The Dr. Hyman Show - Uncovering the Roots of Exhaustion—and How to Feel Like Yourself Again

Episode Date: December 1, 2025

Many people experience a deep, lingering fatigue that isn’t fixed by a full night’s sleep, and it often stems from real imbalances inside the body. When mitochondria—the tiny engines that power our cells—are stressed by poor diet, toxins, infections, or lack of rest, the whole system can slow down. Ongoing stress can also disrupt the adrenal system, leaving some people feeling wired and anxious while others feel drained from morning to night. The encouraging news is that steady habits like nourishing whole foods, balanced blood sugar, restorative sleep, and gentle movement can help the body find its rhythm again. With the right support, energy often returns, and a sense of hope does, too. In this episode, I dive into, along with Dr. Izabella Wentz and Dr. Elizabeth Boham, the real roots of chronic fatigue, showing how stress, lifestyle, and hidden imbalances drain our energy—and how practical, nourishing habits can help restore it. Izabella Wentz is an internationally acclaimed thyroid specialist and a licensed pharmacist who has dedicated her career to addressing the root causes of autoimmune thyroid disease after being diagnosed with Hashimoto’s thyroiditis in 2009. She is the author of three books on Hashimoto’s: Hashimoto’s Thyroiditis Lifestyle Interventions for Finding and Treating the Root Cause, Hashimoto’s Food Pharmacology, and Hashimoto’s Protocol, which became a #1 New York Times bestseller. Dr. Elizabeth Boham is Board Certified in Family Medicine from Albany Medical School, and she is an Institute for Functional Medicine Certified Practitioner and the Medical Director of The UltraWellness Center. Dr. Boham lectures on a variety of topics, including Women’s Health and Breast Cancer Prevention, insulin resistance, heart health, weight control and allergies. She is on the faculty for the Institute for Functional Medicine. This episode is brought to you by BIOptimizers. Head to bioptimizers.com/hyman and use code HYMAN to save 15%. Full-length episodes can be found here:How to Reclaim Your Energy and Overcome Chronic Fatigue Tired And Wired: How To Heal Adrenal Fatigue Getting To The Root Causes Of Why We Are All Tired (0:00) Introduction to the episode with Dr. Izabella Wentz (1:34) Overview of health ingredients and functional medicine (2:41) Factors damaging mitochondria and lab testing for fatigue (6:27) Dietary changes and time-restricted eating benefits (9:10) Food as medicine and the impact of common drugs on energy (11:43) Exercise and optimizing nutrient levels for mitochondrial health (15:42) Stress management and sleep for better mitochondrial health (18:45) Red light therapy and key nutrients for mitochondrial protection (21:18) Dr. Izabella Wentz's personal experience with fatigue and adrenal dysfunction (28:13) Testing and types of chronic stress (36:04) Diet, blood sugar, and adrenal function (39:36) Functional vs. conventional medicine approaches to fatigue (43:40) Chronic infections and identifying the root causes of fatigue (47:34) Common drivers of fatigue and the role of heavy metals (49:11) Personal journey with chronic fatigue syndrome and functional medicine solutions (51:18) Personalized support, supplementation, and sleep quality

Coming up on this episode of the Dr. Hyman Show. 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 12 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. Have you been feeling stressed or tired lately? You might be low in one powerful mineral. That mineral is magnesium.

Most people are. and most supplements don't fix it because they only include one or two forms. I use magnesium breakthrough from bioptimizers because it has all seven forms of magnesium your body needs for sleep, stress, and recovery. It actually works. You can feel the difference. From November 23 through December the 3rd, you get 25% off. This is the once a year sale you do not want to miss.

Go right now to bioptimizers.com slash hymen and use code hymen. 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've 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 Hyman Hive for live Q&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 Dr.hyman.com. And if you prefer to listen without any

breaks, don't forget, you can enjoy every episode of this podcast, Add 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. And we don't have enough of those. We have too much

the bad stuff. None of the good stuff. Then our body's dysfunction. And the goal of functional medicine is to get your bodies functioning again, hence the name. So one of the things I want to dive into today 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 to thousands of them in every single cell. They have 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, and 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 meet. Basically, the 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 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 bit. 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've got to 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 a 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-year testing and provides a comprehensive roadmap to help you find the root cause of what's happening beneath the surface. And you go to Functionhealth.com forward slash mark. There's about 50,000 people on the membership rolls now.

