Uncovering the Hidden Causes of Long COVID and Chronic Fatigue: What Most Protocols Miss

What’s Inside This Episode?

•  Why long COVID and chronic fatigue are more alike than most realize
  

• How spike protein becomes the “final straw” for an already stressed system

• The difference between whispers and shouts in client symptom history

• Why standard immune testing often gives false negatives

• The five hidden drivers behind long COVID and chronic fatigue

• Dr. Hirsch’s four-step framework for long-term recovery

• Why testing might be unnecessary and what to do instead

• How to build resilience with herbal, nutritional, and nervous system support

• Why proper sequencing is key to sustainable detox and repair

• A look inside Dr. Hirsch’s hybrid coaching model and success rate

Resources and Links:

• Download our FREE Guide to Unlock the Power of Optimal Energy
• Join the Next-Level Health Practitioner Facebook group here for free resources and community support
• Visit INEMethod.com for advanced health practitioner training and tools to elevate your clinical skills and grow your practice by getting life-changing results. 
• Check out other podcast episodes here

Guest Resources and Links

• Join Dr Evan Hirsch’s FREE Facebook Group
• Connect with Dr Evan  on:
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Grab his free Gift: Free Masterclass

Guest Bio:

Evan H. Hirsch, MD, (also known as the EnergyMD) is a world-renowned fatigue expert, best-selling author, and professional speaker. He is the creator of the EnergyMD Method, the science-backed and clinically proven 4-step process to resolving Long Covid and Chronic Fatigue Syndrome (ME/CFS) naturally. Through his best-selling book, podcast, and international online program, he has helped thousands of people around the world resolve their fatigue. He has been featured on TV, podcasts, and summits, and when he’s not at the office, you can find him singing musicals, dancing hip-hop, learning languages, and traveling with his family.

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Transcript

 

Dr Ritamarie  

Long COVID isn't just long, it's complex, but really it is just a new name for chronic fatigue and all the underlying causes of chronic fatigue, that we really need to dig into when people are suffering. 

 

So I want to talk today about what works and what doesn't, and what the overlaps are. And I've brought in a very special guest today, Dr. Evan Hirsch.

 

So we're diving deep into a condition that wasn't even heard about five years ago, but in reality has probably been there for a very long time.

 

So my guest today, who's going to be sharing his brilliance today with us, is Dr. Evan Hirsch. He's an MD, also known as the Energy MD, and is a world renowned fatigue expert. He's a bestselling author. He's a professional speaker, and he's creator of what he calls The Energy MD Method. 

 

So, we're going to dive into a science-backed, clinically proven four step process for resolving long COVID and chronic fatigue naturally.

 

When he's not in his office, and I'll attest to this, you can find him singing musicals, dancing hip hop, learning languages, and traveling. And as we were getting ready for this, and I was setting up my lighting and microphones, I could hear him gently humming in the background. 

 

So welcome, Evan. I'm so excited to have you here.

 

Evan H. Hirsch, MD (01:52

Ritamarie, thanks so much for having me on. Good to see you again.

 

Dr Ritamarie (01:56)

It's great to see you again, too. We've had these conversations, a bunch over the years. You've done some really nice talks that I've heard. And I just wanted you to share with our health practitioners out there, what they need to be looking at. What's the four step process that you've developed for looking at COVID, long COVID, and how is it different and similar to chronic fatigue in both the underlying? So let's start there. 

 

Let's start with how is it similar and different from chronic fatigue syndrome?

 

Evan H. Hirsch, MD (02:28)

So it really is a condition just by a different name. The reality is when you're looking at an actual definition, or a diagnosis, of chronic fatigue syndrome, it's kind of like symptoms that persist for longer than six months, and they include chronic fatigue, post-exertional malaise, sleep issues, body pain, and brain fog for the most part. 

 

With long COVID, basically the diagnosis now is for those symptoms or any sort of weird symptom. There can be over 250 different symptoms that can come from COVID that are persisting for longer than two months. So very similar, you know, and when we're looking at what's really going on, we're looking at the causes and the causes are all the same except for the spike protein, which is the newcomer on the block.

 

Dr Ritamarie (03:19)

I'm wondering, do you see when you do a complete history, which I know you do, on a person who's suffering from what seems to be long COVID, or they've come in and said, I think I have long COVID because blah, blah, blah. I haven't been the same since, right? 

 

The people who suffer after having COVID versus the people who have it is gone, and they're back to their normal life within three weeks to a month. Is there a difference in the history that says, the predilections were there, but they just weren't already manifesting and COVID just kind of threw them over the edge. 

 

Evan H. Hirsch, MD (04:00)

The history is not very specific. I think the most specific thing that we've seen that's corroborated by the research is that when you have five symptoms or more, when you have COVID, and they are mild, you are significantly more likely to get COVID. And so some of that comes from the spike protein getting into different parts of the body, because the symptoms that you have are directly related to where in the body does the spike protein go.

 

And then in addition to that, since there's these five different symptoms that you're experiencing, it's the severity of those as well, or the fact that they are mild indicates that they're bypassing the immune system. Because when your immune system is functioning correctly, and it sees something, and it gets rid of it out of the body, you're going to have a strong reaction like when you have a strong flu,

 

It's because all those symptoms are the manifestation of the immune system trying to get rid of the infection, right? And so when you don't have strong symptoms, and they're more mild, it's because the spike protein or whatever kind of infection, is bypassing the immune system and going deep into the system.

