Why Your Fatigue Gets Worse After Exercise (Post-Exertional Malaise Explained) w/ Evan H. Hirsch, MD

Why Your Fatigue Gets Worse After Exercise (Post-Exertional Malaise Explained) w/ Evan H. Hirsch, MD

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So if you feel worse after exercising, you may have post-exertional malaise. So today we're going to get into what is post-exertional malaise? Do you have it? And then what is causing it? So welcome back to the EnergyMD Podcast where we help you resolve your long COVID and chronic fatigue syndrome naturally so that you can get back to living your best life. So post-exertional malaise pretty much is found in

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all of the people that we work with. Sometimes it's called PEM. um And uh it's really, it can be unpredictable and it can also be predictable. So, you know, if you're, if you're having a good day, know, oftentimes you're going to have these fluctuations when you're having long COVID or chronic fatigue syndrome, where you've got good days and you've got bad days, but the bad days really outnumber the good days. And most of the time when people would join our program, they've got

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seven bad days a week. Maybe they've got one good day and six bad days a week. you know, progress really isn't linear as I digress. You know, you're not going to just start having more good days per week. What ends up happening is that the bad days are just as bad. But then, you know, the next month you have, let's say one more good day per week where you'll have two good days per week, five bad days and the five bad days feel just as bad.

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And as you actually, the good days start to get better. All of a sudden, the bad days start to feel worse because you're doing more. So just notice that as you're kind of moving through a process or a program like ours, that's addressing the root causes. So let's say you're, you're in a day that's, that's feeling all right and you're going for a walk or you're cleaning the house or even if you're not feeling right, but you're still exerting yourself. then later on that day or the next day you're, you're wiped out. Okay. That's post-exertional malaise.

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And the reason why is because exercise is stressful on the body. There's something called hormesis, which is basically this concept that in order to build muscle, there needs to be some kind of stressor on the body. So in exercise, if you're lifting weights, if you're running or whatever, you want to push yourself so that, you know, the body has some sort of stressor that then it builds back stronger. Well, guess what? That really doesn't work.

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at all for people who have long COVID or chronic fatigue syndrome. The challenge is that you are already stressed and that your mitochondria, which produces 70 to 90 % of your energy is found in every cell in the body, except for red blood cells is already compromised. It's already damaged and you're not able to produce the energy that you need. um And then the adrenal gland, which manages stress in the body by producing cortisol.

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is also compromised. So when you have a total body burden of the toxic five, this is the combination of heavy metals, chemicals, molds, infections, and nervous system dysfunction that basically everybody with long COVID and chronic fatigue syndrome have and set the stage for the long COVID, right? So that you had either a, um, the shot or a virus. And then all of a sudden you ended up having these symptoms.

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Yes, there's a significant part that is from that, but there's also the other toxic five that need to be addressed that really set the stage. You know, why did 36 % of people who get COVID end up with persistent symptoms and the other 64 % don't? Is that the right math? Yes. And the other 64 % don't. And a lot of that has to do with the fact that, you know, do you have the toxic five in your body that is not allowing your immune system to get rid of COVID once you acquire it?

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Okay. And you're not lazy. You're not out of shape. This is just kind of how the situation progresses where your body is just not able to exert itself because of the, the total amount of stressors that are, um, encroaching on your ability to function. Um, stats are that 58 % of people with long COVID also meet the criteria for ME CFS. Now post-exertional malaise and ME CFS is chronic fatigue syndrome.

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Post-exertional malaise is part of the diagnosis for chronic fatigue syndrome, not necessarily for long COVID, but most of the people who have long COVID symptoms or majority that also have fatigue have this post-exertional malaise. Okay. There was a groundbreaking study in 2024 that showed that after exercise long COVID patients showed

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an acute reduction in mitochondrial enzyme activity, severe exercise induced muscle damage, amyloid deposits accumulating in muscle tissue. Now, if you remember amyloid deposits are generally when they're accumulating in the brain, they're causing Alzheimer's, uh local and systemic metabolic disturbances. So basically blood sugar dysregulation. And a lot of this comes from the stress that ends up happening, not just with the damage from the mitochondria.

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but that damage to the adrenals. And when the adrenals aren't functioning correctly, the thyroid is not functioning correctly and then either is the sex hormones. Okay, and the adrenals produce cortisol, which manages blood sugars, which then affects your metabolic health. uh In fact, exercise makes mitochondrial dysfunction worse, causing more tissue damage leading to worse energy production.

05:49

Okay. And unfortunately, you know, this whole concept of graded exercise, lot of doctors are still recommended, are still recommending gradually increasing exercise, you know, which is this idea that they're thinking that, um, you know, that you can retrain the body to acquire more, more energy. But the reality is, is that you only have a certain amount of energy when you have these conditions and that when you use them up, you know, you can either think about this as like,

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golf balls in a container and that once you use them up or an energy envelope, where once you exceed it, then you're not going to be able to function. You don't have more energy that's available. And the research has disproven this whole idea about greater exercise, especially for this population. And a lot of people who have long COVID don't realize it. The challenge is that you can get, there's over 250 different symptoms that you could get.

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after COVID and it doesn't have to be right after you had the viral illness. It could be months after, you know, and so that makes it more challenging for people to determine if they have it and then to find help, unfortunately. But any sort of weird symptoms since 2020 needs to be assessed for long COVID. Okay. So, you know, what you can do is, you know, start tracking what your baseline looks like.

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You know, how much activity can you do in a day that keeps you at kind of like a safe level? you know, practice, you know, radical pacing, try to stay at like 50 to 70 % of your perceived capacity, not a hundred percent. And then address the root causes, right? You you're not going to get better unless you are moving through a process that is addressing all of your causes, including the toxic five. So not just the spike protein.

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but you also want to be moving through addressing heavy metals and chemicals and molds and infections and nervous system dysfunction. All of these will stress the body out and compromise your hormones like adrenals, thyroid sex hormones. It will damage the mitochondria. And so hopefully you can see that these are already causing these same problems that exercise does, right? These are already the stressors that are on your body. And then

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You add in another physical stressor like exercise, or you add in a mental, emotional stressor, like work or relationship challenges or something that stresses you out. All of those things are going to compromise your ability to manage stress. So it's this total body burden. And you have to poke a hole in the body in the bottom of this barrel known as the human experience and drain out the toxins, the infections and the stressors.

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Okay, and that's the fastest way to get better.

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So you're not broken. You're not imagining this. Your body needs a completely different approach. So, you know, I've helped thousands of people at this point resolve their long COVID and chronic fatigue syndrome. And so if you are interested in seeing if we're a good fit to work together, you can go ahead and click on that link below and check out my latest masterclass video where I go into my philosophy of care. And then if you want to see if we're a good fit to work together,

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you can hop on a free call with me where I'll go through a process to see if I feel like you're a good fit. And then you can see whether or not you feel like I'm a good fit as well. All right, great. Hope that was helpful for you. Whatever you do, take action, keep moving forward through a process, get your questions answered, make sure that you get help so that you can be on the other side of this so you don't have to suffer any longer. All right, hang in there and I'll see you in the next episode.