Health Expert Reacts: SciShow on Exercise Actually Makes ME/CFS Worse with Evan H. Hirsch, MD

Health Expert Reacts: SciShow on Exercise Actually Makes ME/CFS Worse with Evan H. Hirsch, MD

00:00

Hey there everybody. Welcome back to the EnergyMD podcast. My name is Evan Hirsch. am your host and we help you resolve your long COVID and chronic fatigue syndrome naturally so that you can get back to living your best life. So today I'm going to be doing something different. I'm going to be doing a reaction video to this video by SciShow called exercise actually makes chronic fatigue syndrome worse. And I want to give you my take on what they have to say.

00:29

So we'll listen to a little bit and then I'll make some comments. If you're feeling tired during the day, some common advice might be to go for a walk, do some light exercise, or simply take a nap. But for some people, no amount of sleep or calisthenics will help. That's life with myalgic encephalomyelitis. So right now he's just going into the definition of ME-CFS, which is good so far. Also known as chronic fatigue syndrome or ME-CFS. And while there's still a lot scientists don't know about the condition, they've learned quite a bit in the last few years about how different it is from other kinds of fatigue, including the fact that exercise actually makes it

00:59

Yeah, I couldn't agree more. This is one of the things that really gets me upset when I hear that people are going to their providers and their providers are saying that you should increase your exercise and that's actually going to be helpful. We'll talk more about the mechanisms in a bit and some of the challenges with some of the research.

01:26

You might have heard of chronic fatigue before as a social media buzzword or maybe as a symptom of other chronic illnesses. But when we're talking about ME-CFS, just calling it chronic fatigue syndrome doesn't tell the full story. It's not the kind of fatigue you might feel after pulling an all-nighter. ME-CFS is a neurological disease. It's not just being tired because the grind never stops. When no amount of sleep makes you feel refreshed, you may have ME-CFS. Or when exercise makes you feel like you have the flu, that's also a symptom. There are probably 15 to 30 million people around. So I agree so far. I do think that we...

01:54

There is a challenge with differentiating chronic fatigue and ME-CFS and long COVID because you can have chronic fatigue and just because you haven't been diagnosed or you don't meet the criteria for chronic fatigue syndrome, which he's going to talk about more in a little bit, you still need help. So just because you haven't been officially diagnosed or if you don't meet the criteria, it doesn't mean that you shouldn't seek help and you shouldn't be helped.

02:20

world living with ME-CFS. you haven't heard of the condition, maybe that's because some researchers estimate that around 90 % of people with it are undiagnosed. And that's big deal because this is definitely true and it's only increasing with long COVID. Most people don't even realize that they have subsequent symptoms related to COVID or viral illness since 2020.

02:39

As you might have gathered from the symptoms I just mentioned, it can totally change the way you live your life. You may find that doing chores or schoolwork is suddenly much more exhausting than before. You may be forced to give up hobbies that once filled you with joy because your body can't keep up with them anymore. Ultimately, up to 75 %

02:51

Yeah, when I had my chronic fatigue syndrome, I couldn't sing. I couldn't sing and perform. And that was one of the things that really made me happy. And I see this time and time again, unfortunately with people is that they have to let their hobbies go and they're really just surviving. ...percent of people with ME-CFS are unable to work and some can't leave their bed. And a reinvigorating stroll around the block won't help with these symptoms. People with ME-CFS see their blood oxygen levels and heart rate drop significantly after exercising.

03:15

So that's a really important point is that, you know, the these mechanisms, know, yes, you can have fatigue from not exercising enough, but when you have chronic fatigue syndrome, exercising is actually stressful on the body and we'll go more into the mechanism in a little bit. Pretty much the opposite of how you'd want to feel after a workout. One of the most characteristic symptoms comes after physical or mental strain. It's called a post-exertional malaise or PEM, and it's a huge debilitating result of ME-CFS. It can happen when you've spent a lot of energy of any kind, including exercise, writing, sensory overload,

03:45

So this is all true and what he doesn't speak about, well let's just check. So yeah, so anything that can be stressful in the body, whether it's mental, emotional, or physical,

04:14

is going to end up making you feel worse. So whether that stressor is having a difficult conversation with somebody at work, that would be a mental stressor or emotional, um whether it's something physical like exerting yourself where you're exercising or even if you're just going for a walk or whether it's an insult from some sort of toxin. I talk a lot about the toxic five, the heavy metals, the chemicals, the molds, the infections and the nervous system dysfunction, all of the or trauma.

