Re-energize from Chronic Fatigue & Long Haulers, with Dr. Evan Hirsch @EvanHHirschMD

Welcome to another episode of Live like youe Matter. We have Evan Hirsch here today, and he's wicked cool. I know. I love all of our guests, but he's also wicked cool, and I'm convinced I know him in another life.

Yeah, before we hit the report button, we were trying to figure it out. We can't.

Yeah, yeah, we played you a geography too, and it didn't work. But we know him. We know him anyway. Evan Hirsch, MD, is our guest today. He's world renowned fatigue and long haulers expert, which is apropos of what we're going to talk about today. And he's the founder and CEO of the International center for Fatigue. Through his bestselling book, podcast, and international online programs, he's helped thousands of people around the world resolve their ME cfs. Now I have to ask him what chronic fatigue takes. What's me Now I gotta do this over. What's that mean?

Myalgic encephalitis. It's what the Brits and beyond call it.

Got it.

You don't have to do it over. This is just part of the introduction.

Okay. So he's helped a lot of people heal their symptoms naturally and is on a mission to help 1 million more. He's been featured on television, podcasts, summits, and when he's not at the office, you can find him singing, musicals, dancing, and playing basketball with his family. Welcome, Evan. Should we call you Dr. Hirsch or Evan? Let's just get. Really.

Whatever you want. Evan is fine. Right.

As long as we feed you dinner and are nice to you. Like I always used to say to people, don't kick me. And you can call me whatever you want because I'm an obgyn. People used to kick in the Bronx.

Right. Well, thanks for having me on. It's great meeting you guys.

Great.

Great. Dad.

We're casual, if you haven't noticed.

Love it. Yeah.

All right, so.

So we're actually going to get something done today.

We will get done because, well, you were telling us a little bit about how you got into this, so I always like a little background of why chronic fatigue, why long haul. What? Well, what got you into this?

So I was already practicing functional medicine when I got sick. But let's back up a little bit. I went to medical school, started my residency program, fell in love with my wife, and three months later, she got sick with fatigue, and it took her about three years to get mostly out of it. And during that time, I'm working 80 hours a week during my family medicine residency, and Asking everybody and their mother about fatigue. And it's pretty much low. Thyroid, hepatitis, heart disease, lung disease. There's not much. Might be one thing I'm missing or.

Just not sleeping enough, or just not.

And no one said Lyme, right?

Nobody said Lyme. Nobody said any of that. No Lyme, no mold, none of that, unfortunately. And so after that, she was mostly better. And we got married, we had a child, I started my functional medicine practice. And then two years later, I got chronic fatigue. And it lasted for five years and just about destroyed every aspect of my life. My business was blowing up. I was doing really well, but I had to keep hiring people to do my job because my brain fog was so bad I couldn't remember anything. And I kept sleeping under my desk. My crossroads moment when I knew things had to change is when I was looking up at the bottom of my desk for the 1,732nd time, or whatever it is five years where I had been doing that and realized, hey, something has to change. And then I went on this mission of finding every single cause of fatigue that I possibly could, because I knew coming from a functional medicine perspective is that if I found every single caus that I was going to be successful. And so I read every book that I could, went to every conference, blah, blah, blah, and found 33 different causes and then started working on myself. And turns out I had 30 of those 33 different causes.

So you're a wicked slacker.

Underachieverachiever. And what I found is that everybody who has chronic fatigue and long haulers has 20 plus of those 33 different causes. And that's one of the reasons why it's so complicated to treat. But that became my mission. Mission is to I was able to help myself, and I'm on this mission now to help a million people take their energy to the next level. Because what is life without good energy? You can't really do anything right.

Yeah, no, I want to actually pause for a second because I think the point you're bringing up is a point that we, as functional medicine practitioners, I think view as obvious. And I think it's really, for the majority of people, not which is most of the stuff we treat is a systems approach. It has at least three to five root causes, if not 20 to 30 root causes. It's never just one thing, or the way I say it, at least once in a while, it's one thing. It's called a miracle. You do something and it changes. And that, that does occasionally happen, but that's a Miracle. And I never count on miracles. Most of the time, it's hard work getting through whatever issues. So I just want to pause because I think that's a point that's not often emphasized, and it's really important, and.

That'S really different than what we learned in medical school. Right?

Exactly.

Oh, I remember asking why in med school. I was like, Persona non grata for like a week. People were like, why'd you ask why? I was like, I wanted to know. And it was so. I mean, the teachers were like, they went gray from the question. They really did.

I love asking why. I think that's, you know, what we're looking for is the why of the why of the why. You know, how do we get down to the real root cause?

Yeah. Yeah. All right, so keep going. I'm sorry. I just wanted to pause because. So you found 33 main causes.

