This is open mind.

Now, one of the most common complaints patients come to me with is that they're tired all the time. We've all heard it, whether it's coming from a friend or a spouse or coworker, or even yourself. Why the heck are we all so tired? Well, there's a lot of reasons, but the worst part is that so many of us think that feeling tired is a normal part of life. We try our hardest to push through it.

We douse ourselves with caffeine and sugar to stay awake and get through everything on our to do list in a day. And at night, we scroll through our phones, we drink alcohol. We binge read ice cream and Netflix until we fall asleep. And then we wonder why we feel crappy and tired of what I call FLC syndrome. That's when you feel like crap.

Now, these behaviors are really just a band aid, you know, caffeine, alcohol, sugar, they help us navigate the landscape of fatigue, but they don't help us get to the root problem, and it only makes us more tired and more burnt out in the long run. So how can you quit the cycle, and how do you get your energy back? Well, the good news is there's a lot you can do when you look at this through the lens of functional medicine, and I'm living proof, then it works. And it's really one of the most important things I learned on my own health journey. And it's not something I've just done with myself, but I've done on hundreds of thousands of patients and had incredible success with.

Because fatigue can get better. When we understand how our biology works, when we get rid of the bad stuff, we put in the good stuff. When we hunt down and root out all the causes, which are anything from toxins to allergens, to microbes, microbiome, to poor diet, distress, or lack of things we need to thrive, like the right nutrients, the right food, whole food, love, meaning, purpose, these are all the ingredients for health. When we don't have enough of those and we have too much of the bad stuff, then our bodies dysfunction. And the goal of functional medicine is to get your body's functioning again.

Hence the name. Hi, I'm doctor Mark Hyman, and welcome to Health hacks.

I want to tell you about my story about my personal struggle with fatigue. And not just any kind of fatigue, but severe chronic fatigue syndrome, where I was totally incapacitated. It happened when I was a young doctor. I was about 35 years old, and I just come back from China, where I lived for about a year, and I was exposed to huge amounts of mercury. And I didn't know that was ultimately the cause, among other things.

But it poisoned my system. I got really sick from one day to the next. I went from being able to ride my bike 100 miles a day to not being able to walk up the stairs. I could remember 30 patients that I seen a day and not take notes and remember everything at the end of the day, to dictate their charts, to not even being able to know where I was at the end of a sentence. I had severe brain fog.

I couldn't sleep. I was exhausted all the time. Even when I slept, I never woke up, recovered and rested. My whole system went in total collapse. I went to doctor after doctor, and they were like, well, you know, stress, it's on your head.

You're depressed. They gave me prescriptions for Prozac, for Ativan, for Xanax, for who knows what. And of course, I didn't take it. None of it worked if I would have taken it, because it wasn't addressing the real cause. And that really drove me being so sick, drove me to dive deep into understanding how the body works, how my own body worked, why it went Keflui, and to know, really, the true origins of disease.

It was. Was a blessing and a curse. I mean, it was a curse because it was miserable to go through, but it was a blessing because it helped me learn about human biology, not from a textbook, from. But from my own body, from my own suffering from my own severe symptoms that I knew were not in my head. I knew I wasn't actually psychologically depressed, but I was physically depressed.

And I began to understand the root causes of illness, to understand how my systems work together. And I learned how to get my energy back. And I want to tell you that story through my own lens of how I began to understand fatigue. So one of the things I want to dive into today is one of the key factors that's driving fatigue for most people. Now, it all starts with your mitochondria.

So what exactly are your mitochondria? And what is the meaning of these little things? And it's a big medical word, but it's really important to understand, because this is the source of your energy. This is the source of all the power that drives everything in your body, including your brain, and it reflects itself in your energy levels. Now, these tiny little energy factories inside our cells, and there's hundreds of thousands of them in every single cell, they have really important job, and they basically convert the food you eat and the oxygen that you breathe into energy that your body can use in the form of ATP, that's your gasoline.

And it's so critical. This process of converting food and oxygen into energy is the fundamental process of life. So we're going to discuss the role of mitochondria and what they have to do with our energy and our overall health. And the top things you got to do to improve your mitochondrial health to address burnout, fatigue, and step into your most energetic life ever. So that sounds good to you.

I want to get started. Let's just sort of dive into a little bit of background on mitochondria. Now, each cell has hundreds of thousands of these little energy factories, and they're extremely sensitive to all kinds of insults. So there's a lot of things that can screw them up. They exist in great numbers, especially in a lot of the active organs, like your brain and your heart and also in your muscles, because they need a lot of energy.

Our mitochondria are where our metabolism happens. When we say metabolism, that's what we mean, basically. The metabolism is the biochemical process of running your life, essentially. And there's millions of chemical reactions in it. But the fundamental core is this process of extracting energy from food and combusting it with oxygen inside your cells in the mitochondria to make energy in the form of ATP, which is essentially the gasoline that powers all of our cellular functions.

So what happens when our mitochondria become damaged? Well, that's what happened to me, and it was a disaster. I just couldn't do anything. I couldn't think, I couldn't move. I was exhausted all the time.

I felt like I was walking through hair gel. It was awful. And I have deep sympathy for those who experience fatigue, because I've lived a lot of my life struggling with it, and I've been able to figure it out, but it's through a lot of hard work, and I'm going to share what I've learned, both on myself and with my patients. So you can help understand maybe what's going on with you and why you're dragging around a little bit. Now, the problem is that our mitochondria are highly sensitive to all sorts of insults, right?

Everything we're exposed to in a day, and we call this the exposome. What is our biology exposed to? What is it exposed to in utero, in our early childhood, in our adult lives? What are the insults that are going on? And what are those kinds of things that can be affecting us?

What is the exposome well, it's the sum total of our lives washing over our biology. It's psychological stress. It's our horrible diet. It's environmental toxins and heavy metals. It's latent infections.

It could be mold. It could be allergens. All these things create inflammation and free radicals or oxidative stress. Some oxidative stress, which you're familiar with. It's when an apple turns brown or your car rusts, or whatever that's called.

