Fatigue is one of the most common symptoms of PCOS. In this podcast, fatigue expert Dr. Evan Hirsch outlines the 15 underlying causes and offers practical advice on what you can do to fix your fatigue and start feeling energized.
- The relationship between hormones and sleep
- The role of nutrient deficiencies (magnesium, b12, vitamin D)
- Labs to request that get to the root of your fatigue
- The role of emotions and mindset
Dr. Evan, as he is affectionately known, is the best selling author of Fix Your Fatigue: The 4 step process to resolving chronic fatigue, achieving abundant energy and reclaiming your life! and one of the nation’s leaders on finding the root causes of chronic fatigue and resolving them. He suffered with chronic fatigue for 5 years before he achieved resolution using the Fix Your Fatigue Program that he developed at the Hirsch Center for Integrative Medicine in Olympia, Washington. He has helped hundreds of people resolve their chronic fatigue and is on a mission to help 100,000 more through his videos, online courses, books, 1-on-1 consults and the training of providers. He has lectured nationally and internationally on topics in integrative and functional medicine and is board certified in family medicine and integrative medicine. When he’s not at the office, you can find him singing musicals, playing basketball, traveling, dancing hip-hop, and spending time with his wife and daughter.
Amy: I think that fatigue is probably one of the most troublesome symptoms of PCOS. It’s certainly was for me. I would say that fatigue was my rock bottom, where I wasn’t really able to cope with life and be the mom that I wanted to be to my little children. At the time, they were three and one. My boys were these little toddlers, and I’d spend most of my day lying on the couch. That was really my moment where I realized that pills weren’t going to fix my ill, that I needed to take charge of my PCOS. It kind of led me on my PCOS Diva journey.
For those listening, it sounds a little bit like you, I have a great resource today that I want to introduce you to. It’s a book called, “Fix Your Fatigue, the 4 Step Process to Resolving Chronic Fatigue, Achieving Abundant Energy and Reclaiming Your Life,” by Dr. Evan Hirsch. I am fortunate enough to have Dr. Evan on the program today to tell us more about his work. He is one of the nation’s leaders on finding the root causes of chronic fatigue and resolving them. He suffered from chronic fatigue for five years before he achieved resolution using the Fix Your Fatigue program that he developed at the Hirsch Center for Integrative Medicine in Olympia, Washington. Welcome, Dr. Evan.
Dr. Evan: Thanks for having me, Amy.
Amy: I’ve been reading your book all week, and boy, I wish I had it, like how many years ago? 14 years ago, when I would have had hit my rock bottom and was too tired to get up to be a mom to my kids. I think, we were talking before we started recording about this idea that there really is no magic bullet, no magic pill, that you can take to fix your fatigue.
I loved in the beginning of your book, you really lay it on the line that it’s probably not going to be an easy fix, that it’s a journey. I was wondering if you could share a little bit about what to expect when you say, “Okay, I want to start healing myself.”
Dr. Evan: Absolutely. The first thing to remember is that everyone has different causes of fatigue. I’ve found that there are 15 causes, and I know there’s more than that but those are the ones that I’ve found. Everybody’s got a combination of those, and everybody’s different. So why does something work for somebody else over here, but it doesn’t work for me over here? That’s really why it’s so complex and why you can’t do a research study on chronic fatigue and get it right, because you can’t isolate one particular variable, which makes it so complex.
Amy: Yeah. I think for me getting my blood sugar balanced, was huge, and when you have little kids you’re not getting sleep. I think you sort of overlook the fact sleep is such a healing method for people with fatigue. I’d venture to say most of us probably don’t get enough.
Dr. Evan: Absolutely. Yeah, and what’s really interesting too is that the causes of sleep problems are also usually the causes of fatigue. There’s huge overlap in there. With sleep some of the, if I can dive into sleep there for a little bit?
