Unlock Your Energy: The Hidden Impact of Fatigue on Diabetes

Evan Hirsch, MD

I’m the EnergyMD, and my story started when I had a functional medicine practice and I got chronic fatigue. Unfortunately, I went to 20 different practitioners and couldn’t find help. I realized after napping under my desk for the thousandth day in a row that I had to do something about it myself. So I went on this journey, and I knew that if I could find all of my causes, I was going to be successful. So at this point, we’re looking at 38 different causes of fatigue. So everybody that I see who has chronic fatigue has a combination of these causes. It’s never just one thing. People who have diabetes have these causes as well. So then I wrote a book about it, and now it’s been my mission to help these people resolve their chronic fatigue.

Beverly Yates, ND

What a wonderful mission! These issues of fatigue have been around for decades. Originally, some of the biggest messages that people got were that their fatigue was quite all in their heads. There are some medical doctors whose careers started that way and who are quite famous for talking about how fatigue, just like yourself, chronic fatigue got them started on this path. It’s interesting when it’s personal because that makes it more real sometimes for those of us who are health professionals who maybe aren’t particularly naturally empathetic, but when it’s real for us, then suddenly we can hear it in the people that we serve. then some of us are already empathetic. We don’t have to have the problem to understand that it’s real for the person we’re serving. What’s one of the things that you want people to take away from your session here as we get started as a key understanding around fatigue as it applies to pre-diabetes, Type 2 diabetes, and diabetes more broadly?

Evan Hirsch, MD

A lot of people may understand that when you have hypoglycemia and your blood sugars are too high, you can potentially have fatigue. But a lot of people also don’t realize that when your blood sugars are too low, you can have fatigue. When people have diabetes or other blood sugar irregularities, you’re going through this flow where sometimes you’re too high and sometimes you’re too low. Then that brings things back to diet, which is such an important component of this, where you want to make sure that the blood sugars are released very slowly into the bloodstream. That means that for any foods that you’re consuming that may be hypoglycemic, you have to make sure they’re bound up to protein or fats. That’s an important point. The other thing, too, is that if people have regulated their food and their diabetes and they’re still fatigued, other things could be happening, and we can go into those as well.

Beverly Yates, ND

Let’s take a look at that because for some people who are on the reversing Type 2 diabetes journey, their health journey, they’ve been on it for a while. We’ve had some successes, and they’ve had some things not go the way they would have preferred. One of the things that gets stuck is that sometimes people are eating what appears to be a healthy nutritional plan. They are physically active. They’re working on exercise, and they’re consistent with it, which is so key. They’re doing strength training. They’re paying attention to the two most basic building blocks. But those aren’t the only pieces. What are some other things that people might be missing when it comes to fatigue? Because I’m sure some of this is not obvious to the general public.

Evan Hirsch, MD

I like to look at this in the realm of causes, and I break them into two categories of deficiencies. These are things that are not in the body that are supposed to be there or not in their life. then toxicities. These are things that are in the body that aren’t supposed to be there. When we look at deficiencies, there can be deficiencies in hormones like adrenals, thyroid, and sex hormones. We can look at deficiencies in mitochondrial function, which is found in every cell in the body except for red blood cells and makes about 70 to 90% of our energy. We can have deficiencies in a lot of lifestyle habits like you were talking about. Sometimes people aren’t getting enough good sleep. They’re not getting enough good food, and they’re not getting enough good movement. So as long as those are the things you have control over, those lifestyle habits. But some of those other things might be off in terms of the deficiencies. Then, with the toxicities, the big ones are what I call the toxic five. Heavy metals and chemicals cause mold, infections, and trauma. Each of those things will cause stress on the human organism and, consequently, will cause a lot of the deficiencies that we mentioned. Then what’s interesting is that if you have stress going on in the body that’s trying to be regulated by the adrenal gland, the adrenal gland makes cortisol. Cortisol manages insulin; insulin regulates your blood sugars, and consequently, you may have blood sugar issues, even though you think your diet is perfect. Sometimes it’s because you have one of these stressors, whether they’re mental, emotional, or physical like these toxins that I’m talking about that can be causing some of your blood sugar issues.

Beverly Yates, ND

Those are factors right at the root cause level. Are there any simple ways that people can, like, do a self-assessment or check in to have a better appreciation for whether their issues might have to do with deficiencies or the environmental side of this?