Oxidation. And oxidative stress is something that happens in our bodies. It's necessary for cell signaling, for regulating our immune system and our ability to kill pathogens. In fact, the way your white blood cells killed viruses and bacterias, they try to oxidize them, right? They put in hydrogen peroxide or even ozone they produce in your cells to kill the bad guys.

So our body has a natural ability to produce oxytocin stress as a defense mechanism. It also helps regulate homeostasis in the body, since this is basically the regulatory pathways that control everything. But you can have too much oxygen stress, and that can damage your mitochondria and cause internal malfunction. So a little bit is part of our normal biology, and we have mechanisms to mitigate it, but it's often out of control, and that leads to kind of runaway cell injury. This is like a car rusting, you know, just as a car rust, when it's exposed to oxygen and moisture.

Our cells also get damaged when they're exposed to too many reactive oxygen species or free radicals. Now, what does that do? Well, this damages our cells. They work less efficiently. They have problems functioning if they're not kept in check with antioxidants, which are kind of like an anti rust system.

We have. We have our own built in antioxidants. You can get them from vitamin C and vitamin E and all that. But our bodies actually own internal antioxidant systems are way more powerful. But they're often hampered because we're nutrient deficient, which they need.

Or the enzymes don't work as well because of all the burden they have to deal with. Or they're just overloaded. They just can't keep up. Right. When your mitochondria are not working properly, then you start to feel the symptoms, right?

You feel low energy, you feel fatigue, memory loss, maybe more pain, brain fog, cognitive decline. You get muscle achiness, weakness, migraines. Aging itself is a mitochondrial disease, a mitochondrial dysfunction. And so many of the diseases of lung aging, so many of the things we get as we go through later life, like heart disease, cancer, diabetes, Alzheimer's, dementia, all sorts, even Parkinson's, they're all strongly tied to dysfunction in your mitochondria. And that mitochondrial dysfunction is connected to things like type two diabetes, metabolic syndrome, obesity.

In fact, when you have insulin resistance, it, by definition, is a metabolic dysfunction and is affecting mitochondrial function. And the problem is, 93% of us are metabolically unhealthy, meaning we have some problem with our mitochondria at some degree or another. All the diseases of aging are essentially mitochondrial diseases. So it's one of the ten hallmarks of aging I wrote about in my book young forever. And it's an essential concept here, which is that there are fundamental processes that go wrong that underlie all disease.

So if we get to the root cause, the underlying processes, and we dress those, one of the key ones is mitochondrial dysfunction. We can actually address many downstream diseases that are the result of these dysfunctions. So diabetes, heart disease, cancer, dementia, Parkinson's, these are downstream to mitochondrial dysfunction. And if you address the cause, you can really avert or even reverse many of these conditions when you have too many free radicals. And I'll explain why you're getting too many in a bit.

It damages the mitochondria. We become less efficient in making new mitochondria. We're not as good at taking out all the damaged old mitochondria through a process called mitophagy. I'm going to talk about how we can up regulate mitophagy. That means fagi means eating.

So mito means mitochondria. So it's sort of the eating of your mitochondria. In other words, you're recycling and getting rid of old ones and making new ones. So, I mean, you ever wonder why a three year old just bounced around with endless energy while a 90 year old sort of move around pretty slow? The three year old has mitochondria that function like a well done machine.

There's lots of mitochondria. They're souped up, whereas the 90 year old has slow, rusty mitochondria. But it's not something that has to happen. It's the consequences of us not taking care of our mitochondria. And this is really one of the fundamental concepts of functional medicine, is that you can take care of the fundamental biological systems in your body that drive all disease.

And in truth, functional medicine is not about treating a disease. It's about creating health. And that means creating a healthy mitochondria and knowing how to do that. Okay, so what are the symptoms of poorly functioning mitochondria? Well, fatigue is probably the most common symptom.

And the good news is that we can reinvigorate our mitochondria. We can help restore their function. We can take our energy and our lives back. It's really possible. I'm a testament to that.

I've done it. I promise you, it works if you know what to do. It took me a while to figure it out because I didn't have the roadmap that I do now. But after 30 years of practicing functional medicine and seeing thousands of tens of thousands of patients, applying this to myself, and then I really come to understand deeply how to assess and how to treat mitochondrial dysfunction. We have to figure out, for every individual, what's causing the damage in the first place, because it's not the same.

The end result is damaged mitochondria. But why does any one individual have more damage or less damage? And is it from a different trigger? Right. One person may be their microbiome, another person may be heavy metals, and another person may be mold.

Another person may be too much sugar and prediabetes. So all these are different causes for the same final pathway. So what are the top insults that damage our mitochondria? So that's the first step, is getting rid of the stuff that damaged your mitochondria and reducing it or eliminating it? The second step we're going to talk about is how do you rev up your mitochondria and get new ones and better ones?

So the first reason in our society that our mitochondria is not functioning well is our diet. It's our standard american diet, our crappy diet. This is full of processed food and inflammatory foods and foods devoid of nutrients and phytochemicals. All of that has a huge impact on our mitochondria. So how did that work?

Well, our diet is critical in maintaining mitochondrial health and function. And the nutrients we consume directly influence how our mitochondria function and whether they cause oxidative stress and free radicals, and damage our mitochondria in a vicious cycle, causing more energy loss. Or on the other hand, how do the foods we eat protect against damage to our mitochondria and improve their health? One of the biggest drivers is ultra processed foods. And you're probably sick of hearing me talk about this, but I'm going to keep talking about it because it is the central problem of our time.

Ultra processed food is the new tobacco, period. It's addictive, it causes serious health consequences. It's ubiquitous, it needs to be regulated, legislated and addressed. I'm working on this in Washington, but it's a whole nother conversation. But we're trying to get food labeling to get be clear so people know what they're eating, or getting, you know, various initiatives that help us to kind of reduce our ignorance, I would say, about the dangers of these foods.

So these are foods that have a high amounts of refined sugars or flour. They are full of deconstructed ingredients from raw materials like soy, corn and wheat that are of broken down into their separate molecular structures. They're reassembled into science projects that may look like food, but are actually not food by the definition of food. If you look it up in the dictionary, which is something that supports the growth and development of an organism, which certainly don't, they do the opposite. These ingredients that are in these foods do a number of things.