Dr. Evan: Yeah, and there’s also so much overlap with PCOS as well, because in many ways sleep is an endocrine issue. Because I get more people to sleep by giving them things in the morning, than I do by giving then anything at night. Those things in the morning are thyroid, if their thyroid is low, adrenal support, nutrient deficiencies like B12, iron, stuff like that. Because it is a circadian rhythm dysfunction. The rhythm, your sleep-wake cycle is disrupted.
If you’re tired during the day and you’re supposed to be awake, your body gets confused. I tell people, “You’re supposed to be awake during the day and then asleep at night.” Your body’s kind of this, it’s asleep and awake during the day, and then you have that same thing at night, so you don’t get that really good deep sleep. So fixing the hormones pays a huge role. Often times there’s some neurotransmitter issues that might be going on because of those hormonal issues, so I’ll give people relaxing things to take at night.
Progesterone helps people fall asleep. Estrogen helps people stay asleep. People forget about that. Often times I’m doing it with post-menopausal women, but if someone is younger and they need their hormones fixed, and they have some of these symptoms, they can say, “You know what, I may have estrogen deficiency.” That’s why sometimes the pill works, because it’s a combination of estrogen and progesterone, so that can be helpful for some people.
Amy: Yeah, and women with PCOS tend to be really lower progesterone. Also B12 levels are often very, very low, especially if you are taking Metformin and you’re not supplementing with any B12, because Metformin depletes B12. Vitamin D is a huge deficiency for women with PCOS. Since we’re talking about deficiencies, magnesium. Women with PCOS are 19 times more likely to have low levels of magnesium, and what could that do to your sleep?
Dr. Evan: Yeah, magnesium is amazing, involved in 550 different enzymatic reactions in the body. Everything from detoxification to sleep, to muscle relaxation, central nervous system relaxation. It’s so incredibly important, you know, gut function. Yeah, and so getting magnesium tested but also taking magnesium. Taking a chelated form of magnesium, it’s going to be better absorbed and you just take it to bowel tolerance. I basically have people start off with one tab at night, increase every three nights, because there’s a bit of a delay.
If you take it every night you’ll end up with diarrhea. But if you take it every three nights, eventually you’ll start getting soft stools, and that’s your, quote-unquote, bowel tolerance. That’s the amount that your gut can take before you actually get diarrhea. So it can also regulate your gut, which is really nice to. But yeah, it’s so important.
Amy: Yeah. Maybe you can go through, I know 15 sounds like a lot of root causes of your fatigue, but maybe would you mind going through them for us?
Dr. Evan: Yeah, that would be great. I love talking about that. Sleep is the first one. It’s so incredibly important. 30% of the population doesn’t sleep well, if not more. Heavy metal toxicity, hormone dysfunction and that can be adrenals, thyroid, sex hormones like we see a lot with PCOS. We’re going to come back to that when I start talking about some novel theories on PCOS causes.
Infections, that could be infections in the gut. It could be everything from a bacteria, to a parasite, to yeast, or it could be in the bloodstream, or systemic like through the rest of the body, like Lyme and some of its co-infections.
Nutrient deficiencies we talked about a little bit, like B12, vitamin D, iron. Lack of exercise, and this usually once people … it’s kind of like the first tier. As you get out of high school and you no longer have gym class, then that’s the first step that ends up happening, you’re not exercising as much.
Dehydration, people should really be consuming, based off their body weight I say half their body weight in ounces, but usually around three liters of water a day, and putting in a pinch of sea salt can be incredibly helpful because that actually nourishes the adrenal gland.
Amy: I thought that was a great tip in your book, and easy to do.
Dr. Evan: Right, yeah, absolutely. Now, if you get bloated with it or if you start to get swelling with it, then you know that it’s not for you, but 90% of the time it’s really great.
Then chemical toxicity, constipation, lack of oxygenation. So if you’ve got stuffy nose or obstructive sleep apnea, you’re not getting enough oxygen into your body, which also goes along a little bit with the lack of exercise. And then mold toxicity, so when people have been exposed to mold. Methylation issues, which has to do with detoxification. It’s very much related to B12 folate and thyroid deficiencies.
