What Causes Chronic Fatigue & How to Treat It with Dr. Evan Hirsch

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Chronic Fatigue is a common issue we see in many of our clients. And how could it not be? As Dr. Evan Hirsch describes it, there are 15 common causes to chronic fatigue, all of which can be categorized into two groups – deficiencies and toxicities. Deficiencies can be hormonal, nutrient, lifestyle and even sleep related. Toxicities include the more well known toxicities like heavy metals and mold but even other toxicities like negative emotions and electro-magnetic fields. 
 
But when working with chronic fatigue, where do you start? And what is the difference between chronic fatigue and chronic fatigue syndrome? In this episode, Dr. Hirsch describes the differences, how he determined protocols for both and solidified the fact that you can REVERSE both chronic fatigue and chronic fatigue syndrome.

On top of that we discuss a big contributor to chronic fatigue…MOLD! Mold is a growing concern (see what we did there?!) for chronic fatigue along with many other health concerns. Did you know that 50% of the buildings in North America have mold? And it’s not just the old historical buildings. New builds are seeing mold growing before home buyers even move in.

Tune in to learn about chronic fatigue – the causes and ways to treat it.

Dr. Evan Hirsch suffered with fatigue for 5 years before he achieved resolution using the Fix Your Fatigue Program that he pioneered in his medical practice. Through his best selling book, free Facebook group, group and 1-on-1 coaching, he has helped thousands of people across the nation optimize their energy and he is on a mission to help 1 million more. He is board certified in family medicine and integrative medicine and when he’s not at the office, you can find him singing musicals, dancing and playing basketball with his family.

Get Dr. Evan Hirsch's FREE download of Fix Your Fatigue here

Connect with Dr. Evan Hirsch:
Facebook Group: fbgroup.fixyourfatigue.org 
facebook.com/DrEvanHirsch/ 
linkedin.com/in/drevanhirsch/
twitter.com/drevanhirsch 
instagram.com/thefatiguedoc/
youtube.com/c/EvanHHirschMD

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TRANSCRIPT


Christine:                      Hello everyone, and welcome to this new episode of the 360 Health Biz podcast for a new amazing episode and I'm so excited. So with me today are two amazing people, I had a lot of fun with on different occasions, but both times in San Diego. And this sounds a little bit lonely. [crosstalk 00:00:25]

Christine:                      One of them is obviously my wonderful cohost Kendra Perry. And then we also have Dr. Evan Hirsch who is such a great friend of me and we boogied over at Mindshare Conference night and it was so funny because I sat next to him and I had no idea that it was him, actually. I really didn't recognize him for a second. And he just smiled and it was like, "Hi! Hi, creepy dude." It was the guy from [crosstalk 00:00:51].

Christine:                      You know it's like this Superman movie, you know without your glasses and put your glasses on, now I get it. I kind of get it now. So anyway, he's super wise, I had the honor of interviewing him for a summit that I did two years ago, and so we're going to talk about chronic fatigue which I think for us practitioners, really important to understand, 'cause it's more difficult or, not more difficult, but more complex than we might think.

Christine:                      To celebrate though, we have a review, thank you, and Kendra is going to take it away and share that with you and say thank you so much, and then we're going to introduce Evan more formally and then we're off to the races.

Kendra Perry:                Awesome. So we have a really exciting review from Bella180. She says, "Love them," that's the title of her review, and then she says, "I love listening to them, they are fun and I feel they have a very relaxed way of getting a tonne of good and useful info. I totally feel like hanging out with them and being their friend." Someone wants to be our friend!

Christine:                      You are! You can hang out with us any time. [crosstalk 00:01:54] You're in the club.

Kendra Perry:                Oh my god, I love it, guys. And if you guys love us and you want to support us, really the best way to do it is to leave us a five star review on iTunes 'cause it helps us get in front of more people, get out there, and it only takes two minutes, so you can just pause the podcast right now and then go over and do that thing on iTunes. Go give us a five star review. Thank you! All right, so I want to reduce, introduce Dr. Evan Hirsch, I want to reduce him to a small man. We're going to introduce him. And I just want to quickly read his bio 'cause he's kind of big shit.

Kendra Perry:                I was just creeping on his website before I came on and I was like, "Oh my god, he's big shit, I'm getting excited." So, Dr. Evan Hirsch suffered with his fatigue for five years before he achieved resolution with the Fix Your Fatigue program that he pioneered in his medical practice. Through his bestselling book, free Facebook group, group and one-on-one Coaching," he has helped thousands of people across the nation optimize their energy and he is on a mission to help one million more. That's amazing.

Kendra Perry:                He is board certified in family medicine, integrative medicine, and when he's not in the office, you can find him singing musicals, dancing, playing basketball with his family. So tell me more about the musicals. I'm like, super intrigued.

Christine:                      I buy it. I saw you on stage, dude. I totally buy it.

Dr. Evan Hirsch:            I love musicals. I love watching them, I love singing them.

Kendra Perry:                Oh my god, that's amazing.

Christine:                      Which one is your favorite?

Dr. Evan Hirsch:            "Les Mis" is definitely my all time favorite, but it really depends on the flavor of the month. "Dear Evan Hansen" is amazing, I mean I love story that's told with music, 'cause music brings out the emotion and just like, one song brings you back to the whole story and you totally feel it all over again.

Christine:                      Very true, very true. So I have Evan so much and we had this discussion before because you know, you're like my bridge guy, you're one of the board certified MDs, family doctors who I not, haughty might not be the right word, but it actually is, you know? He was actually totally fine with communicating with health practitioners who might not have gone to medical school and I find that so so important that we do have that bridge.

Christine:                      So it's going to be super exciting because we have so many different perspectives today to talk about. But, you suffered from chronic fatigue and it would be interesting because you had all this medical background already, so what was going through your head when you were tired all the time and you didn't really have an answer?

Dr. Evan Hirsch:            At that point I was already practicing functional medicine and I had come out of my residency, my wife had had fatigue three years prior and we had had a child, I finished residency, I started a practice, and then I went into fatigue, and frankly I'm not a great patient and I was just kind of pushing through and I just thought that, "This is just temporary, it's going to go away" and it didn't, and I just got worse.