Yeah, and so. But I mean, I think the biggest thing was, like, the shame that I felt being a functional medicine provider and having fatigue and the guilt that I felt because I couldn't help out at home. We had this new child and she would say, daddy, play with me. And it broke my heart when I told her that I couldn't. All I could do is, like, lie on the couch. And my wife's like, hey, can you do the dishes? And I couldn't. And so not good for any of my relationships, not good for my self worth. And I was fearful that I was going to lose my business because I couldn't. I mean, it was just not a pretty time at all. But I feel so blessed that I was able to come out of it.

I think you really highlight something that, I mean, so we also have a book about my experience, maybe your experience living with me, about toxins, because I was a total hot, toxic mess. And I think sometimes we have to get to that point in order to make that difference, because now you have a whole level of understanding and compassion and experience with what people are going through. And it brings. It really brings something humbling, I think, to be able to say to people, look, I've been there, and we're going to get you through this. And I totally relate. I'm like, oh, I should have been perfect by now. I do functional medicine, and I'm more than 10 years in. Why aren't I perfect? But you're also human.

So how long did it take you to actually recover once you started looking into it?

Hold on. Are you recovered?

That's a really great question, because I was talking about this with My wife, because we're still doing tweaks. And this is really, I don't want to say a lifelong journey, but it is a long journey. It took me a year or two to get 8 out of 10 energy. And so I have really good energy. I can do everything that I want. But there are still some tweaks that I'm working on. There are still some toxicities that I'm getting rid of. I'm doing my tests every year, and every year the mold is getting less, and I'm making sure my house is clean and working on the infections and Bartonella and Babesia and Epstein Barr virus and Coxsackie and all these things. And I continue to make progress, and I'm really happy with where I am. But I think that we have to kind of change the conversation a little bit in terms of resolution, especially when it comes to something like chronic fatigue syndrome. And this is something that is. This is actually the first time that I'm actually talking about this after having this aha with my wife just very recently, because I've had a lot of, you know, like, I know that everybody who joins my program is going to be successful because we're addressing so many different causes. The question is about absolute resolution and how long it takes. Right. There are some people who get it at perfection. Exactly. And that's part one of the reasons why I got chronic fatigue, too, was because I'm trying to please everybody. I'm trying to be absolutely perfect. Right. And there's way too many variables that come into play in order to have that sort of perfection with a program like this. But I do know that everybody gets better with a program. Program like mine.

Well, let's talk about that for a sec, because we have patients who are fatigued, and then they say to me, why aren't I perfect? I'm like, well, first of all, you're not going to be perfect ever, because this is a process, not a destination. And second of all, the improvement in your symptoms doesn't occur in a vacuum. And so, particularly on the heels of two years entering our third year of a global pandemic, that's a level of what I call water torture or just constant level of stress. And so those ongoing or recurring or new or environmental stressors or life stressors or birth, death, anything that's occurring because you're not living in a bubble, that's adding to the stress of the system. And so you have to take that into account because you're going to backslide, get in a car accident. Backslide. Have a major event. Backslide. Get Covid. Backslide. And then you crawl out of it and get back. And you wrote a book. Then I'm assuming you went on a podcast tour. Backslide. I know that's. For us, it's been very intense. So whenever you have those, that's going to make it even harder to get out of the hole. Because you're not living in a vacuum. Bubble. Life happens.

That's such an important point. Because this process, I tell people, if you're going to break it down, it's really simple. You just remove the crap that you're exposed to, and then you fix. And then you remove the crap that's inside you. Right. The crap that you're exposed to. The crap that's inside you. Sounds easy, but in terms of the crap that's outside of you, you're never going to get rid of that unless you're living on a desert island or. It doesn't have to be a desert island. It could be any kind of island. Except for Hawaii, that probably has a warm one, preferably.

But even then, if you eat the fish with the microplastics and this. We've messed up this world enough that you can't avoid it. The best thing we can do is optimize what we have, and those of us that have better genes can do it better. Or those ones that have genes that are less good that need more support.

Evan, you and I are in that second category. And he's like, I have the good genes.

Yeah, I don't think so. I wish that. I wish. But.

No.

But, yeah, no, I think that that makes complete sense.

So let's talk about COVID Yeah.

Well, first, what's the definition of long haul?

It's this little known thing.

Covid. Yeah, let's talk about definition.

I won't say the C word. I'm just so out of practice because of censorship. So just so you know, I'm going to refer to it as, you know, the pandemic virus and stuff like that. The other C word, I should say. Right.

So the definition off the other C word.

Now I'm like, cancer.

Oh, yeah. My family, it wasn't called the C word. It was called, you know, in a whispered tone, she had. You know, I legit thought that was a disease for a long time.

