Dr. C: Hey, Dr.

Alan Christianson here with you, back for another episode of the Adrenal Reset
Summit. We've got a real treat: we've got some topics today we've not gotten into as
much as we should, and they're super-important.

I'm really glad to have Dr. Evan Hirsch here with us, to help us out in some of these
things. So this is a really neat connection: Dr. Evan, he's the best-selling author of "Fix
Your Fatigue: The Four-Step Process for Resolving Chronic Fatigue, Achieving Abundant
Energy and Reclaiming Your Life!"

What's unique here is that he got into focusing upon chronic fatigue because of his own
story. Dr. Evan saw firsthand for five years how much fatigue could just debilitate
someone's health and life, and how there's just so many unresolved questions, chronic
struggles, and sometimes lack of support in the medical world.

He developed a protocol, this program he's done that helped heal himself, and now he's
helped hundreds of thousands of other people. Dr. Evan is in clinical practice; you can
find him at the Hirsch Center for Integrated Medicine in Olympia, Washington. If he's
not there, this is somewhat neat stuff: you might find him out singing musicals or
dancing hip hop. So pretty well-rounded guy there, Dr. Evan.

Dr. Hirsch: Thanks, Alan.

Dr. C: An awful lot more creative than me. Glad to have you on board here.

Dr. Hirsch: Thanks for having me.

Dr. C: So, talk just a little about your story and what developed your interest and your focus on
fatigue and adrenal health.

Dr. Hirsch: Absolutely. So when I was in residency, my wife, who I had just met, developed fatigue.
She was first diagnosed with adrenal fatigue, and she really didn't have much
information. She found James Wilson's book and brought it to a naturopath, and they
helped her diagnose it. But I was totally powerless, because here I am in residency,
conventional medicine, family practice, and I had nothing for her. It was incredibly
challenging for us.

Then she got through it. She's got a wonderful story as well. She went through a lot of
emotional changes, and that was really helpful for her. Then I came out of residency, we
had a child, I started a practice, and then I dipped into fatigue and had fatigue for about
five years. Yeah, it was devastating, the brain fog. I had to cut down on my workload,
had to bring on other practitioners to help support the practice, and it was scary trying
to do all these things and trying to be the best husband, father, doctor and boss that I
could possibly be, and I felt like I was failing at all of them.

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Dr. C: Wow.

Dr. Hirsch: It was devastating. Then I started doing more research and started learning more, and
just really dove into every potential cause of fatigue. I knew that if my differential
diagnosis was broad enough, if I knew all the potential causes, I could knock them off
one after another. That basically led me to my next one and I basically put that together
as the Fix Your Fatigue program.

Dr. C: That's fascinating, and I'd love to go deep on a couple of the points that you mentioned.
One of those was about your wife and how she sought out some help and saw some
books and got a sense of what may be affecting her.

You mentioned how you were in your clinical training and there weren't a lot of
answers. You know, in many cases there is not just a lack of understanding, but often
just straight up antipathy or contradiction as to whether or not this whole thing even
exists. Was that something that you faced or had to sort out as you were helping her?

Dr. Hirsch: Absolutely, and I see a lot of patients who come to me with that trauma from a
conventional practitioner who says either, "It's all in your head," or "There's nothing to
be believed." It's devastating. One of the main things that we can provide as
practitioners is the hope and the commitment that we're going to work with somebody
until the very end and help them until they get better. So yeah, absolutely, it's
challenging.

Dr. C: That's beautiful. Something else that struck me from that, that I really loved hearing you
say, was that upon understanding that you'd have this fatigue and realizing that you
couldn't do what you wanted to do, your thought process was not, "What's a herb or a
medicine that's going to give me energy?" Rather, your thought process was, "What is
the real cause? What's behind this thing?"

Honestly, on both sides of medicine, it's not thought of that way, like, "What can we do
to treat these symptoms?”, it's sometimes just, "What can we do naturally to treat
these symptoms?" But the real mindset is: "What is the deep cause?" So in terms of
your care, and now with working with hundreds of thousands of people, what are some
of the real big causes you see that are often missed?

