Always Tired? Here’s How to Tell If It’s Chronic Fatigue | Dr. Mark Hyman

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. Welcome to Doctor's Pharmacy and another edition of Health Bites. I'm Dr. Mark Hyman. Now, one of the most common complaints patients come to me with is that they're tired all the time. We've all heard it, whether it's coming from a friend or a spouse or a co-worker or even yourself. why the heck are we all so tired? Well, there's a lot of reasons, but the worst part is that so many of us think that feeling tired is a normal part of life. We try our hardest to push through it. We douse ourselves with caffeine and sugar to stay awake and get through everything on our to-do list in a day. And at night, we scroll through our phones, we drink alcohol, we binge eat ice cream and Netflix until we fall asleep. And then we wonder why we feel crappy and tired of what I call FLC syndrome. That's when you feel like crap. Now these behaviors are really just a bandaid. Caffeine, alcohol, sugar, they help us navigate the landscape of fatigue, but they don't help us get to the root problem. And it only makes us more tired and more burnt out in the long run. So how can you quit the cycle of fatigue and then sugar, caffeine, alcohol to manage all your symptoms? And how do you get your energy back? Well, the good news is there's a lot you can do when you look at this through the lens of functional medicine. And I'm living proof. that it works. I want to tell you about my story, about my personal struggle with fatigue and not just any kind of fatigue, but severe chronic fatigue syndrome where I was totally incapacitated. It happened when I was a young doctor. I was about 35 years old and I just come back from China where I lived for about a year and I was exposed to huge amounts of mercury and I didn't know that was ultimately the cause among other things, but it poisoned my system. I got really sick from one day to the next. I went from being able to ride my bike 100 miles a day to not being able to walk up the stairs. I could remember 30 patients that I'd seen a day and not take notes and remember everything at the end of the day to dictate their charts to not even being able to know where I was at the end of a sentence. I had severe brain fog. I couldn't sleep. I was exhausted all the time. Even when I slept, I never woke up, recovered and rested. My whole system went in total collapse. I went to doctor after doctor and they were like, well, stress, it's all in your head, you're depressed. They gave me prescriptions for Prozac, for Ativan, for Xanax, for who knows what. And of course, I didn't take it. None of it worked if I would have taken it because it wasn't addressing the real cause. And that really drove me, being so sick, drove me to dive deep into understanding how the body works, how my own body worked, why it went to flu and to know really the true origins of disease. It was a blessing and a curse. I mean, it was a curse because it was miserable to go through, but it was a blessing because it helped me learn about human biology, not from a textbook, but from my own body, from my own suffering, from my own severe symptoms that I knew were not in my head. I knew I wasn't actually psychologically depressed, but I was physically depressed. And, I began to understand the root causes of illness, to understand how my systems work together, and I learned how to get my energy back. And I want to tell you that story through my own lens of how I began to understand fatigue. And it's really one of the most important things I learned on my own health journey. And it's not something I've just done with myself, but I've done on hundreds of thousands of patients and had incredible success with because 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 to 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 and we have too much of the bad stuff. none of the good stuff, then our bodies dysfunction. And the goal of functional medicine is to get your body's 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 of thousands of them in every single cell, they have a really important job. And they basically convert the food you eat and the oxygen that you breathe into energy that your body can use in the form of ATP. That's your gasoline. And it's so critical, this process of converting food and oxygen into energy is the fundamental process of life. Let's just sort of dive into a little bit of background on mitochondria. Now, each cell has hundreds of thousands of these little energy factories, 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 mean. 