Mitochondrial dysfunction. The mitochondria is the energy center of every cell in the body, about 80% of our energy comes from these mitochondria. That can be damaged by heavy metals, chemicals, molds, infections, some of these things we just mentioned. Depression, anxiety, mood disorders can also cause fatigue. Sometimes the question is, is the fatigue causing mood disorders? Is the mood disorder causing the fatigue?
And then allergies, so whether that’s inhaled allergens or whether that’s food allergies, which plays a big role, and tied into there also is blood sugars. I’m going to dive in and put a plug in there for the paleo diet. I’m a big fan of a meat and veggies diet. Grains are really toxic. Every time you consume grains, they cause your blood sugar to spike, and then that causes your insulin to spike. You guys with PCOS, you all have high insulin, so that ends up disrupting your adrenals and causes more stress on your adrenals, which compromises the whole axis of all of these hormones and the beautiful dance that exists between the thyroid, the ovaries, and the adrenals.
Amy: You know, there’s, lately I’ve been hearing from a lot of women who want to be vegetarian, want to be vegan, and really try to work that lifestyle, that diet, but still not feeling better with fatigue being one of those major issues. I don’t believe that there’s any one-size-fits-all approach. I certainly think that a diet, and I’m sure you’re advocating a Paleo diet that’s full of plant-based food, number one. But I do think that most women with PCOS need a little animal protein to feel good. Just curious about your thoughts on the vegetarian/vegan lifestyle, maybe how that might lead to fatigue.
Dr. Evan: Yeah, it’s very challenging. I definitely work with people who are vegan and vegetarian, and sometimes we have to supplement with other things that they’re not getting from meat and meat products. But like you said, it’s not a one-size-fits-all. I like to start with the Paleo diet as a jumping off place for people, because it also helps regulate the blood sugars, but it definitely has to be individualized for folks. It really does need to be largely plant-based. I tell people, if you’re looking at your plate it should really be half to three quarters vegetables, and then a quarter to a half of meat, maybe an additional starch like a potato.
Yeah, there’s a lot of really great nutrients that you find in the different varieties of meats. But you also have to remember that what we’re talking about is we want organic, we want low toxicity, we want grass fed. Because if you don’t have grass fed meat, it’s informatory. There’s something called arachidonic acid that’s in beef that is pro-inflammatory, unless the cow is a happy cow and has been eating grass and has been grazing the field. Then you’ve got an increase in omega-3 fatty acids and the meat becomes anti-inflammatory, and that can make a huge difference in how people feel as well.
Amy: As you were listing the different triggers of fatigue, so many of them fall into the PCOS category. Obviously the sex hormone dysfunction, nutrient deficiencies. I think the mitochondrial deficiencies, I think many women with PCOS have issues there as well, and adrenal function, thyroid gland function, emotional stress. Where do you begin? If you have all these factors that are coming into play, where do you begin addressing?
Dr. Evan: You have to start with the basics, you know, this beautiful work that you’re doing. You have to be drinking water, and eating the right foods, and exercising, and getting your brain in the right place, starting to think positive thoughts. Thoughts are vibrations and vibrations attract. If you’re thinking negative thoughts, you’re going to be attracting negative things into your life, so you have to make that brain switch too.
That’s definitely the place that I like to start. And then I like to start by regulating hormones and boosting hormones, if I can, if that is possible. Because the stronger that you are, the more robust your adrenals, your thyroid and sex hormones are, the more easily you’re going to be able to tolerate removing heavy metals and chemicals and molds and infections.
But sometimes, for some reason, people can’t tolerate those things, and then we have to jump to what I call the usual suspects, those guys that are really causing a lot of the problems from the brain down.
Amy: In your book, I thought you had some resources if you need to get some lab work done. How do you know that you have hormonal imbalance and to what effect, to what degree, unless you actually get some lab work done? I think a lot of women have a hard time getting the right lab work done. Maybe talk about that.