Dr. Hirsch: Absolutely. So I've found there are about 14 causes of chronic fatigue. Some of those
are heavy metal toxicity; chemical toxicity; infections; mold; negative emotions; EMFs
(electromagnetic frequency) toxicity or electromagnetic hypersensitivity syndrome;
adrenal fatigue; thyroid fatigue or thyroid dysfunction; sex hormone dysfunction;
nutrient deficiencies; lack of exercise; constipation; mitochondrial dysfunction;
methylation issues; dehydration and food allergies. That's it. That was me trying to
remember all of them.

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Dr. C: I wasn't counting to make sure you got all 14. That was a good list.

Dr. Hirsch: Thank you. I mean, they are so numerous and there's probably some that we haven't
found out about yet as humans, but it's a complex web and everybody has multiples of
them. Nobody's got just one. And often they feed off of each other, like the heavy
metals, chemicals, infections and mold, all affecting the adrenals and causing adrenal
fatigue.

Dr. C: Yes, you can often have multiple causes. That's interesting. A good point you bring up,
too, is that the causes are different from person to person; the combinations can be
different from person to person. This is where I think all medical worlds often do get
stuck, too, is they think about, "What is the cause for a condition?"

In many cases the same condition, the same symptoms, can have different causes for
each person, and that's where I think about a syndrome or a constellation of symptoms.
I think in many cases someone will take a diagnosis of, say, chronic fatigue
immunodeficiency syndrome and then view that as a starting point: "Well, how do we
treat this?" There are still things to investigate further, there are deeper things behind
that.

Something you've done a lot of work in, more so than many others, are these hidden
infections. Can you talk a bit more about these, and their relevance to fatigue
syndromes?

Dr. Hirsch: Absolutely. So these organisms are really part of our natural biome. We are actually 90%
bug and 10% human. Of ourselves, of our mass, that is our normal composition, which
really blows people's minds: "Wow, 90% bug!" It just tells you how important these bugs
are for producing vitamins in our guts and for regulating our overall immune systems.
It's just so incredibly important to keep that in mind as we go through.

What ends up happening is that people either get an overwhelming burden of an

infection, or they get some of the, what I call "the usual suspects": heavy metals,
chemicals, molds, other infections, negative emotions and EMF's. That turns the
immune system on its head, and all of a sudden these bugs can now become
opportunistic, and they proliferate, and they start to cause problems.

The first thing that they do is that they cause inflammation so the immune system is
reaching to these infections. It tries to bind them up and try to take care of them and
get rid of them out of the body, and it's asking for help. It says, "Hey, white cells, red
cells, all you friends here: come help me!"

You end up getting swelling, redness, and dysfunction. Normally if you had an infection
or, let's say you broke your ankle: you're going to get swelling, and then that swelling is

Dr. Evan Hirsch Page 4 of 15

 going to recede as things get fixed. Unfortunately, in this situation, the infections are
not being remedied; the immune system can't take care of it on its own, and the
inflammation persists. So it's left in the "on" position.

With that inflammation, you start having problems with anti-inflammation. What's our
main anti-inflammatory? It's cortisol. The main hormone produced by the adrenal gland.
So cortisol comes to the rescue and starts putting out this fire of inflammation, and you
just drain that cortisol more and more because that inflammation is stuck in the "on"
position. You drain that adrenal gland, you drain that cortisol down, and that can be a
huge cause of the fatigue.

Dr. C: That's great. So say someone has some, some fatigue symptoms. What are some
subtypes to their symptoms, or patterns, or things they might notice, that could make
someone think that the infection is maybe more relevant to them personally?

Dr. Hirsch: It's really any weird symptom. Sometimes it's just fatigue; it's brain fog. But sometimes
there's weird symptoms, like pain on the bottom of the feet. Or headaches and neck
pain, sleep issues; depression, anxiety, and constant sweating. So I have some patients
who come in and they're like, "I've been sweating for years, you know, like I'm always
hot." That could be a Babesia infection. Pain on the bottom of the feet? That could be a
Bartonella infection.

There are some very weird symptoms where people have to start thinking out of the
box about, "What could this be?" Oftentimes those symptoms or those infections will
have a constellation of symptoms within them.

