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EP172 The One About Fatigue Part 1

Transcript Of Today's Episode

Dr. Martin Jr.: You're listening to the Doctor Is In podcast from martinclinic.com. Although we share a lot of practical, and in our opinion, awesome information, what you hear on this podcast is not intended to diagnose, cure, treat or prevent any disease. It's strictly for informational purposes, so enjoy.

Hello, I'm Dr. Martin Jr.

Dr. Martin Sr.: And I'm Dr. Martin Sr.

Dr. Martin Jr.: And this is the Doctor Is In podcast, and this is episode 172. [00:00:30] Today it's gonna be part one of a two-part series that we're titling The Three Biggest Causes Of Fatigue In Women.

One of the things that, I would say the biggest symptom that people get a hold of us for is fatigue. It's a frustrating thing. Many of you that have been with us for a while know our history, and know how we kind of went off in the direction that [00:01:00] we are in now. Of course, it has to do with my mother, your wife, and her initial symptoms were just a tremendous amount of fatigue.

It's funny, we have a good old video on our website on a documentary that was done, and my mother was in that documentary. I think it was in the ... was it the '80s?

Dr. Martin Sr.: Yeah. Late '80s.

Dr. Martin Jr.: So I mean, it looks like an '80s video with the hairstyles. I get a kick out of watching it. I remember the '80s. It's [00:01:30] interesting. But that fatigue, we get so emails and so many questions about fatigue. What we wanted to do in this next couple of episode is try to ... We're big fans of what we call the 80/20 rule. We want to give the three biggest causes of fatigue, and they pretty much would cover at least 80% of the people that get a hold of us for fatigue.

Dr. Martin Sr.: Oh yeah.

Dr. Martin Jr.: If you're listening and you're exhausted, [00:02:00] one of the questions we like to ask people is, when was the last time you felt fantastic? When's the last time? And you always-

Dr. Martin Sr.: I scale it up because I always ask 'em, "Okay, I'm 10 out of 10," and most days I really am. I'm very thankful about that. But I say, "Okay compared to that, 10 being me," and they know me in the office. I'm jumping around, and I'm pretty, I get pretty excited pretty quickly. "Okay, you're 10 out of 10." "And what are you?" And then I get the number, [00:02:30] right? Twos and threes, and minus zero, and minus 10, and barely functioning. I get a lot of that. So it's the first question that I ask. It's always that, because I wanna know what their energy levels are, and the vast majority of people that come in, yep that's ... I mean, they might have other issues, but that's certainly part of it.

Dr. Martin Jr.: It's a symptom for so many issues.

Dr. Martin Sr.: Yeah. Mm-hmm (affirmative).

Dr. Martin Jr.: And that's what we wanna cover. So we could've titled this just as easily The Three Main Causes Of Exhaustion [00:03:00] In Women, Three Main Causes Of Fatigue, Three Main Causes Of Chronic Low Energy. I mean everybody goes through a period of time where they may feel a little low energy, the body might be fighting something off. But I'm talking about somebody who is tired everyday. They go to bed tired. They either sleep or they don't sleep, most of the time they're not sleeping.

Dr. Martin Sr.: Mm-hmm (affirmative).

Dr. Martin Jr.: They're tired in the morning. If they do get a good nights sleep, they're still tired. They're just exhausted. And think of the effect that, and we hear this, [00:03:30] it has on their life, their family life, economic life, their marriage, their relationships. I mean, when somebody is exhausted it is almost impossible for them to maintain a normal day-to-day routine.

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: And it's frustrating because, and here's the thing, if you and I are out playing a sport and you twist your ankle, you could wrap it up, get on some crutches [00:04:00] for a bit. And if you were hobbling along somebody would come up and say "Hey, what happened to your ankle?" Cause you visibly are limping around. When it comes to things like exhaustion, most people look at ya and they can't appreciate what's really going on. Yeah, you may look tired. I remember if, talking to mom about when she was going through real exhaustion back in the, a long time ago. People [00:04:30] would, they didn't know how to handle it a lot of times. Every once in awhile somebody would come up and say, "Oh, you look so exhausted," or "You look so tired," which is not a compliment. It's not a compliment, right?