Evan Hirsch, MD

About 75% of these causes—of these 30+ different causes—can be determined by symptoms in history alone. We have a checklist on our website that people can check out. Don’t go there now. It’ll still be there after this talk, but it’s called the step-one checklist. It goes through a lot of these things. Just based on your symptoms, you’re going to be able to find 75% of these causes.

Beverly Yates, ND

People appreciate checklists. It gives folks a chance for that self-reflection to say, This is great; I didn’t know about that, I forgot. That’s right. I was supposed to be doing that.  All of those things can apply to any category. We’re all busy people, and there’s just sometimes a lot of conflicting information. When people look at the environmental side and when they look at the deficiencies side, let’s look at the efficiency side first, and then we’ll move to the environmental side. We look at the deficiency side. Are there any common myths out there where people may be getting a lot of conflicting information that you would like to just clear up while we’re here together?

Evan Hirsch, MD

There are a couple. One of the big ones probably has to do with hormones. A lot of people think that if you fix your hormones, then everything gets better. Part of that is true. But it’s important to remember that those deficiencies are still Band-Aids; they’re natural Band-Aids. By optimizing the adrenal gland, the mitochondria, the thyroid, the vitamins, minerals, etc., you are going to feel better. But there’s still Band-Aids, and you still have to come back to those root causes. The toxic five that I talk about. The other thing, too, is that there are misconceptions about laboratory testing. A lot of laboratory testing is highly imperfect. So for things like thyroid, we do what we call a subjective ramp-up. We ramp people up to an ideal dose, and that’s their optimal thyroid dose, and everything works better. It regulates blood sugars, decreases inflammation, decreases heart attack and heart disease, and decreases cholesterol. Optimizing the thyroid is amazing. Unfortunately, with thyroid lab testing, a lot of it lags behind several months, and it may take a year or two to figure out your ideal dose based on, like, what I learned in medical school, which is that you change somebody’s dose if their thyroid numbers are off, and then you wait for two months, then you do the lab again, and then you take a look, and then you change the dose again. Instead of doing that, we do a bit of a ramp-up. We get them at their ideal dose. If you go beyond that, you feel hypothyroid. We feel like you just drank a big pot of coffee, and then you can back down to what we considered to be your optimal dose.

Beverly Yates, ND

That’s one area where I’m sure of confusion and also where people feel like they’re not sure who to listen to. The thyroid area is famous for this problem and has been for decades, that’s for sure. The lab tests are sometimes not as helpful as they could be, and the interpretation of the lab tests is also sometimes not as helpful as it could be. People’s lived experiences don’t always, unfortunately, align with whatever the diagnosis maybe when it comes to the thyroid realm of things. What are some other areas of misconception or myth? Understanding? Because when we’re talking about fatigue, like so many things with blood sugar, there’s this thing around Type 2 diabetes or pre-diabetes where people are often blamed for their diagnosis as if they somehow awakened in the morning saying, Let me screw up my health. How can I do it today? Underlying nastiness and presumption in many people who have this diagnosis work hard, surprised, and hard at being healthy. They’re not getting the help that they so richly deserve. One of the reasons we do these summits is to bring together experts, dispel myths, and give people hope, inspiration, and clarity. Is there another element of fatigue that underlies the issues with blood sugar regulation here that people need to have better information on? I feel like there’s a lot of conflicting information out there, and it would be so good for people to say. Now I understand why this is or isn’t working for me.