Dr. Evan Hirsch:            And brain fog got awful, to the point where I couldn't really remember much about the person who was sitting in front of me when I was doing my one-on-one consults. Thank goodness I had an electronic medical record where I could keep all that information in there, but once they were out of that chair, I really couldn't remember much. I could be present with them, I felt like I was practicing good care, but once they were gone, yeah it was out of my brain. And then I wasn't available for my family. I would come home and I couldn't play with my daughter.

Dr. Evan Hirsch:            She was like, "Daddy let's run around," I'm like, "I just need to lie down." And I felt incredibly, my buttons on guilt and shame were pushed because I couldn't help out around the home. My wife was doing everything and I couldn't do dishes, you know I just couldn't support them and I felt awful about it. So finally I started diving into it deeper, started looking at all the research, read all the books I could, and piecing together all the causes that I could find.

Dr. Evan Hirsch:            'Cause what I was realizing, and also while I was doing this you know with functional medicine lends itself to the most complicated cases, and so as I got better treating other people and I was like, "Oh, I'm having success with this, I really need to start practicing this on myself," but I found that as they were getting better that it was really all about addressing all of the causes, and so that's my huge takeaway for people is that a lot of the times people are looking for the best treatment and I find that it's not the treatment, that it's all about the causes, because if you find the causes, then you can actually tailor the treatment specifically to the cause and then you're not wasting money and time and energy treating something that you don't even have.

Kendra Perry:                So can we talk a little bit about the causes? I'm super interested what you found to be some of the primary drivers of the chronic fatigue, because I think from a conventional medical model I mean, no one really talks about that and I don't really even think there's a treatment for something like that.

Christine:                      No, I can only imagine that if you go to your doctor simply let's get some blood work done and then, you know, it might be a sluggish thyroid, but that's probably everything that there's in the toolbox. That's what I would imagine.

Dr. Evan Hirsch:            Yeah, conventionally it's thyroid, it's liver disease, congestive heart failure, it's like some of the more severe stuff that are usually as you get older, hepatitis, can be some of those too, but it's mainly thyroid. And so what I've found is that there's fifteen different causes of fatigue and they can really be grouped into two categories: one is of deficiencies and one is of toxicities. So the deficiencies are deficiencies in hormones, adrenals, thyroid, sex hormones, as well as nutrients, and then of course deficiencies in lifestyle stuff like sleep, deficiencies in exercise unless they're really chronically fatigued where they shouldn't be exercising. Deficiencies in water since most of us are walking around chronically dehydrated. And then [crosstalk 00:07:39] There you go, right?

Christine:                      Yeah see, you're right there and I'm just like, "guilty."

Dr. Evan Hirsch:            We're going to pause this so that Christine can go get some water.

Christine:                      [inaudible 00:07:47] Slipping on stuff and I literally came up to my office and I saw my water bottle and I was like [inaudible 00:07:52]

Dr. Evan Hirsch:            Vader. And then there's the toxicities: heavy metals, chemicals, molds, infections, allergies, negative emotions, which people really undervalue. [crosstalk 00:08:06] Electromagnetic frequencies, you know all these toxicities that we're exposed to nowadays that just really cause all of those deficiencies. So, those are really, I found that there's like different levels of problems, so I'll consider a level one problem as a problem that can be fixed with lifestyle, lifestyle and diet. And the level two problem is one that can be fixed with deficiency and then level three problem is the one that people have a number of toxicities that have to be removed, and so those are the harder ones to treat.

Kendra Perry:                Yeah, you definitely come across people where you're like, "Do we even need to do testing? It sounds like you just need to stop eating fruit loops in the morning and start liking your life again."

Dr. Evan Hirsch:            Right! Huge.

Kendra Perry:                Yeah, totally. That's awesome. That's such a comprehensive list, I love it, like that's exactly what I would say, so I feel like we're on the same page in that we should be friends.

Dr. Evan Hirsch:            Absolutely.

Christine:                      Yeah I was like, "Totally," but I'm the like, you know the person, I'm like the one in the back in the classroom like, "Aw fuck this isn't how I learned to do," you know? So there is a, I have a plan. I'm a new practitioner, which I'm not people, but you know, imagine me to do, a lazy one. But how do you work through this? It totally makes sense, right? Those are all the things where I would go, "Light bulb, light bulb," and check, check, check, and see what's going on.

Christine:                      But if I have someone, and say we just had a coach who just went to health coach school, a general health coach school, and it's like, "Oh my god, I'm totally overwhelmed right now." Do you have a priority list? How do you even tackle all of this? I mean for us, I think, after a while you just even listen to the person and you kind of see things flare up in them, like in their aura, you know, however you work. You just hear it out. But when you haven't had as many clients yet, how do you logically do this?

Dr. Evan Hirsch:            So you do kind of like what I talked about going from like level one to level three. So you start off with the stuff that you know. If you've just come out of school, you know about lifestyle and diet stuff. So you're going to clean up their diet, you're going to get rid of their grains and their gluten and their dairy and all that crap, and you're going to get them sleeping better, and you're going to start working on mindset stuff, so all of that stuff can be really great and you can get a certain number of people better. And then if you're not getting results in three months or so, depending on how often you're seeing them, then you're going to move on to level two.

Dr. Evan Hirsch:            So then you're going to look at okay, let's start running some labs. This isn't that way that I do it, I get all of my labs, I try to get them all up front as soon as possible 'cause I find it saves a lot of time, but you also don't have to have your people spending $4000 on all these labs initially, 'cause that's not your specialty.

Dr. Evan Hirsch:            So then you start looking at the deficiencies. So you're looking at adrenals, thyroid, sex hormones, nutrients, making sure they're drinking enough water. You know, all these sort of things. That's where I would go. And then if you're still not having success, and you also have to make sure your treatments are correct, that you're optimizing all these things. So I do ramp-ups on all of these things, 'cause most of the time the body's going to tell you when you've have enough of them. So if you're ramping up on your adrenals, you've got them nice and robust, and then you move on to mitochondrial support, and then you move on to thyroid, I call those the big three, and I ramp up on each of those to a significant amount so that you're making sure that you're giving, 'cause I like to move the needle.

Dr. Evan Hirsch:            So I like to use things that are powerful and safe at the same time which is why I love natural medicine. So we ramp up on those, and that's going to give you an idea about how much, what you have to go to next, but you want to make sure that you're doing it right, that you're not just giving somebody a glandular on adrenal support, or if you're giving them, the worst is giving them adaptogens. 'Cause adaptogens are wonderfully balancing, but they're usually not strong enough and you're not going to shift the needle if somebody's got fatigue.