 

Dr Ritamarie (05:05)

Makes sense. What percentage of people who have COVID experience or, are diagnosed, so to speak, with long COVID?

 

Evan H. Hirsch, MD (05:16)

So according to the CDC, they say 20%. I've seen studies up to 40% of everybody who has COVID ends up with persistent symptoms. So the numbers are quite high. The numbers are skewed a little bit different also in terms of the population from chronic fatigue syndrome, where generally people are younger and more active with long COVID. And a lot of that has to do with the fact that they're typically exercising, and they go back to exercise too soon.

 

You know, so the thinking is that the spike protein, the virus ends up getting into the mitochondria. The mitochondria makes 70 to 90% of our energy. 

 

When you go back to working out too soon and the spike protein is still in the mitochondria, and you ask the mitochondria to turn on and produce a bunch of ATP or energy, basically it supercharges the reproduction of the spike protein of the virus. And so consequently that ends up increasing mitochondrial damage and causing people to have more of an issue. 

 

So I would say the population is really more like 30, age 30 to 60, though we've got some college kids, unfortunately, in our program, which is really sad. But, and with chronic fatigue syndrome, oftentimes it's more like above the age of 50, but it can be a little bit younger than that. But that's what we're seeing.

 

Dr Ritamarie (06:38)

Are you saying that what you're seeing is that the symptoms tend to be people who are more prone to the long COVID syndrome? Are the people who are more active like marathon runners, triathletes, lifters, et cetera?

 

Evan H. Hirsch, MD (06:51)

Yeah, it's been really interesting to see that. It's not always the case, but, especially if people already have predispositions. I mean, I should say the other things in terms of people's history, like if they already have autoimmune disease, even though it's mild, let's say they've got Hashimoto's, right? Or let's say they've got food allergies, or they've got some sort of immune system dysfunction, you know, along the gamut, so it can be pretty mild, but that can also, sometimes predispose. 

 

Dr Ritamarie (07:18)

So are you seeing that somebody who was a little fatigued before or had some minor things or may have had autoimmune disease, but it hadn't yet been diagnosed, that those are the people that tend to have a higher evidence of what's the word, incidence of long COVID.

 

Evan H. Hirsch, MD (07:35)

Yes, and the challenge is that, everybody, I believe at this point in time, everybody has some degree of autoimmunity, right? You can't have the toxins and the infections that we're exposed to on a regular basis without having the immune system react to those things. And that's essentially what autoimmunity is. And so we're all kind of existing with some of that. So, yes, and my population is skewed also because this is kind of what I'm looking at all day long. 

 

And so, yes, I do think that there is this predisposition for people who have autoimmunity, maybe a little bit of fatigue already. They’re like, I knew I had something going on, but it's not until I got COVID where all of a sudden now I have to do something about it, which is really unfortunate. And it's just like the natural state of the human is that we're not going to make a significant investment of time, energy, until we have to, right? We'd rather focus our time doing other things, which makes sense.

 

Dr Ritamarie (08:31)

Which makes total sense. You see that, I'm sure, in your practice as well as we do, is that people wait. They wait a long time. So I've been talking recently about if you don't listen to the whispers, you're going to have to pay attention to the shouts, right? Because that's what happens, right? 

 

The body's going to whisper, something's out of balance, do something different. Something's out of balance, do something different. But most of us ignore it. Even those of us who know better will tend to ignore that, because you don't want to be slowed down. You keep going on with your life. And then it's often when we get hit with the hit, the two by four over the head that we have to do something about it..

 

Evan H. Hirsch, MD (09:11)

Yes, and I think it's this disconnection, too, between the mind and the body. Where we're very cerebral beings, you and I, we're in this conversation, and we're thinking about things. What are our bodies doing right now in this moment? We'd have to pause, and we'd have to tap in, and that's the mindfulness component that we talk about a lot in our program when we're doing nervous system retraining, because it's that, it's paying attention, and it's listening to our bodies.

 

That is really a skill that we need to cultivate that isn't taught anywhere, you know, as we're growing up. So I really wish that these things obviously were taught by our parents, were taught in elementary schools, we’re fostered in that way to give us more connection with our bodies and more mindfulness.

 

Dr Ritamarie (10:00)

Yes, absolutely. So, we tend to be beings that we keep going, right? And maybe we're reinforced as kids, it's nothing. You just have a little tummy ache, or you have a little headache, go take an aspirin. 

 

And we were taught really young, I was taught really young, to turn off those signals from my body rather than paying attention. Interestingly enough, as I raised my kids when they were little, they would say, I have a tummy ache. I'd say okay, let's just sit with that. What's going on? Let's ask your body some questions. What is it trying to tell you? What's going on? And they would typically go, I think I have to poop. Or they'd say, I didn't get enough sleep last night if it was a head thing or whatever, but I always stopped and asked them to go deep and ask the body. But most kids aren't raised that way. 

 

I'm a little wacky, and that's how I raised my kids. But I wish I was raised that way, because I wouldn't have learned to turn things off and ignore things when they were little whispers, right? 

 

So let's talk about some of those whispers and some of those symptoms that may be whispers and some of them might be shouts. You said 200 plus different symptoms. 

