This Is Why You're TIRED All The Time! - FIX THESE 3 Things | Mark Hyman & Steven Gundry

Time controlled eating, and that is limiting the amount of time during the day that you consume. Food is probably one of the number one fixes in our current energy crisis. The more you kind of snack throughout the day, the actual harder it is for your mitochondria to make energy. It's actually the fructose that's the troublemaker in stopping energy production. Fructose goes directly to your liver and regular table sugar is half fructose, folks, goes directly to your liver and actually stops ATP production. We are overfed and underpowered. And what the heck does that mean? We in general Americans, eat nearly 16 hours a day, almost continuously from sun up until well after sundown. And we have what's called mitochondrial rush hour, which, living in la, is easy to understand, but simplistically, our mitochondria can handle sugars, fats and proteins. And we use a slightly different system for making energy from sugar, from fat and from protein. In the good old days when we ate whole food, like you advocate, and I advocate these different components, sugars would arrive first in the mitochondria, they'd be followed by protein, sometimes later, and a long time later they'd be followed by fats. And mitochondria have, if you will, basically a freeway, an energy producing freeway. Now, when these things arrive in a staggered fashion, the freeway moves great. But what happens is with our modern diet, with processed foods, with ultra processed foods, we have combined simple sugars, simple proteins and easily absorbed fats that hit our mitochondria simultaneously. And the mitochondria actually can't handle all these. So we actually have stagnation in the energy producing highways. And we have systems on freeways, okay, we're going to have traffic lights that's going to control the onslaught of all this. But we get mitochondrial gridlock. And I use the example. So, okay, let's have breakfast. At 7:00 in the morning, all of a sudden you're slamming with all three of these components and your mitochondria literally go into gridlock for two or three hours. You begin to get sleepy at 10 o', clock, you say, oh, I need a little pick me up.

I'll have a donut and a cup of coffee. And once again, traffic gets slammed. By that time, it's lunch, we slam it again. And so this process of gridlock really.

Never stops until we go to sleep. And even after we go to sleep, there's still two to three hours of backup, if you will, on the mitochondrial freeways. So our mitochondria's really never have a chance. And in researching this book and trying this out on my patients, one of the things that was dramatic was that if I could lessen the period of time that you're asking mitochondria to handle food, the better off you're going to be because they have a chance to recover and heal themselves, if you will.

And that gets into part two of the book. How do you put this into practice?

So your book is quite extensive and it really goes into detail about a lot of these unusual compounds that come from a disturbed gut microbiome that have broad spectrum challenges in the body. And this is what we've been doing in functional medicine for decades. It's really the foundation of my practice. It's really the key to getting people healthy. And I sort of agree with you that a lot of the beginning and the end of health starts in the gut. And it's really always the first place we start with food and gut repair and functional medicine. But you talk about the plan of how do you do this? What are the do's and don'ts of the energy paradox when it comes to eating?

Well, first of all, the more, and you and I, I think, would agree completely with this, the more you stay away from, from processed foods, from ultra processed foods. That's really the fundamental starting point. The more you actually use whole foods and literally foods in their whole state, the better off you're going to be. Number two, I can't resist telling people to get lectin containing foods out of their diet.

Lectins are part of the plant defense system against being eaten or having their seeds being eaten. And these are proteins that Dr. Fasano and others have shown disrupt the gut wall. And they in themselves are antigens that in my original line of work, heart disease, attract inflammation to the wall of blood vessels. And so they're a nasty bunch of compounds and they're in so many of our favorite foods, such as whole grains. The nice thing about beans is beans are loaded with lectins. But pressure cooking and soaking beans and fermenting beans actually eliminates the lectin problem.

So there's soft pressure cooking. Grains do the same thing.

Great question. Pressure cooking will not break the gluten in wheat, barley or rye. Gluten resists pressure cooking. There is a gluten like protein in oats that also resists pressure cooking. And I can't tell you the number of people who have gone on a gluten free diet with autoimmune diseases with celiac who are not cured they still have celiac because the foods that they're eating, like oats, like corn, are loaded with lectins. And just recently I had a gentleman who we, I don't like to use the word cured of rheumatoid arthritis. But his markers vanished by following our program. And then he was a snowbird. And he came back this winter in his rheumatoid artery. One of his RA markers was elevated for the first time in like four years. I said, you've been cheating. He said, no, no, no, are you kidding? I wouldn't do that. And I said, well, something's getting in your diet. I said, what do you have for breakfast? He says, oh, glad you asked. I've been on a pressure cooked oatmeal kick. Every morning I have a bowl of pressure cooked oats. And I said, wait a minute, you can't do that. It's on your list. You can't pressure cook oats. And we pull out the list. He said, oh, o, that's the change. And so we took it out. A month later, his RA was back to normal.

Yeah, absolutely. I see that so often. Yeah, I see that so often. So getting out lectins, eating whole foods.

Any other sort of key dietary do's and don'ts.

Yeah, so one of the, I think the shocking benefit of time controlled eating and that is limiting the amount of time during the day that you consume food is probably one of the number one fixes in our current energy crisis. And it seems almost.

Contradictory, paradoxical if you will.

The more you kind of snack throughout the day, the actual harder it is for your mitochondria to make energy and the more you limit, you have to.

Eat to get energy. But what you're saying is if you stop eating, you actually are better at the end of the day making more energy.