We have about 200,000 people on the wait list, but you can jump the waitlist 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 this inflammation. Also, 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, we 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 a low thyroid, which is very common about one in 10 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 of the process of figuring out what's going on and what to focus on. For example, if you have a lot of inflammation, you've got to address that. Or if you're a nutritional efficiency, you can fix that. Or if you're metabolically dysfunctional with pre-diabetes,

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's going to 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. You know, 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. And I do these programs all over the world, these longevity programs called Young Forever. There's retreats. I do it in the Beza, I do it in Europe, some of America. And it's amazing in just a week or even five days, people's energy level will dramatically change, just switching off their problems. or their typical inflammatory diets to an anti-inflammatory diet. So how do you do that?

You want to 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, Alagutanans, which is a polyphenol found in pomegranates, raspberries, and strawberries

and strawberries are transformed by your microbiome into the super powerful active compound called urolithinae. Now, most people have lost the bacteria to do this conversion, and you can actually take ulythanae as a supplement, which I do every day. Now, this helps maintain mitochondrial quality control. It regulates what called mitophagy, which is the removal of damaged mitochondria and 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 an 8-to-12-hour window. So you can basically eat dinner at 6 and have breakfast at 8 in the morning, and that's 14-hour fast. And that'll actually help to improve your mitochondrial function. If you don't like the idea of cutting out ultra-process food or change 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 10 to 12 hour window, right, from a.m. to 8 a.m. to 8 p.m. or 8 a.m. to 6 p.m. Now, that's going to give your body enough time without food to focus on cleaning up and repairing damage you in a mitochondria. Now, you still want to focus on getting ultra-processed food, right? Obviously, don't just eat ultra-processed food in a time-and-trick eating. It's a 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 non-prescription, are sugar, caffeine, and alcohol. And 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, use 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, if 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 oxidative stress. And that's all the colorful phytochemicals. 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-3 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-3s. You can add more if you want. They don't have mercury in them, so that's good or very low levels. Also add a handful of walnuts, flax seeds, chia seeds. Those are omega-3 containing plant foods, but they don't get converted as well to the EPA-D-HA that we need. So you need both. A vitamin C containing foods are great. citrus foods, kiwis, bell peppers, vitamin E, also grain antioxidant.

They're an almond, spinach, olive oil, sunflower seeds, hazelnuts, avocados. Zinc, really important for mitochondrial function and 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 got off the ultra-processed food, cut down the sugar and starch, got up the alcohol as much as you can. and you've taken the right foods to boost your nutrient status, you might want to start to move. Actually, we think, you know, we're spending energy when we exercise, but it actually gives us

more energy. Exercise is so good for your mitochondrial. 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 exorcines, right? Those are cool. You never heard of those before, right? They're signaling molecules that are tissues secrete in response to exercise. So when you exercise, you're producing these beneficial compounds called exorcines that have a positive influence on our biology, including making new mitochondria. So these exorcines help you make new mitochondria. Now, what kind of exercise you do?

There's all kinds, but you need all of them. aerobic or cardio, high intensity interval training when you're doing like wind sprints. And strength training or resistance exercise are all really important for strengthening and improving the function of our mitochondria. And it also does 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, which 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. That'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. What else does NAD do?

Now, NAD activates something called their Sertuins, which are part of the longevity. 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. Do you ever wonder why you still feel stressed, wired, or wake up tired even when you're doing everything right. There's one nutrient deficiency I see over and over again in my community and in my patients, magnesium. Magnesium is responsible for over 600 reactions

in your body, including energy production, muscle recovery, nervous system regulation, and sleep quality. But here's the problem. Most magnesium supplements use the wrong formed, so your body can't absorb them. That's why I take magnesium breakthrough by bioptimizers. It's the only supplement I found with all seven essential forms of magnesium your body needs in one capsules. Since I started using it, I've noticed deeper sleep, better recovery, and a sense of calm that I can feel at the end of a long day. And I hear the same thing from my audience. You can actually feel the difference. If you're struggling with sleep, stress, or low energy, this is one of the simplest upgrades you can make. It's Black Friday savings season. From November 23rd through December 3rd,

you get 25% off. This is the once of your sale you do not want to miss. Plus, this part is exclusive to my audience, and only at bioptimizers.com slash hymen. You'll not only get an amazing discount, but also free gifts with select purchases. Go right now to bioptimizers.com slash hymen, use code hymen, and grab your favorites before the steel disappears. After December 3rd, it's gone. Don't miss it. 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-3 fats. Probably 90% of us are deficient or insufficient.

And so you want to be taking a high-quality fish oil supplement. My favorite is omega-3 rejuvenate from Big Bolt Health. True 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-3s and how they process it. Antioxins 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, thymine, riboflavin, niacin, B5, B6, biotin, folate, B-12, these are all co-factors for making energy and supporting all the processes

occurring in a rheumatic chondri. And again, you can just take a multivitamin. Now, B vitamins are really high in animal protein, especially organomites like liver, eggs, fish, leafy green vegetables. Now, if you're a vegetarian or vegan, you want to be careful. You have to supplement with a B-complex. You're not going to get B-12 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 adrenalose function.