One, they flood the bloodstream with sugar, whether it's from bread or from, from actual sugar below the neck. Your body can't tell the difference between a bowl of sugar and a bowl of cornflakes, right? So this overwhelms the mitochondria because they're trying to process all that sugar and they convert, trying to convert to energy, and that leads to the excess production of reactive oxygen species. Now if you're eating foods with lots of antioxidants, you kind of balance the whole thing out. But if you're eating just basically processed science projects, they require a lot to process and they produce more exhaust, which basically is the reactive oxygen species.

So when you eat food, calories, energy, and you breathe, you combust it, and a number of things happen. One, it goes down in semi lying to produce ATP, which is good. Second, it produces carbon dioxide as a byproduct, which you breathe out. Third, it produces water, which you need, and you pee out. But fourth, and this is the problem, is that it produces reactive oxygen species.

In other words, it produces these free radicals as a normal consequence. But when we don't have the right food, we're producing too many of these. And our own bodies can't mitigate the effects. And often nutrient deficiencies like zinc or manganese and other nutrients are really important. Our selenium for regulating our reactive oxygen species through various enzymes like sod and catalase and glutathione, peroxidase.

These are all enzymes that are antioxidant enzymes that are producing these really beneficial antioxidant systems. But we become dysfunctional in these systems because we don't have enough nutrients. And what happens when you have too much of these reactive oxygen species, or free radicals. They basically damage the mitochondria itself, they damage the power plant, and they reduce their ability to produce energy efficiently. So it's kind of a vicious cycle.

Now, when you look at the research, it shows that fructose directly inhibits mitochondrial enzymes involving making ATP. Doesn't mean you don't eat fruit. It means you eat fruit as a whole fruit, not as fruit juice or high fructose corn syrup. And fructose is extremely damaging to the mitochondria when it's consumed by itself. Now, the oxidative stress produced by a mitochondria damages them even more, creates a vicious cycle.

So it's like a chain reaction. It's really like a hydrogen bomb, just go. It's like a chain reaction. And that's what happens with free radicals. It just creates a.

Like a wildfire spread of oxidative stress throughout your body. And we need ultra processed foods. In addition, they create inflammation and they lead to insulin resistance. And that actually is really a challenge, because when you have sugar and refined carbs all day, our cells become less responsive to insulin. The pancreas produces more insulin, helps the blood sugar into the cells.

But over time, that leads to this problem called insulin resistance and high insulin levels. Now, mitochondria and insulin resistance cells have less glucose to convert to energy and more glucose floating around the bloodstream. So that makes us feel tired from basically a lack of ATP being produced and all that excess sugar that can't get inside our cells is converted into triglycerides by the liver, and then the increase in triglycerides levels in the blood, which is seen in metabolic syndrome type two diabetes, they all increase heart disease risk. That extra calorie is stored as fat because mitochondrial dysfunction makes them less metabolically flexible. So actually, when you eat sugar, it causes a damage to your ability to turn food into energy.

So you get less energy and you're more tired, and your mitochondria become less effective. And it's this vicious cycle of the sugar causing more metabolic dysfunction, which causes more trouble regulating sugar, which causes more insulin resistance, which causes more mitochondrial dysfunction. And you're in this vicious cycle. So the key to our health is metabolic flexibility, and that's our ability to switch from burning carbs to burning fat for energy. So not only we're not burning as many carbs, but we aren't able to switch to burning fat efficiently, leading to a low energy state, then switching to fatty acid oxidation, which is burning fat for more energy actually can create more oxidative stress and more mitochondrial damage.

So at least a vicious cycle and a high sugar diet basically leads to a high blood sugar, which creates oxygen stress that damages our mitochondria. It causes insulin resistance, it lowers our energy output. It's a vicious cycle and that makes us have more cravings for energy dense food, like ultra processed foods that are loaded with starch and sugar, and lots of inflammatory fats like trans fat, omega six, seed oils and more. And the ultra processed foods are also low in really important nutrients that are necessary to protect your mitochondria, like the right protein, fiber, vitamins, minerals, phytochemicals and antioxidants that our mitochondria need to function optimally. It's kind of like running a power plant without proper maintenance, which is the antioxidant repair, and without fuel.

There's a lot of nutritional deficiencies that go into causing mitochondrial dysfunction. And there's so many common nutritional deficiencies of nutrients that are essential for turning food into energy. For example, we need magnesium to make ATP. But probably 45% of people are deficient in magnesium in America and many more are insufficient. There's minerals like zinc, selenium, copper and iron, which are all co factors for many of the cellular processes involved in antioxidant status and protecting our, in protecting our cells from damage.

B vitamins, very common deficiencies in folate and b. Twelve, many cases, these are co factors that support energy production. So you actually need the B vitamins to produce energy, sort of like the helpers on an assembly line converting food into energy. Now when we don't get enough of these nutrients, it just reduces our ability to produce energy and our energy output. And the damage is done because 60% of our diets comes from ultra processed food and that's very nutrient depleted.

It's loaded with starch and sugar and it also doesn't contain any of the essential nutrients. So we become more deficient over time. People think if you're overweight that you're overnourished, but actually you're the undernourished and overfed. You have too many calories and not enough nutrients. And many of these people are very nutritional deficient.

When you do their blood work, and I've done this many, many times, you just see how grossly malnourished they are when it comes to levels of nutrients that are needed for every single function of your body. All right, so what else besides our diet damages our mitochondria? Well, many things. It could be microbes infections from underlying virus or bacteria. You know, for example, when you get the flu or if you had Covid, you'll feel tired, right?

Because these viruses or even bacteria can produce toxins that damage our mitochondrial membranes, that actually disrupt our mitochondrial function. And we see this, right, sometimes. Covid-19 had led to long Covid, which is really concerning. And a lot of that has to do with mitochondrial dysfunction that happens as a result of chronic inflammation from long Covid. So how did this work?

Well, SARS CoV two virus attaches to the receptors called ace two receptors. These receptors are essential for mitochondrial function. Now, when the spike protein from the coronavirus binds to the ace two receptor, it really disrupts the mitochondrial activity and it leads to decreased energy production and more free radicals or oxidative stress. They looked at a study which tried to estimate the incidence rates of fatigue after Covid. And researchers reported a 68% increased risk for fatigue.