You know, it's very Brighton Beach Memoirs. Right? Isn't that what he says? She's got cancer. You know, Anyway, sorry.

The other C word. So a long hauler.

The other other C word, right. Yeah. So long haulers, the definition is basically a persistence of symptoms from getting the pandemic virus. And so those persistent symptoms, right now it's kind of the definition is up in the air, but it's like 12 weeks. So it's like three months. It keeps changing. It was 30 days initially, but basically three months after you get the C word and you still have persistent symptoms. That's considered long haulers.

Okay, so is there.

Why so long?

That's a very good question. Yeah, I don't necessarily entirely agree with it. You know, the thinking is that the virus should be able to take care of things in a certain amount of time. But I think that some of the. Yeah, I don't entirely know why that's the current, you know, diagnostic criteria, but if somebody is suffering and it's been a month, you definitely need to address it, because the sooner you address it, the faster you're gonna get better.

Yeah, yeah. Three months seems way too long for me. I mean, the minute people are saying that they're sick, we're like, okay, do this, this, and this. And when you're out of quarantine, come in for IVs and get yourself together and we'll. So, okay, so three months is crazy.

Yeah, this world is a little crazy these days, so I don't take anything for granted. All right, so what. What's your secret Sauce? I guess in terms of. So you've identified 33 root causes. Are they the same for long hauler, or is that more for chronic fatigue? How much difference is there? What do you got? What do you got for us?

Yeah, they're pretty much the same because half of those causes are deficiencies that are caused by the toxicities. So when people have deficiencies in hormones, adrenals, thyroid, sex hormones, in nutrients, vitamins and minerals, in mitochondrial function, in neurotransmitters, those are all caused by the toxicities, by the heavy metals, chemicals, molds, infections, allergies, negative emotional patterns, and electromagnetic fields. And the pandemic virus. I'm just going to say it. Since you've said it. Should we just say it?

You can say whatever. Remember we said be bullied.

You just don't care.

So.

When you get Covid. So Covid is just another virus that kind of fits into there. The reason why there are so many 200 plus different symptoms associated with COVID is because it lives in the bloodstream and consequently can go anywhere in the body. And consequently, it can cause inflammation in any part of the body. But the secret sauce really is treating a Live active virus. So there was one study that was done that looked at people who were asymptomatic four months after they got Covid. And half of those people had positive live active virus on intestinal biopsy. So these are people who didn't have any more symptoms anymore. They still had live active virus. And so my supposition is that 100% of those people who actually still have symptoms have live active virus. And this is also what we see when you start to treat with antivirals. And everything that I do is natural because in the online health space I operate as a coach. And so we're using herbs and whatnot to go after these viruses. But that's kind of what we're seeing, is that you start to go after those and then the symptoms resolve. So that is the secret sauce is addressing the live active virus and then addressing all these other different components. Because why are we seeing younger people get it? Most of the people who are getting long haulers are active people less than the age of 50. And a lot of it happens because they either start being active too soon or they have been. They're training for like marathons and stuff like that. And their adrenals and their mitochondria are already compromised, but it hasn't been an issue. But then all of a sudden you add in the virus and then they try to do stuff on top of it and they don't realize that they're actually sick or because it's so mild or whatever. And then that just causes additional stress on the human organ and then everything gets out of whack. But they also have these other pre existing conditions which aren't diabetes and high blood pressure and whatnot. They are heavy metals, chemicals, molds, and other infections that are present. And then all of a sudden it's the straw that broke the camel's back.

Yeah. No, I think that for me, Covid is so unique. Well, among a lot of other things. But Covid's one of the biggest unique things is people have this initial surge, they feel better and then whammo. And even if you don't go too long haul, at least for two, three weeks, people always have this like, they feel better and then they, they get whacked. And I haven't seen that with any other disease maybe. I, I just literally have not seen that. So it's, you can see it post op.

Like I always say. I used to say when I did surgery, you're going to feel really good and then you're going to do too Much. And then the going to think a truck ran over you. And that's similar to what's happening when people recover from this, is they think they're better, they go back to normal. Life is business as usual. And then it was way too much because of that underlying mitochondrial. I always say to people, it's a mitochondrial issue. You have a mitochondrial problem, and the virus is what triggered it. But really, this is a mitochondrial problem. It's affecting head to toe, your hair's falling out, your brain's not working, everything.

And it's this chronic stressor we talked about before, about how we can't control everything in our environment. And it's this ongoing chronic stressor that you're just kind of on this tipping point. And then all of a sudden you're like, I'm gonna go for a run today because I feel great. And guess what? It puts you over the edge too much.

So you mentioned over 200 symptoms. So how would. Basically, is it fair to say if after three months from getting sick, you still feel unwell? You have long Covid?