Dr. Martin Sr.: Yeah, and like you say, it's not visible. And just, point of what you're saying, because I see a lot of people and they say "Yeah, but I'm still doing a lot of things." The point is, is that I say "Well yeah, but you're running on fumes. And you're doing things on your personality," because if a man ... [00:05:00] Again, I don't wanna be, it's not 100%. But a lot of men when they're exhausted, they wouldn't get out of bed for the same amount of exhaustion that women have. Women are usually driven. They know they've gotta do this, this, and this and this, and they gotta get it done. So in spite of the fact that they don't feel well, they still do things.

Dr. Martin Jr.: Yeah. They manage to hold things together.

Dr. Martin Sr.: Yep.

Dr. Martin Jr.: But it's definitely straining them, and a lot of times it can strain all the relationships around them because the energy's just not there. [00:05:30] Again, so that's what we wanna talk about. We wanna talk about the three main causes of exhaustion, or fatigue, in women. These three areas, as we mentioned, it's gonna cover 80% of the people that are listening. And let me just say this, it's impossible to have full energy if you have a problem in any of these areas. We'll say that right off the top.

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: As an aside, it's also, I don't wanna say impossible, but it's very difficult [00:06:00] to lose weight if you have a problem in any of these areas cause these spill over to metabolism as well. And it's also very hard to have a sharp brain if you have a problem in these three areas. So these three areas will cover a lot of different areas. So if you're listening and you're frustrated because you haven't been able to find answers ... A lot of people go to their doctor for low energy, they get a lot of blood work done, and things generally come back normal generally speaking. And a lot of times people with exhaustion, [00:06:30] and the frustrating thing is a lot times they're told it's in their head or they're depressed. And here's the thing, we always tell the story of the Titanic when we talk about energy.

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: The Titanic, everybody, pretty much the whole world has seen the movie. It's still one of the highest, I think it's second overall still in history of revenue. So I mean it's, everybody has seen the Titanic pretty much.

Dr. Martin Sr.: It's a fascinating story.

Dr. Martin Jr.: We're all familiar with it.

Dr. Martin Sr.: Mm-hmm (affirmative).

Dr. Martin Jr.: [00:07:00] We all know the end result, but most people are unaware that the Titanic had actually received a whole bunch of warnings throughout the day from other ships that were already in the direction they were going. They were already in the ice. So the Titanic knew that there were problems ahead of time, right?

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: And we all know what happened. In fact I think it was the US California, right? USS California, they were ten minutes or so ahead and they sent a [00:07:30] warning saying "It's terrible." And one of the last communications from the Titanic was from the wireless operator, and he tapped back and basically saying "Shut up. Shut up. We're tired." They were tired of hearing the warnings, and then of course the rest is history. The point of this story is, even the Titanic had warnings. It wasn't like they didn't know what they were going into. And the body does the same thing. A lot of times, one of the first warning [00:08:00] signs that our body gives us is lack of energy. And we tell people that lack of energy is like a check engine light, right?

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: A check engine light can mean a lot of things. Energy can mean a lot of things. Almost anything can cause low energy, but that's a check engine light that just went on. And you're not gonna take electrical tape and just cover up your dash, and just ignore the check engine light. And even in a car, a check engine light could [00:08:30] be nothing. It could be that you didn't tighten your gas cap, I found that out. It says to click it, and that can do it. Or it could be something serious like your engine's gonna fall apart unless you get it checked out. And energy could be the same thing.

But here's the frustrating thing when it comes to energy, it's hard to figure out why you have low energy. Traditional blood testing, unless you have anemia or something that just jumps out on the report, it is [00:09:00] very difficult to figure out why you have low energy. So that's why it's frustrating. So a lot of people are frustrated. But let me just say this, fatigue is a warning sign. Fatigue is a check engine light. There's a cause. Fatigue doesn't just happen for no reason.

Alright, so that's a long introduction. Let's talk about the three energy killers in women. So today we'll talk about as many of them as we can, and then we'll carry over next week into the next [00:09:30] episode. But we'll list them right off the top. So the three biggest energy killers in women.

The first one is the Bermuda Triangle of Hormones, which we talk about a lot, but we're gonna go into a little bit more detail about that. That's the first one. So the Bermuda Triangle of Hormones; we're talking about cortisol, we're talking about thyroid hormones, and we're talking about estrogen. But we'll come back to that. The second cause, or the second energy killer in women is high circulating insulin. That's a big cause [00:10:00] of low energy in women. And the third thing is very specific deficiencies, nutritional deficiencies that is common in women that can lead to fatigue. And we'll list, and we'll talk about those deficiencies on the next episode as well. So those are the three big headings. So it's the Bermuda Triangle of Hormones, high circulating insulin, and deficiencies.