That's a lot. And a 430% increased risk for chronic fatigue in 5000 patients within eight to 16 months post infection. That's a staggering number. 430% increased risk for getting chronic fatigue after Covid. Now, why did they do that?

Well, Covid induced a strong immune response that leads to the release of cytokines. You've heard of that cytokine storm thing. These are the inflammatory messengers of your immune system. Now, these cytokines can cause excessive production of free radicals or reactive oxygen species inside the mitochondria. What does that do?

It damages our mitochondrial DNA, which is a separate DNA. It damaged mitochondrial proteins and lipids, which make up the cell membranes and the parts of the cell, and all that impairs mitochondrial function and energy production. Not only that, but the SARS CoV two virus can interfere with cellular cleanup and mitophagy, which is our mitochondrial programming. This targets and destroys damaged mitochondria. So basically, not only do you get damaged mitochondria, but then you can't get rid of them, right?

And that leads to the accumulation of dysfunctional mitochondria, which perpetuates the whole cycle of cellular stress and damage. How long does that go on for? Well, it depends on the individual. Now, long Covid fatigue symptoms are most likely the manifestation of mitochondrial dysfunction. There's lots of other examples of viruses that have different impacts on our immune system, but similar impacts on our mitochondria by causing oxygen and then that depletes our energy level.

So it's not just Covid, but many, many viruses in the flu. Obviously, Epstein Barr you've heard about that causes chronic fatigue syndrome, Lyme disease, an intracellular tick infection, or spirochete, can cause that. Bacterial infections, right? Can cause fatigue. Staph, strep, E.

Coli, all these things disrupt mitochondrial function. They make us tired. That's where we get tired when we're sick of something, right? Our gut bacteria are another big factor. It's not quite infections, but it's imbalances or dysbiosis.

And our gut bacteria majorly influence our mitochondrial function, which can make this a chronic, low grade insult to our mitochondria. So when our microbiome, our gut bacteria, that whole ecosystem of bugs in our gut is overloaded with bad bacteria, from a poor diet, from not enough fiber, from too many processed foods, from emulsifiers and thickeners, when we have too much sugar and starch, which feed the bad bugs, when we have toxins that affect your microbiome, we have too much stress. It all causes this vicious cycle of inflammation inside the body, and it leads to something called the leaky gut, where bacteria release endotoxins that enter the bloodstream and trigger inflammation. And food particles, or partially, food particles get in and also trigger inflammation, leading to food sensitivities. Now, this inflammation damages our mitochondria, and it can lead to significant mitochondrial dysfunction.

So anything that causes inflammation, right, whether it's infection or anything else. So what else? Well, toxins, heavy metals. That is what caused my chronic fatigue syndrome, which was mercury toxicity. What happens when our mitochondria are exposed to heavy metals like mercury, lead, and cadmium is pretty bad, right?

What they do is they inhibit key mitochondrial enzymes. They bind to sites inside the cell where the cofactors that are activating your antioxidant systems, like iron, copper, magnesium, are supposed to bind. This causes oxytocin. Stress damages our mitochondria, membranes in our DNA, depletes of antioxidants, inhibits the process of mitophagy, which is the process of degrading and removing those damaged mitochondria, and that leads to the accumulation of damaged, dysfunctional mitochondria. Now, when I was dealing with mercury toxicity, when I had chronic fatigue and mitochondrial dysfunction, it impacted every area of my body, including my brain, which showed up as brain fog, depression, add, memory loss, you name it.

My mercury poisoning came from living in China, in Beijing during the winter, where people heated their homes with raw coal, which is a source of mercury, lead, and lots of other contaminants. I was breathing that in every day. I also ate a lot of tuna fish sandwiches growing up, and I had a mouthful of mercury fillings. And so my exposure accumulated over my lifetime, and it also accumulated because of my own genetic risk that interfered with my own ability to detoxify metals and many other things. And this eventually caused my toxic load to overflow, essentially, which is when my symptoms start developing.

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Never skip therapy day with Betterhelp. Visit betterhelp.com healthhacks today to get 10% off your first month. Betterhelph.com healthhacksh E A L T H A C A K S now, there's a lot of other environmental toxins we're exposed to that can cause mitochondrial dysfunction. It's everywhere. Mold, toxins, BPA, plastics, phthalates, air pollution, even indoor air pollution from furniture off, gassing, fragrances, scented candles, dust.

So you got to keep your house clean, get an air filter. Even chronic stress can actually be incense, a toxin that leads to mitochondrial dysfunction. So let's talk about stress. How does stress and chronic psychological stress impact our mitochondrial function? Well, it increases the production of something called reactive oxygen species.

We talked about the free radicals. It depletes our own antioxidant systems. It messes with our mitochondrial dynamics, basically the splitting of old mitochondria to fuse with better functioning mitochondria. And our mitochondria basically do this process of fusing with stronger, better functioning mitochondria to stay healthy and efficient. And when we're stressed, there's too much splitting and not a fusion.

And that results in the accumulation of more damaged mitochondria. Now, the research shows that oxidative stress and mitochondrial function are heavily implicated the pathology of schizophrenia, which is interesting. And when you look at, by the way, I just got to take a sidebar here, but a lot of the brain diseases are mitochondrial diseases. We know it plays a role in depression. We know it plays a role in Alzheimer's, in autism, highly dysfunctional mitochondria in the brains of autistic kids.

So we basically know that all of this chronic psychological stress basically impacts the energetics of metabolism. And how does it do that? Well, cortisol is our main stress hormone, and it's produced in the mitochondria of the adrenal glands. Stress activates our hypothalamic pituitary, adrenal axis. That's basically our hypothalamus telling our pituitary in our brain to go to our adrenal glands to regulate our stress response.

And that instructs the adrenal glands to make cortisol. Now, how does that impact mitochondrial function? When cortisol is released, it initiates the shifts in energy metabolism. So there's more sugar in the bloodstream to prepare the body for fight or flight situations. So, when you're stressed, you want sugar floating around your blood so you can run really fast.