Evan Hirsch, MD

There’s a couple. Another one that I would touch on would be this idea that there is one cause, and that’s for a lot of those people who are fixing their diet, they’re doing all the lifestyle things, and they’re still having issues, whether it’s blood sugar issues or whether or not it’s fatigue. We’re looking at these 30 different plus causes, and there’s always this combination. Unfortunately, what doctors learn in medical school is that generally there’s a unifying principle or there’s like one cause that’s causing most, if not all, of your symptoms. So that’s an important thing. So you have to be curious, and you have to look for these other causes. The other thing, too, is that a lot of people don’t believe that they have mold issues. “Oh no, not me. I don’t have any mold issues.” But the reality is, if you’ve ever lived in a home that has ever in its history had any water damage, whether a busted pipe, a leaky roof, or a flood in the basement, it’s highly likely that you came into contact with that mold that will increase inflammation in the body. What needs to be done to mitigate that inflammation? It’s your natural anti-inflammatory called cortisol. Which works with the immune system, and cortisol is also supposed to be managing your insulin. So if it’s over here, it’s not going to be over here; it’s not going to be increasing. Your energy is not going to manage your blood sugar. It’s important to remember that about mold. then the other one is also trauma. How trauma stays in the body. You don’t have to have some significant abuse, or what we consider significant abuse, anything we call big trauma, as opposed to little, tiny trauma where you can have it. You can have different things happen in your life that change the way that you see the world and make the world feel unsafe. Then consequently, that creates an ongoing stressor on your body, mental and emotional, that ends up increasing the inflammation in the body, and the inflammation affects the immune system, all the hormones, and consequently your metabolic self and your blood sugars, etc.

Beverly Yates, ND

Those things can live on in the body, and they have their memory, if you will. It almost seems to me like it’s both a physiologic-pathologic interaction as well as an energetic imprint interaction. That trauma is underappreciated in terms of both its impact on our health going forward and what it’s going to take to improve things and undo the impact. It’s non-trivial. because it isn’t often neatly inside of clinical assessment like we don’t necessarily have a lab test per se to objectively measure that, under the whole idea of test don’t guess. It’s like, well, but meanwhile, these things can live on and make a huge difference in how people’s lives unfold and can be. Frankly, the wildcard is that if the person’s doing all the other things, it’s certainly worthwhile to look at that because we all have different vulnerabilities, that’s for sure. One day someone could insult you, and you don’t care. You’re like, you just blow it off, and another day someone insults you and it wounds you. That people who have experienced trauma can be like that just depends.

Evan Hirsch, MD

We have to assume, too, that everybody has experienced trauma. So for people, I never thought that I did. Then, when I started to look at it and work with a trauma coach, I was like, There are certain ways that trauma has affected my life, and consequently, I need to look at those things, and it ends up improving my life for the better and decreasing the stress that I feel chronically, like you said, energetically in my life.

Beverly Yates, ND

These conversations are going to be evergreen and probably even more enriching. So anyone who’s listening, if you would take a moment to just reflect and listen to what Dr. Hirsch is saying here around this topic and just, consider and please don’t minimize whatever your experience has been, sometimes we get shined on and we get gaslit about this. If this is true for you—something that’s happened in your family, something that you are sensitive to, or something that you often notice that you just can’t sustain attention on—it may be something worth taking another look at. In other aspects, when we’re thinking about fatigue and the body’s energy system, I’ve always thought that it’s profoundly unfair that when you think about all the things that go on with diabetes, anything about blood sugar regulation, you think about issues with chronically high blood sugar or chronically low blood sugar because people can crash up or they can crash down. You have hypoglycemia up and hypoglycemia down because our audience here is both a general consumer as well as colleagues and health professionals. It all represents energy, but yet it’s not available to people in a useful way. It’s just ironic. What are your thoughts about that?

Evan Hirsch, MD

It’s true, and so much of it has to do with how the rest of the systems are working. We talked about cortisol, and we talked about insulin. Many things have to be working right for it to lead to energy, so your blood sugars have to be shunted with the insulin into the cells to be able to do what it’s doing. When the levels are too high and it’s knocking on the door the cell is saying, “Hey, no more, I’m now insulin-resistant.” Then consequently you’re going to have problems. Then when the blood sugars are too low and you need the sugar into the cells it’s not there, so when you’ve got that yo-yo going on, it’s hard on your fatigue.

Beverly Yates, ND

It makes sense. It makes sense. People start to feel maybe a little bit of happiness, and then they’re dropped back down again. What have you experienced for the work that you do around fatigue? When people who have diabetes say that they just can’t get up off the couch, they don’t have the energy to exercise; they have the will and desire the intention, but they’re just so exhausted. Any thoughts about that?

