up at 5 a.m., I'm going to go two hours. maybe I'll have tea, but I'll go two hours without any food. Then I feel very hungry. So seven to eight, I'll eat a meal and I'll usually have a pretty heavy meal. So today, for example, I had two breakfast tacos. And the thing is, when I have two breakfast tacos, I know that I'm going to need enough calories. So I do this on purpose. So I know that like if I eat, well actually, so today I woke up at seven. It's different with kids. So let's do this. So if I eat at eight o'clock between 8 and 10 a.m., I'm not going to be very productive because now I'm going to be digesting. So this is my digestion phase. So I'm not going to do

much work. Then I'll kind of get a second wind. Sometimes I'll even take a nap here. So if I eat, I'll share with you all an interesting technique. One of the best ways to avoid after food, after meal fatigue is to lay down on your left side for 20 minutes. So I'll lay down like after, I'll try to have a decently heavy meal. I'll lay down on my left side for about 20 minutes and close my eyes. Maybe I'll doze a little bit, I won't actually sleep. So let's say 10.30, I wake up. Then I'm going to do some kind of like random work between 10 and 4. This is going to be stuff like meetings, emails, other kinds of like low cognitive activity work. And then between 4 and 7, or sometimes between seven and 9, here, sometimes I'll do more creative work. Like I'll do writing or whatever, and then it's

bedtime. So the key thing about like maintaining your energy level throughout the day is like this afternoon crash is oftentimes if you don't eat enough for breakfast and you're starving at noon and you eat very heavy at noon, you're going to have an afternoon crash. You're going to have an afternoon crash. So there are three reasons why you have the afternoon crash. Number one, we're hungry because rushed in the morning. I'm rushed in the morning. Reason number two, had caffeine in the morning, right? I wake up, I have my cup of coffee. It's an appetite suppressant, right? And four hours later, the caffeine starts to wear off a little bit. So not only do we like start to feel that tiredness,

but then this appetite suppressant makes us even more hungry. And then we eat a really big meal. So this plus this equals big meal. Once we have a big meal, big insulin spike. Makes us feel tired. Then what happens is now, let's say two hours later. So six hours post caffeine, the caffeine's really starting to wear off.

So this is going to make me tired. And on top of that, it's now 2 p.m. And what do the monkeys do at 2? On top of that, roll in circadian rhythm. You're going to be more tired. This is why people crash in the afternoon. Right, because everything aligns. And so if you're saying, okay, I'm tired in the afternoon.

What should I do? Well, you can do all kinds of stuff. One is you can just take a nap. Second thing you can do is eat something with your coffee. Third thing you can do is cut back on your caffeine intake. Four thing you can do is when you eat a big meal, make sure it's low carb. Fifth thing you can do is have a snack at 10 a.m. so that you're not starving when noon comes around.

Sixth thing that you can do, and I don't know if you all have done this, is have more coffee. So I know we covered a lot of stuff. And unfortunately, like, that's, if you're tired, it's not simple. So if you think about what is the feeling of tiredness? The feeling of tiredness is an amalgamation of all kinds of mental and physiologic signals. Insulin, glen, inflammation, glycogen stores, fat stores, circadian rhythm stuff. There's stuff going on in your brain in your reticular activating formation that is causing you to lay down or calm down or feel tired. Your vagus nerve is active or inactive

depending on what's going on. Even the way that you breathe will affect your fatigue level. And so people are struggling with tired. Everyone's more tired. Why is that? When I work with people, I tend to split into two buckets. There's the circadian stuff, which has to do with your body's natural rhythms and how we may not be aligned with those kinds of natural rhythms. How if we get interrupted sleep or if we don't sleep enough or if we sleep too much, how we'll be tired the next day. And in the most unlucky cases, what we're talking about is actual pathology like sleep apnea. So there are circadium stuff is kind of like sleep. But then there's another whole piece to this which is metabolism, which is our actual energy level.

And how our level of fatigue throughout the day is going to be dictated by all these different kinds of metabolic hormones and sugar balances and stuff like that. Which is why everyone will say like, oh, I cut out gluten and now I feel so much more energetic. I'm doing keto, I'm doing intermittent fasting, I feel so much better, I feel so much better, I feel so much better. And there are all kinds of physiologic reasons for that. And so what everyone is doing is they're saying like, okay, so which one of these should I do? Should I do keto? Should I do intermittent fasting? Should I cut out dairy? Like, should I become vegan? Should I get one of those little watch things that monitors my sleep level? What should I do? Should I take melatonin? Should I take this supplement? Should I drink more coffee? Should I drink less coffee? Should I drink a special kind of coffee? Should I drink more expensive coffee? everyone's wondering, like, how do we do this stuff?

Like, what's the right answer? And I don't know how to say this, but like, if any of that stuff worked super, super, super well, it would eliminate everything else from the market, right? Like, that's what happened with antibiotics. If you look at, like, the alternative medicine that's out there, there's very little alternative medicine for the stuff that we do really well with regular medicine, right?

Like, even people who are super into alternative medicine, like these are a lot of my patients. If they get sick, they'll take a course of antibiotics because it works really well. So there's a really interesting principle from the history of medicine that when there is one treatment that works, if you have 10 treatments for something,

all of them don't work well. When you have one treatment that exists, that's because it works really well. It's just Darwinian. It's like the theory of evolution and natural selection. So you have all these thousand diets in which one should you do.

It comes down to these factors. It's not about one diet. It's not like this one is the thing that works. They all work to some degree. is which one fits for you, what's your particular pattern of tired? Are you tired first thing in the morning when you wake up? What's your caffeine consumption like? Do you crash in the afternoon?

Do you really hit your stride at 7 p.m.? Because the more that you understand yourself, the more that you'll be able to leverage any of these individual things and figure out what kind of plan works well for you. If you found this video helpful, check out Dr. K's guide. We've spent hundreds of hours writing and filming to help people understand their mind so that they can build the lives that they want.

that they want. So check out the link in the description below.