 

Evan H. Hirsch, MD (11:11)

Exactly, 250 different symptoms. The big ones are fatigue, and we're talking about real exhaustion. I mean, it can be anywhere on the gamut from having a hard time getting out of bed, needing to survive on caffeine, but it's a worsening of your energy level. And so there's that chronic fatigue, there's post-exertional malaise. 

 

So when people exert themselves, and they feel worse, where they find that they can't go for a walk, or go for a run, or exercise, any particular way, or if they do too much around the house, then they have to lie down, right? They go from a sitting to a standing position, and they get lightheaded. That's orthostatic hypotension that comes from the adrenal gland not working right because of the stress of the long COVID. So that's the fatigue.

 

The brain fog, where you're having a hard time searching for words. Cognition is really not ideal. There's sleep issues, having a hard time falling asleep or staying asleep. There's body pain, whether it's joint pain or muscle pain. And those are really the most common. Obviously there's the loss of smell and taste. There can be other neuropathies, so numbness and tingling in the hands and feet. 

 

Like I said, 250 different symptoms. So it could be almost anything. So for the practitioners who are listening, when you have somebody who's presenting to you, and their symptoms started since 2020, you have to consider long COVID as part of your differential.

 

Dr Ritamarie (12:38)

Absolutely. You know, it's interesting. because when you said fatigue, it stops you in your tracks. And the only time I remember ever experiencing that kind of fatigue as an adult was in the first, I think it was the first few days. I had COVID once back in 2022. And it stopped me dead in my tracks. 

 

You’ve known me for a long time, and I'm like, blah, blah, energy, energy, energy. And I literally was like, I was on a call, and I knew that this was happening. I was with my clients, and I was doing lab analysis. And my brain kept saying, make them go away. Why won't they just go away and leave me alone? I need to lay down. 

 

I had never had a thought like that before. And I knew, because my husband had had a positive test a few days before, and I refused to test. And then I finally said, yes. And it was like dead stopping me in my tracks. And it was even like a couple of weeks later. I tried to lift weights again, because I didn't do anything during, and I tried to lift weights, again. And I went, okay, this is easy. 

 

Okay, I'm done, right? So if you're hearing that from people that they used to do all this stuff, but now it's like, it's exerting just to walk around the block or go down to the mailbox. This is when you're starting to think, what's going on here, right? And are there tests that you do?

 

Evan H. Hirsch, MD (14:05)

Great question. I do not. And so at this point in my practice, I assume that everybody has the spike protein in addition to the other things. And so we're just going to address all of it. And so some of the testing that's out there is looking for microclots and hypercoagulation, which can be a little bit helpful, but we treat everybody in our program, because they all have hypercoagulation and microclots anyway. 

 

There's antibodies to spike protein that you can look at. The challenge is that when you test, and if you're using an imperfect test, which we can talk about in a second, and the test comes back as negative, then it's not going to be treated by practitioners. At this point in time, I have been fooled enough by tests where it is a better use of people's time, energy, and money to address the heavy metals, the chemicals, the molds, the infections, and the nervous system dysfunction. 

 

I'm talking about all of these, all of the heavy metals, all the chemicals, all the molds and mycotoxins, all the infections in order to make sure that I leave no stone unturned and address everything. The reason why I've been burned is because testing is imperfect. And when we're looking at, by the nature of these illnesses, COVID and chronic fatigue syndrome is that you have immune system dysfunction. 

 

So if you have immune system dysfunction and then you're asking the immune system to give you an accurate read on a laboratory test, you're barking up the wrong tree, right? You're hoping for something that may not happen, right? So if we're looking for antibodies to the spike protein, antibodies are part of the immune system. If the immune system is dysfunctional, it may not read the spike protein, may not respond, it may not give you an accurate read, and then you don't necessarily test it. 

 

And the same thing goes for all serologies. So if you're looking at different infections, and the immune system's response to those, you may not get a response, does that mean you don't treat the infection? And so I've learned that that's not the case. 

 

And part of it too, before I get off my soapbox, is that all of these toxins, the toxic five that I talk about, including the infections and the nervous system dysfunction, they're all kind of bound up together. And so when you start to pull out the heavy metals, or the chemicals, or the molds, the infections get released. And so you may do a test, and looking at, are the infections present, and they are not present.

 

But then, once you start removing these toxins, then all of a sudden the infections are released. And then if you did a test at that time, you'd get a positive test if the immune system is functioning correctly. But I just find that it's just better just to go ahead and treat so that as we move through this process, I know that these toxins and infections are going to continue to be released. So I just  make sure I've got things on board to capture them as they're being released.

 

Dr Ritamarie (16:46)

Got it. Well, so it sounds like a lot of people are testing spike, do you test the spike protein or just antibodies to the spike protein? I keep hearing people testing the spike protein.

 

Evan H. Hirsch, MD (16:56)

I don't do either.

 

Dr Ritamarie (16:58)

Right, but I'm saying if you do, right? If somebody comes in and says, I had this tested, and they're off the charts, you know that that's part of the problem. But if it's suppressed, it doesn't tell you that that's not part of the problem. That's what I'm hearing.

 

Evan H. Hirsch, MD (17:13)

Exactly, yes. There are false negatives, not necessarily false positives. And so if somebody has a positive test, that's great and that's supportive. If they have a negative test, it doesn't mean that they don't.