Yeah, that's exactly right. I'll give you an example. We're actually supposed to have significant downtime for repair work, for repair work for our brains, replacement repair work for our mitochondria. And that would normally have happened because we were sunlight creatures and we were controlled by sun and we'd get up when the sun came out and we basically go to bed when the sun went down. And even the advent of fire 150,000 years ago, we were still exposed to orange light, red light, and we certainly weren't exposed to blue light. So. So we still had a limited period meeting. And the evidence is if we have a 12 hour window of no eating, which is really easy if you think about it. That's 7:00am to 7:00pm That's a 12 hour eating window. And you'd have from 7:00pm to 7:00am of not eating. We begin to shift into mitochondrial repair. And what's really exciting is the more you go beyond 12 hours, the better the repair work goes. Let me give you an example. There's not a lot of repair work done on LA freeways during the day because the traffic is so bad. I drive into LA very early in the morning or to Palm Springs very early in the morning from Santa Barbara and that's when the repair work's going out. Cause there is much traffic on the road. Well, our mitochondria do the same thing. If they're doing work they have no time to repair. And it's the repair of mitochondria undoing the damage of our eating that actually allows mitochondria to get back to full power. So the more we can limit the time period that people eat, the better. Now the first thing we don't want to have people do is okay, what Dr. Gundry says, tomorrow morning my first break fast is going to be at noon. I am going to hold off break fast until noon. And I can tell you that 80% of your listeners and my listeners will fall flat on their faces because 80% of Americans are insulin resistant. And with insulin resistance, that's in the book too. You can't use free fatty acids, fat as a fuel. You can't, you can't get to them. And so you got to build up slowly intolerance. And we have a six week program holding people by the hand and changing when they eat breakfast one hour at a time. So that we're going to stepwise because people fall flat on their faces with attempting intermittent fasting because they don't have the availability to mitochondrial flexibility of changing fat metabolism.

So you talk about a lot of other things that are really important parts of energy, including exercise, packing, sun exposure, avoiding blue light, which ruins our circadian rhythms, and even getting a dog. And can you talk a little bit about those things before we have to wrap up the podcast?

Yeah, I mentioned that blue light from our devices, from our lights, we are constantly being exposed to blue light. And blue light is really detrimental to almost all of our functioning, including our mitochondria. And really.

We are awash in what I call junk light. And I think one of the most important things people can do is two things. Be exposed to red light at sunrise or sunset. If you're going to take walks, that's the time to do it if you can't get exposed to red light, get yourself a red light box. There's a number of red light and near infrared light makers. I particularly use a joovv device, but there's plenty of other ones. And expose yourself to red light. Interesting. One of the things I learned, which I found hard to believe, but we actually produce ATP from melanin exposure from natural sunlight. And so we do photosynthesis. Exactly like a plant. And it may be why, fundamentally, we want to be outdoors, we want to be at the beach, we want to be exposed to sunlight. And it may be that we're far more attuned to to what sunlight is actually doing for us at a basic level than we thought. Plus, there's really cool evidence that sunlight actually activates mitochondria and it changes the way water moves in mitochondria. But that's a whole other subject. And so why get a dog? Two reasons. I'm a big fan in the book of exercise snacking, and there's really good evidence that walking upstairs for a minute may up and down stairs for a minute may have the same effect on your mitochondrial function through the production of myokines from our muscle cells as 20, 30 minutes of walking on a treadmill. And the effect of five minutes is even more. So why get a dog? Dogs are gonna have to go out at least twice a day, and dogs will take you for a walk. The other thing about dogs is the evidence is overwhelming that people who have dogs have a much healthier and diverse microbiome than people.

Because the dogs licked in the face.

Let your dog lick your face, and they bring in all these amazing dirt microbes into your house that you will mix with amazing.

So take home from the Energy, the Energy book, you've written this really extraordinary sort of breakdown of a lot of the reasons why we're all struggling with fatigue. What to do when you get up and go has got up and gone. You know, one of the most important things people can do on day one to really look at what the causes are of their energy deficit and how to reboot it. Like you were just sort of summarized the take home from the book. What would they be?

I think the take home of the book is the more you get processed foods, simple ultra processed foods, and quite frankly, early on, the more you get modern fruit out of your diet, the better. And that always gets people riled up. And my Twitter lights up.

Modern fruit has nothing to do with healthy fruit. Believe it or not, a cup of grapes has more sugar than A full sized Hershey's chocolate bar.

And I could tell you which I'd rather have. But neither.

These things have been bred for sugar content. And we have to also remember that it's actually the fructose that's the troublemaker in stopping energy production. Fructose goes directly to your liver, and regular table sugar is half fructose, folks, goes directly to your liver and actually stops ATP production. It was one of the most enlightening findings of my research through the last few years. And the more I research how fructose works, the more scared I am of how much fructose is in a typical American diet. So that's number one. Number two, the less you snack, the better. The farther you stop eating before you go to bed, the better. And if you can get a three hour window between the last thing that went in your mouth and going to sleep, it'll make a huge difference in your energy levels and your sleep pattern.

What are the kinds of things that you found are the common drivers of fatigue for patients?

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

Or eating processed food or the soil's depleted.

Oh, my goodness. Right.

I mean, the average apple you eat has been stored for a year, right?

Yeah, absolutely.

Go pick an apple from a tree and go eat one that's been in a warehouse for a year. Very, very different experience.

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

Heavy metals.

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

Yeah. And so when I, you know, I remember when I had chronic fatigue, I went to doctor after doctor after doctor and they're like, well, there's nothing wrong, or your tests are normal, or this is a little off, or that's a little off, but nothing really and, yeah, you know, take some Prozac. You know, here's something for sleep.