For example, Bartonella: if you have pain on the bottom of your feet; migraines or
headaches; neck pain; sleep issues, you probably have Bartonella. And that's something
that probably a lot of people who are watching this have never heard of before. Now
they're going to go Google it and they're going to say, "Oh my gosh! I totally have
Bartonella."

You fix the Bartonella, you get rid of the Bartonella, and all of a sudden, it plays a huge
role in their energy.

Dr. C: Do you see things as far as just overall health of immunity in general, like how
susceptible someone is to recurrent colds, flus, bladder infections, things like that being
relevant as well?

Dr. Hirsch: Absolutely. The immune system could be hyperactive, or it could be hypoactive, or
underactive. People say, "Oh, you know, I never get sick." That's also a sign that their
immune system is not functioning appropriately. It's usually because the immune
system is distracted by one of the usual suspects: heavy metal, chemicals, molds,

Dr. Evan Hirsch Page 5 of 15

 infections, allergies, emotions, EMFs. Any one of those things is really going to pull that
immune system away and not allow it to do what it's supposed to do.

What's interesting is that when you start to remove those usual suspects, all of a sudden
the immune system turns around and sees the infection sitting there. Then all of a
sudden someone starts experiencing symptoms of Die-Off from an infection, or
experiences symptoms of the infection because the immune system hadn't been seeing
it until that moment.

Dr. C: So I definitely want to talk and come back to the idea of Die-Offs and how symptom
progress may not be linear, but I want to back up for just a second. Let's say someone
has had chronic fatigue, they've had adrenal stress, and they want to dig down and find
their real root causes. They think from what you mentioned, or their general immune
system in the past, that this could be a big issue for them. Now there's a bit of a
divergence between the conventional world and the more progressive model of
identifying and understanding these. Can you talk about what someone might
encounter or what steps they might want to take in terms of just screening for chronic
infections?

Dr. Hirsch: Absolutely. As you mentioned, it is challenging to test for infections. There are a couple
of different ways. The first way is a serology test, which is an immune system's reactivity
to the infection. And that's IgG, IgM, IgA, all of these different immunoglobulins. That is
the main test that I run in my clinic, and it's not a perfect test because it really depends
on an intact immune system. If the immune system is distracted with the usual suspects,
oftentimes you're not going to get a good test.

That's really interesting to see a before-and-after. You get rid of somebody's heavy
metals and then all of a sudden, they've got Lyme. Because you repeat that test and
then you're getting a positive test.

Another test is a PCR test, which looks at the DNA of the particular infections. That can
be done by blood and that can be done by urine. Now the challenge with that is because
infections oftentimes are hidden in different parts of the body. So they'll be hidden in
the joints, in the tissues; you know, Bartonella, I love Bartonella so I keep talking about
it. Bartonella will hide in the endovasculature, so in the blood vessels; it's going to hide
in the skin. You're not going to see it if you're doing a blood test or you're doing a urine
test.

Sometimes you're going to get a better test if you do provocating test. Basically, if you
get like a massage, a Rolfing session, or you do a bunch of jumping jacks, where you're
dumping a whole bunch of stuff into your bloodstream, and then you do the blood test
and the urine test. The urine test that I like is called "DNA Connections," it seems to get
a lot of infections that the serology test doesn't, but it is, in fact, more expensive.

Dr. Evan Hirsch Page 6 of 15

 Then the last way of testing is really by symptoms. So as I mentioned, there's this
constellation of symptoms for some of these infections that can really be diagnostic.
Even the Centers for Disease Control indicates that Lyme in a lot of these infections is a
clinical diagnosis.

Based off of its symptoms, you can make a diagnosis of the infection that's present. It's
really helpful because oftentimes I don't need to do it, or people think I'm some kind of
genius because I say, "You know, I think you've got this infection," then we run the test,
and sure enough, they have the infection. But did I really need to run the test? Because
they had the conglomeration of symptoms. It helps to get that confirmation.

Those are the different ways that I see about evaluating whether someone has
infections.