 

Dr Ritamarie (17:26)

Got it. Okay. That's really good to know. And I want to really emphasize that, because I talk about that when it comes to like serum B12 testing, which I think is a test that if it's super low, you probably are low in B12, but if it's high, it doesn't mean anything, because it could be, it's not the right form. It's not getting into the cells, and you combine that with functional tests. So that's kind of what I'm looking at. You're looking at a dysfunctional immune system and asking it to give you a mark that it's active, and what it's active against, and it can't. 

 

Evan H. Hirsch, MD (18:02)

I don't really do testing anymore. And so the other thing that, in terms of the testing, is the urine tests. I think urine tests are the best tests for heavy metals using provocation, chemicals, and mycotoxins. I do think that they are the best tests. However, those tests are really tests of excretion. They tell us how good somebody is at excreting, because I can't tell you how many times I used to test people initially, and nothing shows up. And then I test them six months into the program when I've done a number of these four step processes that we're going to talk about. And then all of sudden it's a waterfall, and all this crap is coming out. And it really depends on where they're at in the process, how open are their detox pathways, you know? And what I found is, in treating these people over the last decade, is that all of the heavy metals, the chemicals, the molds, the infections, they all end up coming out over 12 months. 

 

And so that's why I was finally like, all right. I'm going to quit wasting people's money on testing. And I still think testing is great for other populations. But for my people, I'm just going to go ahead, and I'm going to treat them. We don't have to wait for tests to come back. They don't have to spend the money on the test. We're just going to address everything.

 

Dr Ritamarie (19:13)

Right. So that makes sense. And also, what I find with testing like that, you do the test, and it comes back kind of moderate, comes back and then you start to do this work, and it comes back higher, people get pissed, right? They get really upset. Like what are you doing? You're making me worse when really what you're doing is releasing these things, whatever they are, mold, toxins, virus, remnants, from the tissues, right?

 

Evan H. Hirsch, MD (19:45)

Yes, and I found that when I gave them the initial test, I would prompt them about what this is going to look like in the future. So I was going to say, whatever this test comes back as, just know that it may look worse in the future, because when we start opening these paths, you know? I start talking about the test, about what it's really measuring, right? It's measuring excretion. It's not measuring your total body burden.

 

Dr Ritamarie (20:07)

Got it. So I want to go back to a question I asked you earlier. And in light of what we've just discussed. So when someone presents to you with these exhaustion and post-exercise malaise, et cetera, et cetera, et cetera, and you're suspecting long COVID, what predisposes people basically? Right? 

 

Let's talk about that. Because we all do a really thorough history. I mean, I know you and I do. I don't know if everybody out there does, because it's a 15 minute visit, and we don't really get into it, but we do a really extensive history. 

 

What kind of things are you picking up in the history? They're going, hmm, chronic fatigue. This all started in 2020, blah, blah, blah.

 

Evan H. Hirsch, MD (20:49)

Yes. It's a viral illness that happened since 2020, it doesn't have to be diagnosed as COVID, that ended up with persistent symptoms, whether the symptoms went away and then came back and then persisted, or whether or not the symptoms stayed after the viral illness. 

 

And then in terms of the predisposition, it really is this combination of the toxic five. It's the heavy metals. It's chemicals, it's mold, it's infections, and it's the nervous system dysfunction, or trauma, that people have had during their lives. When we start to take a look, and we can put the pieces together by looking at their history, that's kind of like the spike protein in COVID, becomes the straw that breaks the camel's back. But the reality is that there's this predisposition and that the immune system was already kind of on the precipice of having issues. 

 

And so, because as we talked about, having those mild symptoms and those persistent symptoms, is all about COVID and the spike protein, being able to navigate around the immune system and getting deep into the tissues, into the different parts of the body to manifest the symptoms. And so it's really that avoidance of the immune system that really can only happen when you have the Toxic 5 on board. So that's always what I'm looking at. And so when I'm going through a process and reversing it, I'm very much focused on the Toxic 5 and then I also make sure that we're addressing COVID and other viruses.

 

Dr Ritamarie (22:20)

Okay, so I want to get back to the toxic five and your four steps that you generally take people through. So with the toxic five, if you're not doing tests, you're not doing hair mineral analysis or urine or, provoked urine or whatever, to test for metals. How are you, what in their history, or what are you looking for, to be able to say, this person probably has these things going on.

 

Evan H. Hirsch, MD (22:44)

So, I'm going to treat them all for it anyway. My history paperwork used to be 17 pages and now it's like five pages. The reason is, is because if I'm going to treat people for all the toxic five, I'm going to treat them for adrenal gland and mitochondrial dysfunction, which basically everybody here has who has chronic fatigue. 

 

The questions that I have are, do they have thyroid issues? Do they have vitamin D, B12, iron issues? And what are their lifestyle habits and their mindset? I'm treating all these things already, my history has decreased. 

 

But for those practitioners out there who want some more specifics, you're asking me for, in terms of their history, we're looking at, do they have any smoking exposure, which is going to be cadmium?

 

What is their fish consumption? I had chronic fatigue syndrome for five years. And part of my story was that I grew up eating a lot of tuna fish. How much fish did they eat growing up? Did they have mercury fillings? Otherwise known as amalgams, right? You know, in terms of the chemicals, eating pesticides, like growing up in the eighties, we didn't know a lot about organic food and whatnot, right?