Right.

You know, and it's just. It's so frustrating as a patient to go through this litany of doctors and not really getting an answer. And, you know, and I think that fatigue you don't often treat directly because, you know, you. Yeah, you can take Provigil, which will sort of make you more awake, or you can take Ritalin or Adderall, which is like a, you know, stimulant to help you have more energy. But. But those are sort of like beating a dead horse. You have to figure out what's really going on. And I think, you know, when I. When I first sort of discovered what happened with me was the mercury was the thing that was driving it, and.

Right.

And it created a whole cascade of problems. So it affected my gut, it affected my immune system. So I was chronically inflamed. I started developing all these rashes and all these sores, and all these things are. My eyes would look like a raccoon if I ate certain foods. I'd get bloating. And I. And I also develop, you know, real cognitive issues and real trouble thinking and focusing and fatigue. And I. And I realized that, you know, these. These insults that happen, you know, affect all these different systems in your body. So when you're diagnosing someone with fatigue, it's all the other symptoms and all the other pieces that give you the clues about what's really going on for this person. So it's not like one treatment for fatigue. There's dozens and dozens depending on what you find with that story.

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

Yeah, right. Poison my mitochondria. And, you know, turned out I had a gene that affects my muscle enzymes, my energy cycle in my mitochondria. Yep. And at least to have an easier ability to be damaged by it, which is why I had this elevated thing called cpk, which is a muscle enzyme. And it was. It was this abnormal test, but it wasn't really so severe that it was a disease, but it wasn't normal.

Right.

They're like, I don't know what's wrong, you know, like. But we. We can figure that out using the roadmap of functional medicine.

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

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

Sometimes it's just that simple. Right?

Like sleep. So the quality of sleep also matters. You know, sleep apnea is another cause. It's often very undiagnosed in patients.

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

Yeah, sudden death, that's not a good outcome.

No, that's not good.

So, Liz, you had a couple of cases I wanted to share with Everybody and this 35 year old woman with weight gain and diabetes, tell us about her and how she presented and what you found and how you worked up the case and what you did with her.

So this woman came to see me when she was 35 and she had obesity and type 2 diabetes and depression and heartburn. She had a lot of other things too, but those were some of the main issues. And actually the reason she came to see us was because her depression medication wasn't working. And she's like, I really need to find another way to deal with this. So she had, when we looked at her timeline, she started gaining weight when she went to college in her 20s and started to put on a bunch of weight, enough weight also. And maybe she was at that point eating, making a lot of the wrong food choices. She also started to get some heartburn and in her 20s. So she was put on a PPI. She was put on the acid blocker when she was in her 20s and she was still on that same acid blocker now 15 years later. So she was put on the acid blocker in her 20s for her, for her reflux.

Those medications when they came out, they were not designed to be taken forever. They were at six weeks for an ulcer. We were told they are very powerful drugs that suppress acid production in the stomach that cause long term complications. And they do. But we now have them for sale over the counter and doctors prescribe them like candy. And they have serious complications if they're used liberally like that.

Absolutely.

Instead of figuring out why you have heartburn in the first place, she couldn't.

Get off it because the heartburn kept coming back. So here she was 15 years later. And then she slowly, after college, the weight just kept coming on, so she just kept gaining more and more weight. Her health was just deteriorating in a way. She just got more and more tired. And then in her later 20s, she started to have some depression and she was, she was tried on a bunch of different antidepressants and they didn't really make any difference. And then a couple years before she came to see me, she was diagnosed with type 2 diabetes. So she wasn't yet on her any medication for diabetes. She was trying to control it with diet, but her blood sugar was high enough to get the diagnosis of diabetes. And she's only 35 and you know, and she, and she just wasn't feeling good. So she said, you know what, I've got to try a different way. So she stopped her antidepressants because they weren't doing anything and came to see us. And so for me, you know, looking at her timeline and putting together, you know, connecting the dots, when I see somebody with fatigue and depression and on a PPI on an acid blocker for so long, you know, one of the things I really think about is protein. And what is that person's protein status?

Why is the acid blocker problem for protein?

Right. So you need acid in your stomach to break down your food and it starts. Acid also encourages a lot of our digestive enzymes to work, which is all really necessary for the body to break down its protein into amino acids that you can absorb. And then when the body absorbs those amino acids, they get used in the body for all sorts of different things, from healing your skin to, to making muscle. But also they're used to make your.

Neurotransmitters, your happy new mood chemicals.

Absolutely right. So they make your serotonin and your dopamine and your gaba, which help you focus and have energy and feel happy.

That sounds good.

Yeah.

Focus, energy and feel happy. I want some of that.

So when you take an acid blocker, you're decreasing your ability to break down your food and break down your protein and pull. Pull all those really important amino acids from your food. And for some people, and depending on the length of time you're on it, it can have a huge impact.

It also impairs other nutrients, like B12, which also is a big cause of fatigue and depression.

Yes, B12, it impairs the absorption of a lot of your minerals. So we see people develop osteoporosis after years of being on these acid blockers. So people will have low zinc, low calculator, calcium, low magnesium.

And zinc is more important than ever with COVID 19, because it helps to.

It's so important.

Viral attachment replication.

Yeah.

So important for your immune system. Right. So.

I saw that she had this depression, the fatigue, the acid blocker. And I go, oh, I wonder what's going on with her protein? So we do this cool test where it looks at plasma amino. Amino acids, which are those building blocks of protein in your body, so you can measure your amino acids in your blood. And we did. So we measured her amino acids, and she was low in lots of amino acids. I wasn't surprised.