Kendra Perry:                Okay, I love that. I'm always saying the same thing about adaptogens. I'm just like, sure, but it's not really going to do anything. I just want to back up a little bit because I want to, can you actually tell me what is chronic fatigue syndrome, how is it diagnosed, and is there a difference between chronic fatigue and chronic fatigue syndrome, or are they synonymous? I would love to know that.

Dr. Evan Hirsch:            Yeah, they are totally different. Not totally, but they are different. And they're a gamut. You know, whenever I'm looking at things I'm always looking at a gamut. I don't care about these diagnoses. Chronic fatigue syndrome, according to the Institute of Medicine and CDC and stuff like that is, if you had a certain number of symptoms for six months. Well, if you've had fatigue that's not relieve, I mean the way that I define fatigue is if you have fatigue if you're tired and it's not relieved by rest.

Dr. Evan Hirsch:            So if you're getting seven to nine hours of sleep a night, good sleep, and you're waking up and you are still tired, then there's a problem. And even after a week of this happening, you really need to start looking at what's going on here and what might be some of the causes. Now, if you've just had the flu that wiped you out and it's taken you a month to recover, first of it shouldn't take that long, but second off, as long as you recover and you get back to base line, like you're doing all right.

Dr. Evan Hirsch:            But if it's lingering, you want to do something about it sooner than later. The body is yelling at you to do something about it. You have to listen. So I consider, and then chronic fatigue is just that persisting for several weeks to several months. It doesn't have to be six months and it doesn't have to be all those other symptoms that they talk about too.

Kendra Perry:                Yeah, it's so interesting because I say chronic fatigue a lot. Like I say debilitating fatigue, ongoing fatigue, chronic fatigue, and I say chronic fatigue a lot and I get these people messaging me on Facebook who have chronic fatigue syndrome and they're getting mad at me, 'cause they're like, "You make it sound like you can actually reverse it and get rid of it! You shouldn't say that and you shouldn't say that," and I'm like, "Well, I think you can reverse it."

Christine:                      I think you can.

Kendra Perry:                [crosstalk 00:14:09] That's kind of what I'm trying to tell you. It's just interesting. Thanks for clarifying that.

Dr. Evan Hirsch:            Yeah and you know that challenge is that they haven't been helped and it's been 10, 20, 30 years, so then they get pissed off at somebody talking about a way to help somebody, and either they don't have the hope anymore to explore another option. They are resigned to where they're at. So now they're just pissed off because what if you're right? What if you're right and you can heal it and that means that they've been suffering needlessly for all of these years and they don't want to take that next step because it's too scary or it's too challenging or it's too expensive or whatever they think.

Kendra Perry:                Yeah, and I think people really, a big reason why I don't like diagnoses is that people really connect with it. They bring their diagnosis into their story and-

Christine:                      They become the diagnosis.

Kendra Perry:                They become it, yeah. So I think that's a tough one to deal with for sure. [crosstalk 00:15:03]

Christine:                      They define everything by their diagnosis. "Oh, I can't do this 'cause I have thyroid," "Oh, I can't do this because I'm gluten intolerant," and it's like, work on it then! It's like...

Dr. Evan Hirsch:            Although it's challenging to hold both sides, too, because often times having a diagnosis can be really comforting. You know, as long as it's the cause. Like, okay, I've got heavy metals, chemicals, molds, and infections. Yes, there's a lot of reasons why you have fatigue. So it's like, "Oh, and all of a sudden I've been suffering all this time and now I know why." That's very different than grabbing that label and being like, "I can't do things because I've got this label."

Christine:                      Absolutely. So I have a question. When we were talking about gauging the needle and not using adaptogens and things like that. I find it really hard to find research on what to use. So I use only natural supplements of course, but I find it really really difficult to know what to use, what not to use, obviously I'm in Europe, so I'm more limited as well. How did you figure out your protocols? How did you, I can imagine you had to figure it out by yourself. I can't imagine that it was just there.

Dr. Evan Hirsch:            Correct. Well I mean, I like to copy people who are successful and then I make modifications. And I like to ramp-up and I like to experiment, so I'm going to keep pushing the dose until the body says, "No," and I do that enough times where I get an idea about what a good dose is, what a good dose isn't, what side effects people are going to get from things like licorice root. I used to use licorice root all the time with everybody in high doses and then people started getting high blood pressure and they get all this swelling and electrolyte imbalance and I'm like, "Oh no, I've got to find something else. Licorice root is good as a part of all this, but I've got to find other things in order to complement."

Dr. Evan Hirsch:            So you look at the research, you look at what other people are doing that they say is successful, but you always have to take that with a grain of salt because everybody thinks their protocols are amazing.

Christine:                      Yeah, for sure. I'm just too overwhelmed to even change mine. [inaudible 00:17:06] Obviously they work, but I'm convinced that there could be even better ones, but literally at the moment it's just too overwhelming. I think I could fall into that rabbit hole and just not come out of it for years. Just give it to me, tell me what to do. But things are looking well, I mean that's why we take other courses and why we try to [inaudible 00:17:29]

Dr. Evan Hirsch:            Right. And being curious, and when you can't help somebody that you go back to the drawing board. You don't throw the baby out with the bath water, but you say, "Okay, what am I missing?" So if they're working, awesome, that's great. If they're working 100% of the time, great, but if they're working 95% of the time then when they're not working, then it's like, "Okay, what am I missing," and that's when you learn. And that's what happened to me and in treating myself and in treating all of these people.

Dr. Evan Hirsch:            I started off in integrative medicine and functional medicine where I was like, "Okay, I'm fixing all these deficiencies, I got a certain number of people better," and then there were people who I couldn't get better. It's like, "Okay, now I need to go to environmental medicine. I need to start learning more about," I never wanted to treat infections. It was always way too complicated for me and all this stuff about Lyme and I was like, "I do not want to go into that world." But then I realized that I couldn't help those people until I started learning.

Dr. Evan Hirsch:            I read Horowitz's awesome book on differentiating all the co-infections and then I started learning more about these awesome supplement lines like Fire and White and Beyond Balance and a number of these that are really good at getting at the infections. I learned about LDI, Low Dose Immunotherapy, and became an expert in those things because I had to, and because it's so incredibly gratifying when somebody comes and I can say, "Oh, you've got bartonella and I know exactly how to treat you and you're going to feel better in this amount of period."

