The Hidden Cause of Your Fatigue

Welcome to Integrative Medicine with Dr. Leland Stillman, the podcast where we explore the best of East and West, old and new, conventional and unconventional, in search of answers to medicine's toughest cases and most difficult problems. This podcast is for informational purposes only. Diagnostics and therapeutics discussed on this podcast may or may not be right for you, so talk to a qualified practitioner before taking action based on what you learn here. If you'd like to become a patient at my practice, go to StillmanMD.com to schedule a complimentary discovery call. Thank you for listening and welcome to today's episode.

Are you eating clean, healthy food, picking the highest quality ingredients, walking away from the grocery store with a bill that feels astronomical, and yet you still don't feel well? I'm Dr. Leland Stillman. I'm back for an exciting episode for you where I'm going to break down one of the most common mistakes that I see my patients making, and I want to be really clear clear from the outset. This is for you if you're already motivated to eat well, you're eating high-quality food, picking high-quality ingredients, you work really hard at your health— that's how you feel anyway— and yet you feel like you're still not making progress. One of the things I've found in practice may shock you. You may just not be eating enough. So this comes up in my practice all the time. I'm going to call this woman Julia, but the truth is there are so many women who fit this, fit this story in my practice that I You can't even keep track of it. Fewer men, more women, but yes, this meant this problem does apply to you as well, gentlemen. So pay attention if this resonates with you. I often see patients who come in having eaten very carefully for many, many years, organic whenever possible, minimally processed. They often practice portion control, often because they're concerned they're going to gain weight. They don't want to gain weight, and that actually starts to create a problem. They're often undereating protein, potassium, and folate. Those are 3 of the most common deficiencies that I see when when we actually look at their dietary data. What we see on their labs often confirms this. They'll have low levels of zinc, that's lack of animal protein. We'll see low levels of folate, that will manifest as an elevated homocysteine. It can also manifest on a hair test in a variety of different ways, particularly in slow oxidation. We may or may not see low potassium on labs. That's actually very hard to detect until it's very advanced. What we'll almost always see is a potassium that's under 3 grams. And that for me right there is a red flag. I've been blown away, frankly, by how people struggle to get better when their potassium intake every day is under 3 grams. I mean, it's really that serious. So what is happening when the body is living in this state? Inadequate folate, inadequate protein, inadequate potassium. And I'm just picking those three because honestly, there's so many patterns here that I could have pulled out of this case and those like it that It could be like a 1-hour or maybe like a multi-day seminar on how to eat and how to get a nutrient-dense diet. But these are 3 of the most common. So these 3 nutrients do a couple of key things in the body that most people don't realize or even think about. So protein is the building block for hormones like tyrosine and neurotransmitters like dopamine, norepinephrine, and epinephrine. Those are key components. Of energy generation within the body. So if you don't have enough tyrosine from a low protein intake, you should expect to feel tired, sluggish, need an afternoon nap, not have the motivation that you used to have, not have the drive, not have the focus, not have the mental clarity. I see it every day. When we hit reasonable protein targets on a daily basis, we unlock a lot of really profound improvement and transformation. Potassium, I call the redheaded stepchild of the supplement industry, and I love talking about potassium. Potassium because frankly, I feel like nobody else does. And I think that's a shame. I want to explain why I call it the redheaded stepchild of the supplement industry. You have to get grams of potassium a day for optimal physiologic function. My goal for my patients is 5 to 8 grams. That might not mean anything to you. So let me break it down in terms of food. That would be 2 large baked potatoes, 3 large bananas back to back. That's a lot of food. Okay. There are people who don't eat that much food in an entire day. And those are the two heaviest hitters in my book when it comes to potassium on a per gram basis. There's other sources, and