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 gonna 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 gotta get to the root cause and it's different for everybody, right? So ask what could be damaging your mitochondria. Now, you need to sometimes do some digging, but if you know you're eating processed food, you're not exercising, you're smoking and drinking too much, I always start there, right? You can pretty much figure out the cause or if you're nutrient deficient or you're not taking a multivitamin, there's a whole bunch of things you can do that are low hanging fruit that will help your mitochondria. But sometimes you need lab testing to figure out what's driving your symptoms. And the problem is most conventional doctors don't do comprehensive testing, which includes inflammatory markers, nutrient levels, heavy metals, thyroid testing, autoimmune markers, and more, all of which can help you get to the root of your fatigue. And essentially that's why I co-founded this company, Function Health, which tests over 110 biomarkers and twice a year testing and provides a comprehensive roadmap to help you find the root cause of what's happening beneath the surface. And you go to functionhelp.com/mark. There's about 50,000 people on the membership roles now. We have about 200,000 people on the wait list, but you can jump the wait list using that code functionhelp.com/mark. Now, some biomarkers we test are important and they can help really pinpoint the cause of your fatigue. The first is HSCRP or C-reactive protein. This measures inflammation. So it can be from any source, but it tells you there's inflammation. Also, your 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 and mercury. We look at cortisol for adrenal function to see if your cortisol is low or high. We look at thyroid hormone, which is key to metabolic health and mitochondrial function. and if you have low thyroid, which is very common about one in 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 You're testing done to start changing your health to improve your energy levels, but it can help really speed up the process of figuring out what's going on and what to focus on. For example, if you have a lot of inflammation, you gotta address that. Or if you're nutritionally deficient, you can fix that. Or if you're metabolically dysfunctional with prediabetes, you can fix that. So how do you start to unpack all this? Well, I want you to take stock of your lifestyle and your diet and your habits. Keep a diary. What does your diet look like? You find yourself reaching for carbs 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. I do these programs all over the world. These longevity programs called Young Forever. There's retreats. I do them in Ibiza. I do them in Europe, some in America. and it's amazing in just a week or even five days, people's energy level will dramatically change just switching off their process 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, ellagic tannins, which is a polyphenol found in pomegranates, raspberries, and strawberries, are transformed by your microbiome into this super powerful active compound called urolithin A. Now most people have lost the bacteria to do this conversion and you can actually take urolithin A as a supplement, which I do every day. Now this helps maintain mitochondrial quality control. It regulates what we call mitophagy, which is the removal of damaged mitochondria 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. That'll actually help to improve your mitochondrial function. If you don't like the idea of cutting out ultra-processed food or changing your diet, maybe just try the time-restricted eating. But I'd recommend both, right? It's basically kind of a form of fasting that requires you to push the time you eat your first meal a few hours forward so you don't have this constant load of food and stress on your mitochondria. Giving them a break helps them to reset, to clean up, and to repair. So maybe instead of eating right away when you wake up, wait two or three hours and eat all of your meals within a 10 to 12 hour window, right? From 8:00 AM to 8:00 PM or 8:00 AM to 6:00 PM. That's going to give your body enough time without food to focus on cleaning up and repairing damaged DNA and mitochondria. Now, you still want to focus on getting with the ultra processed food, right? Obviously, don't just eat ultra processed food and do time restricted 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 there's no safe level of alcohol, sugar, and alcohol, I think it was recreational drugs used occasionally and sparingly and for fun, but not as a staple. Caffeine is a little different. But again, if you're always tired and you're struggling to wake up, you might want to consider a caffeine holiday, 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 to 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, DHA that we need, so you need both. Vitamin C containing foods are great. Citrus foods, kiwis, bell peppers, vitamin E, also great 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 processed food, cut down the sugar and starch, got off 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 actually gives us more energy. Exercise is so good for your mitochondria. Why? well, it boosts something called mitophagy. That's the clearance of these damaged mitochondria, and that optimizes and strengthens mitochondrial function. It combats aging and age-related diseases. So exercise is the best therapy for your mitochondria. It produces a release of something called exerkines. All 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 extra kinds that have a positive influence on our biology, including making new mitochondria. So these extra kinds help you make new mitochondria. Now, what kind of exercise shoes you do, there's all kinds, but you need all of them. Aerobic or cardio, high intensity interval training when you're doing things like wind sprints and strength training or resistance exercise are all really important for strengthening and improving the function of