And in a 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, right? 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 imagine threat to your body or ego. So it's not actually something that it 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. You know, 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, that 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, getting a massage, just hanging out, just making time to be.

get regular date nights with your partner to connect. Deep deeper relationships also are in a dose of stress. Some people need therapy or counseling to 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 doctor's pharmacy, but learning how to manage an advocate 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 captured 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 1,000 miles because they're the one step, that's from the Dada Ching. Starting with like one or two things that you change, you know, it can be easy. Just get more sunlight in the morning. Maybe 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 on a 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 make sure you have blackout shades in your room

or where eye shades, particularly night, or cover your body, so you're not getting any light exposure. And then you want to 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 photo biomedulation or PBM or low-level light therapy, or LLT. Now, this process involves light absorption by something called cytokrome 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 upriculates 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, you 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, I want to focus on another 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. Carnotene is critical in fat metabolism. And their lower levels of carotene 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 energy. Another important nutrient is alphaipoic 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 co-enzyme Q10.

low levels are associated with fatigue, with mitochondrialous function. So getting out of a COQ10 is important. Another key nutrient is N acetyl-sistine. This is a precursor to glutefion. 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 co-factors for making energy and supporting all the processes in our mitochondria. You also want to take magnesium.

I like magnesium glycinate. It's the relaxation. mineral helps combat stress. It boosts energy production. It helps insensitivity and also many other things. So the other thing I would take is official. And I mentioned the omega-3 rejuvenate from Big Bold Health. But omega-3 fats are really important for the cell, your 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. My issues with fatigue actually started with my first year in college. And I went from this

like really bubbly and bright-eyed and bushy-tailed person that started college to all of a sudden sleeping through my exams, right? So I slept through one of my final exams. As you can imagine, like being a Taipei person, I was like, oh my gosh, why did I sleep through my exam? And I had laid down the day before at like 3 to 4 p.m. to just take a nap. And then following morning, my exam was supposed to start at 7 a.m. and I, you know, ran into the exam. exam room at 8 a.m. because I had just woken up. And I was on this journey of like, you're always so tired. Why are you so lazy? Right. I had to eventually like come up with accommodations to to make up for my fatigue so I could study. And I kind of figured out during my

second year and undergrad. And by pharmacy school, I just really had a system where I just really learn how to be very efficient and studying and getting things done and very productive. And the time, with the little energy that I did have, but I did require like 12 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, I 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. sleep 12 hours a night. And I was like, huh, 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 12 hours a night to 11 hours a night. I was grateful for that, right? 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. I was reading them when I was listening to audiobooks 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. And this was 10 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 15th person brought up adrenal fatigue. And I was like, oh, okay, well, maybe this is a thing because I have all the symptoms. And I tried the interventions and I got better. Holy cow, my brain works. I'm waking up early in the morning. I don't need 11 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 10 years ago and I 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? So the adrenal system has an adaptive response. So it doesn't just fail all at once or doesn't just.

just kind of get dysfunctional at once. What are the, one of the stages that people go through? And how do many people recognize that so they can actually avert the kind of final thing, which I had, which is chronic fatigue? Mm-hmm. 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, you know, rock stars in a hotel room, like you just have all

this energy and you feel like you just drink a whole bunch of Red Bull and you're, you can't sleep, you're wired. you're like on the go, you're doing tons of things. Everybody around you is too slow, not smart enough. Like they just don't get it. And so this is how people usually feel in the high cortisol state, very like irritable. And they're kind of jumpy, right? If 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 kind of 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 3 p.m. 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, oh, I have a million things to do, like I need to do them. If 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 9.30. I like, I used to wake up at 6 a.m. going to go running. 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? And 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, you know, 11, 20. 12 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 12 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 yeah i mean i think that's true you know i think the the sense of um being exhausted in the morning is it's 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 think about you know if you haven't slept for you know a while you become more cranky and irritable it's not because your jerk. It's just because your nervous system is just fried. And so, you know, we see, we're seeing this. And then questions, symptomatically, we can diagnose it. But are there tests

that we can do to actually help figure out what's really going on? I love recommending tests. I do a lot of them myself. And if I had my way, I would have everybody do various functional medicine tests. The adrenal saliva test 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 10 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 Addisons.

And I'm like, okay, well, you've got to go to a doctor that is an integrative practitioner. And 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 finally they do the test and they get their results, you know, a few weeks later, sometimes a couple of months.