04:44

otherwise known as trauma, all of those are going to be stressful on the body and consequently, they are going to put this heavy burden. And so anything that you do additionally to stress the body, in this case, we're talking about exercise, is only gonna make you feel worse. This process is enough to earn you one of those Sherlock Holmes hats. This SciShow video is supported by John. Yeah, so they're gonna go right now into the diagnosis.

05:16

ME-CFS comes from a combination of both genetic and environmental factors, but it's most often triggered by an infection from another... So it's about 20 % genetic and 80 % environmental, with the environmental being what I call the Toxic V, heavy metals, chemicals, molds, infections, and nervous system dysfunction or trauma. Right now he's going to talk about the most common one, which is an infection typically from Epstein-Barr virus, but it can happen from any of the Toxic V that I've just mentioned.

05:45

disease. Epstein-Barr virus, the virus that causes mono, is one of the more common culprits for triggering ME-CFS. To be clear, not everyone who gets mono will develop it, but for the people who do, it can be confusing and frustrating.

05:54

Yeah. So the question is why do some people who get mana, why did they end up developing it? Why can't their immune system end up getting rid of the Epstein-Barr virus? And this is because the other toxic five are present. If you have heavy metals, chemicals, molds, other infections, nervous system dysfunction or trauma, those are all going to cause immune system dysfunction, nervous system dysfunction. And consequently, when you get a particular infection, whether it's Epstein-Barr, whether it's COVID, whether it's a parasite, whether it's uh bacteria,

06:24

the Lyme, whatever, the immune system is not functioning correctly to be able to get rid of that particular infection. And then the infection can go deeper into the body and persist. And this is really important because a lot of people, and I've done a video on this previously, you can search for it.

06:53

But you the difference between long COVID and ME-CFS is very subtle. The only difference really is this trigger where, you COVID is the trigger. And for people who've got ME-CFS, who've had it before 2020, they have a different trigger. They might've been a different COVID virus or a coronavirus, or it might've been Epstein-Barr, or it might've been any one of the Toxic Five could have been the straw that broke the camel's back. But the reality is, is that the stage was already set because there was already some of the Toxic Five present.

07:23

And the same thing goes now for long COVID, where the toxic five is present and then COVID becomes the straw that breaks the camel's back. Long COVID is the term used to describe when you have symptoms that don't go away for at least three months after getting COVID. ME-CFS is just one possible outcome that falls under the general umbrella of long COVID. In fact, some studies suggest that half of people who have long COVID also meet the criteria for ME-CFS.

07:42

Yeah, I would definitely agree with that. And he's going to go into the diagnostic criteria for ME-CFS where, you know, the difference really is having certain symptoms for up to six months versus in long COVID where it's at three months right now. Why that difference? I think it's just because it's become frank to us that we need to move more quickly since we're seeing so many people who are struggling with long COVID.

08:12

tees apart because we're not entirely sure what's going on in the body that leads to ME-CFS. One possibility is that an infectious virus can switch on a gene that messes with your immune and nervous systems. ME-CFS is classified as a neurological... Yeah, that's an interesting theory. You know, this idea about having an infection that switches on uh a particular gene.

08:31

What the reality is is that it's more about having toxins and infections in the body that end up causing inflammation. So if we work backward from symptoms, every symptom is caused by inflammation.

08:46

And inflammation is the immune system's reaction to something in the body. And it just depends on where it is in the body that ends up determining where the, where the inflammation actually happens. So if you've got pain in your joints, your thumb joints, let's say, and uh that there, there is potentially an infection that's in that area. The immune system is trying to get rid of that infection. So it's mounting a response. It's causing inflammation as it's trying to get rid of that particular infection. And part of.

09:15

of what comes with inflammation is pain and dysfunction. So when functioning correctly, as you probably have heard, inflammation can be a good thing. So if you break a leg, you have inflammation to the area, or let's say you get a big scratch or a cut and you get a bunch of white cells to the area, there's pus, there's red cells, white cells, et cetera. They're all going to that area to try to heal the area and then they heal it and then it's fine. But when there is heavy metals, chemicals, molds, infections in the body in a particular

09:45

area, the immune system can't get rid of it entirely and it's stuck in a chronic inflammatory response. It's kind of like the light switch is left on and there's a lot of inflammation happening and that causes pain and dysfunction no matter where you are in the body. If that pain and dysfunction and inflammation is damaging the mitochondria, which is found in every cell in the body except for red blood cells, and it makes 70 to 90 % of our energy. If that gets damaged, guess what happens? Your energy goes down and you have fatigue.