Yeah, I mean, and I would even say, you know, after 30 days. I mean, because the thing is that is those. What ends up happening too is that the newer symptoms get worse and the older symptoms get better. So that's generally what people will report. Well, they'll say, you know, hey, I started off with these. And people who have like five or more symptoms initially, even if they're really mild or more likely to get long haulers, but let's say that they have anosmia, so they have a hard time, they lost their sense of smell, and that maybe gets better at month one or maybe month two. But then all of a sudden they've got pain on the bottom of the feet that they never experienced before, which is awful. Right? But they didn't have it initially.

And that's not a lot of cartonilla symptoms.

So that's actually a really great question, because what we see is that Covid is acting in two different ways. So sometimes Covid is causing those symptoms, and sometimes Covid is a biofilm dis, or what I call the whack a mole effect, where it's causing. So you start hitting Covid, and all of a sudden it causes some of these other infections to come out. And they're more opportunistic because Covid has hijacked the immune system off into left field. And then all of a sudden the other bugs become opportunistic because you need a somewhat intact immune system in order to Keep all those bugs in check.

Yeah, another straw.

So what percent of people actually get long haul? What's the estimates?

So for people who are outpatient when they had Covid, so they didn't go into the hospital and they just suffered with it at home or whatnot, it's 10 to 30%.

That's a lot.

Yeah.

People bet based on one in a billion.

Well, but is that even with Omicron, which is. Or is that based with the delta variant or does not.

Yeah, that's alpha delta. So haven't seen enough on the Omicron yet to be able to make that comment. And that's just outpatient. So if we're looking at people who've actually been hospitalized, it's 75 to 85% of those people.

Wow.

Holy shit. So.

It'S crazy. So if you think about some doctors to take care of them.

I know, right?

They don't even know they need taken care of, honestly. They're just. They're like, I never recovered.

Yeah. And, you know, I saw an interesting stat the other day, which I hadn't even thought about this, is that there was an insurance company that was claiming. Claiming that there were 40% more claims or 40% more people getting on disability than ever before that weren't related to Covid.

Yeah. Interesting, huh?

So some of this might be vaccine accident and some of it might be long haulers. I don't know what else it would be besides those two things.

Or what happens is that the virus is, as you mentioned, it's uncovering some other issue. And that issue comes. So if your Lyme was at bay and your immune system was functioning, then you got sick with COVID and it knocks out your ability to fight it off. Now you've recovered from COVID but all of a sudden you have debilitating Lyme, or it's the thing that knocks you into complete adrenal overload and you can't function. I think it's the inciting event often.

Or you were able to handle mold before and you had to good detox and then.

Or at least some detox.

Or some detox.

Yeah. Or even stuff that's more detox. Right. Or even stuff that's more conventional. Like maybe you get afib.

Right. You know, out of the blue.

Right. And so, yeah, and I think there's just such a huge lack of awareness of that association between, hey, I got Covid. And then a couple months later I got this other condition that we. That the conventional establishment doesn't see. And a lot of Functional medicine docs, unfortunately, doesn't. Doesn't even see the correlation between, hey, did the COVID play a role here?

Is there any way to figure out before infection? Is there a genetic test? Is there some way to go, okay, you're at risk and you're less at risk. Is there some way to suss that out because it feels so random?

Yeah.

Who gets really sick?

Yeah, that is a really, really great question. And I don't know. I mean, it's all these causes that we people were. What's that?

You're supposed to know. Come on.

Swinging. Yeah. I mean, it's one of these things where. Yes. If you're going to check for all of those different causes before you go out and hang out with some of your friends and be like, oh, I've got mold, I've got adrenal gland dysfunction, I've got thyroid issues, and all teetering on the edge, I really shouldn't get Covid. But who's going to do that? I mean, people do that when it comes to pregnancy, right? They do, yeah.

But I have to be honest with you. I was really nervous about COVID because I'm. That you and I are like soul illness people, except I never had the Lyme stuff. You're gonna knock on something. So anyway, heavy metals, mycotoxins, chemicals. No glyphosate, celiac disease, adrenal fatigue. And so I was so terrified of COVID And my Covid was a little headache. I was like, oh, I think I have a headache. And postnasal drip and fatigue. That was my Covid. Him, the strong, like, ox who nothing ever. I don't know, nothing ever seems to faze him. Got really sick. Like, really sick. And so that did not match my expectation for how things were going to go because I figured I would be the one down for the count. And he would be like, Covid's not a big deal. And I'd be like, it really is. And it was totally opposite.

