Fix Your Thyroid Fatigue Naturally with Dr. Evan H. Hirsch, MD

In this episode, Dr. Evan Hirsch, world-renowned energy expert, founder, and CEO of the International Center for Fatigue talks about fatigue in Hashimoto’s, what causes fatigue, and how they can get better.

Below is the conversation between Dr. Anshul Gupta and Dr. Evan Hirsch where they discuss in detail fatigue in Hashimoto's, its causes, and much more.

Dr. Gupta

Hi Dr. Evan, we would like to hear your story and your personal experience with fatigue in your life. So, can you share with us what happened to you and how you got better?

Dr. Evan Hirsch

Back in time, I was working in brick and mortar job when I got fatigued very often. That was when I started my functional medicine practice. Suddenly my energy started to go downhill to the point where all of a sudden, I was napping underneath the desk and essentially hiding from my life, staff, patients, and my family at home. 

Things were getting worse day by day, I got awful brain fog, in which I was even not able to remember the patient sitting in front of me. I was having body pain and crushing fatigue. After several years of sleeping underneath the desk, I felt very guilty about the fact that being a practitioner of functional medicine I was not able to help myself. I decided to move on to a mission to fix my problems. 

I went and read everything, and attended seminars, and conferences to figure out the causes. Luckily, I was successful and found that there are 33 different causes of fatigue and everyone who is suffering from fatigue has more than 20 causes. 

I had 30 out of 33 different causes, which we will talk about. After figuring them out, I worked on removing them which helped my energy get a little better.

Eventually, things got better. Today I can say firmly that I have great energy, which has helped me write a book and help millions of people resolve their fatigue.


Dr. Gupta

That’s great. Let’s talk about all these causes, and why people with Hashimoto’s are feeling fatigued.

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Dr. Evan Hirsch

Yes, let's do that first. Why are people who have Hashimoto's also fatigued? All of these causes that we're talking about today of fatigue are also the causes of autoimmunity. People with Hashimoto’s know that one autoimmune condition can lead to another autoimmune condition. These toxicities trigger autoimmunity and attack the thyroid, causing Hashimoto’s, which ends up damaging the mitochondria. 

Now the mitochondria produce about 80 to 90 percent of our energy and so when that happens then your energy is going to tank significantly, the toxins also are going to mess with your hormones and so consequently they play a huge role in energy. 

So, that is going to significantly decrease your energy in addition to causing autoimmunity to the thyroid and Hashimoto’s.

Let's dive into the causes.

There are 33 different causes. Don't get overwhelmed by that number because you'll see it kind of makes sense in a moment that we can separate it into ‘deficiencies’ and ‘toxicities.’ 


Deficiencies are things that are not in the body but are supposed to be in the body. 

For example; say you are deficient in hormones like adrenals thyroid sex hormones like Oestrogen, Progesterone, and Testosterone, or deficient in Mitochondria, or vitamins, minerals, or in lifestyle habits, no good sleep, enough water, etc. 

So, deficiencies are neurotransmitters so dopamine and serotonin are those sorts of things that aren't in the body the way they're supposed to.


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Toxicities are when we are looking at things like heavy metals, chemicals, molds, infections, allergies, negative emotional patterns, electromagnetic fields, etc. There are 86000 different chemicals that we are exposed to regularly. 

Some studies show that before you get out of the house in the morning you may be exposed to three to five hundred different chemicals, all of which are going to damage the mitochondria, upset the hormones, and increase autoimmunity.

When we look at mold, we are looking at about half the buildings in first-world countries that have water damage from mold. When we look at infections, such as Lyme-type infections like Borrelia, and Bartonella which is one of the major ones that I have seen with Hashimoto’s.

Then, there are allergies, and negative emotional patterns, which are anything that happened to you in your life that has increased stress and changed the way you look at the world. There are oftentimes called aces. 

Adverse childhood events or anything from really significant abuse may be considered milder. Like, rejection of a peer group, which increases stress on the human organism, brain, adrenals, and other hormones. 

Consequently, that can set the stage for allowing a number of these toxicities to take hold and then consequently damage. Electromagnetic fields that have a battery or emit any sort of wavelength or frequency can damage DNA, increase inflammation in the body as well as autoimmunity. 

So there are deficiencies and toxicities. The main causes are toxicities that end up causing 90% of the deficiencies as well as the autoimmunity in the process of Hashimoto’s.

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Dr. Gupta

Thank you so much for sharing these valuable insights, that was a very comprehensive and detailed list of things. People often have this question: how can they find all these root causes, because most of the regular labs will not have access to these tests? So, are there tests available for all toxicities and deficiencies or is it clinically experienced?

Dr. Evan Hirsch

Most of it is clinical experience. What I have found is that 75% of these different causes can be determined by symptoms alone so that is 27 out of 33 different causes. 