I'm not telling you all to go out and eat two large baked potatoes and three large bananas every day. It's more context dependent than that, but I consistently see people avoiding or eating small or too small portions of potassium-rich foods creating this deficiency. Now, what does potassium do in the cell? What potassium does in the cell is it participates in the water bonding networks of the cell that allow for energy generation to happen. And guess what happens when you don't have enough potassium? You feel tired, you feel sluggish, you basically run out of energy production across the entire body. And here's what happens when you have too much sodium in your diet relative to potassium: you wind up with things like high blood pressure, you can wind up with immune dysfunction, you can wind up with a whole lot of other problems. Why don't people hear about potassium from supplement salespeople and marketers? Simple. If I were going to tell you to get a significant proportion of your daily potassium from supplements, I'd have to tell you to take like 10 capsules, and you would think I was crazy. It's just not reasonable. The other reason is that potassium in people with particularly chronic kidney disease can cause death. Not to put too fine a point on it, but it can actually be lethal because the kidneys have to filter it. So in a small proportion of the public, who may or may not consume YouTube videos like this, right? It can actually be really dangerous and you have to moderate your potassium intake. In fact, in extreme kidney disease or end-stage renal disease on dialysis, patients have to carefully restrict potassium to less than 2 grams a day. And I just told people that my goal for my patients is 5 to 8, right? So you can see why you've never— maybe rarely hear about potassium. But I have to tell you that when we get patients on a potassium level in their diet that meets their actual physiologic needs, some really profound, powerful things happen. And that's why you can probably tell I'm really excited about it. So that's what happens with low potassium. What happens with low folate? Folate is required for detoxification of the body and production of hormones and neurotransmitters. And honestly, that is like the beginning of what folate does. It does a lot more than that, but here's what I tend to see when people don't have enough folate. As far as like a clinical picture, they wind up with all kinds of problems related to their overall health. And again, it's hard to be specific here because it can manifest in so many different ways, but they'll wind up with high blood pressure. Wind up with a high homocysteine that then predisposes them to cardiovascular disease and stroke and heart attack and all these other things. And they'll wind up with this gradual worsening of their energy and their mood and their motivation. They may end up with, you know, frank or outright depression or anxiety. Why? Because the folate is not available to create the neurotransmitters and the hormones that they need in order to feel healthy, normal, motivated, and to enjoy life. That's one of the reasons why folate is something that I pack into pretty much every supplement protocol that I give to patients, because what I've observed is that when you don't give them adequate folate, particularly when they have a significant need, you will just not see the same results as when you do. What I don't think patients realize is how much of their folate intake is truly in their control. And I'll give you two quick anecdotes to explain this. So I was just reading my friend Joel Salatin's book, The Marvelous Pigness of Pigs, and he points out in his book that the pastured eggs they raise at his farm, Polyface Farms in Virginia, were documented to have 1,200 micrograms or 1.2 milligrams a day of folate. And I remarked to my wife, who I was reading the book to, and our son— I read this book, I'm reading this book to our, my wife and my son right now. I remarked to them, I use this much folate as a base for patients. I might add more if they had a higher need, but that's like the base. I put almost everybody on 1.2 milligrams a day of folate. Joel gets that in one egg from his farm. Now compare that with the USDA standard for an egg. It's much, much lower than that. I don't recall exactly off the top of my head, but it's something like 100 micrograms or less. So just changing the source of your food to a more local, more slow food, more regenerative agriculture source can have a huge impact on your nutrition that you may not see. But let me tell you, you can feel the difference. Okay. I'm going to give you another story. I've observed that patients often avoid legumes, lentils, and beans.