10:15

that gets into the nerves, you may have a neuropathy, numbness and tingling in the hands and feet or mouth or head or wherever. You can also have brain fog if it's getting into the nerves or if you're getting microclots that are decreasing the ability for oxygen and blood flow to get into different parts of the body, including the brain. Okay, so really important to note that there are these different mechanisms at play and that it really is more about the inflammation than it is

10:45

about the uh infection that's turning on a particular gene, though that might be happening as well. disease. But that doesn't mean it's independent from the immune system. Some of the most well-known neurological diseases like multiple sclerosis work this way too. There's research that... Yeah, and you know, Lyme disease and some of these other um causes are...

11:04

known as the great mimicers. And oftentimes they can mimic other conditions like MS. MS is basically an autoimmune condition where the immune system is attacking the myelin sheaths and it ends up destroying them. Well, oftentimes there's a particular infection or a toxin that's located inside those myelin sheaths. And it's just the immune system doing its job, trying to get rid of these things, the toxins and infections that are in the body that aren't supposed to be there. And the byproduct is that it ends up destroying

11:34

a part of the body that the infection or toxin is hiding in. It suggests broadly that several cells of the immune system work differently than they otherwise would in people with ME-CFS. Since increased inflammation is a hallmark of the disease, it's worth further research to figure out exactly which immune cells could be problematic here. Ultimately, figuring out what—

11:50

Well, I'm not exactly sure whether or not that's really important to determine which parts of the immune system are problematic. The reality is that there's inflammation, there's thousands of different immune cells, and they're all trying to do their job of getting rid of crap out of the body that's not supposed to be there, right? That's the immune system's whole job.

12:08

for the most part, is to get rid of things out of the body that are not supposed to be there, okay? So is it really gonna help us determine which immune cells are kind of doing that? I don't think so. I think that's more of an intellectual exercise. But when we talk about getting people better, the reality is working backwards from inflammation to what the causes are, I think is most successful.

12:33

led to your symptoms and getting a diagnosis can be literally exhausting. get diagnosed with ME-CFS, you have to experience a variety of symptoms from PEM to cognitive dysfunction, lightheadedness when you stand up, and extreme fatigue. Plus, you have to show a specific combination of these symptoms for at least six months before diagnosis. And that diagnosis is just the beginning. The next step is learning how to manage your symptoms. One early management ideal. Yeah, well, and I would say, I mean, so I agree with that diagnosis, you have to have...

12:56

the exhaustion, the post-exertional malaise, the brain fog, the body pain, sleep issues, and you have to have them for more than six months.

13:06

But he's saying, and then the next thing is management. would say the next thing is actually what is the cause. And so he's using management because that's kind of conventionally understood as the disease needs to be managed. But I can tell you that we're resolving long COVID and ME-CFS every day. You can go to our website at energymdmethod.com slash results and find almost a hundred testimonials just in the last couple of years and since we've been collecting them. So resolution is definitely possible.

13:36

But so take this next segment with a grain of salt because this is the conventional idea around management. Yeah, that's very funny and unfortunately also very true.

14:04

Unfortunately, way too many practitioners still believe that if you exert yourself, that that'll end up causing what's called a hormetic reaction or hormesis, where you're basically stimulating the body to regenerate and heal itself. And it just doesn't work when the hormesis is more stressful um on the body. And so the stress on the body ends up winning out over the benefits of hormesis.

14:30

VO was spread throughout the scientific community due to a controversial study called the PACE trial. The trial reported that patients with ME-CFS showed normal physical function after increasing their exercise. But the researchers defined normal functioning as lower than the measurements that patients needed to be included in the study. So they could actually get worse and still be counted as normal by the end of the study. even though PACE- Yeah, this is a huge problem with this study and unfortunately did a lot of damage.

14:52

patients and professionals alike have denounced the results of this study, that paper has still not been retracted. So since there are all sorts of less thought out conclusions about the condition floating around out there, here's what we do know about managing ME-CFS effectively. While there are no FDA approved medications for the condition yet, people who live with it have found that some medications can help ease a few of their symptoms. These can include painkillers or prescription medications to help with sleeping issues.