And you think I'm seeing a protein. How can she be low in amino acids? We don't see protein malnutrition in America, but we do see large numbers of patients with very low amino acids for a variety of reasons.

Right, right. And so.

I suspect with her that the acid blocker was a huge reason for that, that she just wasn't breaking down her food. Well. And absorbing her amino acids well. And so one of the things we were able to do was give her some of these amino acids for the period of time. So we gave her a complex of amino acids, and then I also gave her some amino acids that were really focused on production of neurotransmitters. So things like tryptophan 5, HTP, tyrosine, GABA, these things that help the body with production of those neurotransmitters. And, you know, you have people take the amino acids between meals because it helps with. It's better absorbed that way. And that was really helpful for her. You know, that helped her energy. She noticed a tremendous difference in her energy. It actually helped her hair. That wasn't, you know, she wasn't coming in completely complaining about it.

Of course it helped her hair for your hair Right.

Yep. And it helped her mood, so it made a big difference in the depression. So she started to be more active and move more. And then, of course, we wanted to wean her off of the acid blocker. So. And with the type 2 diabetes, we also needed to work a lot on her diet also, of course. So we put her on a low glycemic diet. Diet. We took away all the refined carbohydrates and the simple sugars and, you know, made sure she was getting good quality protein when she was eating and good, healthy foods. And with that shift in diet, we've been slowly able to wean her off of the acid blocker, which is, again.

Another one of the things we've talked about on the podcast, which is reflux or heartburn. And it's such a problem. These medications are in the top three of all medications prescribed in the world, and they are very powerful and strong. And they do. They do have this negative impact on causing everything from small bowel overgrowth and digestive issues. They cause irritable bowel mineral deficiencies, osteoporosis, pneumonia, and so forth. But what's interesting is that the way they're designed makes it almost impossible to get off of them. And you have to know what you're doing, so you have to start. So to deal with the causes of what the reflux is.

Yeah, right.

Which is often diet.

Yep.

Sometimes it's a bacteria, but. But then you have to slowly taper it off. There's something called rebound that happens, so you basically stop it and you get a flood of acid and that causes more heartburn. So you really have to know what you're doing. And people think, oh, I've tried to stop it. I can't. For those listening, I want to. Want you to understand that there is a way to get off of these drugs, but you can't. You can't just stop it like that. You have to know what you're doing and you have to figure out what the cause is. So, like you said, you changed her diet. She doesn't need it anymore.

Yep.

And, well, you know, she needed it less and less, but we still needed to wean her, like you said, because there's that rebound that occurs when you've been on it for a long time. So we did have to wean her and use some other things to help with, you know, we used a little dgl. We, you know, we had to use some other things to help her digestion in addition to diet. And we were able to, you know, weaner off of it. So in the long run, her absorption of her protein is going to be better, so her mood's going to be better. So, you know, and of course, now her blood sugar is getting way, much better and she's losing weight and she's feeling happier. You know, it's pretty phenomenal.

So fixing her gut and giving her some amino acids, that's not something that most doctors will do when someone comes in with depression or fatigue, but it's really how we approach patients at the Ultra Wellness Center. And really the beautiful thing about the model of functional medicine, because it can help so many people with challenging issues that nobody can figure out.

Absolutely. Absolutely. And it's fun to do, you know.

It's fun. Yeah. It makes medicine interesting because I remember I used to work in the emergency room for years, and I found it really boring. And how can you say it's boring to work in the emergency room? There's all this excitement and this and that. Like, well, once you've learned how to. The recipe for everything. What's the recipe for? Asthma or back pain or heart attack or stroke or someone who's got, you know, needs to be intubated or someone who comes in with a fracture, whatever, dislocated shoulder. It's. It's like a cookbook recipe. So right then you just look at the nurse and you go, heart attack treatment, stroke treatment. It's like they know it's. You have to write the orders, but it's like everybody knows what's going on. There's no thinking involved. You make that, you know, it's a kidney stone. You do this and, and, and, and, and, and most of the things you see in the emergency room are relatively common and relatively easy diagnose. And occasionally there's a puzzling case, but it's kind of boring. And, and I found that that functional medicine is, is a constant puzzle that you have to figure out. Everybody's different. It's totally personalized. Talk about precision medicine. Personalized medicine, precision nutrition, personalized nutrition. That's what we do. That's what this is about. And no two people are the same. And you could have somebody else coming in with depression and fatigue and diabetes, and they could have a different story with different factors and different causes.

And I think that's why so many physicians are turning to functional medicine. Because, you know, of course, they have this inquisitive mind and they want their problem solvers and they want to look at how all the patterns come together. And I think that's really what has attracted a lot of people to the training because it's getting us back to really looking at that whole person and the individualized person.

It's true. I think there was some tech conference out west where they said functional medicine was sort of one of the leading trends in medicine and healthcare. So I think that's true. So you have another case, Liz, of a 50 year old woman who also had been fatigued her whole life and been working hard. Tell us about her and what was going on with that because it was a little bit of a different story.