Well, this is what's really interesting, too, is that when somebody comes into your office and they say, I never get sick, or they say, I get sick all the time, they're both sick and they both have issues. The person who never gets sick, their immune system usually isn't functioning well. So I think that that's kind of part of it, and that's why a lot of these people who have more mild long haul or more mild Covid end up with long haulers, is because your immune system is not able to mount a strong enough response, because it's dealing with all this other stuff. Not to say you're going to get long, Covid. I mean, I certainly hope not. Knock on wood. But I'm just saying, it's that maybe the immune system is distracted enough where it's not able to address it full on.

No, and I'll say, personally, I think I'm probably 94% better or something of that nature, but there's that little bit. And I had. We had Covid in August, so it's been. We're recording in January, so it's been a while. But there's this little piece that's not quite there.

Usually around household chores, seems to show up conveniently, like, sorry, I forgot to do that. I'm like, oh, convenient, that Covid brain. So convenient.

Well, at least she's understanding.

Or he'll like, you know, sometimes I'm like, oh, you're going through menopause. You can't think of your words sometimes. That's another way that I've seen it, right. I love to bust his chops because he's usually healthy and I'm like, the hot mess.

So you go dump some ice water on yourself in the morning and you'll be healthier, too.

I just saw something in the New York Times today that said that's bad for you. That's like, not good for you. And I was like, oh, I should show this to my husband. Cold showers.

It's in the Times. It's got to be true, right?

Yeah, totally. It's in the New York Times. So.

So you have a four step process, right?

Is it four steps?

All right, so what are the four steps?

Sounds so easy.

I know, right? So the first step is to assess all the causes. So of these 33 different causes, 75% can be, you can figure out based off your symptoms alone. And basically what I did and, you know, it'll make sense to you guys, when you're sitting down with somebody one on one, it's like, what are the first thing that you're doing? You're looking for diagnosis. Like, what do they have? What are all the causes that they have? Right? So 75% of these causes can be determined by symptoms alone. Right? What did we learn in medical school? I mean, this is like one of the things that holds true for medical school. 90% of a diagnosis is history and symptoms. Right. And then the 10% is labs and physical exam. Right. And the same goes here. So when people join our program, we've got this amazing workbook where they'll go through step one, usually in the first hour, and just based off their symptoms, they're gonna know 75% of the their causes, and then they can spend their money on the 25% where you really need it. So that's the first thing, is assessing those causes. And what's also interesting is of those 20 plus causes that everybody has, the challenging thing is that everybody has a different 20 plus causes. Right. So somebody might have 1, 3, 5, 7, 9, and somebody else might have 2, 4, 6, 8, and 10.

Right.

So that's assessing the causes. And then you got to build this.

Into an algorithm, Evan, like a computer program. You just fill it out and then it spits out. Okay, here's you.

Right. And then match it up with the supplement, which is essentially what the rest of the process does. Yeah. And that I do want to do. That I just haven't figured out yet. But a lot of it, you know, that would really help the people with brain fog for sure. And the people who are too tired to go through the whole process, save for later. Exactly. Now the process is all about step four, which is removing the toxins. But we have to do step two and step three in order to be successful in step four. So step two is replacing the deficiencies. We start off with boosting the big three, so adrenals, mitochondria, and thyroid. So as you guys know, adrenals manage stress in the body, produce cortisol. It's our get up and go. And it got up and went in so many of these people, pretty much everybody. And then mitochondria. Yeah, and mitochondria produces 80 to 90% of our energy. It's in every cell except for red blood cells. And that combination then in turn, when you start to support the thyroid, if it's still needed, is really the biggest shift that I see. And I do it in that order. Adrenals, mitochondria, thyroid. Because thyroid will function better when you start taking stuff for adrenals. And then thyroid will get more into the cells when you start taking mitochondrial support. And so sometimes you don't even need additional thyroid after you do adrenals and mitochond. But then if you do, we do this subjective ramp up, which everything works better when thyroid works better. Right.

So I feel a lot of people know adrenals. I think a lot of people have heard of adaptogenic herbs and supplements for adrenals. Mitochondria support is definitely out there, but I think it's less known. So can you kind of elaborate, what are your top Three, five supports that you, that's your favorite.

Who are your favorite children?

Absolutely.

That's a game our kids like to play.

Who wins?

No comment.

No comment. Very well done. Nice job. I think they're listening right now.

Fifth amendment was put together for a reason, you know.

So my favorite mitochondrial support include D ribose, CoQ10, acetyl L carnitine. The product that I like to use is ATP360 by Research Nutritionals. That's kind of basically going through this program when you have like 20 plus different causes. I'm always trying to do double and triple duty per supplement, but oftentimes it's like one supplement per cause. And so the mitochondrial one that I like best is that ATP360 where it is, you are adding things to the Krebs cycle in order to make it work better. But a lot of this is also about removing these toxins in step four that have squashed the mitochondria. Right. Because it's a two step process. You have to reinvigorate the mitochondria. Oh, glutathione's a favorite too. But you have to reinvigorate the mitochondria and then you have to remove the toxins off of it. You can't just do one.