So, let's talk about the Bermuda Triangle of Hormones. We've had a lot of names [00:10:30] for this over the years. We used to call it "The Unholy Trinity of Hormones". We kinda like the concept of the Bermuda Triangle because it's just mess.

Dr. Martin Sr.: Yeah, it's a mess. And it's complicated, right? You get in there ... And mainstream medicine has, they've missed the boat here because they always, like you said, they look for disease. So most tests are looking for disease and not for imbalances. And if your hormones are not balanced, [00:11:00] ladies, it's complicated in the sense that you need balance. I loved your illustration, if we just talked about the thyroid for a second, I think we talked about this maybe a month ago or whatever that in a whole year you're complete amount of thyroid hormone that is secreted is what? Is it a tablespoon or less?

Dr. Martin Jr.: I think it's a teaspoon.

Dr. Martin Sr.: It's a teaspoon.

Dr. Martin Jr.: Which is amazing to think about.

Dr. Martin Sr.: Yeah, [00:11:30] imagine the organ that sort of orchestrates that-

Dr. Martin Jr.: Yeah, the master gland in a sense, right?

Dr. Martin Sr.: The master gland, thyroid, operates on a teaspoon of-

Dr. Martin Jr.: That's how powerful the thyroid hormone is.

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: And imagine trying to test it properly, when even the slightest decrease in the amount that you produce can cause major effects in the body. And some people are more [00:12:00] sensitive. Even the smaller decrease in thyroid hormone has a big effect on them. So when they get tested, it's very difficult to test the thyroid.

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: And also, and this is something else a lot of people don't understand when it comes to testing. So imagine you have 100 people that get a test done. So 100 people go in, they get a test done. This is how they come up with values. So they have the 95 percentile. So 95% of the people fit in a range, and that range is normal. [00:12:30] 2.5% are below that. 2.5% is above that. And here's the thing about that, if you go somewhere and you look at 100 people, there's not 100 healthy people out there out of 100. And definitely not 95 of them are healthy.

Dr. Martin Sr.: Exactly.

Dr. Martin Jr.: So what ends up happening is, is that as the population gets sicker the blood tests, it shifts. It's like the bell curve, right?

Dr. Martin Sr.: Mm-hmm (affirmative).

Dr. Martin Jr.: So 95% fit into the healthy range.

Dr. Martin Sr.: Well look at what we see in the thyroid today compared to what it used [00:13:00] to be. I mean, I can tell you exactly why, but the thing is, the laboratories have not adjusted to that at all. And this is why, when did they come out with the TSH, in the early seventies? I mean, it was the test of all tests for the thyroid. The problem is, is like you say, you can't compare the 1970s to the year 2019. Completely different, we live in a different world environmentally and nutritionally. [00:13:30] You name it, it's completely different. And this is why I always tell my patients, "Look, if it walks like a duck and talks like a duck, you got all the thyroid symptoms, it's your thyroid." The lab is not, you can't rely on the lab. You have to rely on your symptoms.

Dr. Martin Jr.: No. A thyroid is, the thyroid really you have to pay attention to the symptoms. Why don't you talk a little bit about the idea of the Bermuda Triangle of Hormones? Cause women that are exhausted rarely just have a problem [00:14:00] with their thyroid, or they rarely just have a problem with cortisol or their adrenals, or rarely have a problem with their ovaries or estrogen or progesterone. It's typically the Bermuda Triangle, all three are involved. We've talked about this a lot. In fact, if you go to our website you can sign up for free and watch a course, a full video course that we did on the metabolic storm. We call it How To Repair The Bermuda Triangle Of Hormones And How To ... a lot of people have gone through that program, they feel better. You can go right to our website and [00:14:30] sign up for it. But why don't you talk a little bit about the idea of why these three hormones are connected?

Dr. Martin Sr.: Yeah. Women, their hormones are very very much connected to one another. So one of the biggest things, to use as an example, that we see in the office is what we call "estrogen dominance", too much estrogen. That of course is in relationship to progesterone. Okay, just for bad periods, weight gain, they don't [00:15:00] feel good, mood swings, maybe acne, and endometriosis, polycystic ovarian, you name it. Bad periods, and some patients come in and they've been like that from the day they ovulated for the very first time. And then they wonder, "Well what's that got to do with my thyroid?" Well it has everything to do with the thyroid, because when estrogen is dominant the thyroid is slowed down. The thyroid won't work at the top of its game. It's [00:15:30] very much connected to the ovaries. Of course, men, we don't have that connection.