And it's like six months have gone by where, you know, 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 you are, if you're 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 to you yes i think it's so true because i think the you know that most of the time people walk in and they come in their symptoms i could tell what's going on and then the test will confirm it um and i think we do see stages of the test

where we'll see, for example, 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, kind of flat lining. And I think that, you know, that's something that is sort of an end stage process. And, you know, in terms of the sort of treatments and the diagnosis of it, you know, you sort of you challenge some of the traditional view of this. You know, you say this is sort of, you know, doctors talked about this as a bogus diagnosis and dismiss it. And, you know, why do you think that is? I think, you know, 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 of what was going to. going on was kind of like a mild Addisons 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 hypothalic pituitary adrenal axis dysfunction. And that is a real thing.

And there's public literature around it. And same with like leaky gut 10 years ago. It was 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, you could call it burnout. You can call it adrenal fatigue.

I call it adrenal dysfunction because I feel like it. it rolls off the tongue a little bit easier than hypothaline pituitary adrenal axis dysfunction. And 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. Yeah. Amazing. So in your book, Adrenal Transformation Protocol, you talked about, you know, just chronic stress being a huge cause of this and how it creates a demand for high cortisol and adrenaline. end. 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, it was something else. I mean, it was physical stresses and some psychological stresses. It was a combination of things. So I wondered for the audience, which you just said them unpacked the four types of chronic stress that can

sabotage our adrenals. 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 5 a.m. to go to do your exams. That can be incredibly stressful. You have a really annoying boss who's just a jerk. That could be incredibly stressful. You have a lot of family drama. That's currently stressful. And people recognize these kind of stressors. I know one of my books, somebody wrote a review that was like, I didn't need to do anything that she recommended. I just put 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 like positive stressors so you have a beautiful baby and that beautiful baby doesn't sleep right 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 but they can be a bit overwhelming um then they're kind of like hidden psychological

stressors so maybe you had a history of um adverse childhood events something you happen in your childhood that was traumatic you probably don't even have a recollection of it but um or maybe you do but it has shifted your um your hpa access to be more um you know more on high alert and kind of put 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 like unpack modern life. If you are not sleeping a lot, if you are skipping

meals, if you are exercising, over-exercising, right? If you're eating foods that are inflammatory to you, your caveman or cavewoman brain is going to say, holy cow, we must be in a war, in 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, you know, 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. Yeah. I mean, 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 into 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 sort of highlight that 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 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 had insomnia. I was waking up at 3 a.m. 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 then there's also like the hidden stressors where people might not realize them they're not in their lifestyle their lifestyle might be like spot on and perfect right 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. And usually in that case, it could be a hidden source of inflammation in your body. Totally. And I'm like, and And I think that what's interesting is when I, when I had chronic fatigue, it 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 weight and sleep cycle is important. heating at their same time is important. Your body is a biological clock. And there's a whole system of medicine called chronobiology, which is the science of 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. And that is really not good for us. And it really requires sort of discipline. I've repeated state of circading rhythm and of reducing the things that cause adrenal dysfunction to kind of help you help you fix that. The 20 to 30 percent of patients who come into their primary care doctor's office come in with the chief complaint of fatigue. I'm tired. I'm tired. And, you 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 want to come in is I'm tired and I want to feel better. so I think functional medicine is really well you know it's I think it's great for whatever we're

working on but I think it works really well with fatigue you know in conventional medicine you know all of our training we were really focused a lot on acute care medicine and you know 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 you know so one of the great things in functional medicine is we really focus on, 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? And I think that's really critical. And one of the great things about functional medicine is we talk about their timeline, which just means, you know,

their whole life story. You know, what was their life like as a child, even when they were a fetus, you know, what kind of illnesses that they have when they were younger? How did they feel when they were 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 and saying, I have fatigue, I'm tired. 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 it doesn't seem like it's related to that problem, then you just ignore it. So 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 going to 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're breastfed, whether you took any biotics, 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, yeah, I was in Thailand and I got sick. And I never been the same.

And 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 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 and 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 right and and i don't blame i don't blame prozac is the treatment for depression i mean for fatigue right maybe you've had a

low depression it's not that we're you know they don't blame physicians for that they're given a very short amount of time to deal with this very complex symptom 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 go you riddling. Or maybe they give you provigil. Right.