Kendra Perry:                I'm super intrigued-

Christine:                      [crosstalk 00:19:00] Because it's true! It's like, I love it. [inaudible 00:19:01]

Kendra Perry:                I know. It's overwhelming for sure, there's a lot [inaudible 00:19:04] and you have to be a forever student. But I'm super intrigued about Lyme and mold these days, 'cause yeah, that's not something I ever wanted to deal with. I would refer those people out, but now I have all these women in my group membership program where I'm like, "I think you have mold. I think you have Lyme." And now I'm like, "Oh crap. I was right about this." And so how often do you find that is involved in fatigued and what's sort of your general approach to those types of people, because I know the symptoms for the two can be very, like the same and there can be a lot of overlap with the two as well.

Dr. Evan Hirsch:            Yeah, there's a huge amount of overlap and so there's certain things, as I'm going through creating my group coaching program right now, there's a certain things that I asterisk where you can really kind of make a diagnosis by symptoms, but there are certain things that you can't. And a lot of the toxicities you can't because there's so much crossover. But mold is huge. I never thought I would be dealing with so much mold, but 50% of all the buildings in our country in the modern world have water damage.

Kendra Perry:                50%?! Holy crap. I was like, "What?" Okay, that's good to know.

Dr. Evan Hirsch:            And most of those have mold. And so then it really depends on how much exposure you've had, what your genes look like. I don't ascribe to the Shoemaker protocol and it's entirety, but there's certain things that I pull out that I think are good. You have to assess the body, looking at mold in the body, and you have to assess the home, looking at mold in the home. Because if somebody's living in a moldy environment, I can't get them better.

Christine:                      I know, it's nuts. And I just had a client who showed me a picture and everything was green, like literally. And it was a new building, it was only five years old, but obviously they skimped on building materials, I don't know. But it's so hard because I was like, "You have to move, basically," and she's was like, "No fucking way," and I was like," Well there's not much I can do." But it's rough. I think it's so underestimated and I had just a friend last week posting on Facebook that she needs a place to go because she go severely sick and she just found out it was because of mold and she needs to move. It's nuts. I think it's a topic that, as an integrative practitioner, a functional medicine practitioner, you have to know about. And so it's on my to-do list as well.

Kendra Perry:                I still have a mold course, so I'll give you access to it, Christine. You can- [crosstalk 00:21:24]

Christine:                      Oh good. I still haven't done yours, you know! I'm like, so it's literally my course! For some reason I'm just like, I need to oh god, I need a second life, yeah.

Dr. Evan Hirsch:            And Kendra if you want me to come talk about mold in your course, I'm happy to do so.

Kendra Perry:                I would love that. That would be so fantastic, because yeah, it's a hot topic. A lot of people are asking about it. I sort of know a few things like, generally to do. I'm making sure I'm asking those questions in the intake form, but yeah, I'm kind of like, "Okay, we need to do," so obviously the first step is getting out of the mold environment when it comes to mold. And then after that, I've heard that you want to do a lot of binding. Is that your approach?

Dr. Evan Hirsch:            Yeah. And so, just to give you specifics, the ERMI test for the home, initially, to determine whether or not they have mold in the home, because they could, and then you want to do a urine mycotoxin test, either through Real Time Labs or through Great Plains. And so then you know there's mold in your body and whether or not there's mold in your home. If there's mold in your body and there's no mold in your home, and you know that the mold in your body is from another location, either from work or your car...

Kendra Perry:                In your car? Would that be like for people who live in like a rainy, tropical environment? Would they have moldy cars? 'Cause that can happen to anyone.

Dr. Evan Hirsch:            It can happen to anybody. Oftentimes it's because the mold will get into the clothes, it'll get into furniture, it can get in get into everything and then you just basically take those clothes into your car and then your car gets moldy. But oftentimes there can be a leak in the car as well. But once you make sure, you look at all those things, you make sure the person's not being exposed to mold, then you know, "Okay, this is from a previous place."

Dr. Evan Hirsch:            Like I lived in a moldy place when I was in medical school, so I was like, "Okay, my place is clean now. It means that the mold that is in my body right now is from a previous infestation, a previous exposure, and so then I need to remove that." And so then that's with binders, so there's a number of different binders. There's activated charcoal, there are the french clays, there are humic and folic acids, oftentimes using a combination can be good. There's certain binders that are better for different things. And then using glutathiones so oftentimes binding things up and using glutathione to get it out. So those are kind of the big things that I'll use.

Dr. Evan Hirsch:            And then if somebody can't get out of a space, oftentimes using an air filter like IQ Air or the Air Doctor. Basically, you want something that can get mycotoxins or mold toxins which are particle size that are down to .003 microns. And so you have to use something like those two that'll get down that small. You can't just use a regular HEPA filter, because those will get mold spores. They may say "mold" on them, but that's just mold spores, that's not mycotoxins.

Kendra Perry:                Right. Yeah, that's so interesting. So what I've found with the people who I suspect have mold, they're the people who just like don't respond normally to the protocol that I give them. It seems like every time we try to do anything with them, they're like having a crazy, exaggerated, intense reaction and you're just like, "Oh my god. Like, what is going on here." And yeah, they just seem to, do their detox pathways get really clogged up or something or does that affect that? Because that's what I see.

Dr. Evan Hirsch:            Absolutely. Yeah, and some of the symptoms that they'll get that are less non-specific or more specific are some of the sinus stuff, sometimes they'll get ear congestion. They can get itching, so itching around the anus, itching around the ears, which can be fungi in general, it can be yeast or mold. You can get neuropathies. Often times they will walk into a place, they can detect mold instantly because they've got so much mold in their sinuses, so they can smell it, and then they know that they need to leave, otherwise they're going to start getting brain fog. So those are some of the more specific symptoms. But otherwise it's just the chronic fatigue and the sensitivities are really a big one.

Kendra Perry:                Oh man, that's so interesting. So mold is a big one. So something I'm interested about, I feel like mold has always been around, do you think there's something going on these days that is making us more sensitive to mold? Because it's not like mold is a new thing. Hasn't it always been around?

Dr. Evan Hirsch:            Yes. But there's a couple things. So one is total body burden. So the more crap that you have on your liver and the more crap that you have on your immune system, the worse your going to be, so the more reactive you're going to be. If you've got heavy metals, chemicals, and molds, which then allows a bunch of these infections to become opportunistic in the body and start wreaking havoc. That's one thing.