So, this is one thing when joining our program they open up the workbook. The first part of step one is that they need to talk about them for an hour or so. They'll be able to go through that process just based on their symptoms. 

This way they will know 75% of the causes, and the rest 25% need lab testing, which includes testing for heavy metals, chemicals, molds, stool tests, and more.

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Dr. Gupta

That’s great. I think we can now delve into the infection part of it like, what particular infections have you seen associated with Hashimoto’s?


Dr. Evan Hirsch

Yes, I would love to talk about Bartonella. Let me start with a story of when I first saw this in my practice about seven years ago or so. 

The name of my patient was Sarah, she came up to me saying she has pain in the bottom of her feet, she has even got muscle cramps and body aches. She is having a hard time sleeping. 

Most of the time she is anxious. Based on these symptoms I was able to make out that she most likely had Bartonella, which is a bacteria found in upwards of 50 all domestic animals. If you have ever been licked in the face by an animal, you likely have this, you can even get this from ticks or mosquitoes, or blood transfusion.

So we started treating her with herbs. One night she ends up calling me saying now she is having symptoms of Graves disease, Graves disease is Hyperthyroidism, producing too much thyroid. I asked her how she can say so, she mentioned that she has her heart racing, sleep anxiety, and diarrhea, which are all classic signs. I asked her if she should take the same dose of thyroid because she was already on thyroid medicine and it turns out she hadn't changed her thyroid medication.

I asked her to take a lower dose of thyroid tomorrow as I think she was on probably 60 or 120 milligrams of Armor thyroid at that point. Now throughout the next couple of months, we were able to wean her off of her thyroid medication completely. 

Over time I have seen that about half of the people who have Hashimoto’s and Bartonella can wean off of their medication their thyroid medication significantly. 

Not entirely 100% like Sarah but what that told me was that Bartonella was living inside the thyroid or it was affecting the thyroid in some way that was shutting down the machinery but that as we started going after Bartonella we found that the thyroid turned back on and then we no longer needed as much thyroid medication or what we call exogenous thyroid. 

It was as if we ramped up on the Bartonella treatment that we were able to decrease the thyroid medication. I've seen this with other infections too like anaplasia is one of them. But Bartonella is the big one that sticks out to me. Molds sometimes can be one of them too.

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Dr. Gupta

How do you check for Bartonella? Do you have any of the specific labs you work with or go through just regular labs?

Dr. Evan Hirsch

If somebody has pain or sensitivity in the bottom of the feet, they may be misdiagnosed with plantar fascitis. They may also have muscle cramps, especially in the calves, usually, during the night, trouble falling asleep, anxiety, depression in addition to thyroid issues. Sometimes, there can also be some Bartonella striae that look like a cat scratch or scratch mark or stretch mark without any weight changes. These are discerning symptoms that is not caused much by other problems.

Then, we go with herbs that are antimicrobial. Sometimes, the herbs that you have been taking for other infections in this program will themselves take care of Bartonella and the improvement in symptoms will indicate it if it happens.

Dr. Gupta

Any particular supplement you prefer for Bartonella?

Dr. Evan Hirsch

I am a big fan of Byron's white formulas. There is a formula called Abarth that we use for infections. But, that is so potent that it can give effects by just increasing drops of dosage over a week. So, it should not be used without guidance from a medical practitioner. It sometimes needs to be supported with other supplements like binders.

So, when you google Byron white formulas, the reviews are sometimes bad. Because people take it in the wrong dosage or combinations which causes some bad die-off reactions.

Sometimes, when not treated properly, a cascade of infection breakout can happen.


Dr. Gupta

So, do you treat these multiple infections together or one by one?

Dr. Evan Hirsch

I usually address the symptoms that call my name first. So, this will mostly be the central one. So, we will be actually treating all the infections together but the process will be ramped up for the one that shows clear symptoms.

Say, if a person has Bartonella, and has severe pain in the bottom of the feet. We treat it and then the cramps worsened. Probably, the immune system is reacting to the bug dieing off which we call the die-off symptoms. So we will increase the die-off support for the particular infection.

If when treating for Bartonella, the person starts sweating more, then there may be these other infection symptoms popping up. When air hunger is increased, the heart rate is abnormal, or sleep is getting worse, probably we may need to go after babesia.

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Dr. Gupta

It's awesome that you provide support to your patients. Even though they might be aware of them, they won’t be able to achieve their own goals. So, can you walk us through the four-step process so that people have an idea about it?

Dr. Evan Hirsch

Yes, sure.

Step 1: Figure out what causes you have. The first step in the four-step process is assessing the causes. So like we talked about there are 33 different causes for everybody who has fatigue and an autoimmune condition like Hashimoto’s. 75 percent of these causes can be determined by symptoms alone.

Step 2: Replace the deficiencies, like adrenals, thyroid, and mitochondria, which we call the big three. This makes our body robust. 