Absolutely. So she was 50 when she came to see me. And the real reason she came in was her weight. She had started to put on weight and she was frustrated with it. So she came in because she's like, I want to get some of the weight off. But she also noted that she had significant fatigue. It wasn't fatigue that kept her from working. So she, she was actually a worker. She was very successful with her job. And then she had worked her whole life and she sort of pushes through, you know, but more fatigue than, you know, other people around her. She'd know, you know, even when she said, even when she was a kid, she had more fatigue than her friends and she would want to sleep more and, you know, rest more and not exercise as much. So she noted she had fatigue her whole life, but, you know, over the last few years it had gotten worse. And you know, with the weight gain, she said, let me go in, let's deal with this. So she came in to see us, you know, she, she's, as I said, she works all day, she'd come home, she'd cook dinner, she'd have a couple glasses of wine to calm down and, and you know, just got up the next day and did it again. So I thought that was really interesting when you hear that on somebody's timeline, right, that long history of fatigue. Yeah, it makes you think about different things, right. And, and so, and also hers was like not the level of fatigue. I mean, she still was functioning but just not at her optimal. So, you know, I started thinking, okay, let's look at her genetic makeup. Let's look at her genetic makeup. So we did a genetic panel that looks at, you know, some SNPs, some variations in somebody's genetic makeup that can influence, influence diseases that they get as well as influence need for different nutrients or supplements. And so one of the things we found out is that she had a homozygous variation with the MTHFR gene.

That's a mouthful I know. What is that? Break that down for us.

So the MTHFR gene is a gene that encodes for an enzyme, and homozygous.

Means she has two copies, one from her mom and her dad.

She got both, which. It has a bigger impact in terms of her life. And so that's the methyltetrahydrofolate reductase enzyme.

Another mouthful.

Yeah. And that enzyme is involved in methylation or transfer of methyl groups, which is involved in multiple different processes in the body, everything from detoxification to making your neurotransmitters to energy production. So it's involved in so many pathways in the body?

Yes, it's basically like this process where you take the carbon and three hydrogens, which is called a methyl group. And I think of like the currency of the body, where there's all these chemical reactions happening, literally billions of reactions happening every second. And one of the main ones that is going on is this process of called methylation, which is a transfer of these groups. And there's genes that regulate the nutrients that are involved in pathways, the enzymes that regulate these chemical reactions. And so you can have variations in your ability to do that, that can have impact on your health. And that's what you're talking about.

Absolutely. You know, it's been associated with depression. People who have a homozygous variation of this gene, the MTHFR gene, have an increased risk of depression, they have an increased risk of fatigue, they have an increased risk of miscarriages, neural tube defects, and so it's significant. There's been a lot of research on this gene. It's very interesting. And it impacts lots of different systems in the body. And that enzyme needs B vitamins. So B vitamins are really crucial for that to all work well. And we know that when people have this genetic variation, they can't take folic acid. That's a synthetic form of folate that's in a lot of supplements. They can't take that, activate it and.

Utilize it, or even the stuff you get from food sometimes, right?

Yeah, some of the stuff from food, too. I mean, a lot of food is naturally methylated, but like a lot of our processed food has had folic acid sprayed onto it, and the body, it's fortified. It's fortified. The body can't really utilize it, can't activate it and utilize it in the body. And so people, you know, and conversely.

It can become toxic.

Absolutely cause problems.

So if you actually think you're doing something good, taking folic acid and you have this problem, you're actually doing harm.

Right, right. They're saying that it may build up in your tissue, might increase risk of cancer. There's a lot of things that we're looking at with that. So, you know, we always focus on the better quality supplements that include a better form of folate, the methylfolate that was really important for her in this situation. We also gave her a good multivitamin, a good B complex, and we increase the folate in her diet with all the foliage, the folate rich foods, the green leafy vegetables, but all your vegetables are rich in folate. So we increase those in her diet. And we also dealt with, we cut back on her alcohol. Because alcohol uses up your B vitamins.

Yeah. She was drinking two glasses of wine a night to calm down.

Right.

A lot of times people have these genetic variations, but they can explore, express themselves in different times of your life, depending on what else is going on. So, you know.

Probably what happened with her is over years of just drinking a little too much alcohol, it became more of an issue because she was wearing down her B vitamins and she needs those B vitamins for that methylation process to occur. So both of the things came together. She had her genetics and her environment, and they made the fatigue even worse. We often see that gene express itself or people have problems when they go to college, for example. So kids that have that genetic variation and then they go to college and start drinking more, and then they start having problems with depression. You know, that's a kind of a pattern that we sometimes see because, you know, you've got the change in diet, you know, maybe, you know, not eating as much vegetables, then you're drinking more.

Mom'S not there making you eat your.

Veggies, and you've got that genetic variation. And then, you know, there's so many things that come into play. But I think it's important when you look at that timeline that helps us give us those clues.

Yeah, so true. One of the other big causes we see is just what people are eating. Like if you're eating a nutrient depleted, ultra processed diet with tons of sugar and inflammatory foods, it tends to cause you fatigue.

We see that all the time. You know, people eating the wrong foods at the wrong time, eating a lot of refined processed foods, causing their blood sugar to spike and then they, then it drops. Not eating enough protein. I mean, there's so much with diet that has a huge impact. And like you mentioned, the inflammatory foods, so foods that may be causing inflammation for that person, you know, gluten and Dairy. And so those are the big ones. Those are the big ones. And so a lot of times we'll do. One of the biggest tools we have in our toolkit, right, is that comprehensive elimination diet. And it can be really helpful for patients. They work with our nutritionists and get on a really good try and elimination diet. And many times patients will say, I started to feel so much better.

Right.