Dr. Evan Hirsch:            The other thing is kind of how buildings are made. I've got a 1920's home, it's got good ventilation. A lot of the newer homes are sealed way too soon. So usually you know, Christine you were talking about this like it's only a five year-old home. If you're driving around town, you're seeing a home being built and it's raining and it's framed, it's just being in the framing stage or whatever, it's just wood, like that home is just prime because it gets wet. As soon as they think it dries, all of a sudden they're tightening it up, sealing it up really tight, and then it's nice and warm, and that wet wood is all the sudden starting to grow mold.

Kendra Perry:                My mind is just blown. I'm building a house right now.

Christine:                      [crosstalk 00:26:53] You're like, "No!"

Kendra Perry:                I'm like, "Oh my god, what do I need to do?"

Christine:                      Yeah, but it's a problem here because all the new houses are, in Europe, have this energy pass, you know? So they need to be type A which means that they have to use as less energy as possible which means that insulation is crazy. It's supposed to be that you shouldn't even open your windows, so ventilation is inside of the house all the time. But what I can see is that yes, it's super hot all the time, first of all, you do need less energy, but it's because everything is so isolated.

Christine:                      And the thing, though, that you can see pretty much everywhere and here in Luxembourg we are building like crazy at the moment, is that even after a few years, even the outside starts to become very very green. Like it starts to mold from the outside already which just shows me that, okay, even if this is just outside, it's not in your bathroom, this cannot be healthy. And it's beautiful, like high standard buildings, but I just think that we have a building practice at the moment that hasn't been thought through. So I think it's like, yeah this is not going to work. It's going to have some effects down the line for sure.

Dr. Evan Hirsch:            Yeah, and what people can do proactively is just do testing, you know? Like even something cheap like a mold plate test every year, every couple of years, making sure that if you do have a leak, looking in your attic, looking in your basement. If you do have a leak that you address it as soon as possible. Oftentimes as soon as the leak happens, you're already too late or you have to start doing some remediation. But staying on top of it as much as possible. It is unfortunate, but all you can do is the best that you can, and then just make sure you've got binders on board. I recommend that most people should be consuming binders on a regular basis anyway because of all the crap that we're exposed to, so.

Kendra Perry:                Yeah, I take binders three times a day and it's like I've been doing this BioTox which is a binder of some of the stuff you mentioned: humic acid, folic acid, yucca root. Yeah, the Microbe Formulas guys, they make good products. I'm into them. Very cool.

Kendra Perry:                Okay, so mold is a big one. Can you talk a little bit about the environmental stuff, like the heavy metals and stuff? Because I love this. This is a big one and I love seeing people talking about it because I feel like, right now, gut health and infections is so trendy and popular and everyone's talking about it, but I a lot less hear people actually talking about the environmental chemicals, the environmental toxins and how that is huge in chronic fatigue.

Dr. Evan Hirsch:            Yeah. And you know we all start off treating the gut. It's kind of what we learn. And at some point, as you get better and you start getting sicker patients, you're gonna be treating the gut and you're not going to be having success. And then you're going to have to start looking at these other things and that's what happened to me. So yeah, heavy metals, lots of exposures. Mercury amalgams.

Dr. Evan Hirsch:            I had a lot of mercury, I mean I had pretty much every cause which is why I had fatigue. And so I had a lot of mercury from growing up, I had like tuna fish several times a week. The bigger the fish, the more mercury because of all the coal plants that we have in the world right now that are producing mercury vapor that goes into our oceans. So everything that's coming out of the ocean right now has mercury in it, and the bigger the fish, the more the fat, the more the mercury. So tuna and swordfish are huge and so I had a lot of tuna fish growing up, I had mercury filling, every time you bite down you're releasing mercury vapor from that amalgam.

Dr. Evan Hirsch:            So that was my exposure. Arsenic we know about issues with rice. In this country we know about runoff in some of the stuff and some of the herbs and whatnot from China. You've got industrial plant on top of the hill and then the farms down below. And that can be anywhere in the world, not just China. Cadmium from second hand smoke or smoking. So there's a lot of, and then lead, you know it's so interesting the stories that I get, people who are working with plasters or just doing art stuff or lead, lead paints, lead gasoline. So and so grew up outside a lead gas station, or their father worked in a gas station or whatever.

Dr. Evan Hirsch:            The other thing that's really interesting too that people don't realize is that a lot of this stuff gets passed down from mother to child vertically through the placenta. So, moms dump all of their good stuff into their babies and all of their bad stuff. So heavy metals, chemicals, molds, infections, all this stuff are going to get dumped into the baby. Which is why there are some people who, they have have children who have autism, and they're like, "I have no clue why." And when you do the testing, they're just full of toxins.

Dr. Evan Hirsch:            There's several studies now on assessing umbilical cord blood and there's 250 different kinds of chemicals and toxins that are found in umbilical cord blood. So these kids are coming out toxic, which is why, our kids are supposed to be the first generation that's not going to outlive their parents. So I mean, this is a huge problem. A lot of this stuff we are getting through that passing, through the placenta. So yeah, that's heavy metals. I don't know-

Kendra Perry:                Yeah, that generational toxicity is a big thing. Like I'm pretty sure I came into this world with a whole bunch of crap. Because my parents are like in their mid-seventies and my dad can still kick my ass on a mountain bike and I can't keep up and it's embarrassing. Generational toxicity!

Christine:                      Damn you, Karen!

Kendra Perry:                I can't keep up!

Dr. Evan Hirsch:            Right, well and he doesn't have your mother's toxicity.

Kendra Perry:                Yeah, exactly. That's a good point. And I mean my parents, they were raised on eating actual farmer's food. They were raised on, I was raised in the 80's. I ate margarine and low fat everything and [inaudible 00:32:45].

Christine:                      Such a difference made.

Kendra Perry:                Yeah. So it's like when you look at all these causes, it really kind of, you're like, "Well no wonder everyone's so tired." And it's definitely the most common symptom I see in my clients which is why I really transitioned to kind of focusing on it, because originally I was doing gut and hormones and then I was like, "Everyone's so fucking tired. Maybe we should start talking about this." It's so common.

Dr. Evan Hirsch:            And it's so complex. I think if you can treat autistic kids, that's like the ultimate in functional medicine. And then next is fatigue. I mean, because there's so many different causes. You have to be able to treat the gut. You have to be able to treat all these toxicities. There's just so many potential causes.