You know, right. There's drugs, but it often don't work. So, I mean, I think what's graded 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 got to think about and delve through. Like Lyme disease or a virus. Absolutely, right? Yeah. And they're not acute infections are these things that are lingering, smoldering things that, you know, don't make you acutely ill, but that are staying there affecting your overall health. That 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. So your microbiome can make you tired if it's not healthy. If it's not healthy. We see

that all the time, right? So, and then, of course, we're paying attention to the mitochondria, you know, 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 is, is, you know, does this person have some variations in their 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 want it. We take it. 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? Yeah, because fatigue doesn't really mean a whole lot. I'm tired. And it could be caused by so many things. For me, it was mercury. Yes. 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 was like the most extreme version of it where you can barely drag yourself out of bed, it barely function, you know, 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. really don't look at. It's so important to ask those questions, right, of how long has this been going on? Did it just start? Has it been your lifelong? You know, have you been life,

like your whole life been a little more tired than, you know, you're somebody, you know, 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 right so there's so many so many interesting questions that we have to ask and and so one of the things you know at the ultra wellness center that we do is you know we've got um one of our pas will take a really detailed history before you even see the doctor that helps helps us right so you know like 40 minutes or even more getting your whole story well first you fill out a whole a whole

patient packet which is long and extensive then they then the PA gets a long history from you and then we get a lot of time with you as well and all of that really helps to put together your individual story yeah which is is really what's helpful you see the whole patterns right you see all these patterns you connect the dots you see how things are linked up and and then you can decide to dive in to different areas of testing right you said well you know I had that tick bite when I was you know five years ago and I've never been right since or you know like I love tuna fish and I live in Martha's vineyard night swordfish every other week and you know you go maybe it's mercury or you know, you ask other questions relate to their, for example, hormones that, 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, you know, we look at their nutritional status because, you know, 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. And one of the kinds of things that, you know, are the common drivers of fatigue for patients? Oh, you know, there's so many, and we can go through a few cases, but, you know, nutritional deficiencies, huge. You know, you'd think that we were adequately, you know, 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. Or eating processed food or the soils depleted or the food stored for, I mean, the average apple you eat has been stored for a year. Yeah, right? Yeah, absolutely. Go pick an apple from a tree and go eat one that's been in a warehouse for your very, very different experience. 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. Heavy metals. Heavy metals, you know, and I think is really great. Some patients even come in with their timeline, you know, and sometimes that's so helpful because they write down, you know, over the years when certain things happened in their in their health history and then you can look at that and again you start to see some of these patterns yeah and and so when when i you know remember when i

you had chronic fatigue i you know went to doctor after doctor after doctor and they're like well there's nothing wrong or your testosterone or this is a little off or that's a little off but nothing really and yeah you know it takes some prozac you know here's something for sleep right you know and it's just 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 fatigue you don't often treat directly because, you know, you can take provisial, which will sort of make you more awake, or you can take riddle in or an anterol, 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 what's really going on. And I think, you know, when I first sort of discovered what happened with me, was the mercury was the thing that was driving it. And it created a whole cascade of problem. So it affected my gut. It affected my immune system. So I was critically inflamed. I started developing all these rashes and all these sores.

And all these things around my eyes would look like a raccoon. If I ate certain foods, I'd get floating. And I also develop, you know, real cognitive issues and real trouble thinking and focusing and fatigue. And I realize that, you know, these insults that happen, you know, affect all the different systems in your body. So when you're dying that's something with fatigue, it's all the other symptoms and all the other pieces that gave 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. Right. And that mercury for you just depleted your glutathione stores and that then influenced all these other aspects of your health. Yeah. Right. Poisoned my mitochondria. Yeah, right. And, you know, it turned out I had a gene that affects my muscle enzymes, my energy cycle and my mitochondria. Yep. 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.

And it was this abnormal test, but it wasn't really so severe that it was a disease, but it wasn't normal. Right. And they're like, well, I don't know what's wrong. You know, like, we can figure that out using the roadmap of functional medicine. I think it's so interesting how some people just need more support than others in certain areas. And, you know, 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.

Yeah. I remember I was giving a lecture at your ranch one year. And I'm like, this guy's like, you know, I'm always tired. I don't know what you do. I said, how many hours you sleep? is like six. I'm like, sleep eight. That'll be $500, please. Sometimes it's just that simple, right? I was like, sleep. So quality of sleep also matters. You know, sleep apnea is another cause is often very undiagnosed in patients. Often undiagnosed in something we have to look for. You know, 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 gaining weight, right? 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 got to think about sleep apnea. And 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? If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love

to hear your comments and questions. Don't forget to rate, review, and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health, where I am chief medical officer. This podcast represents my opinions and my guest's opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional.

This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at Ultra WellnessCenter.com, and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving help to the public, so I'd like to express gratitude to sponsors that made today's podcast possible.

Thanks so much again for listening.