 

You know, what sort of exposures did they have in terms of pesticides and herbicides and insecticides? Did they store their food in plastics in the fridge, put them in the microwave? You know, glyphosate, was somebody spraying Roundup around the house a couple of times a year? I actually saw my neighbor spraying, and I walked across the street to him, and I said, Hey, what are you doing? And he said, I'm spraying weed killer. You know, he knew he wasn't supposed to be. 

 

Hey Jim, you know that stuff can cause cancer, right? And he's like, yeah, I just do it once a year. And I wanted to offer, “Hey, I'll pull your weeds for you.” I mean, he was just spraying it on the street, but you know, that stuff blows over, even if you're not spraying it in your house, that blows over from your neighbors, comes into your yard and your garden, unfortunately. And even organic food, about 10% of it gets some blow over from other farms, which is really unfortunate. Anyway, that's chemicals.

 

And then in terms of the molds, living in a water damaged house, any home that you've ever lived in that had water damage at any point in its history can mean that people are having mycotoxin illness. And so there's that. 

 

And then in terms of the infections, it can be something as nonspecific as malaise and in large lymph nodes like with Epstein-Barr or cytomegalovirus or HHV-6, or it can be something that's more like Borrelia where there's symptoms that come and go and move around the body, or Bartonella causing pain on the bottom of the feet like plantar fasciitis or muscle cramps usually in the calves, usually at night. 

 

Thyroid issues, feeling cold all the time, or something like Babesia, or parasites, where you've got anxiety to the point of panic attacks, depression to the point of suicidal thoughts, sleep, really bad sleep issues, feeling hot all the time. So there's a number of interesting symptoms based on the infection or based on the toxin that people have.

 

Dr Ritamarie (26:05)

Wow. So there's a lot there. So when you talk about treating them all, what does that mean? Your four step process? Tell us about that.

 

Evan H. Hirsch, MD (26:17)

Yes, so the first step is to figure out the causes that people have. And so, like I said, I'm always going to treat the toxic five, adrenals, and mitochondria. And so the question is, what are the other causes that they have? So that's what we do. We figure it out first. 

 

There's two tests that I want everybody to do. One is an EMMA test to look and make sure that they're not living in a moldy environment. And I do believe that the EMMA test is the best test out there. It looks at mycotoxins and mold spores. But, it's very hard to get people all the way better, which is always my goal, if they're living in a moldy environment. 

 

And the second test that I want people to get is a cone beam CT. I want them to go to a biologic dentist and not all biologic dentists are created equally. So make sure that they talk about cavitations on their website and go get assessed for any sort of cavitations or hidden infections. 

 

Actually, now it's been four weeks. I had my cavitations removed just to kind of get my energy and my health to the next level. I've noticed a significant difference. And I had wisdom teeth removal, 27 years ago, all four of them. And so I had the cavitation surgery done, and I was very pleased with it. But that can be a major deterrent. It's very hard to get people better if you've got chronic infections in your jaw. 

 

I had one person who was one of the more sickly bed bound people that I was working with, and I told her to go get assessed. She went and she got a cone beam CT from a biologic dentist. The biologic dentist said, it doesn't look that bad. She gave me the radiologist report. I was like, it looks like you've got cavitations here. I would go for a second opinion. She went for a second opinion. They got her in the next day, because they found out that it was emergent, and they ended up removing a number of teeth on both sides, because as soon as they got in there, pus just started pouring out of her jaw.

 

And they said if she hadn't come in relatively soon, she probably would have died from the infection that was in her face. So really important to get this assessed. That's not going to happen for everybody. Obviously that was a really serious condition, but you never know why people are bed bound, especially when they feel like they tried everything. And so those are the two big things that I find have been returned. The EMMA test by Real Time Laboratories.

 

Environmental Microtoxin Moldiness Assay, it's called EMMA. And the other one is the Cavitation Evaluation, Cone Beam CT.

 

Dr Ritamarie (28:46)

Cone beams CT. And most dentists don't do that as a routine thing, right? You have to go to a biological dentist. 

 

Evan H. Hirsch, MD (28:52)

Correct. Yes, and I do prefer a biologic dentist that also does muscle testing. And it's really great if you have them muscle test to see if you have cavitations, before they do the cone beam CT to see how accurate they are. But I'm a fan of muscle testing just because I find that it can, it's not perfect, but it can definitely provide some more data that we can use.

 

Dr Ritamarie (29:10)

I agree. And in conjunction with the rest of it, it can be very helpful. Going back to, so step one is to get rid of the top five. Assess for the five.

 

Evan H. Hirsch, MD (29:21)

Well, step one is to assess. Yeah. And, and when I'm assessing, I'm kind of breaking these into two categories, deficiencies and toxicities. So we talked about the deficiencies being adrenals, mitochondria, thyroid, sex hormones, vitamins, minerals, lifestyle habits, mindset. So that's all what I consider deficiencies. 

 

Then the toxicities of the toxic five, the heavy metals, chemicals, molds, infections, nervous system dysfunction or trauma. Hypercoagulation, and then structural issues, if somebody's got obstructive sleep apnea, if they've had concussions that need to be addressed. 

 

Dr Ritamarie (29:55)

Okay, but I want to go back to something, because you said you're not testing other than these two, the EMMA and the CT. So in that phase, what are you doing to determine whether they have those things, or are you just assuming they have all of those things and treating them? That's my question.