Dr. C: You talked about serology, and for our listeners, that means just blood tests. In the
blood, we're measuring antibodies that we're carrying to the infection. Then also about
the PCR, the DNA test. The difference is that the antibody tests, as you said, are
counting upon our immune system to be identifying and making antibodies. If that
happened, great! We may not have a chronic infection to begin with. So that can be an
issue.

So the PCR studies, they're detecting the actual DNA of the organism, not dependent
upon our immune system, but it does depend upon the organism's DNA in whatever it
is you're testing.

Besides some of the Lyme markers, what are some other things you look for chronic
infections? Any other big ones that come up a lot?

Dr. Hirsch: In terms of individual infections there is; Epstein-Barr, cytomegalovirus, HHV-6 ... human
herpes virus number 6, which is not genital herpes. Herpes is a big category of different
viruses.

Dr. C: It's a loaded term.

Dr. Hirsch: It is. Mycoplasma, Anaplasma, Babesia, Bartonella, Borrelia: those are the main ones
that I look at.

Dr. C: For a while, there was thought to be a strong link between Epstein-Barr as a causative
factor of chronic fatigue, and there were some papers done in the early '90s in which
they would treat large groups of people with chronic fatigue through antiviral
medications.

Dr. Evan Hirsch Page 7 of 15

 The tough part about not really sorting people out and looking at individual causes was
that the groups, as a whole, didn't really see radical improvement. When you broke
down individual responses, there were some people that got a lot better, many that had
no difference, and some that had their diseases still progress. It ended up averaging out
the whole group effect. It just shows what you're illustrating is that people have
different causes, and if their particular causes are identified and addressed, then they
can do well, even if there's not one clear cause across the board.

So identifying these and treating these: you mentioned this idea about Die-Offs. So it's
not just a matter of, "Here's a bug, zap the bug, life is good." It's a little more convoluted
than that, I think.

Dr. Hirsch: Indeed, and it can be a slow process, but I always recommend that you know, because
our goal is really to achieve balance. When you hit a bug with a very strong hammer,
often you're going to get problems. You're kind of coaxing things: you want to turn the
volume down on the bug; you want to reset the immune system's relationship to the
bug; and you want to work on it also on an energetic level, which can really help overall
health.

When we treat infections, and we're moving in this slow pattern, part of the reason is
that when you kill infections, they release their crap, as I call it, into the body, and the
immune system reacts.

This is the same reason why, when people get the flu, they get fevers, chills, night
sweats and that sort of thing, is because the immune system is reacting. It's called the
"cytokine surge," and it's the immune system going to grab these pieces of the infection
and move it out of the body.

In order to mitigate this, because this is really the deterrent, the barrier, to people
moving through antimicrobial therapies, is to make sure that the detoxification
pathways are paved. That's using different kinds of detoxification support, whether it's
for the kidneys, the liver or the lymph. I like blood cleansers like sarsaparilla, it works
incredibly well, and I really increase the amount of sarsaparilla that people are taking in
according with their antimicrobial therapy.

There are a number of different herbs that I use as well: activated charcoal, different
ivies, and glutathione. All of these things open up these pathways and allow this crap of
the immune system and the infections to really get out of the body.

That process of the immune system's reactivity is called "Die-Off," or the "Jarisch–
Herxheimer reaction," or just a Herxheimer reaction, that process is Die-Off support.

Dr. C: So "crap" is not an actual medical term ...

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Dr. Hirsch: I use it quite a bit.

Dr. C: It makes a lot of sense. Pretty intuitive.

So these bugs are hard on us because they're giving off their crap. These various wastes
that are hard on our bodies. When they're living, there's always some that are just
giving off because they're metabolizing, and some of them in the population are dying.
When you want to get rid of them, you're saying you want the population to go down
faster, but then you've got more junk spilling in the bloodstream, which means the
body's got more things to process.

The idea is helping all that drain more readily. Have you ever heard the term
"emunctories" before? It's pretty esoteric, but in the naturopathic lineage, a few
hundred years back, that was talked about as being just the critical strategy for so many
chronic conditions was draining the emunctories. That would translate really as just all
the body's main detox pathways that you talked about. So a lot of support and a lot of
history behind that.