Dr. Evan: Exactly. Yeah, thanks for bringing that up. People think that they need a doctor in order to get lab work done, and fortunately in this day and age that’s not the case. I have given some resources in the book that talk about the exact labs that you need to get done. I’ve even created a lab panel at one of these wholesalers, where you go to this website and you can purchase these labs, and then you take them to Quest or LabCorp, and then you get them done. Then I tell you how to go over them in the book too, so that you can really try to fine tune. Then I tell you how to fix them.
My goal with this book really was to try to help as many people as possible for $5 on a Kindle version or $18 on a paperback. If people need more help, then they can either come and do a course with or one-on-one, but that you can get the help you need if you are so motivated by jumping into this book and getting these labs done.
Amy: Yeah. I think if you’ve hit your rock bottom, like I did, gosh this book is a lifesaver. You also have a Facebook group that you can join too. It’s part of the book community as well.
Dr. Evan: Absolutely. Yeah, Fix Your Fatigue with Dr. Evan Hirsch on Facebook. You can search in there and come join us. We’re very close to 200 people, and I just started it in May. A lot of people are … most people are hearing about it from the book and so people are getting in there and sharing their stories and saying, “Hey, I’m doing this part in the book, what are you doing?” It can be a really good support for folks.
Amy: I know that you must see some patients with PCOS, considering that upwards of 20% of women have some symptoms of PCOS. We talked earlier, you had some thoughts on the root causes of PCOS. I’d love to hear what you think and how you treat your patients.
Dr. Evan: Absolutely. I always take a step back when I see a conglomeration of symptoms, and say, “Okay, well what’s causing all this? What’s the root?” When we look at PCOS, it really is about the hypothalamic pituitary gonadal axis. So, it’s this messaging coming down from the brain, going to the thyroid, going to the adrenals, going to the sex hormones that’s not working right. If you look at all of those symptoms of PCOS, they’re all from a consequence of dysfunction in one of those things, and then the complications of not having a great lifestyle on top of it. When I look at that, it’s very similar to fatigue, where there’s a number of things that can cause that sort of disruption. So that’s where I start, and that’s where I help women get pregnant, or help get rid of their hirsutism, the hair on the face and the obesity and stuff like that too.
Those usual suspects that I find really are heavy metals, chemicals, toxicities from these things, heavy metals, chemicals, molds, infections, allergies, emotions and EMFs or electromagnetic frequencies. I find that when we start to remove these things, because these things are either in the glands, or they’re messing with the brain’s relationship to these glands. When we remove them, then the body starts to repair itself and a lot of these things really come into alignment. The other thing that also happens besides this relationship of the brain to the glands, is that sometimes there’s conversion issues. All of your estrogen is coming from testosterone. Whether you’re a woman or a man, that is the conversion pathway. Oftentimes, there is a, and this can happen with men too, I see this a lot with men when they had these toxicities. Where you get a problem with this conversion, either your over converting from testosterone to estrogen, or you’re not converting. That’s why there’s a lot of low estrogen symptoms in PCOS as well, because that testosterone is not converting to estrogen.
None of this has been proven, this is just based off of my experiences and my thoughts on a lot of these theories, but this is where I go. I think the last thing that I would share is there’s an infection that I see a lot that I treat a lot that causes cysts in the body. That infection is called bartonella, that I talk about a little bit in the book, and I’ve done a number of talks on it that you can Google online. Bartonella will causes these cysts and it also causes low thyroid, it causes neck pain and headaches and anxiety, depression, muscle cramping, pain on the bottom of the feet, sleep problems. How many of these things are also existing in PCOS? Once again, it’s never just bartonella. So it’s a combination of bartonella plus heavy metals, or mold, or something like that. But how much of that is playing a role that is exacerbating the situation?
Amy: Where would the bartonella be coming from?