Just makes sense. And it basically tells ourselves to reduce the uptake of sugar from our bloodstream, leaving more in the bloodstream so we can run or fight. The problem nowadays is our modern lives put us under constant stress. Work, our kids, family, finances, travel, chores, all of it. And that can cause high cortisol and high blood sugar levels, which can lead to oxidative stress, insulin resistance, and mitochondrial dysfunction.

Also, this constant activation of this hp axis causes our adrenal glands to make fewer steroid hormones, like DHEA, progesterone, testosterone, and it focuses instead on producing more cortisol. So that's not good, right? High cortisol causes energy to be stored as inflammatory belly fat. Another problem. And then you get constant belly fat accumulation.

That drives more inflammation, drives more insulin resistance. You get into a vicious cycle. Now, eventually, with enough stress, the adrenal glands just become overworked and become desensitized to the signals, and you get kind of burnout, right? It's not well recognized by traditional medicine, but low grade adrenal dysfunction is very well understood. And, in fact, this has been well described in New England journal Medicine by Bruce McKeown in his landmark article about stress and the adaptive stress response a number of years ago.

We'll link to that article in the New England Journal of Medicine. Basically, what you get is adrenal dysfunction and mitochondrial dysfunction and low cortisol and then burnout. And then you just kind of pooped all the time. Now, stress also can negatively impact our mitochondria. But how we deal with stress can have an added negative impact.

Right. If we don't get enough sleep. Right. Because we're stressed, that affects us. Now, our mitochondria are on our circadian clock and have a very important job of producing energy to help the body heal and repair itself at night.

So your mitochondria kick into gear at night to help your body heal. So sleep deprivation actually impairs our mitochondria's ability to fuel these processes. Right. And that results in the accumulation of all sorts of damaged cells, things called senescent cells or zombie cells, that drive more inflammation. Now, all this free radical stuff, it basically impairs the mitochondrial function and impairs the recycling and the formation of new mitochondria.

And that leads to lower energy levels. So you get this vicious cycle of dysfunctional mitochondria, less cleanup of the mitochondria, less making of new mitochondria, and that leads to an energy crisis. Right. There was a study, they looked at a cross sectional study of about 238 middle aged adults. Poor sleep quality and longer sleep latency time, which is basically the time it takes to fall asleep, were associated with mitochondrial dysfunction and rapid cellular aging.

The mitochondria are also the primary site of melatonin production. So all these good things that you need for your body are regulated by the mitochondria. Research shows that blue light exposure late at night might actually interfere with the body's ability to produce melatonin. So don't get that blue light at night. That's your phones and stuff like that.

Drinking alcohol, also not so good for you. Research shows that binge drinking or excess alcohol consumption, basically drinking every day, has serious effects on your mitochondria. In fact, when you're metabolizing alcohol, it increases free radicals. And then those damage to the mitochondria, and that leads to more of the problem we talked about, the accumulation of damaged and dysfunctional mitochondria. It also makes mitochondria not work as well.

They're less efficient at producing energy, impairs the mitochondria's ability to reproduce themselves and to reduces the antioxidant defense systems that are in your body, like glutathione, which is depleted. And that really could be why oxidative stress and alcohol hangovers are associated with mitochondrial dysfunction. Smoking is another big problem. Smoking introduces a whole multitude of harmful chemicals into the body. And what does that do?

More free radicals, more mitochondrial damage. And it basically decreases the whole assembly line. We call it the mitochondrial respiratory chain, which is basically how you convert food and oxygen into energy. That whole assembly line gets interrupted and you get less ATP. What else can cause mitochondrial dysfunction?

Well, overeating, too many calories, and obesity, too many calories in general, even it's good calories, can basically overwhelm the mitochondria, but it's worse when they're ultra processed food or sugar and starch. And that leads to an excess of reactive oxygen species, right. It also leads to obesity in a vicious cycle. So obesity perpetuates obesity, and it's just a vicious cycle. When you have this, you also have higher levels of what we call white adipose tissue, or your visceral adipose tissue.

And that tissue, that fat tissue, is not just hanging there in your belly, holding up your pants. It's basically an endocrine and immune organization, and it secretes hormones. And many inflammatory cytokines are called adipokines, or adipocytokines, that basically stress our mitochondria, making them more inefficient at burning calories. So, basically, when you're obese, you get in an energy crisis. You think you have excess energy, but you're actually in an energy crisis.

Another big factor that drives mitochondrial dysfunction is being sedentary. What you don't use, you lose, right? Not exercising means that you're not working your mitochondria, your muscles are the biggest source of your mitochondria. The way to get new mitochondria we're going to talk about is to exercise and to get better functioning mitochondria is to exercise. Now, what happens is, when you're not exercising, you become more and more likely to not exercise right.

You basically have less energy, you become tired, you become lazy. But it's not because you're lazy morally, it's because you're biologically driving this. You get an ambitious cycle of just poor mitochondrial function, and you get less mitochondrial formation or biogenesis. The quality control that leads to accumulation of weak, poor functioning mitochondria, and higher levels of inflammation are all messed up, right? So, basically, the whole mitochondrial story of making new mitochondria, having better functioning mitochondria, cleaning up old mitochondria, that whole system gets impaired.

That's all the bad news. What about the good news? How do you get more energy? How do you protect your mitochondria? How do you either prevent yourself or actually fix the whole problem of being tired and burnt out?

Well, first you got to get to the root cause and it's different for everybody, right? So ask what could be damaging your mitochondria. Now, you need to sometimes do some digging, but if you know you're eating processed food, you're not exercising, you're smoking and drinking too much, I would start there, right? You can pretty much figure out the cause or if you're nutrient deficient or you're not taking a multivitamin, there's a whole bunch of things you can do that are low hanging fruit that will help your mitochondria. But sometimes you need lab testing to figure out what's driving your symptoms.