Specifically, how do these infections and their crap that they give out, how do they
come into play relative to the adrenal glands and the HPA axis? What's the interaction
there?

Dr. Hirsch: When the infections become opportunistic in the body, they can operate in a number of
different ways. One is if they get into the brain and they start regulating or deregulating
the hypothalamic-pituitary OAT axis, or whether it's the hypothalamic-pituitary-adrenal
axis, or thyroid, or the gonads, ovaries, testes. The infections will mess with the function
of this messaging system of the brain communicating with the glands, telling the glands
whether they're supposed to make more or less hormone.

Another way is, we talked about with the infection, or with the inflammation, where the
infections are triggering the immune system and increasing the inflammation. That, in
turn, is going to compromise these glands and, in turn, affect the hypothalamic-pituitary
axis.

Then the last way is really about how the infections get into the tissues. The immune
system sees these foreign things inside the tissues or the organs, and it attacks. That's
how you get the autoimmunity from the infections, where the immune system is trying
to get at this infection that's existing inside the thyroid, but it has to go through the
thyroid in order to get there, and consequently, it is causing damage and causing
autoimmunity.

Dr. C: You talked about just taking a bit of a time process, both in terms of logistics, but also in
terms of minimizing symptoms. Are there any recent cases that come to mind of

Dr. Evan Hirsch Page 9 of 15

 someone that you've worked with that had chronic fatigue or adrenal stress and you
found some infections and you cleared them up? Maybe there's a case that comes to
mind that you could talk about, like a typical time frame or progression of symptoms
that someone could anticipate?

Dr. Hirsch: Absolutely. You know, this is pretty congruent for almost all of my patients. The first
thing that I do, if I find out that they have adrenal fatigue, is I boost the adrenal glands.
That is the most important thing. Usually, the adrenal support is probably the most
important supplement that I provide people because everything that we were talking
about is stress. Stress on the mental, emotional, physical person, and it compromises
the adrenal glands.

The first thing you have to do is get that adrenal gland back up and running, since it is,
as many call it, the sentinel gland, or the gland that really is the director or the
conductor of the orchestra that is the body. That's super-important to get that adrenal
gland back online. What I find is that when we do treatment, I'm increasing very slowly.
Some of the products that I like to use are Byron White Formulas, which I find to be
incredibly potent with their herbal tincture combinations.

I start people off with a drop of a tincture every night, and increase every week by a
drop. Oftentimes I'll get them up to 15 or 30 drops at night, all the time making sure
that the adrenals are robust because one of the things that happens with Die-Off is that
the adrenal glands will become compromised.

Often, that's when people come to me, and they have seen every best Lyme doctor in
the country, and they're sitting in my chair and they're exhausted because
unfortunately, the Lyme might be dead, but so are their adrenal glands because the Die-
Off wasn't mitigated appropriately.

So this can be any patient that I see who comes in, who has these infections. We work
up very slowly, making sure that we're preserving and keeping the adrenal gland. I tell
people that often it can take between one and three years of resolving chronic fatigue,
depending on the number of causes that they have, depending on the nuances, their
reactions to the supplementation, the treatment, the labs that they get. It's different for
everybody, but that's the general range that I tell people.

Dr. C: It sounds like if you're taking an approach that's measured and gentle enough, they
shouldn't be seeing too many major setbacks along the way?

Dr. Hirsch: My goal is always to mitigate the Die-Off. I tell them, "I want you to have this much Die-
Off," so we know that something is happening, we're on the right path, but I don't want
it to cause untoward effects in the body.

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 It can be bumpy, depending on the infection, everything that's going on with the person.
I try to mitigate it as much as possible, and I'll stop therapy, back it up, whatever we
need to do to make sure that it is minimal.

Dr. C: You almost anticipate, and perhaps if you're not seeing Die-Off, could that be a sign that
you are not seeing the adequate efficacy of therapy?

Dr. Hirsch: Absolutely.

Dr. C: Okay. Can you talk about a preference for using herbs over other antimicrobials? Do you
see most patients need some conventional antimicrobials, or what would you guess are
the proportions that go that way?