Dr. Evan: Great question. I think about 99% of all humans actually have it, and that’s because 50% of all domestic animals have it. A lot of us get it from mother to child through the placenta. Then also it can be transmitted sexually, it can be transmitted by anything that takes a blood meal, so that could be a mosquito, that could be a tick, a chigger, a biting fly, sandfly. So yeah, it’s pretty ubiquitous and it just needs the right environment to pop out and start causing problems.
Amy: I live in New Hampshire, where it’s one of the highest concentrations of Lyme and coinfections. I have many friends that do the magnetic therapy to help remove, or mitigate. I don’t know what you would really call, do you actually remove it with magnetic therapy? I don’t know, but bartonella and Lyme and those co-infections. They seem to have a lot of positive results.
Dr. Evan: That’s wonderful. I’ll have to ask you more about that offline. I’m not that familiar with the magnetic therapy. We’re using herbs and we do some PEMF therapies, maybe that’s what you’re referring to, but I’m not familiar that much with the magnetic methods.
Amy: Okay. Yeah, so what type of herb? Is it something that you could treat, if 99% of us have it, and if it might be causing problems with PCOS, can we just go ahead and treat it?
Dr. Evan: You can’t. Part of that is because the stuff is potent. In order to eradicate a lot of these infections, and when I mean eradicate I mean bring it back into balance, is that you really have to work on a number of different fronts. You have to use a great antimicrobial. You have to balance the immune system. You have to change the immune system’s relationship to the bug. And then you also have to remove what other triggers were present, whether it’s heavy metals, chemicals or molds. You can’t get rid of any infections if you have mold present, it just doesn’t happen. You have to make sure that that’s working too. And then the treatments are really powerful, even though they are natural, that sometimes one drop is going to cause somebody to have die-off, which is basically the bug is dying, it’s overwhelming the system, overwhelming your ability to detoxify the bug, and then that drains your hormones even more. You have to be working with somebody who’s skilled in this so that you can make sure you’re doing it right and you don’t get worse.
Amy: Yeah, that’s interesting. I’m just throwing this out there, I wonder if that’s another reason why berberine works really well for women with PCOS. That’s antimicrobial, and I wonder if on the side it’s helping with these issues as well. I don’t know.
Dr. Evan: Yeah. We love berberine here. My physician assistant, Allyson, has done a whole bunch of research on this and found a bunch of different ways to use it. We see great, great stuff with lowering cholesterol, regulating blood sugars. In a head to head trial with Metformin it was just as good, and then it’s got that antimicrobial activity. So it’s usually more of the antimicrobial stuff in the gut than it is systemic, unless it was some of these other bugs. But yeah, it’s an amazing treatment. I would have everybody on PCOS on it for sure.
Amy: You did mention, when you were going through your thoughts on PCOS, emotions. I really do think that emotions play a huge role. I would love if you could expand on that a little bit.
Dr. Evan: Some of it is the chicken or the egg in terms of emotions. Is there an infection or a hormone or something like that that’s causing the anxiety and depression? Or is it the other way around? Because there is the mind-body connection but there’s also the body-mind connection. Really having that positive attitude is so incredibly important, and that hope, and that desire to get better, and that curiosity. I recently did a Facebook Live on what the best mindset is. You just have to keep going, you can’t settle for no. You just have to remain curious but accept where you are, but continue to move forward. That’s a real challenge. The definition of happiness really is contentment with what you have. Right? Because if you’re wanting something that you don’t have, that breeds discontent and that breeds unhappiness.
But you have to balance the two, because you also want to move forward and find solutions to the issues that you’re having. But you have to be content with where you’re at in order to be able to continue to move forward and get there. One of the resources that I do in my own daily life that I recommend to my patients is to listen to Abraham-Hicks, who speaks all about how to yourself into that positive mindset. It makes a big difference for me in my life, and for a lot of my patients.