Yeah. So step one is to identify. Step two is to support the adrenals, then the mitochondria, then the thyroid. Am I missing step three?

No, we haven't gotten there yet.

And also instead, brain fog is not that bad.

You're checking the plot.

It's good. You were 94% the way there. Step two is replacing the deficiencies. So these are deficiencies in hormones, in nutrients, so vitamin D, vitamin B12, minerals like iron, magnesium, and then neurotransmitter deficiencies. Sometimes I touch on it, sometimes I don't. It really depends. That's one of those that is optional because you're going to get to those in step four as well. And a lot with step two stuff and then lifestyle habits. So we haven't even talked about lifestyle habits. And a lot of it is because the people who come to see me, they've already worked on their lifestyle habits. They've usually seen other functional medicine or natural medicine practitioners, which is great. And oftentimes they're also really tired. And so they can't make changes to their diet, they can't make changes necessarily to their sleep. Like they're just getting by. And so giving them a boost of giving them the step two products can really be helpful for improving their Energy usually gives them an uptick of 2 points. So if they're like a 3 or 4 out of 10, with 10 is ideal energy, they'll end up being a 4, 5, 6 out of 10. Going into step three and step four, and with lifestyle habits, obviously, step three.

Step three.

We're almost there. I promise. This is still step two.

This is still step two. Yeah. Nope, you've lost the plot.

I've lost the plot.

I should have it scrolling behind me or something. But we're still replacing deficiency. So I would say deficiency in sleep. So not enough sleep. So they need to get more sleep. Not enough good food. So that's a deficiency. Right. Not enough movement, though. A lot of the people that we work with, if your energy is not like a 6 or 7 out of 10, you really shouldn't be moving that much, you know, like, it's whatever you can do. Oftentimes they'll tell people, like, do five jumping jacks a day. You know, just kind of get your heart pumping, get it moving a little bit. Your lymph needs a little bit of that help, you know, you can do. You can go hot and cold in the shower, you know, like you were talking about. That can help, too. And then the last one is what we say. Movement, sleep, food, stress, relationships. Well, there's something else I can't remember.

Anyway, we talked about the basics. Eating, sleeping, breathing, moving, pooping, thinking, and growing.

I like that. Oh, that's good.

That's good.

And then so step three is opening up the deep.

Wait, step three. Okay, I'm ready for.

Step three is opening up the detoxification pathways. So this incorporates some of that. So it's. How do we get rid of crap out of the body? We poop it out, we pee it out, we sweat it out, we breathe it out. And so that's kind of what we're doing here. Making sure that people are having bowel movements at least two a day, ideally that we're opening up liver, kidney, lymph, neurolymph pathways in preparation for step four. Because generally when you start to remove the toxins out of the body, it's going to be uncomfortable. They've kind of formed this bond to you. I got my jersey coming out. They got to form this bond to you.

We're loyal. Toxins.

Right. Where they don't want to. Right, exactly. They don't want to leave. And so it's uncomfortable for a variety of different reasons. But you get die off or you get a Herxheimer reaction where you feel Worse. And so your success is really going to be based on how well you have done. Step three. So I think of this process as kind of like a funnel where as you're dumping things into this funnel, as you're starting to remove them, step three determines. Determines how easily they are getting out of the body. So if the patency or the opening is very small, you're going to overflow. Right. As you're dumping these toxins in. But if it's really open, you're going to be able to get a lot of these toxins out in a more rapid fashion. So that's step three. Any questions there?

Well, yeah, because first of all, how long does it take? What's the range? Obviously, it's different for everybody, but what's the range that you've experienced that people go through? Step two and three? Because step one is discovery, right?

So generally. Yeah, exactly. Step one's discovery can usually happen. Obviously, just the symptoms can happen within the first hour. Then they get the labs and whatnot. So that'll take a little bit longer. But generally we want to spend a month or two in each one of these first couple of sections with the majority of our time being in step four, because that's really where the money's at.

At.

Okay, let's talk about step four.

Yeah. And so then step four, we're talking about heavy metals. Right. 100,000 pounds of mercury are dumped into our oceans every year. You know, 70% of our lipsticks are.

Where's it coming from?

Coal plants.

Okay.

Even if we don't have that many in our country, I mean, we have had, but there's plenty of other countries that are still producing a lot of. Using a lot of coal plants.

So is this more about the fish that we're eating or actually being in the ocean? Because it's heavy, so it's not going to be aerosolized. What's the exposure mechanism then?