And my energy improved over time. If we've got chronic stress for some reason because of our perception of the world around us, or we're not taking time to take care of ourselves, or. Or we're eating a diet that's really stressful on the body, or we're not getting enough sleep, or we have a chronic infection. I mean, we do see this with illnesses too, like a chronic infection. Those chronic stressful events over time really can disrupt how all aspects of our hormone system works together. That whole HPA axis works, and it can get dysregulated. And so that's that whole talk of that HPA axis dysregulation.

Your hypothalamus, which is in your brain and your pituitary. So it's all the command and control centers in your brain that then send messages to your adrenal glands that are on top of your kidneys. And they produce adrenaline.

Yes, right.

Cortisol, norepinephrine, and epinephrine. But also dhea, which is a, you know, is a hormone that gets turned into testosterone and estrogen and hormones that impact our blood pressure and electrolyte balance. So that it's involved in a lot of things. And it's important to recognize that.

The pituitary also impacts lots of other hormones in our body. Our female hormones, our male hormones, and so our thyroid hormones. It's all really connected, which is interesting as well. So when people are under a lot of chronic stress over time, the cortisol levels are remaining higher than they should be for long periods of time. And so this is a whole feedback loop, right? This system in our body is a whole feedback loop. So that high cortisol sort of shifts, shifts the way that there's a feedback mechanism that occurs. And in a way, the body sort of slows everything down. And so over time, with high levels of cortisol that are getting released all the time, people start to crash. They have, like that, what they call burnout, or their body sort of just slows down. We see their thyroid slow down. We can see other hormones shift. But we definitely can over time. If we look at. We can see a decrease in cortisol levels. So we can do some special tests that look at that.

It's so important what you're saying, because the stress response is a good thing in the short run, but not in the long term. And we never really had these chronic stresses that we do now. We'd be in threat of danger. We'd mount the response and was good. Right now you're releasing high amounts of cortisol and it's like a drug we give for people with autoimmune disease called prednisone. Or when you, for example, have a disease called Cushing's disease, where your adrenal glands or a pituitary tumor will produce a lot of cortisol that is not regulated by any feedback mechanisms. And when that happens, you get all these problems, right? You get high blood pressure, you get diabetes, your brain shrinks, the memory center in your brain shrinks so you can get dementia and you have muscle loss.

You're more likely to get sick more.

Easily, more likely to get sick. Your immune system stops working as well. So you're really accelerating all these age related diseases. And you're also suffering from FLC syndrome, which is basically when you feel like crap. So let's drill down into some of the symptoms that people who might have this dysfunction. Yeah, absolutely.

So, you know, a lot of times people will, you know, people with HPA axis dysfunction, they'll say, well, you know, I have a good night's sleep, but I still feel tired in the morning, I can't get going. Or other people, depending on where they are in this whole process, they may feel like they're anxious all the time. They can't calm down. They're tired but wired and they're just, you know, really stressed.

You get into bed and you lay there. You're tired, but you can't fall asleep. Yeah, I've been there.

You know, they can have a hard time dealing with the stress of everyday life. They can feel more depressed or irritable. Things that they used to be able to do really easily are hard to do. So things that they, you know, their job maybe, or.

Handling, going to the grocery store even, you know, things that used to be really easy to do every day become tasks for them. They feel overwhelmed and exhausted and they might get, as I said, sick more easily. You can have more cravings for foods. You want it. You're looking for things to pick you up, right? So sugary foods, salty foods. Can you have cravings for them? You may feel more fatigued when you stand up. You get more tired. You may have low blood pressure over time and low blood sugar over time with. With an underactive HPA axis.

So, yeah, there's often the syndrome I see of tall, thin women, which is really common, where they. They get sort of adrenal burnout. They get low blood pressure, so dizzy when they stand up, they crave salt. They have anxiety, they have palpitations, they tend to get hypoglycemic. So their blood sugar actually is. Is not coming up when it should. And so you can kind of pretty much tell that this is going on with people. But what's interesting is it might be worth breaking down. Is that adrenal burnout. Let's just call it that comes in stages, right?

Absolutely.

So the first stages is. Tell us about the first stage and how it progresses to full burnout.

Absolutely.

The symptoms and the treatment are a little different.

They are a little different. So at first.

When you've got that overactive adrenal gland, it's the beginning, let's say, of just handling all this chronic stress. People feel that wired and tired. They're, like, anxious. They feel like they just can't calm down. They feel upregulated inside.

And then over time, what can happen is with having that chronic levels of high cortisol, what can happen over time? As we talked about with that feedback loop.

They get a decreased level of cortisol that occurs.

So initially, high levels.

Initially, we do testing and we'll talk about the testing in a minute. Yeah. And then over time, we see low. And when it's flatlined, what it feels like is burnt out. You just feel exhausted. You can't get going in the morning. You're getting sick more frequently. That's when you see a lot of low blood pressure, low blood sugar, salt cravings. But just literally, you feel that burned out, you're exhausted feeling.

So when it's chronically high and there's chronically low and there's kind of an in between, where you get low in the morning and high at night. So you're exhausted in the morning, but you can't fall asleep at night because your whole.

Yeah, it's like flipped.

Your circadian rhythm is all screwed.

So that's what we do differently than what conventional doctors often do.

By the way, this isn't even a diagnosis in conventional medicine.

No, really, like you were saying, if somebody has really low cortisol or really high cortisol on blood testing, they'll call it maybe Cushing's or Addison's or a very serious Adrenal issue. And we were taught about that in medical school, but we weren't really taught about.