Evan Hirsch, MD

It comes down to the beginning. Where we start, so we have a four-step process that we take people through, where the first step is to figure out what causes they have. The second step is to start replacing the deficiencies. Now, if you haven’t guessed yet, I believe that the toxins in step four are the most important of the toxic five: the heavy metals, the chemicals, the molds, the infections, and the trauma because that causes most of our other issues. However, the first thing that we can do that I believe is most helpful for folks to get up off the couch is to work on the deficiencies and what I call the big three, which are the adrenals, the mitochondria, and the thyroid because when they’re optimized, everything works better. The adrenals manage stress, give you resilience, and help with your sleep-wake cycle so that you’re able to fall asleep better in the evening. You don’t have that second wind at night, and it’s easier for you to wake up in the morning. The mitochondria boost your energy in the morning and also help to create that circadian rhythm. The thyroid is wonderful for all the other things that I mentioned before. But taking those things first thing in the morning is great for giving people an uptick in their energy. If their energy is like a three out of ten, where ten is ideal energy when they first start the program, we do this and step two, and then, I would say, probably 70% of the time, depending on how severe the toxins are, we can notice a significant uptick of one, maybe two points going to four, maybe five out of ten, so that they can then pay more attention to their food. They can start with the mindset practice that we talk about. They can be organized around their supplements and around all the lifestyle habits that they need to be doing. It just makes the rest of the process that much easier.

Beverly Yates, ND

It makes sense. It’s such a fundamental issue, and I’ve found that it’s an obstacle. If you’re fatigued and don’t have energy, it’s hard to concentrate, to focus, to get up and get going, and to do it consistently. It is too hard. Once that and that is cracked when you get your energy back, oh boy. unlocks all the other goodness. Let’s take a moment and start having a look at what goes on on the environmental side of it, because in today’s world, we are inundated with all sorts of things, many of which we probably aren’t even aware of, that make a difference for fatigue and certainly can affect it and, frankly, interfere with blood sugar regulation.

Evan Hirsch, MD

What’s important for people to realize is: What are the different avenues that you’re being exposed to? There’s the air that’s around you. There’s food that you eat. When I’m looking at the air, it could be that there is mold in the environment. There can be other toxins that blow over. Oftentimes, if people are living near farms, you can get pesticides that are in your home that you’re breathing. There can be lead paint in your dust if your home was built before the 1970s.  Um, there’s the food, and so there’s the pesticides that are potentially also in the food. There’s something in the soil that you could be exposed to. There’s the water that you’re drinking. There’s a great site called the Environmental Working Group, which is weg.org/tapwater. TAPWATER, where you can put in your zip code and see how toxic your tap water is. It’s just a good reminder that we need some filters. I’ve got black carbon filtration in my home, and then I also have distillation to make the water as pure as possible. Where are we getting toxins from? Is it from there? What about things that we’re putting in our bodies topically? What about the soaps that we’re using or, the cosmetics that we’re using? You can also go to ewg.org/skindeep, SKINDEEP, and you can look at how they’ve ranked all the different cosmetics you can put in your cosmetics, and you can see how they’re ranked on a scale from one to 10, with one being the least toxic. They even have products there that they consider to be EWG (Environmental Working Group) certified or verified, which are the least toxic available. I do recommend doing this for sunscreen. That’s the main reason why I do it. I’m not wearing makeup, but any shampoos or anything like that that you’re using. Those are some other ways that you might be affected. Then in your home, in terms of we talked a little bit about mold in the air, but it can be behind your walls. As we mentioned before, a lot of people don’t believe that they have exposure, and you could have had exposure when you were five years old. That could still be in your body today. It doesn’t necessarily have to be the mold that’s in your current home or that your home has any water damage. It could be in the past. Those are probably most of the exposures that we have: the things we drink, the water, and making food choices. What are you drinking? Is it just water? Are you drinking lemonade with obviously high amounts of sugar or other products that aren’t the best thing for you? What are you putting in your mouth in terms of food, in terms of liquid? What are you breathing in? I feel like I’m missing something, but those are the main things in terms of exposure.

Beverly Yates, ND

Dr. Hirsch, you were talking about the environmental side of things. Let’s continue that discussion. One of the things that people could use a lot more information on, and you have a lot of deep expertise here, is the infectious side of this. Infection that might lead to fatigue and interactions with people’s blood sugar in glycemic regulation. I’d love to get your thoughts about things that people should be looking for.