It's mainly fish. There is also obviously mercury amalgams. Those are kind of the two biggest sources. But I do think that you're also going to get exposure. I mean. Yeah, it's a good question. You know, how does mercury do in water? And at what temperature is it going to become a vapor again? And are you going to get it through your skin swimming in the ocean or being near the ocean? Do people who live near the ocean, do they have more mercury toxicity?

I don't know. Wash up also. And it gets. If it's in one place, it'll get it everywhere else.

I wish I were Southern, because this would be the point. That's such a good question, honey. You know we don't know, right?

I thought I was marrying a Southern. I married a Texan who lost her accent along the way. So. I always love that Southern accent, but.

Yeah, me too.

She won't put it on for me.

Oh, man.

You'd be like, honey, it's like lingerie. Just talk Southern, right?

All right, so we messed up this earth. We got it.

So we got mercury, lead, lead. We've got plastics. 86,000 different chemicals we're exposed to on a regular basis. 500 different chemicals we're exposed to before we leave the house in the morning from everything that we're putting on our face and whatnot. It's worse for women than it is for men. I think it's 300 for men, 500 for women. And then we're looking at mold. And half of all the buildings in first world countries have water damage, and most of those have mold in them.

Them.

Let's pause for a second on that, Evan, because when you say that, people are like, okay. But when you really drill into it, one thing that's particularly poignant that I find with my patients is dorm dormitories and schools, and that. I mean, school teachers are just getting nailed with mold exposure. And kids who go to college, more often than not, those dorms are moldy, and kids are getting exposed in their. Or if they're going to school in a place that's particular, like a Florida climate, is much wetter. And so those buildings are all much more likely to have it. So the issue is these unconscious exposures. If you drive a car that had water damage, your car can have mold in it because it doesn't fully dry out.

Yeah, and that's a really good point. And people don't realize that it's a place that you lived in, had to have water damage, but it could have been when you were five years old and it's still in your body. And people were like, nah, I don't have any mold. And I was like, okay. Did you ever live in a place that had a flood in the basement? And people were like, oh, actually, every single winter it flooded. Did you ever live in a place that smelled musty? Did you ever live in a place that had cats that peed on the cardboard boxes when you were in medical school? That was part of my story. They peed on those boxes in the basement, grew mold. And that was one of the ways that I was exposed. Did you ever live in a Place that had a leaky roof that had to be repaired. Did you ever live in a place that ever. In the lifetime, I mean, this is all in the lifetime of the home. I live in a hundred year old home. Right. How many busted water pipes have there been in this home? Right. And so these are all things that are behind the walls. If you do see mold, it's very much the iceberg concept where it's like an eighth of what's actually really happening behind the walls. Right. So it's incredibly nebulous and it's a huge part of the work that we do, which is why we actually have a mold remediation specialist who's done this several times to walk people through this process because it is such a big part of the work that we do. I would say mold plus some sort of infection is like the. Yeah, it's deadly. It's like the biggest reason why we see people with me, CFS.

Got it.

Crazy.

So that's mold. Anything else on mold before we move on? So we talked about heavy metals, chemicals and just interrupt me because I get on a roll, my jersey starts coming out.

Yeah, we're going to interrupt. No worries.

That's good. So heavy metals, chemicals, molds, and then infections. And these infections could be Lyme type infections, where you've got borrelia, which you really can't have borrelia unless you've got symptoms that move around the body. Whether they're the joint pain, the muscle pain or the nerve pain. It's got to move around the body where this week or this day it's in this spot and then next week it's in a different spot. And those symptoms have to come and go. Go where Some days are worse than others. If you don't have those symptoms, you really can't have borrelia. And the same goes for Bartonella, where this is going to be pain on the bottom of the feet, muscle cramps, usually in the calves at night, problems sleeping, hard time falling asleep or staying asleep, mood issues, whether it's anxiety or depression, bartonella, striae. So those scratch marks that people get, thyroid issues. I love telling the story about reversing people's thyroid and getting them off of thyroid medication. And one of the main ways of doing that is by treating Bartonella. And people don't have to have all these symptoms, but having like three of them where like pain on the bottom of the feet, misdiagnosis, plantar fasciitis, maybe they've got fibromyalgia, maybe they've got muscle cramps, maybe they got sleep issues and that means they need to be treating some bartonella. Or maybe it's Babesia, where they're sweating all the time or sweating spontaneously. Maybe it's every couple days or a couple weeks. They've got. Got awful sleep, they've got anxiety to the point of panic attacks, depression to the point of suicidal thoughts and shortness of breath. And once again, you don't have to have all those, but a lot of those. Or maybe it's Epstein Barr virus, like having. I mean, they're pretty non specific, but it's the fatigue, the lethargy, sore throat, large lymph nodes, among other things. And then there's the parasites and the yeast and the other bacteria.