 

Evan H. Hirsch, MD (30:13)

Yes, it's more the latter. I'm assuming. Now there's a couple of lab tests that people have already had for them. You know, 90% of people have had a vitamin D test and iron test and a B12. And so those are the things that really need the laboratory testing. And sometimes thyroid can be helpful, but you can also glean a lot just from their subjective answers, you know? 

 

I give most people, if there's any question about their thyroid, I'll do a subjective ramp up where I'm ramping up by, I use a thyroid glandular, because I don't prescribe anymore. And so I'm ramping up by a little bit every two weeks. And when they've had too much, their body tells them, they get palpitations and et cetera, diarrhea, a hard time sleeping. And so then we just back off a little bit and that's their ideal dose. But I don't do that until I've already supported the adrenals and the mitochondria, because those will make the thyroid work better.

 

So I want to make sure that I'm leaving no stone unturned. Replacing the deficiencies is helpful, but it's this whole process since 80% of those deficiencies is actually caused by the toxic five that we address in step four. 

 

I just want the deficiencies to be good enough. So, I don't want to waste time, energy and money. Like, okay, I'm going to give you some B12. Let's retest it. Let's try to get to an optimal dose. It can help people. Yes, absolutely, but the question is where's the best place to spend their time, energy, and money because everybody wants to be better tomorrow, right? 

 

I know that their adrenal or their b12 deficiency, their adrenal, their mitochondrial dysfunction. So much of that comes from the toxic five, and so I want to spend a month boosting their deficiencies, which happens in step two. I want to spend a month opening up the detox pathways, the liver, the kidney, the lymph, the neuro lymph or lymphatic system, the gallbladder, the intestines, make sure all those pathways are open, take a month doing that. So that once we get to month three in the program or so, they can start working on removing the toxic five, because that's going to take six to 12 months for the majority of people. You know what I mean? And so, that's what I tell people. 

 

That's why I say the magic really starts to happen around month nine. So there is a lot of coaching that goes into, “Hey, you may not feel anything until month nine.” And that's hard for people to understand, but when they've been sick for a long time, and they haven't gotten the help, and they kind of understand, and they respect the paradigm, and it resonates with them, then they can make sense of it and then they're okay.

 

Dr Ritamarie (32:52)

Well, okay, so that makes sense then that you're not addressing those toxic five, you're assessing them at the beginning and then you're not addressing them, because what I see a lot of, is people come in, and they have some kind of test done and then they're put on a really powerful program, and they feel like crap. They really feel bad, because their body just can't eliminate. And I won't mention names, but there's some very strong detox programs that a lot of people are jumping into without the preparatory stages, right? 

 

So the four steps that you take people through are assessing for the toxicities and the deficiencies. The deficiencies are not just in nutrients, not just in hormones themselves, but in the functioning, like the mitochondria, the adrenals, right? They're low functioning. So you're doing that in step one.

 

And then you're addressing the deficiencies and that might be what talking about diet, supplements for various things.

 

Evan H. Hirsch, MD (33:54)

Correct, so we start off with the lifestyle habits, so make sure they're getting enough sleep, enough movement, though a lot of these people can't move a lot, so I tell people we want your Goldilocks dose of movement, so move as much as you can without feeling worse. For some people that might be just going to the bathroom and then coming back to bed, but for other people they can work. So lifestyle habits, so then we sleep, movement.

 

Food, it's more about what you're not eating than what you are eating. I know that you're better at this than I am. But generally, I want them to be gluten-free, dairy-free, sugar-free, processed food-free. You know, we can work with people who are vegan, paleo, whatever. So there's that. 

 

And then the last lifestyle habit is water. So three liters of water is necessary in order to be able to really detox. And so people have to kind of work up to that.

 

Dr Ritamarie (34:49)

Depending on their size, like a 4 foot 11 woman and a 6 foot 4 man don't need the same.

 

Evan H. Hirsch, MD (34:57)

Essentially, I mean, it's going to vary. You're right. It is going to vary, but I do find, I used to do half the body weight in ounces, but for most people that ends up being two liters for who I work with. And I just find that they really need three liters. So for somebody who is really tiny, then I might say, okay, let's do two and a half. Somebody who's very hot, large, then I'll say three or four. But I find that three liters really is the sweet spot.

 

Dr Ritamarie (35:26)

And that's a challenge for people. Because even when I say to them, they're like, my God, that's three quarts of water a day. Holy cow. How am going to do that? Right. And well, you have your bottles. Fill them up and make your way through it. Right. 

 

Evan H. Hirsch, MD (35:42)

Everything that I'm using is herbal. So opening up liver and kidneys and lymph and neurolymph and gallbladder and intestines. And so generally we're talking about milk thistle, we're talking about N-acetylcysteine, we're talking about berberine and pinella, we're talking about dandelion. You know, those are the main things that I'm using. 

 

They're great. So, I like those. And about half of the stuff that we use is tinctures and about half are capsules. A lot of the deficiencies, I'm using capsules and a lot of the detox stuff and killing infections. I really like to use tinctures, because we can increase by a drop at a time. And so part of this process, and like you said, they feel worse, they're having a Herxheimer reaction, or die off. It's because they're not detoxing at a rate that their body can tolerate.