And the problem is, most conventional doctors don't do comprehensive testing, which includes inflammatory markers, nutrient levels, heavy metals, thyroid testing, autoimmune markers, and more. All of which can help you get to the root of your fatigue. And essentially, that's why I co founded this company, Function Health, which tests over 110 biomarkers and twice a year testing and provides a comprehensive roadmap to help you find the root cause of what's happening beneath the surface. Then you go to functionhealth.com mark there's about 50,000 people on the membership roles. Now, we have about 200,000 people on the waitlist, but you can jump the waitlist using that code.

Functionhealth.com mark now, some biomarkers we test are important, and they can help really pinpoint the cause of your fatigue. The first is HsCRP or C reactive protein. This measures inflammation, so it can be from any source, but it tells you there's inflammation. Also, your cellular blood count, your white cell count can give you a clue about infection. We might see Lyme disease in the testing.

Heavy metals, we check lead, mercury. We look at cortisol for adrenal function to see if your cortisol is low or high. We look at thyroid hormone, which is key to metabolic health and mitochondrial function. And if you have low thyroid, which is very common, about one in ten men and one in five women, it's a big factor. We'll also look at metabolic dysfunction and insulin resistance, which we measure through looking at glucose, fasting insulin, which never gets measured.

Leptin A, one c. We also check nutritional deficiencies, including omega three s, magnesium, zinc, iron, b vitamins, vitamin D, which are really critical for running your mitochondria. Now, you don't have to get your testing done to start changing your health to improve your energy levels, but it can help really speed up the process of figuring out what's going on and what to focus on. For example, if you have a lot of inflammation, you got to address that. Or if you're a nutritionally deficient, you can fix that.

Or if you're metabolically dysfunctional with prediabetes, you can fix that. So how do you start to unpack all this? Well, I want you to take stock of your lifestyle and your diet and your habits. Keep a diary. What does your diet look like?

You find yourself reaching for carbs and sugar throughout the day. Write down what you eat in the day and record how you feel. What does it make you feel physically? Mentally? Do you have mood changes?

Do you feel more stressed? Do you feel more anxious? It's going to help you get a better handle on how your diet quality affects your energy also. Then you can start to make changes to your diet when you start figuring this stuff out right, and see what happens. You know, most people don't realize that you're just a few days away from feeling better if they address the root causes and they switch up their diet.

I do these programs all over the world, these longevity programs called young forever. There's retreats. I do them in Ibiza, I do them in Europe, some in America. And it's amazing, in just a week or even five days, people's energy level will dramatically change. Just switching off their processed or their typical inflammatory diets to an anti inflammatory diet.

So how do you do that? You want to eat real nutrient dense whole food whenever possible, get rid of all the ultra processed food. Load up on colorful, low glycemic, polyphenol rich veggies and fruits that are rich in fiber and antioxidants. You know, these are full of these phytochemicals, which are essentially the most powerful antioxidants. They help protect your mitochondria from oxidative stress.

For example, elagitannins, which is a polyphenol found in pomegranates, raspberries and strawberries are transformed by your microbiome into this super powerful active compound called urolithin a. Now, most people have lost the bacteria to do this conversion. And you can actually take urolithin a as a supplement, which I do every day. Now, this helps maintain mitochondrial quality control. It regulates what we call mitophagy, which is the removal of damaged mitochondria and recycling hair system.

It also feeds your good microbes and it helps strengthen your gut barrier. And it's a really amazing compound. Other things can be helpful. Time restricted eating. Eating within a eight to twelve hour window.

So you can basically eat dinner at six and have breakfast at eight in the morning and that's 14 hours fast. And that'll actually help to improve your mitochondrial function. If you don't like the idea of cutting out ultra processed food or changing your diethyde, maybe just try the time restricted eating. But I'd recommend both. Right.

It's basically kind of a form of fasting that requires you to push the time you eat your first meal a few hours forward so you don't have this constant load of food and stress on your mitochondria. Giving them a break helps them to reset, to clean up and to repair. So maybe instead of eating right away when you wake up, wait two or 3 hours and eat all of your meals within a ten to twelve hour window. Right. 08:00 a.m.

to 08:00 p.m. or 08:00 a.m. to 06:00 p.m. that's going to give your body enough time without food to focus on cleaning up and repairing damage to your mitochondria. Now, you still want to focus on getting ultra processed food, right?

Obviously, don't just eat ultra processed food and do time restricted eating. It's a bad idea. What about drugs? Well, a lot of medication and drugs that we use every day affect our energy and stress. Now, the most common drugs, which are non prescription are sugar, caffeine and alcohol, and obviously tobacco, but less people are doing that.

So I encourage you to cut down on these dramatically. There's no safe level of alcohol, sugar and alcohol. I think it was recreational drugs, used occasionally and sparingly and for fun, but not as a staple. Caffeine, a little different. But again, if you're always tired and you're struggling to wake up, you might want to consider a caffeine holiday.

See what your natural energy state is. Not that people feel more energy when they stop caffeine. Now, if you drink caffeine all day, that's not good. Just try to do one or two cups in the morning. That's it.

That's going to interfere with sleep, which is going to create more problems. Now what about alcohol? If you drink every night, try to cut down to 654-3210 or occasionally. So I'll drink, but it might be once a month. I don't drink every night.

I don't drink every day. The next thing you want to do is actually lower inflammation. And the best way to do this is to use food as medicine. Incorporate all these anti inflammatory foods that help to boost your energy, to strengthen your mitochondria, and protects against oxygen, stress. And that's all the colorful phytochemicals, there's tens of thousands of them, are food.

They're incredibly powerful and they're something we don't get enough of. Now, what else can you do to help your mitochondria? Well, they're made up of fat, this fat membrane around the outside, and you need the right fats. And the most important fats are the omega three fats. So two servings of small cold water fish every week, like salmon, mackerel, herring, sardine, anchovies, trout.

That's really good. It'll get you a lot of omega three s. You can add more if you want. They don't have mercury in them, so that's good or very low levels. Also add a handful of walnuts, flaxseeds, chia seeds.

Those are omega three containing plant foods, but they don't get converted as well to the EPA dHA that we need. So you need both. Vitamin C containing foods are great. Citrus foods, kiwis, bell peppers. Vitamin E, also great antioxidant.