Amy: Yeah. I’ve shared with listeners that I’m coming out with a book in May. The first chapter is, Think Like a Diva. I think you have to think like a Diva before you can eat and move, it sort of all stems from that place. I talk about how I think so many of us are stuck in that lack place, like, “I’m not enough. There’s not enough time. There’s not enough money.” I do think a resource like Abraham-Hicks gets you out of that lack mentality into wanting more abundance thinking. Yeah, it is a great resource, the books. I have a couple on my shelf but can’t see them right off the bat.
Dr. Evan: I like, there’s a number of different YouTube channels that post things every day. So every day I get something popping up and I listen to it on my way to work. That can be helpful. I think Abraham-Hicks Unlimited You and stuff like that.
Amy: Yes, Unlimited You.
Dr. Evan: So, there are some good ones if people want to taste.
Amy: Yeah, and I think you have to feed your mind with these positive resources, books. I love Audible. I listen to so many Audible books, and podcasts, because we’re bombarded with negative news all day long. I think that really adds to our issue.
Dr. Evan: Absolutely. It’s that balance. You want to be informed, but I don’t watch any news. I get The New York Times highlights come to my email. I’ll read them about 50% of the time. Anything that’s significant, people are talking about at the office or my wife’s going to tell me. But I find that that’s so much healthier for me. Yeah, maybe I’m not as well informed as this person over here, but I’m a lot happier than they are.
Amy: Yeah, no absolutely. This brings us to a close, but before we go I was hoping that you could maybe give us a few action items to really fix our fatigue over the next week.
Dr. Evan: Absolutely. Let’s see, sleep, so incredibly important. Start setting your alarm for … Your alarm on your phone that is, start setting your alarm on your phone for nine o’clock at night, and start to transition at that time into going to bed, turning off your screens and really creating this beautiful oasis of an environment for sleep, so that you can get in there and you can get to bed by like 10:00, 10:30. Because there’s really that window in there that you really need.
You can grab the book and you can check your labs. You can eliminate gluten, which is so inflammatory, damages the gut every time you consume it. On your way to getting more Paleo, you could eat more vegetables. Those are just some tips that I would recommend. I have a bartonella quiz on my website at fixyourfatigue.org. I also have a sleep guide on that same website. You can on there and you can download those for free. Hopefully, those will be helpful for you.
Amy: Tell us more about how women can get in touch with you, or work with you. Do you take telemedicine clients?
Dr. Evan: Yes. We’ve just launched our coaching program. I’m an MD. I see people in my office, but there are a lot of people around the world who want to come see me and they can’t, for whatever reason. I can now operate as a coach, where we do everything virtually. The people who fly in to see me for the first visit, then I can use my MD and really the main thing that they get is my ability to prescribe medications. But otherwise as a coach I can do 95% to 99% of everything that I would normally be able to do anyway. I see people for one on one consultations. You learn more about that at fixyourfatigue.org. Then of course there’s different ways to work with me, I’ve got videos on there, I’ve got the book that you can get. It really depends on what you need, your level of self-motivation, versus if you want to work with me one on one.
Amy: Yeah, well I definitely encourage everybody listening to pick up a copy of the book on Amazon or Kindle. Again it’s Fix Your Fatigue and I’ll have all those links in the show notes. Thank you so much, Dr. Evan Hirsch, for joining us today.
Dr. Evan: Thank you Amy. It’s been a lot of fun.
Amy: That wraps up our podcast today. Thank you so much for joining us. I hope that you enjoyed it. If you liked this episode, please don’t forget to subscribe to PCOS Diva on iTunes or wherever else you might be listening. If you have a minute, please leave me a quick review on iTunes, I love to hear from you.
If you think of anyone else that might benefit from this podcast, please take a minute to share it with a family, friend so that she can benefit from it too. Don’t forget to sign up for my free weekly newsletter, just enter your email at pcosdiva.com to get instant access and make sure you never miss a future podcast. This is Amy Medling wishing you well. I look forward to being with you again soon. Bye bye.