 

And so that's really big for us is to make sure that that's happening. If we're increasing by a drop at a time, we can catch things before they turn into a snowball, right? So, they start to feel worse. We say, okay, hold up. Let's increase your step three support, so that you're not killing things too quickly or removing things out of the body.

 

Dr Ritamarie (36:57)

Right, right. I'm a big fan of tinctures. Also, instead of capsules, I avoid those if I can, going to powders. Some powders taste bad, and people won't take them, but with powders, I can just add them to drinks or yogurts or whatever, and just, you can control the doses. And people who literally open one capsule, one B vitamin capsule and put it in a bottle of water, shake it up, and that's their two week supply. Because if they go higher than that, they get all anxious, and if they go less than that, then their deficiencies are there. Customizing it is a really important piece of that.

 

Evan H. Hirsch, MD (37:37)

And I think, just as an aside, I think B12 is a really interesting conversation, because the people that I work with, they all have MTHFR or the majority, they're all heterozygous or homozygous for MTHFR and other detox issues, detox SNPs, genetic issues. But they can't tolerate methylated B vitamins, you know? And so it's hydroxy or it's adenosyl. It's low dose. It sometimes has to be every other day or once a week, so I agree wholeheartedly, especially in my population.

 

Dr Ritamarie (38:10)

So, and then step four, what are you doing to help them get rid of the metals, and do you have favorite binders and things like that, or where are going with that?

 

Evan H. Hirsch, MD (38:20)

So I like combination binders, so zeolite and activated charcoal, pectasol, a number of these binders that can be really supportive that are going to get at some heavy metals and some chemicals and some molds. And then I do like cilantro and chlorella. And I'm making a change. 

 

I have people, we give them a Google spreadsheet, and they add in a supplement to make a change like every two to four days, depending on what the supplement is. And then they document, they've got a column in that spreadsheet where they document how they're reacting to that particular supplement so that when I look at it, I know what the progression has been and what the chronology is. 

 

We're starting off with the binders and taking the NAC. And I don't recommend glutathione, because it's way too potent for the people that I work with. And then we're going after heavy metals and chemicals with the cilantro and the chlorella and the zeolite. And then we're working on the hypercoagulation by taking things like natokinase and bromelain and sometimes, seropeptase and lumbrokinase. And then we're getting into some of the infections. So we're starting to go after viruses, using things like skullcap and then going after the different, all the lyme type infections and co-infections. 

 

So we're using stevia and Banderol and Samento and then we're getting into Babesia and using things like cryptolepis and artemisia and then houttuynia for Bartonella and using them all in combination, because you these herbs are doing double and triple duty and that what I just mentioned for Babesia is also going to be helpful for viruses and also for other infections, bacteria and yeast, and then going after parasites as well with black walnut and clove, et cetera, so that we're making sure that we're addressing everything. There's this crossover. 

 

There are some questions about COVID and spike protein. Is it really a virus? It doesn't entirely act like a virus. It acts like some of these other things. And so we're hedging our bets by making sure that we're addressing all the different potential manifestations of it, in addition to all these other causes that we see. 

 

And so for me, it just makes sense. And people seem to resonate with the fact that if we're addressing every single potential cause, and I'm not like addressing XMRV virus or some of these other ones, so I would say we're addressing 95 to 99% of all the causes out there with treatments that actually work, we're going to be successful. It's just a question of how long it takes. And so that's really where the coaching comes in.

 

Dr Ritamarie (41:02)

I want to hear more about some. I'll ask you this in a second, but really what I want our listeners to hear, because a lot of our listeners, we have listeners all over the board. We have listeners who are health coaches and nutritionists, but also MDs and all. A lot of times when people hear this stuff, they're like, I can't prescribe. And you said earlier, you're not prescribing. You're not. All of what you said is all within the cornucopia of what we all have access to, herbs, and nutrients, and all that. 

 

So I want you to really listen to that. The herbal kingdom, to speak, queendom, so to speak, is like replete with so many medicines and food itself as medicines. And we don't need to be resorting to, except in urgent cases, to the medical intervention, the pharmaceutical interventions, and you're getting great results with people who have not had results before.

 

Evan H. Hirsch, MD (42:02)

Absolutely. Yes, we're about ready to offer a guarantee, because we're seeing such great results. Yes, which is kind of unheard of. And so, when you're addressing all of these causes, and you're using things that actually work, I mean, these herbs, they're brilliant, and there's lots of research on.

 

Dr Ritamarie (42:21)

So you're bringing people into a program. You mention your program. Is it a group program? Is it a hybrid program like group, combination group with one-on-one? How long are you typically working with somebody? You mentioned nine months is when the magic happens. Are you getting people to agree to a year long program?

 

Evan H. Hirsch, MD (42:40)

So we start everybody off with a six month program and then they just renew for another six months as long as they need it. But essentially, people are generally 60 to 100% better at 12 months for the most part. And so I would say that's the average that we, no, it's not the average, that's the low point, the low end of where we work with people. I would say 18 months is probably the average that we see depending on the severity of what they have. But, we're very much a hybrid model.

 

So when I looked at what people really need from me is that they need to, because I've got a mission to help a million people. And so it's like, okay, well, how can I help a million people resolve their chronic fatigue and long COVID, and use my time, so that they're getting everything that they need. And so that I'm freed up to help as many people as possible. 