They're an almond, spinach, olive oil, sunflower seeds, hazelnuts, avocados. Zinc are really important for mitochondrial function and on oxidative stress management. And you get that from grass fed meat, from wild caught seafood and pumpkin seeds. So once you've tuned up your nutrition, you got off the ultra processed food, cut down the sugar and starch, got off the alcohol as much you can, and you've taken the, the right foods to boost your nutrient status. You might want to start to move.

Actually, we think we're spending energy when we exercise, but actually gives us more energy. Exercise is so good for your mitochondria. Why? Well, it boosts something called mitophagy. That's the clearance of these damaged mitochondria.

And that optimizes and strengthens mitochondrial function. It combats aging and age related diseases. So exercise is the best therapy for your mitochondria. It produces a release of something called exokines. Right.

Those are cool. You never heard of those before? Right. They're signaling molecules that are tissues secrete in response to exercise. So when you exercise, you're producing these beneficial compounds called exokines that have a positive influence on our biology, including making new mitochondria.

So these exercise help you make new mitochondria. And what kind of exercise should you do? There's all kinds, but you need all of them aerobic or cardio, high intensity interval training, where you're doing like, wind sprints and strength training or resistance exercise are all really important for strengthening, improving the function of rheumatochondria. And it also does a lot of other things. Right.

It boosts our muscle strength, it boosts our metabolism, our endurance, makes us be able to do more stuff. Exercise, also a form of hormesis, which we've talked about, that's a stress that doesn't kill you, that makes you stronger and more resilient, and, and it's great. And there's lots of other forms of hormesis that can help, including saunas, cold plunges. All that boosts our antioxidant systems. It increases glutathione, which is our master antioxidant, that helps reduce inflammation.

It also really protects our mitochondria from oxidative stress. It also increases nAd activity, which is really important. That's a longevity molecule involved in energy metabolism, in signaling, all kinds of molecular processes, in DNA repair. And low levels of NAD are really associated with inflammation and aging. Now, exercise boosts NAD, which is good.

And what else does Nad do? Now? Nad activates something called their sirtuins, which are part of the longevity switches that I wrote about in my book, Young forever. Basically a family of signaling proteins that creates more and better functioning mitochondria. So basically everything that, everything that exercise does is great for your mitochondria, right?

So it makes new mitochondria, it cleans up old mitochondria, makes your mitochondria work better, it improves nad status in your body, it boosts your antioxidant system. So it's just all around a good thing. So what else can you do to help your mitochondria? Well, optimizing your nutrient levels and addressing deficiencies is really important. One of the biggest deficiencies, omega three fats, probably 90% of us, are deficient or insufficient.

And so you want to be taking a high quality fish oil supplement. My favorite is omega three rejuvenate from big mold health. True. Full transparency. I'm an advisor and an investor, but I did that because I think it's one of the most effective products out there in terms of omega three s and how they process it.

Antioxidants are helpful to take, including vitamin c, zinc, vitamin e, selenium. These can be all taken in a multivitamin. Also, you want the full spectrum of B vitamins, thiamin, riboflavin, niacin, b five, b six, biotin, folate, b twelve. These are all cofactors for making energy and supporting all the processes occurring in our mitochondria. And again, you can just take a multivitamin.

Now, b vitamins are really high in animal protein, especially organ meats like liver, eggs, fish, leafy green vegetables. Now, if you're a vegetarian or vegan, you want to be careful. You have to supplement with a b complex. You're not going to get b twelve from your food, and you're often nutrient deficient. Now, there's other nutrients that are important.

Magnesium. I call that the relaxation mineral. It's really important for those who are under chronic stress, because stress depletes magnesium. It can lead to burnout and adrenal dysfunction. And magnesium is great because you can get it in almonds, cashews, pumpkin seeds, lots of greens, like spinach, kale, swiss chard.

You can get in your avocados, even dark chocolate and non gmo soy. So it's important to make sure you get a good suite of supportive nutritional supplements. And I basically recommend a multivitamin, fish oil, vitamin D, magnesium, all really helpful, even probiotics. Now, what else can be affecting your mitochondria that you can do something about? Well, stress.

I mean, we all get it. We're all exposed to it. You can't get rid of it. It's around, but it's how you respond to stress, right? Stress is defined as the real or imagined threat to your body or ego.

So a lot of it has to do with our perception. It's a real or imagined threat to your body or ego. So it's not actually something that has to be real. We can just think it's something that somebody said to us that they mean something bad, but it actually isn't, you know, what is it? Is it your job?

Is it family stress? Is it financial stress, your relationships? Maybe social media for sure is driving more stress, trauma, childhood trauma. So you can actually manage it, you can learn how to regulate. And there's really wonderful things that are available now today that are on apps, that are online, that are easy tools to integrate mindfulness into your day.

It can be meditation, walk in nature, listening to music, calling a friend, you know, getting a massage, just hanging out, just making time to be right. Get regular date nights with your partner to connect. Deeper relationships also are in any dose of stress. Sometimes you need therapy or counseling to work through deeper issues. Sometimes childhood events that are severe, like divorce, trauma, abuse, addiction, also affect how we deal with stress.

So learning how to sort of just regulate our systems is really important. And again, we've covered this a lot on the podcast in the past, in the doctor's pharmacy. But learning how to manage and navigate stress is really critical. Learning also how to say no is important. Saying no to somebody else is often saying yes to yourself.

There's other things you can do, like just taking a digital detox. I've been without my phone for weekends or weeks sometimes, and it's just like, wow, I get my life back. It's unbelievable how these little devices have captured our attention and capture our lives. There's other simple practices you can do, like gratitude practices, eating a healthy diet, finding a creative outlet are all great for regulating stress. And it's important also to set realistic goals on how you navigate your life.

Right. Take small steps, make lasting change in your life. Right. The journey of a thousand miles because of the one step that's from the dao te ching. Starting with, like, one or two things that you change, you know, it can be easy.

Just get more sunlight in the morning, maybe walk. Take a walk every day, and then just sort of slowly add things to your life that help layer on the beneficial things you need to do to promote health. The other thing you do to manage your mitochondria is sleep. All right? Get seven to 9 hours of sleep a night.