Dr. Hirsch: I don't use any prescription antimicrobials, except for antifungals, but I won't use
antibiotics. The reason why is a lot of the research that has been done indicates that
herbs are just as good and that when you remove the antibiotics, the infections come
back. They really haven't gotten at the root.

Herbs are really smart, and these Byron White Formulas that I like are really great, they
work on a number of different levels: they're antimicrobial, they're immune-modulating,
and then they're also energetic. I just have really good success with them, and I find
that when people come off of them, the infection stays down and people see really
good results.

Dr. C: You know there are often certain active constituents in herbs that are identified,
concentrated and synthesized, and that's where so much pharmacy comes from. The
whole plant can work in ways that are very synergistic, distinct, and often better
tolerated and less apt to have a detrimental effect on the body.

In terms of treatment goal: obviously, we want to see their symptoms resolve. I'd be
curious about what extent you would say that someone can resolve chronic fatigue
symptoms. Also, in terms of the infection: is the infection resolved or gone, or where are
things at the end of the process?

Dr. Hirsch: I think you can get rid of fatigue entirely. Often people just have to be mindful. They've
gone through a lot of changes during this process, and they can't go back to eating pizza
and drinking beer, part of the reason why they got there in the first place. But if they're
maintaining the diet, lifestyle, stress management and taking their adrenal support it
can work. The goal is a complete resolution, and then mindfulness: making sure you're
paying attention.

With the infection, the goal isn't complete eradication, because like I said, there is this
balance that exists. So we want to turn the volume down on the bug, decrease it to a

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 point where you can change the immune system's relationship to it. That's where LDI, or
low-dose immunotherapy, comes into play, which really is kind of like a homeopathic
dilution of the bug that ends up changing the immune system's relationship to it. This is
very exciting work, a lot of it pioneered by Dr. Ty Vincent.

Sometimes even if you get the infection down all the way, someone's immune system
may still be reacting to it, or reacting to the memory and causing inflammation. When
you introduce the LDI for that particular infection, all of a sudden the immune system
remembers that this infection is, in fact, its friend; they can dance together, and sing
together, and they can create a new symbiosis together, a new balance together. People
appreciate that because they don't like the image of knocking down this infection. They
really want harmony, and that's really what we're trying to achieve.

Dr. C: You've described it before as some people having almost like a "reverse allergy," to
where there's some things you don't need to attack, but you do. In my case: horse
dander. No reason for that that's logical, but my immune system doesn't get that. In the
case of these infections, it's almost the opposite of that. There are some things that you
should suppress to some degree, and yet your body ignores.

It's great that you can find ways to help undo that core part of it as well.

Dr. Hirsch: Right.

Dr. C: You mentioned at the early stages, but also throughout the process about really wanting
to augment and fortify the adrenal function. Are there some favorite adaptogens of
yours you've come to rely upon?

Dr. Hirsch: Absolutely. I'm a big fan of eleuthero root. I find that it can be incredibly stimulating,
yet smooth; there aren't the crashes with it. I used to love licorice root, but then I found
that people were getting high blood pressure, and swelling, and it was upsetting the
electrolyte balance, and I found that eleuthero root is almost as strong as licorice root
without the untoward effects. Then sometimes I'll use other glandulars, I'll use other
adaptogens, but eleuthero root really is my favorite.

I find that it has to be dosed every 3 hours. I find all adrenal support has to be dosed
every three hours, starting from when people are waking up until about four o'clock.
After four o'clock, all of a sudden it starts to affect their sleep negatively. They might do
eight o'clock, eleven o'clock, two o'clock.

That seems to really give people the boost that they need and the energy that they need
throughout the day. That ends up also recreating the circadian rhythm, their sleep-wake
cycle. I can't even tell you how many people I get to sleep better at night by giving them
adrenal support during the day. I mean, it's pretty amazing how that happens.

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Dr. C: What a huge thing. Sleep is so big for us, for the immune system, and all facets of
health.

Any other favorite therapies you like for helping to reset the circadian cycle?