 

So the first thing is they need a plan from me. And at this point in time, I have them fill out a form, and I can look at their history, their symptoms, any lab tests that they provide, and I can create a plan for them over the next 12 months to address all of their causes. So that's super important, is that what is that plan. That's how I personalize it initially. 

 

And then the second thing is, okay, then how do I support them every day along the way? And so we have an online, we've got a group that's not on Facebook, a community, where I guarantee a response from me in two business days. So that means that any question that they have as they're going through the process, they post that question and that I'll respond within two business days. Sometimes it's less than that, because my team, I've got a health coach who goes in there and responds, and sometimes they'll get a response within 24 hours. And so that's the second place where they really need my support. 

 

And then the question is about, okay, well, what if they don't know what questions to ask? How do we support them in that way? Well, every single month they get a call with my health coach. She's been with me for five years. She's excellent. She's going to know 95% of the answers that I'm going to say. And then we also text them every single month and ask them how the program is going to kind of prompt things. 

 

We have a curriculum that they're working through, and we track where they are to make sure that they continue to make progress so that we can reach out to them and make sure that they are in fact making progress. So we've got a number of these things built in to make sure that we're personalizing it.

 

We're providing accountability, we're providing coaching, we're addressing all of the potential causes, we're helping them detox at a rate that the body can tolerate, and we're taking them through a step-by-step process. So even if they have brain fog, now this doesn't work if your brain fog is so bad that you can't show up to appointments or anything like that, but if you've got a little bit of brain fog, but if you have the handholding, or if you've got the handholding, you're going to be successful, that's what we found. 

 

We just can walk people step-by-step, they can check things off as they work through the curriculum, and they're going to be successful. So that's what I found. 

 

I've got the group calls. So three times a month, there's group calls with me, a live Q and A group calls. So almost every single week, we also have a nervous system retraining program, and we've got group calls for those twice a month. We have meditations once a week that are led by our coach. And then we also have journaling that happens once a week. And that's all part of the nervous system retraining. 

 

I feel like we're hitting so many of these different things that there's no way people can't be successful as long as they implement them. So that's the big thing that I talk to people about is that, “Hey, Are you going to implement?” As long as you're going to implement it. And that's why I'm thinking about doing a guarantee is it's going to really hold people like, hey, this is going to be an action-based guarantee. As long as you implement it, you're going to be successful.

 

And we're just going to make sure that we track that. And people are going to want to make sure that they can get their money back if they implement and they're not successful, right? And so I think they're going to be even more successful, because they're going to have that.

 

Dr Ritamarie (46:38)

That's great. So how do people find out more about you? And I know you are, I saw in your links that you have a master class that you're offering, that people can come to. So tell us more about that and where to find you.

 

Evan H. Hirsch, MD (46:51)

I'm at EnergyMDmethod.com. That's energy MD as in medical doctor method.com. And from there you can click on the link to watch my masterclass. It's 20 minutes if you watch at 2x speed, and then you can click on a link and get on a free call with me where we'll go for 45 to 60 minutes where I will really assess to see whether or not I believe I can help you. And if you're a good fit for what we offer, and if you are, then we can talk about what next steps look like. 

 

But you know, I've learned, as I'm sure you have over time, my business only does well if I continue to get people better. And so I'm not going to accept anybody into the program who's not going to be successful. And so about a third of the people I get on a call with, I say, I don't think that this is a good fit for you for whatever reason. And so it's not a foregone conclusion when we get on.

 

Dr Ritamarie (47:43)

That's great and that for our practitioners listening, right? You don't have to accept everybody that shows up. If they're not going to do the work and it's sometimes really easy to figure that out pretty quickly with people that they're not going to be willing to do the work, they're going to self-sabotage. We can't help them, right? There's nothing I can do to help somebody to overcome what they won't do.

 

Right. And so that's a big part of it. So I appreciate you and what you're doing in the world. It sounds like we're very aligned with a lot of the approaches that we take. 

 

And I really love the fact that you rely on natural methods, all the lifestyle habits, because it's critical without the nervous system resetting people can't get well, if they're running around in sympathetic overload 24/7. It just won't work. Right. And rebuilding and renewing their nervous system is such an important part of it. And it is part that a lot of people don't want to do. They don't want to hear that they have to do that, right? They're like, you just tell me to meditate. That's horrible. You know, okay, great. This is what's in my toolbox. This is what's in your toolbox. This is what I'm going to give. I'm going to give my all to you. You have to be willing to do the work. 

 

So I love that message. All of you. I want you to hear that message and not be afraid to say, “No,” to people who you don't believe you can help, right? And it may not be that you don't believe you have the tools to help, but you don't have tools that they can receive to help them. And there's other people out there that they can try. 

 

But the thing is with this, whether it's chronic fatigue, or it's long COVID, or the combination of the two, people have been struggling for a long time, and they're thrown out to the wastebasket diagnoses, and they're just thrown out that it's all in their head. And there are true physical, biochemical, and nervous system kinds of resets that they can do to get well. 

 

So I appreciate what you're doing here in the world. We'll make sure all of your links are in the show notes and the description on YouTube. 

 

And all of us, right? I appreciate the work that we all are doing as functional practitioners. There's not enough of us in the world. We need more and more of this and people need to be helped on a level that deeply shifts all the chaos that's going on inside. So keep doing what you're doing. And until next time, shine on.