Step 3: We open up the detoxification pathways to remove toxins from the body. As when you have fatigue and autoimmunity then those pathways are clogged, so you need to make sure you are having a bowel movement every day, and make sure that your liver and kidney pathways are open.

We have these processes in the body that remove toxins from the body. And when you have fatigue and autoimmunity, those pathways are clogged. 

So, you need to make sure you're having a bowel movement every day, and that the liver and kidney pathways are open which are the filters. If you haven't changed your filter for years it's clogged right and so you want to make sure that you're opening that up. 

We've got the lymph which is the garbage system of the body and so, lymph movement should also be checked.

Step 4: We always like to start with removing heavy metals, chemicals, and molds from the body. Because these keep the other toxin bound to the body and releasing them helps keep the detoxification process easy and clear out this toxic matrix.

We've got a four-step mind-step process that we take people through. and then  We also have two trauma-informed nervous system retraining coaches on our staff who offer one on one or group counseling for people who are going through our programs. Because we want to make sure we leave no stone unturned. We want to make sure that there's hand-holding along the way for every single aspect.


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Dr. Gupta

Let’s talk about chronic Lyme disease. Some people don’t believe it, so they treat it with IV or antibiotics for years. So, what is your approach to Chronic Lyme Disease?

Dr. Evan Hirsch

What my mentors and the centers for disease control in Atlanta say is that for Lyme disease, you can’t have Borrelia unless you have symptoms that come and go with some days being worse and some better. 

These symptoms have to go around the body. It can be nerve pain, joint pain, or muscle pain that moves around the body - one day in the shoulder, next week in the knee, and so on.

If that’s not the case, then it’s not Borrelia.

Usually, we take care of it at the last. So once we go down the treatment process in our program, the immune system will take care of the Borrelia. If it doesn’t, we will take care using herbs and other things.

Dr. Gupta

So, What is your approach - are you a herbal medicine guy?

Dr. Evan Hirsch

Yes, mostly we go ‘No antibiotics’ and ‘No medication’ approaches. We use mostly AL complex by Byron white formulas which do not have a cat’s claw.

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Dr. Gupta

A lot of people have this question in their mind, that they have these chronic infections, but how are chronic infections able to evade our immune system and still stay in our body? Can they cause us any harm?

Dr. Evan Hirsch

Great question, this has to do with having an intact immune system, so if the immune system is functioning correctly, it should be keeping these infections at bay. 

In the human body, we have a huge number, about 90% of the cells in our body are infection or bug cells, and 10% are human cells. The reality is that we still have so many bugs, bacteria, viruses, and yeast that coexist in our bodies. 

When you have heavy metals chemicals or molds, they're going to hijack the immune system off into the left field and the immune system becomes dysfunctional. 

It's causing autoimmunity causing inflammation and guess what now these infections can become opportunistic. So that's why it's so important to go after the heavy metals, the chemicals, and the molds first. As to get rid of these infections you have to have a mostly intact immune system. Because of this many lab tests for immune system functioning may also be inaccurate.

Dr. Gupta

Awesome, that’s a great explanation. 

We have talked a lot about infection, but what advice will you give to people in terms of what they can do now to improve fatigue at this point?

improve fatigue

Dr. Evan Hirsch

So, starting with lifestyle habits is always a very important step. That’s something they have the power to change right now. There is a need to change some of your lifestyle and behavioral habits.

  1.     Go to bed at 10
  2.     Take proper sleep, 7-9 hours of sleep at night
  3.     Keep the room dark while sleeping
  4.     Avoid a lot of movement if you have fatigue until you get the right level of energy
  5.     Drink enough water, 3 liters of water every single day
  6.     Add some sea salt to the water, helpful for the adrenal gland
  7.     Inculcate tapping solutions, like emotional freedom techniques if you feel anxious
  8.     Flip disempowering belief into empowering beliefs
  9.     Take good, fresh, and healthy food, paleo diet
  10. Avoid gluten, sugar, grains, and dairy products
  11. Try jumping jacks, and dancing, for quick movements anytime.

These are some small things that you can do right now to make a change. The next step would be to replace adrenal function, replace mitochondrial function, replace thyroid function, which I call the big three.

Dr. Gupta

This is awesome tons of good information, with great practical insights. People can get better by inculcating small habits, which is great. You are just an encyclopedia of such good information. Thank you so much for sharing all this information, and practical tips by which people can improve their fatigue.

***About the Guest***

Evan H. Hirsch, MD, is a world-renowned Energy expert and is the Founder & CEO of the International Center for Fatigue. Through his best-selling book, podcast, and international online programs (that can be accessed from everywhere), he has helped thousands of people around the world optimize their energy & resolve their “mystery” symptoms naturally (without medications), and is on a mission to help 1 million more. He has been featured on television, podcasts, and summits, and when he’s not at the office, you can find him singing musicals, dancing hip-hop, and playing basketball with his family.

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