our mitochondria. And also there's a lot of other things, right? It boosts our muscle strength, it boosts our metabolism, our endurance, makes us be able to do more stuff. I 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, 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. It's a longevity molecule. involved in energy metabolism, in signaling all kinds of molecular processes in DNA repair, and low levels of NAD are really associated with inflammation and aging. Now, exercise boosts NAD, which is good. And what else does NAD do? Now, NAD activates something called the sirtuins, which are part of the longevity switches that I wrote about in my book, Young Forever. Basically a family of signaling proteins that creates more and better functioning mitochondria. So basically everything that exercise does is great for your mitochondria, right? So it makes new mitochondria, it cleans up old mitochondria, makes your mitochondria work better, it improves NAD status in your body, it boosts your antioxidant system. So it's just all around a good thing. So what else can you do to help your mitochondria? Well, optimizing your nutrient levels and addressing deficiencies is really important. One of the biggest deficiencies, 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 Bold 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. Antioxidants are helpful to take, including vitamin C, zinc, vitamin E, selenium. These can be all taken in a multivitamin. Also, you want the full spectrum of B vitamins, thiamine, riboflavin, niacin, B5, B6, biotin, folate, B12. These are all cofactors for making energy and supporting all the processes occurring in our mitochondria. And again, you can just take a multivitamin. Now B vitamins are really high in animal protein, especially organ meats like liver, eggs, fish, leafy green vegetables. Now, if you're a vegetarian or vegan, you wanna be careful. You have to supplement with a B complex. You're not gonna get B12 from your food and you're often nutrient deficient. Now there's other nutrients that are important, magnesium, I call that the relaxation mineral. It's really important for those who are under chronic stress because stress depletes magnesium. It can lead to burnout and adrenal dysfunction. And 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. 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 imagined threat to your body or ego. So it's not actually something that has to be real. we can just think it's something that somebody said to us that they mean something bad, but it actually isn't. 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, right? Get regular date nights with your partner to connect, deeper relationships also or in any dose of stress. Sometimes you 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 and navigate stress is really critical. Learning also how to say no is important. Saying no to somebody else is often saying yes to yourself. There's other things you can do, like just taking a digital detox. I've been without my phone for weekends or weeks sometimes, and it's just like, wow, I get my life back. It's unbelievable how these little devices have captured our attention and 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 a thousand miles because of the one step, that's from the Tao Te 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 walk, take a walk every day and then just, 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 honors circadian rhythm, so they need a cycle of darkness at night. So make sure your room's blackout. It's really important because even light can get through your skin, your body picks it up. So, you know, make sure you have blackout shades in your room or wear eye shades particularly at 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 photobiomodulation. by modulation or PBm or low level light therapy or LLLT. And this process involves light absorption by something called cytochrome C oxidase, which is a mitochondrial enzyme. And so basically the light, this is amazing, just like your photosynthesis, right? You think only plants do this, but humans do this too. They basically absorb light through the skin. It gets absorbed by a mitochondrial enzyme, just like the mitochondria that are these sort of energy producing cells basically absorb light. and that enhances ATP production and upregulates genes involved in healing and repair. And what do you get when you do that with the light? Well, you get more energy metabolism, less inflammation, better tissue repair, you get protection against oxidative stress, lots of good things. Also, 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 get some light. And last thing I want to focus on is mother key things you can do. There's really important mitochondrial protective and energy boosting nutrients. I use these personally. I've had mitochondrial injury. I take good care of my mitochondria and these nutrients provide lots of additional energy and mitochondrial support along with a whole food plant rich diet. So what are the top ones that I recommend? Well, acetyl-L-carnitine. Carnitine is critical in fat metabolism and there are lower levels of carnitine in chronic fatigue patients than in healthy people. When you take adequate carnitine, it supports the transport of fatty acids into the mitochondria for energy. So