Good quality sleep. Make sure your room is dark. Get sunlight in your eyes every day. In the morning, your mitochondria on our circadian rhythm, so they need a cycle of darkness at night. So make sure your room is blackout.

It's really important because even light can get through your skin. Your body picks it up, so, you know, make sure you have blackout shades in your room or wear eye shades at night or cover your body so you're not getting any light exposure. And then you want to get sunlight through the day, particularly in the morning, and that'll help regulate your circadian rhythm. Certain therapies can be really helpful, like red light therapy. It's called photobiomodulation, and the science around this is interesting.

Basically, exposure to specific wavelengths of light, particularly the red and near infrared spectrum, can really help support mitochondrial function through a process known as photobiomodulation, or PBM, or low level light therapy, or LLT. This process involves light absorption by something called cytochrome c oxidase, which is a mitochondrial enzyme. And so basically the light. This is amazing. Just like your photosynthesis, right?

You think only plants do this, but humans do this, too. They basically absorb light through the skin, gets absorbed by a mitochondrial enzyme, just like the mitochondria that are these sort of energy producing cells basically absorb light, and that enhances ATP production and upregulates genes involved in healing and repair. And what do you get when you do that with the light? Well, you get more energy metabolism, less inflammation, better tissue repair. You get protection against oxygen, stress, lots of good things.

Also, you can just go for a walk outside if you're feeling tired during the day. That's really nice. You can do that. Get some, get some light. And lastly, I want to focus on other key things you can do.

There's really important mitochondrial protective and energy boosting nutrients. I use these personally. I've had mitochondrial injury. I take good care of my mitochondria, and these nutrients provide lots of additional energy and mitochondrial support, along with a whole food, plant rich diet. So what are the top ones that I recommend?

Well, acetyl l carnitine. Carnitine is critical in fat metabolism, and there are lower levels of carnitine in chronic fatigue patients than in healthy people. When you take adequate carnitine, it supports the transport of fatty acids into the mitochondria for energy. So basically, burning, burning energy. Another important nutrient is alpha lipoic acid.

It's a powerful antioxidant, probably one of the most important ones in the body. It also promotes mitochondrial biogenesis, making new mitochondria. It improves your insulin sensitivity and lots more. Another key mitochondrial nutrient is coenzyme Q ten. Low levels are associated with fatigue, with mitochondrial dysfunction, so getting out of a Coq ten is important.

Another key nutrient is n acetyl cysteine. This is a precursor to glutathione. We also call it Nac or Nac, and that can help really reduce oxidative stress and mitochondrial function. You also want to be on a b complex, as I talked about before, because the b vitamins are the critical cofactors for making energy and supporting all the processes in our mitochondria. You also want to take magnesium.

I like magnesium glycinate. It's the relaxation mineral, helps combat stress, it boosts energy production, helps insulin sensitivity, and also many other things. So the other thing I would take is a fish oil. And I mentioned the omega three rejuvenate from big, bold health. But omega three fats are really important for the cell, your membrane function of your mitochondria, because your mitochondria also have membranes and they need to write omega three s to regulate inflammation and many other factors.

What other cool things that I've learned about mitochondria, and then what do I take myself? Well, I definitely take something called mito pur, which is the first product to unlock a precise dose of purified urolithin A. That's what I was mentioning before from pomegranate. Its gut microbiome, if its a healthy one, converts that into urolithin A, which most people cant do. And when you have enough urolithin A, it revitalizes the mitochondria.

It supports your cellular health. And I take it every day you can try to boost it naturally. But you know, only about 15% to 40% of people have that gut microbiome to produce it from the elijah tannins in your food sources. So you probably need to take it. Another good product is mito PQQ from designs for health.

It's a supplement that supports optimal mitochondrial biogenesis. It's a critical process for promoting healthy aging and energy production and oxidative stress regulation. Also another product I like to use is mitochondrial NRG like energy, but NRG also from the diets for health. It's kind of like a multivitamin for the mitochondria. What about NMN?

It's a precursor to NAD. I also take that it's really critical for energy production, for DNA repair, for cell signaling, for mitochondrial function, reducing oxidative stress and boosting longevity. It's really important. So when you supplement NMn, it can boost NAD levels in many organs and tissues, including the liver, the muscle, the brain. It improves mitochondrial function, it improves energy metabolisms and cellular health.

In fact, in animal studies, NMN has demonstrated the ability to extend lifespan to enhance cognitive function, to provide protection against age related diseases like diabetes and heart disease and neurodegenerative disorders. There's a lot of human studies still needed, but the initial research is pretty impressive that it could offer pretty good benefits by just taking NMN, including all the things we just mentioned, metabolic health, cognitive and physical performance, energy levels. There's a product that I like called Wonderfeel younger NMN. It's got a clinically relevant dose. You need about 900 milligrams, a thousand milligrams, which it has, because most of the supplements out there contain about 250.

So you have to take like four times the dose, which gets very expensive. And this is a research backed product. This supports healthy NAD levels. I also recommend, if you're trying to find these products, you can go online, but I've curated them all in an online store, which I use for my patients. You can access that, it's just go to drheiman.com and get the link to the store and you can just check out all these things and read about them and get them if you want to, although, you know, there's no attachment here to where you get them from.

If you're feeling tired all the time, it's not that something's fundamentally wrong with you, right? It doesn't have to be this state that you have to live with and adapt to and endure, right? It's often caused by things we have control over. It's our diet, it's lifestyle, it's the stress we're under, it's environmental toxins that can be addressed, that all these things drain our energy levels. The good news is most of these factors are within our control, and we have the power to reclaim our energy at any age by making small, meaningful adjustments to our everyday lives, which can lead to significant improvements in our energy over time.

And I've done this myself. I continue to learn about how to do this. I'm constantly improving my mitochondria, and in fact, sometimes I feel like my whole life is about my mitochondria, but I'm getting them to work better. But it's essentially a critical factor, because at the end of the day, your mitochondria determine the quality of your life, the quality of your energy, the quality of your health, and your longevity. So it's important to learn about them, take care of them, and thank you for during this podcast with me, but it's one of my favorite topics, and I want to make sure you really understood it.

And I'll see you next Tuesday for another episode of Health Hacks.