Evan Hirsch, MD

When we talk about infections, we’re looking at viruses, bacteria, yeast, and parasites. Sometimes they’re spirochetes, which are like types of bacteria that change their shape and any infection that’s in the body. There’s an acute infection and a chronic infection. Acute infections are like when you get a cold, you get over it, and then it’s gone out of the body and the immune system has the memory of it. Chronic infections are infections that get in the body and stay in the body, and the immune system is trying to get rid of them, but it’s not able to. Usually, it’s because these infections are good at hiding themselves inside the body in different compartments. What ends up happening is that the immune system is then stuck in the same position because the immune system’s whole job is to remove things from the body that aren’t supposed to be there. So it’s reacting to these infections that it just can’t quite get to, and that’s called inflammation. So what ends up happening then is that cortisol made by the adrenal gland, which in our bodies may be an anti-inflammatory among some other hormones, is trying to deal with that inflammation to bring down that inflammation. Consequentially, then, that has that effect we talked about before with cortisol, insulin, and blood sugars on the blood sugars. Consequently, you’re going to have a problem with your blood sugars. Once again, it’s another stressor that is potentially affecting the blood sugars. When we’re looking at these infections, the biggest one on the block and a newcomer on the block is COVID. We’re seeing a lot of people with long COVID now where they start with just a little virus, but then their symptoms persist, and sometimes the symptoms go away for a month or two, and then they come back with their weird symptoms. There can be over 250 different symptoms associated with long-term COVID. That’s one that I just want to draw some attention to. But fortunately, among these different infections, most of them can be determined by symptoms alone. A lot of people will have some testing done. Like I said, a lot of testing is imperfect. So you may say, Well, what? I had some testing for COVID, and I don’t have it. I don’t have long-term COVID, and I had some testing for Lyme. I don’t have it on. Fortunately for a lot of these, I had some testing for parasites. I don’t have it. Unfortunately, the testing isn’t good for most of these infections. Some of the testing is called serology testing, so it’s looking at the immune system’s reaction to these bugs. But if your immune system is dysfunctional because you have heavy metals, chemicals, molds, infections, trauma, whatever, and it’s not operating at its best, you’re asking a dysfunctional immune system to give you an accurate response or an accurate test. It just doesn’t work well. You have to look at that yet. Your symptoms and your history. Even the CDC in Atlanta says that most of these infections are considered clinical diagnoses. based on your history and your symptoms by a clinician who knows what they’re doing to help you determine which of these you have.

Beverly Yates, ND

It makes sense. I can see where this is an area where people might get quite confused. Some of these illnesses, whether it’s parasites or some of the chronic viral loads, wax and wane. They don’t; they’re not in a steady state, or they don’t make themselves obvious. Is this part of what you’re talking about when you say that testing is imperfect?

Evan Hirsch, MD

There can be parts of it. Some of these infections do cycle, so sometimes they are going to be more prevalent at different times of the month, depending on how much inflammation you have in your body or what season it is in the calendar year. That can be part of it. But some of it is also the testing itself. We talked about the issue with the serology testing or the immune system. But the other thing is that sometimes we’re doing testing with what’s called PCR, or like a DNA test, where you’re looking at a particular infection. A lot of this has to be done in the compartment where the infection lives. For example, if you are doing a PCR test in the blood and you’re trying to test for something called Bartonella. Bartonella oftentimes lives in the muscles, and it can cause things like pain in the bottom of the feet, usually misdiagnosed as plantar fasciitis, or muscle pain, misdiagnosed as fibromyalgia. Then, if it’s in the muscles, it’s not going to be in the bloodstream. Unless you’re going to do a muscle biopsy, which nobody’s going to do on you, you’re not going to be able to find the Bartonella. Even if you did that, it still probably wouldn’t be a great test. You’re not going to be able to find a lot of these small infections that are living in these different compartments that aren’t necessarily where the testing is being done.

Beverly Yates, ND

That’s a fine example. Thank you for explaining that. I was thinking of some of the people over the years that I’ve heard who say that they were told they had plantar fasciitis, but yet any of the treatments that they went through never seemed to resolve it, and people did not think, Hey, this could be Bartonella. That could be a classic example where one disease entity mimics something else. So it’s a clinical misdirection. People think they’re looking for and assessing one thing when something completely different is going on.