basically burning burning energy. Another important nutrient is alpha lipoic acid. It's a powerful antioxidant, probably one of the most important ones in the body. It also promotes mitochondrial biogenesis, making new mitochondria. It improves your insulin sensitivity and lots more. Another key mitochondrial nutrient is coenzyme Q10. Low levels are associated with fatigue, with mitochondrial dysfunction. So getting out of a coenzyme Q10 is important. Another key nutrient is N-acetyl cysteine. This is a precursor to glutathione. We also call it NAC or NAC and that can help really reduce oxidative stress and mitochondria's 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, helps instant sensitivity, and also many other things. So the other thing I would take is fish oil. I mentioned the Omega-3 Rejuvenate from Big Bold Health, but Omega-3 fats are really important for the cellular membrane function of your mitochondria. Because your mitochondria also have membranes and they need the right Omega-3s to regulate inflammation and many other factors. What other cool things have I learned about mitochondria? And then what do I take myself? Well, I definitely take something called Mitopure, which is the first product to unlock a precise dose of purified urolithin A. That's what I was mentioning before from pomegranate. it's gut microbiome. If it's a healthy one, converts that into your lithin A, which most people can't do. And when you have enough your lithin A, it revitalizes the mitochondria. It supports your cellular health. And I take it every day. You can try to boost it naturally, but, you know, only about 15 to 40% of people have the gut microbiome to produce it from the eliGat tannins in your food sources. So you probably need to take it. Another good product is Mito PQQ from Designs for Health. It's a supplement that supports optimal mitochondrial biogenesis. It's a critical process for promoting healthy aging and energy production and oxidative stress regulation. Also, another product I like to use is Mitochondrial NRG, like energy, but NRG, also from Designs for Health. It's kind of like a multivitamin for the mitochondria. What about NMN? It's a precursor to NAD. I also take that. it's really critical for energy production, for DNA repair, for cell signaling, for mitochondrial function, reducing oxidative stress and boosting longevity. It's really important. So when you supplement NMN, it can boost NAD levels in many organs and tissues, including the liver, the muscle, the brain. It improves mitochondrial function, it improves energy metabolisms and cellular health. In fact, animal studies, NMN has demonstrated the ability to extend lifespan, to enhance cognitive function, to provide protection against age-related diseases like diabetes and heart disease and neurodegenerative disorders. 'Cause a lot of human studies still needed, but the initial research is pretty impressive that it could offer pretty good benefits by just taking NMN, including all the things we just mentioned, metabolic health, cognitive and physical performance, energy levels. There's a product that I like called Wonderfeel Younger NMN. It's got a clinically relevant dose. You need about 900 milligrams, 1000 milligrams, which it has, because most of the supplements out there contain about 250, so you have to take like four times the dose, which gets very expensive. And this is a research backed product that supports healthy NAD levels. I think we're gonna go through all the research. We're gonna link to in the show notes, you can go through that. I also recommend if you're trying to find these products, you can go online, but I've curated them all in an online store, which I use for my patients. You can access that. It's just go to drhyman.com and and get the link to the store and you can just check out all these things and read about them and get them if you want to. Although, you know, there's no attachment here to where you get them from. If you're feeling tired all the time, it's not that something's fundamentally wrong with you, right? It doesn't have to be this state that you have to live with and adapt to and endure, right? It's often caused by things we have control over. It's our diet, it's lifestyle, it's the stress we're under. it's environmental toxins that can be addressed, that all these things drain our energy levels. The good news is most of these factors are within our control. And we have the power to reclaim our energy at any age by making small, meaningful adjustments to our everyday lives, which can lead to significant improvements in our energy over time. And I've done this myself. I continue to learn about how to do this. I'm constantly improving my mitochondria. And in fact, sometimes I feel like my whole life is about my mitochondria, but but getting them to work better. But it's essentially a critical factor because at the end of the day, your mitochondria determine the quality of your life, the quality of your energy, the quality of your health, and your longevity. So it's important to learn about them, take care of them, and thank you for enduring this podcast with me. But it's one of my favorite topics and I want to make sure you really understood it. So thanks for tuning in and I'll see you next time. If you loved that last video, you're gonna love the next one. Check it out here.