Christine:                      It's like this beautiful kaleidoscope of fangs, you know? So I'm still look for like, do you do mentorships or anything like that? I have all these courses I want to take and I'm just like, "It's too much," you know? But is it something that you do?

Dr. Evan Hirsch:            I'm going to be coming out with a course in the next six months or so with-

Christine:                      For practitioners as well, or?

Dr. Evan Hirsch:            Yeah, for practitioners.

Kendra Perry:                Yeah, awesome.

Dr. Evan Hirsch:            Right now I'm doing the group coaching for clients, but then yeah, practitioners. And it's going to be, I'll have like live Q&A twice a month or so so that we can go over cases in addition to having the digital content so people can run their cases. And I'll do it probably as a membership model so that, if people use it for what they need and then if they don't need it, they don't need it sort of thing.

Christine:                      Sign me up!

Kendra Perry:                Me too. I love it. Yeah, I think there needs to be more courses for practitioners that kind of ties everything together, 'cause who were we interviewing the other day?

Christine:                      Tim?

Kendra Perry:                It was a doctor. Oh yeah, Tim Jackson. He's like, "There's no school for functional medicine. Sure there's a university of functional medicine, but it's not very functional." And I mean, and you still can't run the test, right? You really need to bring it together and I feel like we can all kind of like, all of us practitioners should just combine brains and make a super brain.

Christine:                      It's very true. I think we have such a huge movement and so many really smart people that come out with their protocols with, you know, what you do right now you know, Evan. Like learn from every expert and then puzzle it together. It's just like, I'm the lazy one, I just wait until all you guys come out with courses and just, you know, summarize the whole thing.

Dr. Evan Hirsch:            That's not lazy, that's smart.

Kendra Perry:                That is smart.

Christine:                      I'm a CliffsNotes kind of person, you know?

Kendra Perry:                Well that's good though, 'cause a lot of people are just like you, right? They don't want to be boots on the ground, they just want to get the information from the experts and that's totally cool. No shame in that, girl. Don't shame yourself.

Dr. Evan Hirsch:            Yeah, no shame.

Christine:                      I got fine while I fooled with this, so it's totally fine. But I feel like there is no real hub, you know? So it is a shame a little bit, 'cause I think a lot of us have to re-invent the wheel in a way all the time. But it's obviously good if you understand everything, but it makes me and I'm sure a lot of listeners very happy to know that you're coming out with a course and a membership. So that's awesome to hear.

Kendra Perry:                We'll keep our listeners posted on that course, just [crosstalk 00:35:49]

Christine:                      Yes, please keep[crosstalk 00:35:51]

Dr. Evan Hirsch:            I will.

Christine:                      So we can let them know when it's ready.

Kendra Perry:                Okay. Can we talk a little bit about Lyme? This is another one that I'd love to pick your brain on, 'cause yeah, another one where I have the mold/Lyme people where I'm like, "You maybe have mold, but maybe you have Lyme." And we addressed mold, but let's talk a little bit about Lyme. And do you think people can still have Lyme even if they didn't notice that bullseye bite on their body?

Christine:                      [inaudible 00:36:17] thing, yeah.

Dr. Evan Hirsch:            Yeah, only about 10% of people actually get the bullseye rash.

Kendra Perry:                Awesome.

Dr. Evan Hirsch:            Yeah and oftentimes they don't have Lyme per se, like borrelia, but they can have a lot of the other co-infections. So there's a lot that can travel inside that tick or anything that takes a blood meal. So it can be ticks, it can be sand flies, it can be biting fleas, it can be blood transfusion. It can be vertically from mother to child, it can be sex, it can be kissing, like there's so many different ways that you can get a lot of this stuff. They're very opportunistic bugs.

Christine:                      I just want to create a bubble right now and just go inside.

Dr. Evan Hirsch:            Well and sometimes it's not even a big inoculation. I was talking to somebody yesterday who yes, he got bit by a tick. He saw this big fat tick and then he was really badly fatigued. It's like, yeah that's real causation, but for a lot of folks, they don't have that sort of thing. And oftentimes, we all have these infections.

Dr. Evan Hirsch:            So bartonella is an infection that's found in upwards of 50% of all domestic animals. If you've ever been licked in the face by a cat or a dog or whatever, you probably have bartonella, but you don't have the symptoms of it because your immune system keeps it in check.

Kendra Perry:                Right.

Dr. Evan Hirsch:            And so it's only when these bugs become out of balance and they become opportunistic when you get heavy metals, chemicals, molds, infections, motor vehicle accident, divorce, stressful whatever that causes the cortisol to stop managing the immune system and then these bugs come out and say, "Hey nobody's managing us anymore. Let's have a party!"

Kendra Perry:                Yeah, I would, too. I would do that exact same thing.

Dr. Evan Hirsch:            Exactly.

Christine:                      You and me both, girl. [crosstalk 00:38:00]

Dr. Evan Hirsch:            So you don't have to get, so a lot of us have these bugs already, you know. Epstein-barr virus. It's like being re triggered. So it's setting up an environment that is not habitable for these bugs. It's creating more of a balance and it's less about eradication because oftentimes we can't destroy them entirely. We just want to bring the volume down on them and then release the immune system. Because what I've found is if you don't have a functioning immune system, you cannot bring those bugs back into balance. And you can't have a functioning immune system if you've got heavy metals, chemicals, and molds.

Kendra Perry:                Word.

Dr. Evan Hirsch:            You're not going to bring the immune system back in balance with the bugs.

Kendra Perry:                Yeah. And do you think there's a way to address Lyme that doesn't involve a ton of antibiotics? I feel like most of the Lyme people I meet, they're on a crazy antibiotic schedule. I mean like, okay well maybe that'll work, but what's going to happen after that?

Dr. Evan Hirsch:            Yeah, I don't use any antibiotics and I get really good success. You know, all the research on antibiotics are, you stop the antibiotics and your symptoms come back.

Kendra Perry:                Yeah, there you go.

Christine:                      Why is nobody telling you that, right? It's like, seriously, people?

Dr. Evan Hirsch:            But the herbs will go deeper and you will get more eradication, but the challenge is, like I said, a lot of those people. So this is also a challenge of the functional medicine community is 'cause you've got the mold expert and you've got the Lyme expert and you've got the leaky gut expert, but nobody's pulling this stuff together like you're talking about with Tim.