Evan Hirsch, MD

It leads to the point around, like, What should you be looking for—a diagnosis or a cause? Because oftentimes you can have a diagnosis like plantar fasciitis or fibromyalgia, and you still don’t know what the causes are. Notice I said causes, not causes. It’s always a number of these different causes.  But that’s why it’s so important to make sure that you’re focused on what your causes are. Even though it sounds overwhelming like there are 30 causes and everybody’s got 15 or 20 or whatever, the reality is that you can work through a process of just matching up a treatment for a particular cause that you have to be able to reverse. then you’re done, and you’ve fixed the root causes, and you don’t have to deal with this diagnosis, which is just the combination of symptoms generally or laboratory tests that point to the particular pain that you’re having.

Beverly Yates, ND

That just makes sense. I can see where there is a confusing can that just pops up left and right, both for the clinician trying to guide this as well as the person who’s asked for help. I’d love to get your thoughts on how fatigue applies when someone has diabetes. Do you feel like it is a good idea for them to try to push through, or should they instead consider the fatigue as a primary symptom and that they need to check out root cause options?

Evan Hirsch, MD

They need you to listen to your body and push through unfortunately doesn’t do you any favors because the reality is that your adrenals, your mitochondria, and all these other things are already compromised, so you’re not able to make the energy that you need. When you push through, you’re just increasing stress. We’re talking a lot about stress today, but not in ways that maybe people have spoken about before. There’s mental and emotional stress. There are physical stressors, and there are energetic stressors. There are spiritual stressors. Any of these stressors can end up compromising the hormones, the mitochondria, and many other things that we’re talking about. If you try to push through, which would be a physical stressor or maybe a mental emotional stressor, if you’re doing a job where you’re thinking a lot, consequently, it’s just going to push you back further and further, and you’re going to keep getting worse and worse. so you have to take care of yourself. This is part of the reason people come to see me: oftentimes they’ve been pushing through for years, and with the human organism, you can only push it so far until it starts calling out for help. As clinicians, we’ve gone through medical school, residency, clinical practice, working tough jobs, or whatever. This is a story for so many people in our society. There are so many stressors that we have to deal with regularly, and we’re required to continue to push through to continue to function in society. Unfortunately, I just don’t believe that society is made for humans the way that it should be. So trying to recreate your life for what is ideal and changing your mindset to envision what your ideal life would be are things that I encourage people to do. So trying to create their life around and their work around what they want their life to look like as opposed to fitting themselves into their work.

Beverly Yates, ND

Those are great distinctions, and I feel like they’re life-affirming, which means that people have more of an opportunity to have their lifespan and their health span be the same. Many people lately are finding that their health span is nowhere near long enough for their life span. I cannot tell you how many people in my life, Dr. Hirsch, have said to me who’ve been folks in their seventies, eighties, and nineties that they got older and older, that if they’d known they were going to live that long, they would have taken better care of them.

No one has a crystal ball to know when their expiration date is, so today, since so many people are living longer but not living better, this is part of that secret sauce. This fatigue issue is fundamental to diabetes and blood sugar control, that’s for sure. Thank you so much for being our wonderful speaker here and partnering with me on this mission. Dr. Hirsch, where can people find out more about you if they want to connect?

Evan Hirsch, MD

I’m at energymdmethod.com. We’re everywhere on social media. It’s @evanhirschmd from most of our channels. Then you can also text me from our website. It comes directly to me. It’s in the bottom right-hand corner. You can click on it and go ahead and do so, being transparent about our programs and our pricing. At this point, we have a program for almost every single budget to help people figure out their causes and resolve them. Thanks for having me on.

Beverly Yates, ND

It’s my pleasure. Thank you for being a partner in this. Friends, please share this session with Dr. Hirsch, who has shared so many wonderful pearls of wisdom with us. Share it with everyone who shared it on social media. Tell your besties about it. The more people in your life understand what you’re going through with diabetes, the more they can help you, support you and understand what it might be like from your point of view. One of the things that’s so interesting about Type 2 diabetes, despite how common it is around the world, is that the explosion in this is pretty, pretty amazing. People feel very lonely and isolated as if they’re the only ones with the problem. I assure you, you’re not. Now is the time to connect with the people who care about you. They have good information, too. Thanks, friends. Have a beautiful day.