So the thyroid, and this is where you can have hair loss and you can have ... I mean, exhausted, which we're talking about today. But when estrogen is dominant, the thyroid is effected. And then you add in your adrenals, your cortisol, your stress hormone, that's adding fuel to the fire. It's just, it's making things even more complicated.

Dr. Martin Jr.: [00:16:00] Which is why women have symptoms. A lot of times they have a hard time figuring out what's going on cause they have symptoms of all three.

Dr. Martin Sr.: Mm-hmm (affirmative).

Dr. Martin Jr.: So let's talk quickly, let's just go through the different parts of the Bermuda Triangle, just so that we can add a little bit of clarity to that for people. So the thing that we tell people about the thyroid is, you have to remember the thyroid is the master gland. It's tiny, it doesn't weigh much, but yet it can control every system and almost every cell in your body. It can affect hair, as you mentioned, it can affect everything. [00:16:30] When your thyroid is slow, everything slows down.

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: Everything slows down. But the thing about the thyroid, is that the thyroid is a puppet. It only does what your brain tells it to do, specifically your pituitary and your hypothalamus. So you have your hypothalamus that tells your pituitary that then goes and tells your thyroid to get to work. So you could have a problem in the thyroid, or you could have a problem in the pituitary, or you could have a problem in the [00:17:00] hypothalamus. And any one of those things can affect.

So think of this, how complicated this is for a second. The hypothalamus uses a hormone to tell the pituitary which uses a hormone to stimulate the thyroid which is thyroid stimulating hormone. TSH, secreted by your pituitary gland, tells your thyroid to get to work. Then your thyroid turns around and then makes T4, T3, T2, T1, and then some calcitonin. But the active form [00:17:30] of the hormone is T3, yet 90% of the hormone that is made by your thyroid gland is T4. So then T4 has to be converted into T3. So think of all of the things that can go wrong in a thyroid. It's amazing.

Even, we talked about before, something like insulin resistance can affect the thyroid. So we'll talk about that in a second, but that's the thyroid. And so the thyroid's a puppet. And here's [00:18:00] something else about the thyroid that we like to tell people: subclinical hypothyroidism, so you can have a sluggish thyroid can exist for seven years before any change in blood numbers. So you can have every symptom of thyroid, and it won't even put a dent in your lab values. So you've gotta wait seven years sometimes to see an effect in your blood.

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: So I mean, it's a very frustrating experience. And it kills their energy, which is why we list it as an energy killer for women. [00:18:30] It's a very big, common one. They gain weight all over. They have hair problems, thinning eyebrows, body temperature issues, dry skin. I mean, there's so many ... You can imagine, even a typical presentation of what you see for somebody with thyroid all the time.

Dr. Martin Sr.: Well, yeah, exactly. They come in, and they "Hey Doc, I just look at food and I'm gaining weight." Why is that, right? "Hey, my hair." "I look at your hair, it looks pretty good to me." And the woman, "Oh, but look [00:19:00] at the patches," or "It's falling out. It's very dry. Look at my nails." For a woman, these things, they ... Men, we lose hair who cares, right? But for a woman, that is an important thing. But they can't, nobody can tell them why that's happening, so these are typical.

Dr. Martin Jr.: Well especially when their blood values are normal. So let's quickly talk about cortisol which is another part of this Bermuda Triangle of Hormones. Well, the same thing. The hypothalamus tells your pituitary gland to get your adrenals going, and then adrenals will secrete cortisol. [00:19:30] And here's the thing, cortisol is a cyclical circadian hormone, meaning it has a time of day when it's supposed to be higher and it has a time of day when it's supposed to be lower. Now, since cortisol will raise your blood sugar levels, will get you in that fight or flight, you want that in the morning, but you don't want that at the end of the day when you're trying to sleep.

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: But somebody that has adrenal exhaustion, or they have an issue with their adrenal glands, or they've got elevated cortisol, [00:20:00] it's high all the time. And when it's high all the time, good luck. And you and I always talk about cortisol being an accelerant, meaning you add cortisol to anything it makes it worse. Cortisol to high blood pressure, it makes it worse. Cortisol to your gut, makes it worse. Cortisol to your brain, makes it worse. So I mean, this is a-

Dr. Martin Sr.: Can't focus, you can't, yeah.