Dr. Evan Hirsch:            It's just not happening. So if somebody's focusing on Lyme and they're not getting rid of heavy metals, chemicals, and molds, then they're never going to be able to get rid of these bugs, you know? And there's good research on that too. I know that there was one study on mold and Lyme, people who had both, when they treated the mold, the Lyme went away.

Kendra Perry:                Oh, interesting.

Dr. Evan Hirsch:            Yeah, and it was a small study but it's still significant. I still see it a lot where we remove those things and then we can get rid of the Lyme. The other thing, too, is figuring out exactly which bug somebody has because, and this is another one of the problems with the antibiotics, is that in order to address all of them, you have to use multiples and different combinations, and the herbs are a lot more elegant in terms of how they work. But, you have to be very specific that you have. So you know, if somebody's got borrelia, AKA Lyme, they have to have symptoms of either muscle pain, joint pain, or nerve pain that moves around the body and comes and goes.

Dr. Evan Hirsch:            So if you don't have those symptoms, you can't have borrelia. If you have bartonella, you're going to have three of the following symptoms, where headaches, neck pain, body pain, anxiety, depression, sleep problems, pain on the bottom of the feet, usually misdiagnosed as plantar fasciatus, cramping, usually in the calves, usually at night, cramping of the muscles, usually in the calves usually at night, thyroid problems, usually stretch marks, often times in weird places on the body. So those are all going to be, and if you have three of those, often times that can be really indicative of bartonella, especially the pain on the bottom of the feet and the muscle cramping.

Dr. Evan Hirsch:            But it's huge in people who can't sleep. So Christine this is really big where-

Christine:                      This is very good. I'm going to ask them about their feet next time. I haven't done that yet, but...

Dr. Evan Hirsch:            Absolutely, yeah. Ask them about-[crosstalk 00:41:27]

Christine:                      Dude, it's just like another question in my questionnaire where people are like, "Why would you want to know about this?" And it's like, "Yeah well now..."

Dr. Evan Hirsch:            Yeah if I don't get people better with replacing all the deficiencies and working on all the sleep stuff that we talked about on your summit, then I go into the infections, you know. Bartonella can play a big role. And then babesia plays a huge role. Often times these people can't sleep at all. They have sweats because it's very [crosstalk 00:41:56] it's malaria where they'll have day sweats or night sweats. They usually have shortness of breath or a cough or some sort of lung issue that's happening.

Kendra Perry:                [inaudible 00:42:04]

Dr. Evan Hirsch:            And then they have really bad anxiety to the point of panic and they've got really bad depression to the point of suicidal thoughts. And most of the people that commit suicide around these things usually have babesia. So trying to fine tune, and then to make things more complicated, different parts of the country these bugs are going to look differently. Different parts of the world, these bugs are going to look differently. So I recently was at a conference where I learned that actually on the East coast, sometimes those bartonella symptoms that I just mentioned can be from babesia. It's like, "All right, great. So if I'm not having success this way, then I have to start looking for that." So it can be more complicated, but those symptoms can really help point people in the right direction. They can be like, "Oh my gosh, I totally have bartonella and nobody's ever talked to me about that before!" And the treatment's not that hard as long as, treatment's not that hard if it's straightforward, but you know you have to remove all the other crap too.

Kendra Perry:                And so it's better to kind of determine if you have these infections based on symptoms and not with testing? Or is there a way to test for these things?

Dr. Evan Hirsch:            Yeah, so the blood testing is not good because when we're looking at Western blot tests or whatever for Lyme or any sort of serology test, you're looking at the immune system's reaction to the infection. So if the immune system is dysfunctional because you have heavy metals, chemicals, and molds, and if you're looking, you're trying to assess for a test where the thing that you're testing for is not working right. So I really like the DNA connections test which is a urine PCR test. And I try to provocate every test that I do. I try to provoke it. I try to push things out of their hiding spots and so what they do is they, you can either do intense exercise for 30 minutes prior to that urine test, or you can get a lymph massage prior to the urine test because a lot of this stuff is [crosstalk 00:43:54]

Christine:                      Oh, my god. My mind has been blown this entire episode.

Kendra Perry:                I know! I've taken like five pages of notes!

Christine:                      The glasses emoji is like, right in my face.

Kendra Perry:                I've got the star one, the stars eyes emoji.

Dr. Evan Hirsch:            Well we're recording it right? Oh no, we're not recording! Just kidding.

Kendra Perry:                No, we are. Oh my god that's happened before. Don't scare us.

Christine:                      Yeah, don't joke. But this is awesome. I'm just like, gosh, your brain.

Kendra Perry:                Yeah, this is awesome.

Dr. Evan Hirsch:            Just trying to drop a ton of knowledge.

Christine:                      Good, we like that.

Kendra Perry:                So good.

Dr. Evan Hirsch:            And don't get overwhelmed, anybody. This is just knowledge, this is just education, you don't have to do anything about this right now. Just take it for what it is.

Christine:                      Just sign up to Evan's course once it's ready.

Kendra Perry:                Yeah, like you said if you came and talked to my practitioners, because it's so funny. I'm like going through a lesson, I'm like, "This is a lot of information. I'm probably overwhelming you," and they're like, "Bring it on! I love being overwhelmed!" It's so hilarious. I'm like, "Okay, here you go!"

Christine:                      It's true, though. Like when I get into something I'm a pit bull, like I can't let go. I want to know everything, like every little bit of it. But I think that's like a common trait. But I wish we had, like I really have this idea that at some point we need to bring all of, maybe our guests or just everyone you know together and just like, everyone has brain dump their expertise and we'll [inaudible 00:45:22]. Just like a charge [inaudible 00:45:25] all our knowledge in like one thing. Wouldn't that be amazing?

Kendra Perry:                The ultimate brain.

Christine:                      Yeah, exactly. Exactly. It would be awesome. I need to think about that. I need to do something like that. No, this is awesome, like I love it so much.

Kendra Perry:                Okay, so what haven't we talked about. I feel like we've talked about a lot of good stuff.

Dr. Evan Hirsch:            Let's see. Heavy metals, well we haven't talked about, so chemicals, 84,000 chemicals that we're exposed to on a regular basis. You know, everything from lipsticks and cosmetics to pesticides in our foods. There's been some good studies on before and after with kids. Feeding them an organic diet versus a non-organic diet and they have pesticides in their urine and they've got behavior issues and you remove them and they get better. And I really like the Skin Deep website [crosstalk 00:46:18]

Kendra Perry:                I use that all the time.