Dr. Hirsch: Oftentimes I'll give things before bed, so I like melatonin. Melatonin, especially
liposomal melatonin, has now been shown to detoxify the brain, so that groggy feeling
you feel in the morning is really a detox. You just need to take more detoxification
support. Getting people up on their melatonin; 5-HTP, the precursors to serotonin;
lemon balm, there's a number of relaxing herbs that I like. GABA as well because often
sleep is also a time where people will have increased anxiety, and sometimes the
insomnia is more from anxiety than it is from anything else.

I also find that optimizing thyroid, B12, vitamin D, all in the morning can be huge,
because all of those things, in addition to the adrenals, can really support this circadian
rhythm where you're supposed to be awake during the day and then asleep at night. If
you're not, then you're kind of awake-and-asleep during the day, and then you're
awake-and-asleep at night.

People will tell me that they're up at night going to the bathroom, and it must be
because they have to go to the bathroom, and I say, "No. I can drink a liter of water
before I go to bed, and I'm not going to wake up until the morning because my body is
going to shut off that urge when my circadian rhythm is correct."

However, I don't have the iron with the thyroid. I'll have iron around noon, or even at
night, and that seems to help as well.

Dr. C: That's great.

Any relevance that you see in terms of blood sugar and the circadian cycles, and any
favorite techniques you've developed helping regulate blood sugar?

Dr. Hirsch: Absolutely. That's a great question. Often people will wake up in the middle of the night
with the Somogyi effect, where the adrenals are being kicked on because blood sugars
are too low. That's because blood sugars are going like this throughout the day because
people are eating too many carbs, too much sugar. I'm just a big fan of the paleo diet,
and even leaning into the ketogenic diet. I find that consuming meat and fat every two
hours with vegetables as your carbohydrate works really well for my patients.

Sometimes I'll use berberine, which does double duty because not only is it going to
regulate blood sugars, in a head-to-head trial with metformin, it was just as good, but it
also will kill infections.

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 Those are kind of the tools that I use, food is such a huge component of this. You have
to balance it, because I have also read, and I have seen, that some people have to have
grains while they have adrenal fatigue, and that it's too hard on the body, it's too
stressful on the body, to be on a paleo diet. There is some balance and some nuances to
therapy, depending on the person and their issues.

Dr. C: That's great. Great thing to qualify that way.

What are we going to see next from you? Another book coming out, or other projects?
What should we look for here in the future?

Dr. Hirsch: I'm working on an online course, and so I really have this tiered system where if you can
get help just by getting my couple-dollar Kindle book, great; if you need more support,
then you can move up to the online classes. If you want to come see me, great, you can
come see me.

My goal really is to help 100,000 people resolve their chronic fatigue, and I can't do that
alone. I'm going to train providers; I'm going to get the word out; I'm doing a whole
bunch of Facebook Lives and stuff on YouTube, just trying to help as many people as I
can.

Dr. C: That's really cool. Where should people go when they want to learn more about you and
stay up-to-date with the programs and the rest of the things you're working on?

Dr. Hirsch: If they go to fixyourfatigue.org I've got a free giveaway on there, which is a sleep
chapter taken from my book that talks about all of my tips and tricks on how to get rid
of sleep issues. They can sign up for a free phone consult and learn everything that I
have to teach.

Dr. C: That's awesome. Dr. Evan Hirsch, thank you so much.

Dr. Hirsch: Thanks, Alan.

Dr. C: If you've really had adrenal stress and been categorized as chronic fatigue syndrome,
fibromyalgia, things on this continuum: think about the possibility of infections. Check
out Evan's work; consider working in more detail along these lines. I love what he said
about how he knew that fatigue would happen for reasons, and if he identified the
reasons, and just lined them up, he could knock them down and get there eventually.

The correct mindset is knowing that your body can recover. We're these amazing
machines of homeostasis. If they're not working right, there's a darn good reason why. It
just takes yourself, whether you're pairing with someone smart like Dr. Evan, to find out

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 what that reason is and clear that up for you. Never give up, and never think that you
are stuck with issues like that.

Dr. Christianson signing off, and take great care. Back with you again really soon. Bye-
bye.

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