So I'm going to interrupt for a second. So here's. I'm with you 100% on what you're talking about. What I'm not, what I don't actually get is how do you do this in the group setting? Because everybody.

Wait, you do this in a group setting? I totally miss that.

Yeah, no, that. He runs programs and it's a group.

Well, I do one on ones and groups. So there is some depending on. Depending on which level they want to join, but there is just group. Group components. And so. That's a great question. You want me to answer that?

Yeah, yeah, please.

Well, I just want to make sure there wasn't more to the question.

No, I mean, it is so complicated. Everybody is so unique. I struggle to do it on one on one. So how do you do it in the group?

It is like a cattle call. You are like, okay, you got 1, 3 and 5, you go in that corner and you got 2, 4, 3 and 7. You go over there.

Right.

Well, I love the way you think. So it is that algorithm that you were talking about. Initially, we are matching them up with the tre treatment for the, you know, whatever. Eventually they'll be put into those groups that are more specific for those potentially. But fortunately, these symptoms that I was just mentioning, you can determine which one of these infections they have, for the most part, for a lot of the infections, or at least the Lyme type infections based off of their symptoms. So in that first hour, they go through step one and they know which infections they have, or a lot of them.

So you have a great questionnaire and you're like, if you scored 4 or 5 above on these number, then you've just. This is something you should check off as probably having. So you make them do the work. They're Doing all their own work except for the brain fog patients who are like, I don't know how to do this.

But in the group setting, are you getting actual testing, individualized testing?

Yeah. So then I do. Well, I have them get the 25% that everybody needs. So that's heavy metals, chemicals and mold and stool test. And then when we're in the group format, so then they're moving through and it tells them in step two. Okay, if you had this. Cause we basically have like a causes sheet where they have checked off and so they have this master sheet so they know what their 20 plus causes are. And then they know which supplements to take for each of those because they're basically layering on. Okay. Now it's this cause now I take these supplements sort of thing. And then in the groups they get face to face time with me for five to ten minutes to answer what questions they have. If they're not sure what causes they have, they answer that. If we need to go over labs, we do that then. And then we also have an online community that's like a Facebook group, but it's not on Facebook. It's on mighty networks where they can ask questions as well. Because I think that the gold in a lot of this stuff is getting questions answered in an expeditious fashion so you can continue to move forward. Sometimes people don't know what the questions are. So they just show up and they realize that they actually somebody else asks a question that they didn't even know that they had. Right. So I always encourage people to show up. That's right. Right. And so that's kind of, that's how we do it. But we make sure we do our best. We're kind of like we're going to be hiring an accountability coach who's going to check in with people on a more regular basis. We do have one on ones with a health coach. We have one on ones with a nervous system retraining coach. We have one on ones with me. We've got groups with each one of those people as well as we've got community check in process. We've got medit that happen every Saturday. So we're addressing it from mind, body, spirit, social, all those sorts of things in a group format.

That's great. That's really great. So I mean I could talk about this for hours because I think it's fascinating. Especially I love that you've algorithmically put it into practice, which is so great. But we do have to bring it to an end. So how can people reach you? How can they find you? How do they get your book? Do you have a book coming out on long haulers?

I don't.

Not yet.

I don't. Not yet. We will see how that goes. I got to read Dirty Girl first and then, you know.

Got it. So how can people find you? And we'll put this all in the show notes, but how can they find you?

So I'm@fixyourfatigue.com in case you forget. It's right behind me. But F I X Y-O-U-R-F-A-T-I G U E.com I've got a free Facebook group on Facebook where people can jump in there and there's lots of education. We've got quizzes on our site for Bartonella. If you have Bartonella, if you have Babesia, you want to. Actually, the Babesia quiz isn't ready yet, but we've got the Bartonella quiz. So we've got a bunch of stuff on the website that hopefully can help people on their journey. And then we do offer free calls if people are interested in seeing whether or not we can help you or not. Jump on a free call and explore.

Is that how they get onto a group?

That's how. Yep.

Okay.

That's how they would get onto a group. Yep. And we're also working on creating like a standalone course where if people are self directed and they. They can't afford what we the investment for the larger group, then they can go ahead and move through it at their own pace.

That sounds amazing.

That's awesome.

It's a huge contribution to the field. So. So, Al, thank you for doing the work.

Thank you so much. Appreciate that.

So thanks for coming on. I guess he's looking at me. So. Do you want me to say it? So thanks for spending another podcast of Live like youe Matter. Our guest today is Evan Hirsch. And Evan, it's been awesome to have you here. Thank you.

Pleasure. Thank you.

Thanks so much for having me on, guys. Appreciate you.