Dr. Evan Hirsch:            EWG.org. Really important site for making sure your cosmetics are clean. You know 70%, this is coming back to heavy metals, but 70% of all lipsticks have lead in them. It's really important not to be, and these nano particles are awful, too. There's toxicities in these nano particles that are getting, it's like getting an IV of chemicals right into your body. So chemicals are a big one to avoid.

Kendra Perry:                Yeah, and I think, I mean women, I see this a lot in my membership because its for women and I mean like, they're just lathering, I mean women use so many products. When I go see my girlfriends in the city I'm like, "What the fuck is on your vanity?" There's like 500 products and I'm like, "What are you even like, do you spend like five hours getting ready in the morning? What's all that shit for?" It's crazy. It's totally crazy. And yeah, women just put it all over their skin, make up, make up's a really bad one. Really hard to find, I find, good non-toxic make up that also doesn't have metals in it. Because even some of the mineral make ups have titanium in them or different iron oxides, that sort of thing. It's a tough one. [inaudible 00:47:24] Give me an idea.

Dr. Evan Hirsch:            It is.

Kendra Perry:                Yeah. And what are your thoughts on glyphosate. That's a bad one, hey?

Dr. Evan Hirsch:            Oh yeah, for sure, yeah. I like to test glyphosate in people. But yeah, glyphosate is Round Up. It's that weed killer that causes a lot of neuropathies. It's very quickly becoming a cause of type 2 diabetes. Seeing as like skinny diabetes. You know people who are like, "Why do you have type 2 diabetes?" Well, it's because the pancreas has been toxified by pesticides including glyphosate. And then the insulin can't manage the blood sugars anymore.

Kendra Perry:                And which test are you using to test for glyphosate?

Dr. Evan Hirsch:            I like Great Plains. I like a lot of their tests.

Kendra Perry:                [crosstalk 00:48:05] Is it like a GPL-TOX one, or?

Dr. Evan Hirsch:            They've got a glyphosate one.

Kendra Perry:                Oh, they do? [crosstalk 00:48:12]

Dr. Evan Hirsch:            Yeah, it's like $99.

Kendra Perry:                Oh, awesome. I'm going to order it today.

Christine:                      We have a different version of glyphosate over here, across the pond.

Kendra Perry:                Really?

Christine:                      Yeah. It's still glyphosate, but it's still toxic, most likely, but it's different. It's different from the US because a lot of the ingredients have been taken out because they don't qualify for EU standards.

Kendra Perry:                The EU is much ahead of North America, that's for sure.

Christine:                      There's always like, I feel a little bit better, but it's like, yeah. Still not idea.

Kendra Perry:                And so if you could choose three tests to run on every single client you ever saw, what tests would they be? What are your top three?

Dr. Evan Hirsch:            Let's see. So when I do my assessment, symptom-wise I can determine adrenals, thyroid, sex hormones, mitochondria for the most part, so I don't need to test on those so much. Let's see. Heavy metals, chemicals, molds... You said three tests?

Kendra Perry:                Three tests. Only three. You can only run three.

Dr. Evan Hirsch:            Only run three. So I would say heavy metals and I would say urine mycotoxin for molds. Oh, and the heavy metal test would be a provocated urine test from doctor's data, and then the urine mycotoxin test from Great Plains labs, and then provocated with glutathione, and then I would do the GI map test for stool infections. And a fourth would be serology for like Epstein-barr, mycoplasma, chlamydia.

Kendra Perry:                Interesting. Very cool. I always run heavy metals test, I always run the GI test. Those are part of my top ones, too. I love it. We're on the same page, great. Love it. [crosstalk 00:50:09]

Dr. Evan Hirsch:            Great. Awesome. It's always nice to get that confirmation.

Kendra Perry:                Yeah, I love it. And I'm going to look into this urine mycotoxins test. I find that really interesting. Learn a little bit more about that. Awesome, well thank you so much! This has been enlightening, both our heads exploded multiple times during this [crosstalk 00:50:24] which is a good thing, we like our heads to explode on this podcast.

Christine:                      We do.

Kendra Perry:                Do you have any last questions, Christine?

Christine:                      No, I am exhausted. I have a little brain, you know? But no, I love it, absolutely love it. I think we have to get you back on at some point to talk about your group program and all of the things that you do, you know. Client-wise, too.

Kendra Perry:                The business side of things.

Christine:                      Yeah, so we'll have to do a part two, so stay tuned for that. But thank you so much. This has been so much wisdom. I cannot wait for your program to come out now for practitioners. Like, really am like, I'm ready, go.

Dr. Evan Hirsch:            All right, I'm getting on it.

Christine:                      But yeah, I think that's pretty much it. Oh, you obviously have a book, so people should obviously get that. And just tell people who-

Dr. Evan Hirsch:            Right, I've dumped a lot of my protocols into the book.

Kendra Perry:                I'm sorry is it called "Fix Your Fatigue?" Is that the name of your book?

Dr. Evan Hirsch:            It's called "Fix Your Fatigue," yeah.

Kendra Perry:                "Fix Your Fatigue," awesome I'm going to [crosstalk 00:51:17] buy it today

Dr. Evan Hirsch:            It's on Amazon. You can find more about me at fixyourfatigue.org. There's links to my free Facebook group. You can actually download right now, I don't know how much longer it's going to be up there, but you can download my book as a PDF for free right now on my website.

Christine:                      [crosstalk 00:51:34] I think I have it, actually.

Kendra Perry:                I want that. Awesome.

Dr. Evan Hirsch:            And then I've got the group program which started in January. And I'm doing live trainings, but I'm also recording all of it so people can jump in at anytime.

Kendra Perry:                Awesome. Amazing. And all your social media handles are Fixyourfatigue, hey?

Dr. Evan Hirsch:            They are, yeah. DrEvanHirsch or Fixyourfatigue.

Kendra Perry:                Okay, perfect. Awesome. All right, guys, thank you so much for joining in. Remember, we love Instagram stories, so take a screen shot of this episode if you're listening and share it to your stories. Mention @360HealthBizPodcast and we will share it back to our stories and we will be mutual friends on Instagram. And follow us if you're not already following us and thanks so much guys. As always, we really appreciate you hanging out with us and dealing with our ridiculous talks, and we will see you again in two weeks time. Bye!

Christine:                      Bye!