Dr. Martin Jr.: So it's a major-

Dr. Martin Sr.: And you can't turn your brain off when you wanna go to sleep at night.

Dr. Martin Jr.: That's right. And that's-

Dr. Martin Sr.: And all of a sudden. I've had people say "I used to be a good sleeper, and now I might sleep for the first [00:20:30] hour then I'm up." And I said, "Well that's cortisol." That's what it'll do. It'll wake your brain up. You think it's 7:00 in the morning when it's 1:30 a.m.

Dr. Martin Jr.: The brain's operating, the brain's running. And cortisol will create a ton of information. But here's the thing, it kills your energy, just like a sluggish thyroid kills your energy. So cortisol will kill your energy. But then it also has a whole bunch of peripheral symptoms; craving salt and sugar, [00:21:00] the need to snack, anxiety. Anxiety is such a major symptom of elevated cortisol. Weight gain, all these things. Again, you mash the symptoms of cortisol and thyroid and they can overlap a little bit. But somebody will say "Oh I've got thyroid symptoms," "I've got adrenal symptoms. What's going on?" It's like, "Well you've got the Bermuda Triangle of Hormones going on. They're all involved."

Which brings us to the last one we wanna talk about, which is estrogen. We talk about estrogen dominance a lot. And we always get somebody in menopause, they're like "Well I'm in menopause [00:21:30] so my estrogen's low." It is low, however, estrogen dominance doesn't have to do with the amount of estrogen. It has to do with the ratio between estrogen and progesterone.

Dr. Martin Sr.: Yeah. And that is so key to understand that, because that's why-

Dr. Martin Jr.: So they can be in menopause and still be estrogen-dominant, and it's hard. I understand it's hard for people to understand that, but it has nothing to ... Yes, your estrogen levels have declined.

Dr. Martin Sr.: That's normal.

Dr. Martin Jr.: But your progesterone has declined as well, and you have estrogen dominance. You are dominant compared to progesterone. [00:22:00] So you end up with a ton of symptoms. So you can end up with estrogen dominance if you have too much estrogen and normal progesterone, too little progesterone and normal estrogen, or too little progesterone and too much estrogen. Think about it. So there's a lot of ways you can end up with estrogen dominance, and they're gonna cause a ton of symptoms.

But here's the thing, when you are estrogen dominant it kills your energy. It also causes headaches, and acne, and fibroids, and PICOS, and [00:22:30] PMS, and mood swings, and hot flashes, and on and on and on. Now you take a woman who's exhausted, and they've got so many hormonal symptoms that they don't even know what's going on. They got thyroid, and they got adrenal, they got estrogen dominance.

And a lot of women will say "Well I don't even have my ovaries anymore." Well you can still be estrogen dominant.

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: And that's a major cause of fatigue in women, is they are in what we call a "metabolic storm". They got a problem with that Bermuda Triangle [00:23:00] of Hormones. And until they fix that, they're gonna struggle with their energy. The check engine light's going on because they got a problem with their hormones, and specifically those three hormones are giving 'em major major issues. And it is probably the most common cause that we see, just because we deal a lot with hormones.

Dr. Martin Sr.: Yeah.

Dr. Martin Jr.: Definitely the most common cause that we would see, right?

Dr. Martin Sr.: Absolutely.

Dr. Martin Jr.: Now, time wise, we're running kinda at the end. [00:23:30] Let's do this, next episode we'll talk about the last two causes. So today we talked about the Bermuda Triangle of Hormones. And then we will talk about how to, maybe we could talk a little bit about how to fix it.

But, if what we talked about today sounds like you, go to our website martinclinic.com, sign up for a free video course. It's a full course, ton of information, but more importantly we show you how, in our clinic and over the years, how we deal with the Bermuda [00:24:00] Triangle of Hormones. So go to our website, sign up. It's free. We get so much feedback on that program, that people go through and they love it. I mean, it answers their questions, they feel better. So I would encourage you to go do that.'

So again, we wanna thank you for listening. And have a great day.

Dr. Martin Sr.: Thanks for listening to The Doctor's In Podcast from martinclinic.com. If you have any questions, you can reach us at info@martinclinic.com. If you're not a newsletter subscriber, you can head to our [00:24:30] website and sign up for free. We also have a private Facebook group that you can join. It's a community of awesome people. Finally, I do a Facebook live every Thursday morning at 8:30. Join us again next week for a new episode.