15:12

And remember, these are all band-aids. When you're looking at prescriptions, they're not getting at the underlying causes, like I've mentioned, the Toxic V. I've never met anybody who has addressed all of the Toxic V completely and hasn't resolved their symptoms, right? But you can utilize these medications to kind of block the different pathways. If you're having inflammation and you're having pain, then you can go ahead and you can take something that blocks that pain receptor. But I just think, as a functional medicine, environmental medicine practitioner,

15:41

If we can find and address the root causes and we remove that then we can actually get rid of the inflammation that way. And the same thing goes with the sleep conditions. There's a number of different infections and toxins that will cause sleep dysfunction. And when we remove them, then all of a sudden the uh sleep improves and you don't have to take any sort of sleeping pill.

16:04

Outside of the pharmacy, patients can adjust their activity to match their energy levels from day to day. Keeping a daily activity log may be helpful for figuring out where any one person's exertion limits and PEM triggers are. And once someone figures out their l- I think that's really important, um, you know-

16:18

And, um, the way that I like to talk about this is getting your Goldilocks dose of movement. And so that basically means the amount of movement that you can tolerate without feeling worse. And it's going to be different for everybody. And so we always want you to be moving, but for some people, they can only do exercises in their bed because they're bed bound, um, when they first come to see us. And for other people, they might be able to walk a mile before they get tired. But you just want to make sure that you're not making yourself worse by stress.

16:48

yourself out while we're trying to do all this repair work of managing your hormones optimizing them to decrease the stress in your body manage the stress better and then removing the toxic five that are really causing the mental emotional and physical stressors that you're experiencing. limits, they probably shouldn't push past them. The general idea is if you're feeling good, do your thing. But if you're feeling tired, rest. And in fact, people with ME-CFS can even plan for big energy-expending events, like giving a presentation, by taking extra rest beforehand.

17:17

I would definitely agree with that. And I would also say that, you know, there are certain things that you can take that can be supportive. So you can take some additional adrenal support or mitochondrial support. If you have thyroid issues, supporting your thyroid adequately, making sure that you're optimizing your deficiencies will make you more robust, optimizing vitamins and minerals, lifestyle habits, you know, drinking enough water, getting enough sleep, getting enough movement and not too much movement. Um, and then also eating the right foods and then doing

17:47

some mindset work. And so all of these things, what I consider to be the deficiencies, replacing those will make you more robust, will decrease the crashes that you have in about 50 % of people, usually in the first couple of months when they join our program. And those can really allow you to function better in your day to day life so that you don't have, uh you know, a crash when you're trying to put on a presentation like they're demonstrating here. This way they can minimize the chance of triggering a PEM flare as much as possible with the boom of people getting diagnosed with ME-CFS.

18:17

pandemic, a lot more research needs to be done. But as we learned from the PACE trial, those studies should keep actual patient experiences in mind. If you don't have ME-CFS, exercise is often still the best medicine, at least preventative medicine. But if exercising... Well, and I would say, you know, if somebody has chronic fatigue, that isn't the case. So if you've got chronic fatigue, if you do feel worse when you have, when you exert yourself, when you have PEM or post-exertional malaise...

18:40

then you really need to watch how much you're exerting yourself and don't go beyond that. So it's not just if you have ME-CFS or long COVID, it's also if you have chronic fatigue or a number of other symptoms, you don't want to stress out an already stressed out human organism. It's causing damage to your body. Trying to push yourself past your limits is not the answer. Sometimes. Yeah, I absolutely agree. And I think that, you know, one of the things that is really common for a lot of people we see with ME-CFS and long COVID is a lot of people

19:10

And was part of my issue is that I'm a recovering perfectionist as well. And, you know, doing this mindset work and the nervous system retraining work that we advocate in our program can be incredibly helpful for resetting our nervous systems, but we do not want to push past. We want to realize when we are pushing past and take a step back and realize why are we pushing past? Because the reality is, that we are safe. We are loved. We are enough. And we do not have to push in this life in order to

19:40

deserve love and to be enough.

19:44

No pain is a lot of gain. Yeah, so hopefully that was helpful for you m I felt like you did a pretty good job with the video, but just wanted to give you my take on that um If this was helpful for you Please give it a thumbs up and hit the subscribe button and if you are interested in seeing if we can help you out you can click on the link below learn more about my philosophy of care and then get our free call with me where I'll dive deep into what you have going on to see whether or not we're a good fit to work together and um

20:14

If we are a good fit, if I believe we are and if you believe we are as well, then we can talk about what's included in the program, the structure, and then also the investment. Have an amazing day. I'll see you in the next episode.