These situations where if you did a blood level first thing in the morning, it probably would look okay, and you wouldn't really see a lot of abnormalities in the blood testing. But if you look a little deeper and you do saliva testing and you check saliva four times in a day, and you can check saliva when you saliva for cortisol, when you first wake up in the morning, they call that the cortisol awakening response. What we should see. What we should see with that saliva testing is that when you first wake up in the morning, your cortisol increases. It's almost like a stress test for your adrenal glands. The cortisol awakening response is like a stress test for your adrenal glands. Getting up in the morning is a little bit of a stress for the body. Right. It needs to get going and wake up. And so what we typically see is the cortisol increase first thing in the morning. And that's a good thing. We wanna see that the system's working well. And what we see is the cortisol levels in the beginning of the day are higher, and as the day goes on, they come down. So when you check somebody's saliva tests during the day, we should see it go up when they first wake up in the morning and then start to come down as the day goes on. And that's a very normal pattern. And what we were talking about is, over time, if people have a lot of stress and anxiety going on, you might see high levels of cortisol. And then over time, you might see that it start to flip where they're low in the morning, but too high at night. And then if things really go on for a while, you might see a low level of cortisol throughout the whole day. And it really gives us a lot of information about how best to treat somebody and how best to take care of them and what they need to really focus on.

This is something you wouldn't get at a traditional doctor's office. They're not going to look at your salivate cortisol levels. They'll say, oh, you have Cushing's and there's tests for that, or Addison's and there's tests for that. But short of these two extremes. And that's what's so different about functional medicine. It's really about this continuum of dysfunction. It's not just on or off. So you have diabetes or you don't.

Yeah, right.

And like, you have high blood pressure, you don't. It's a gradual worsening over time. And, and, and those diseases are very particular because they're either a tumor, which is Cushing's, or they're an autoimmune disease, which is usually caused by gluten, the Addison's disease, which is what President Kennedy had actually, and it certainly impure affected him. So when you have these patients come in, you do this history, you find these symptoms, you sort of hear their story. How do you start to approach correcting this? Because, you know, as cause I found, you know, some things are really easy in functional medicine. Someone has, you know, bacterial overgrowth or they have gut issues. Irritable valve, 1, 2, 3. It's fixed. This takes a little bit of time. Because of the amount of stress we've put on our adrenals, we have to constantly try to build them back up over time. And it takes a little bit of time to recover.

Yeah. I mean, I think what's fascinating is, you know, and what we realize is the body has this tremendous ability to heal, right? And we, this is an area where our body can heal. We see it heal all the time. It just sometimes takes a little TLC and some care. And that's where, that's where the lifestyle factors really, really make a huge impact. You know, we work with people to really balance their, their diet and focus on nutrition, and we can delve into each more. Getting good sleep. Resting. Resting is important. Right. We need to give our body time to rest. And we're living in a world where it's hard sometimes to turn it off and people aren't. And so they're really having issues because of it. So we have to help them rest and recuperate and get in their regular meditation and breath work and take time for themselves and turn off the lights at night and turn off the computer and the cell phone. And, you know, diet makes a huge difference. There's so much we can do.

Before you get into diet, let's go back to what you just said. Because the light thing, the computers, the screen, it's not just that they're distracting. There's a biology around your adrenals that has to do with something called your circadian rhythm. And it requires certain types of stimuli at certain times of the day and different kinds of stimuli at the other times of the day. So in the morning, the way to get going with your circadian rhythm and your adrenal glands to properly function is to have sunlight for 20 minutes in the morning, which how many of us actually do that and get outside. And the same thing at night, if you are stimulating your eyes with bright light that isn't. Have all the blue filtered out, which is you can see blue blocker glasses or just getting off screens, and you will actually stimulate more awakefulness and you will suppress cortisol because, like, I mean, suppress melatonin.

Yes.

Right. Because in the morning, you wake up and you. You see the sunlight, well, your melatonin levels go down, so you don't feel sleepy all day. But. But if you're having light at night, it actually keeps the melatonin down so you can't fall asleep.

Yeah, I mean, so circadian rhythm is. Is critical. And we're gonna. We're gonna touch on it with one of the cases I have because. Because, you know, we'll get into it in a minute. But she was working more in the evening shift, and I think it really is hard for a lot of people with. Depending on the shifts that they have to work. But you mentioned that, you know, getting up in the morning, getting outside, getting that sunshine helps for so many reasons. It helps our mood, it helps us fall asleep more at night, and it helps us, you know, our body likes to have regularity and rhythm. And I think that's one thing we really work on with people when they're really struggling with this is getting them in some pattern and rhythm of getting a good sleep cycle, getting a good eating cycle, not grabbing and going, not skipping meals. I mean, there's a lot to be said for fasting. You've done a lot of podcasts on this, and there can be really a lot of great things with fasting, but sometimes when people are really. When their HPA axis is really underactive and it's not working very well, and if they've got the signs of burnout or adrenal dysfunction. Right. We.

Fasting sometimes for too long can be more stress on their body, or some extreme diets can be more stress on their body, and they might not be at a point where they can do it. They can feel good with it. Right. They can't get all the benefit from it. So they can still fast for 12 hours, but we might not be fasting them for six days, 16 hours, or 18 hours during that time.

Well, it's really important what you bring up about food, because there are certain foods that actually cause stress in the body independent of your thoughts, and there are certain foods that reduce stress in the body independent of what you're thinking, Right?

Yes.

So it's actually food can be a stressor or a relaxer, depending on what you're eating. Can you talk about the foods that tend to cause more cortisol, adrenaline and stress in the body? And then some of the foods that we would be thinking about that might help reduce that?