Why?

There's a lot of hate for these foods out on the internet because some people don't tolerate them well, and I get that. Believe me, I have plenty of patients who can't eat them. They just do not tolerate them. But here's the thing. One of the things I noticed is that in traditional cultures, these foods often figure very prominently on the menu, even in cultures where people had very robust, impressive health before civilization arrived and they got running water and electricity and processed food, right? So legumes, beans, lentils can't in and of themselves be bad for people. And I started to notice too that in traditional cultures, they often are kind of a staple food. They're there at every meal. And I thought, you know, there's gotta be something to this. Well, guess what? Lentils and beans are in my book on a gram basis, your best source of folate. So I would observe that patients would come in with severe folate deficiencies. They never eat beans or legumes, and we have to give them a milligram or more of folate a day. When you look at how that stacks up against actual dry legumes, lentils cooked from scratch at home, properly prepared, you can get half of that from just one serving of that one cup. Very reasonable to do. And so what I realized is we were supplementing people to make up for a very dysfunctional diet. Now, again, I can't say all of you go out and eat lentils and legumes and whatever. You have to make sure that your diet is right for you with a qualified practitioner. But I observed this over and over and over again, and I thought, you know, how much supplementation would we actually need to optimize lab values if patients ate the right diet? Which is why at our practice, I often say this, we're food first, supplement second. We, in general terms, make so much less money than a lot of functional medicine practices on supplements because I try to be ruthlessly efficient with the stacks that we're handing patients. And you're not walking out the door with like 30 different SKUs and a $500 supplement bill for a month. That blows my mind because we just don't need to do that in order to get people results when you actually know what works and you actually tailor your supplementation protocols to the patient's unique physiology and circumstances, right? Not that there's, you know, sometimes a time and a place for like a lot of supplements, really aggressive protocol. I get it, but I see that happening over and over again. People are over-supplementing, but they're not taking the right things often because they lack this fundamental insight into what are they actually eating. And then they don't understand, well, how can we fix the holes in your diet so that you don't need so many supplements and you get better clinical results? So back to the story, I was not surprised to hear from this patient that she was weak, tired, anxious, depressed. This is protein shortage. She's lack, lack of energy. Is potassium, it's folate, it's all of them together, right? Again, she was eating high-quality food, but she wasn't eating enough, and she was missing some essential food groups. All right, you have to understand that everything your body does— how you feel, how you function, how your organs work, your immune system, your sleep, your mood— they all depend on these raw materials. And if you do not put the right things into the body, you will not get the outcomes that you want. This is just simple biochemistry and biophysics. And yes, there's a certain truth to, like, mind over matter, and mind-body medicine has a huge value, but believe me, it can be so frustrating to be working on all that stuff and trying to maintain a positive mindset and then find out that one of the big stumbling blocks in your way, one of the big obstacles that was holding you back is one or two simple dietary changes or a foundational supplement that you were just missing. One of the biggest mistakes I want to make sure I, I hit this point because I see it happening all the time is that people will also tend to overcook their foods. Folate, I mentioned specifically in this video, is very heat sensitive. In round numbers, if I recall correctly, when you freeze it or reheat it, something like a third to two-thirds of the folate in the food is destroyed. Stop and think about that for a minute. You buy a ready-to-eat meal, it's frozen, you reheat it, you don't eat the whole thing, you put it back in the fridge, you reheat it again. You just cut your folate intake by what? At least two-thirds, right? What does this mean? We have to take the time to prepare foods in a way at home that preserves their nutrition. We have to take the time to connect with local farmers so that we can get the food as soon as we can from the field. That's the future. That is what our health, the health of ourselves, our families, our communities, our society in general. That's what that depends on. Simple choices, but we have to be serious about them. Okay. So I hope this video has helped you. I'm going to stop ranting now. If you're feeling tired, exhausted, these are some of the things that I share with patients on a weekly basis that I see moving the needle for them. If you want to learn more, I encourage you to look into the 14-Day Reset. This is the starting point for every single patient in the practice. Why is it the starting point? Because I had to pick of all the different things I could teach patients and share with patients, a very short list of things that I knew based on hundreds and hundreds of cases and over 12 years of practice were going to move the needle consistently without making people sick or unwell, right? Because as you know, there's a lot of side effects to a lot of things that doctors recommend. These are gentle foundational things that I trust to help my patients achieve their goals. It's a 14-day reset. It's only 2 weeks.

Check it out.

I strongly encourage you to look it up. Thanks for watching everyone. Take care and have a great day.