That's such a great point. If we eat.

A donut with coffee and sugar, I'm going to an extreme here for breakfast.

It's not that extreme. It's probably the breakfast of most Americans. Dunkin Donuts.

It's really stressful on the body because it causes this spike in our blood sugar because it gets digested and absorbed really quickly. Our blood sugar goes up quickly and the body goes, oh no. Right. It gets stressful for the body. The body produces a bunch of insulin to help lower it. And then what happens is the blood sugar drops afterwards. And so those ups and downs in blood sugar like that are really stressful for the body. And when the body, if your blood.

Sugar is dropping, it's a life threatening emergency. You got to go get food.

Right, Right. So those, you know, if you're, if you're, you know, eating a lot of foods that cause your blood sugar to go up and then drop with, you know, those, those easily to digest and absorb, you know, you have a can of, a can of soda. I mean, we're, you know, those things really are stressful for the body. They create this stress, they create the cortisol response. It's one of the reasons we get a lot of weight gain around the belly when we eat those kind of foods, because they are stressful for the body. And so instead we want to be really balancing our blood sugar.

And before, before you know how to fix it. I just want to point out this study that was just so mind blowing and I read it years ago by a friend of ours, Dr. David Ludwig from Harvard, and he took, he took kids that were overweight and fed him three different breakfasts. Right. Oatmeal, steel cut oats and an omelet. Same calories. Same calories, but different carbohydrate, protein, different fat. What he found was that the kids who had the regular oatmeal, like the quickly absorbed oatmeal, we think oatmeal is healthy. Right. It's not like they're having a donut. Their insulin went up, obviously their blood sugar went up, but their cortisol went up, their adrenaline went up. So the body perceived it as a stress.

Yes.

Whereas the kids who ate the omelet didn't happen.

Yes.

And then the kids who ate the oatmeal were hungrier, wanted more food. So we know that starch and sugar create a biological stress response in the body, and that's bad. In addition to the fact that the sugar causes a problem, your brain chemistry and your neurotransmitters are talking to your fat cells and they're telling them when they're under stress to store more fat. So literally, stress makes you gain weight independent of what you're eating. So it's really, it's fascinating when you look at weight and other issues, it's so connected.

It's so connected. It's fascinating. So, I mean, so really balancing blood sugar is so powerful. It's, you know, I mean, people, sometimes we say these things again and again, like, you know, balance your blood sugar, have a good source of protein, healthy fat and fiber at each meal. And sometimes we say it so much that I wonder, people just, oh, yeah, it's the same thing. They're just saying eat healthy. But it's really critical to have a good source of protein, healthy fat, and great source of fiber at every meal because.

It is not allowing for that stress response to happen in the body. It's nourishing the body, and that's exactly what the body needs.

Yeah. And so I think using food and having the right quality fats, low glycemic diet, lots of fiber, phytochemicals, these are all messenger molecules that help reduce the stress in the body.

Yes.

So we always start with food first, and this is a great place to start in this area, really. Working to balance the blood sugar, preventing those spikes in blood sugar, preventing that stress. We often work to pull people off of caffeine for a period of time. You know, if they're in that state where they're really anxious, they don't need the caffeine. If they're in that state where they're burnt out and exhausted, they might feel like they need the caffeine, but that's actually, you know, a little bit of a stress for their body. And so when the adrenal glands or the whole HPA axis isn't able to handle that stress at this point in time, you don't want to add to it. So we often will pull people away from caffeine or really lower their levels or keep it to a little bit of green tea and just not excessive amounts.

How about alcohol? Is that going to relax you or is it going to cause a problem?

You know, I mean, so, you know, it's really, with alcohol, it's all about Moderation, right. It's really all about moderation. We know that too much alcohol is going to wake us up in the middle of the night. We know that when it wears off, it's. Alcohol is a depressant. When it wears off, we get that rebound stimulating effect. We really need to be working on sleep during this period of time, all the time. But we need to get good, restful sleep. So we just have to watch the amount. I mean, that's really, really important. And so for some of our patients, we take them off of most of the alcohol for a period of time. And it also wears down your B vitamins. And B vitamins are really important for.

So when you drink, you deplete your B vitamins, that's what you're saying?

Yeah.

And B vitamins are critical for the food functioning of our adrenal glands. So things that you might have been. People will say to me, well, I've always had two cups of coffee in the morning and it's been fine. Why can't I have two cups of coffee now in the morning? And when you get to that exhausted, burnt out stage, that's just too much for your body at this period of time. We just have to be a little more gentle.

Yeah, I think that's absolutely right. I also think what you said before, I want to come back to, because it's such an important point, we jump right over it. You said something that I think is worth underscoring, which is that infections or any physical illness can cause a stress response.

Yes.

So let's say you have Lyme disease or you have a virus or whatever, independent of, well, your thoughts or feelings or perceptions, it can cause a stress. And there are certain foods that drive inflammation, that cause a physiologic stress response. So anything in the body that causes inflammation, either your thoughts, which can cause inflammation, or gluten or dairy, or food sensitivities or sugar. All these can cause a stress response. So sometimes getting rid of not just the junk food, obviously the sugar, but actually potential food sensitivities or gluten, dairy can be enormously effective. If you love that last video, you're gonna love the next one. Check it out here.

Throughout your day, you have varying levels.

Of alertness and calmness. Now, if you are very alert, extremely.

Alert, we call that panic or anxiety.

But with that also comes something beneficial, which is focus. So we know that without.