Hidden Causes of Chronic Fatigue & Long COVID

Nick Urban [00:00:01]:
You’re listening to High Performance Longevity, the show exploring a better path to optimal health for those daring to live as an outlier in a world of averages. I’m your host, Nick Urban, bioharmonizer, performance coach, and lifelong student of both modern science and ancestral wisdom. Each week we decode the tools, tactics, and timeless principles to help you optimize your mind, body, and performance span, things you won’t find on Google or in your AI tool of choice. From cutting-edge biohacks to grounded lifestyle practices, you’ll walk away with actionable insights to look, feel, and perform at your best across all of life’s domains. Dr. Evan Hirsch, welcome to the podcast.

Dr. Evan Hirsch [00:00:53]:
Nick, thanks so much for having me on.

Nick Urban [00:00:55]:
Today we’re going to be discussing your, realm of expertise that is all things the low energy, chronic fatigue, long COVID, a whole lot under that realm. We haven’t discussed it much on the podcast so far. So to begin with, why is this an issue? Why is this something that we should actually prioritize and focus on?

Dr. Evan Hirsch [00:01:15]:
So let’s start with long COVID. You know, a lot of people have long COVID and don’t realize it. I just spoke with somebody yesterday who’s been struggling for 5 years with headaches, chronic fatigue, etc. And his mother-in-law just finally said to him, hey, maybe you have Long COVID. And he looked it up and he’s had a conversation with me. And sure enough, that’s exactly what it looks like. So I think my hope is to really bring awareness to people about how much of an issue this is. The reality is, is that about 36% of everybody who’s ever gotten COVID ends up with some sort of persistent symptom, whether it’s really noticeable like chronic fatigue or body pain, sleep issues, cognitive issues, or whether it’s more mild, you know, where, yeah, maybe your brain’s just off a little bit, memory’s not as good, maybe your sleep’s a little bit disrupted.

Dr. Evan Hirsch [00:02:04]:
Um, but you know, there’s 8 billion people on the planet, about 70 to 80% of those have already had COVID, if not all of them. And 36% of those, um, you know, have, have potential, uh, persistent symptoms. So you’re looking at, you know, billion people, this is considered by economic, economists as being like a trillion-dollar annual problem medically and from people missing work. So it’s definitely a big issue.

Nick Urban [00:02:32]:
Years ago, before the, before COVID even existed, I came across an idea of subclinical infections, and that is infections that don’t present with symptoms, like perhaps it’s persistent infections after you get one. And then you have exper, you have symptoms for a long time after that, and unless you actually do something to address them, that they persist. And so long illness isn’t necessarily new, but it is, it seems to be more prevalent, more common these days. You have a framework that breaks down like the root causes of low energy and chronic fatigue. What would you say are the most important things to look at?

Dr. Evan Hirsch [00:03:10]:
So I talk a lot about the Toxic Five. This is a combination of the toxins and infections and nervous system dysfunction that is basically built up in an individual’s body over time. And eventually there’s some sort of trigger, uh, I call it the straw that broke the camel’s back, that ends up putting you into symptoms, you know. And for a lot of people, you know, in the context we’re currently talking about is long COVID. But the reality is, is that you come out of the womb already behind the eight ball. There’s studies to show that over 300 chemicals are found in baby’s cord blood, so basically in the placenta, Right? And then we just continue to accumulate heavy metals and chemicals and molds and these infections that you’re talking about. And then we all have trauma, you know, whether, you know, it’s because we’re raised by imperfect parents and have imperfect siblings and imperfect peers and we’re all trying to get our needs met, or if we have really significant abuse of some kind. So all of those things together end up leading to this perfect imperfect storm that ends up causing people that have the symptoms that they experience.

Nick Urban [00:04:12]:
Do you see outside of COVID that’s the main one we’re talking about now, but like other infections that can lead to these same symptoms?

Dr. Evan Hirsch [00:04:19]:
Absolutely. And you know, there’s COVID, long COVID can cause over 250 different symptoms, which is really crazy. And, but part of that is also because it acts as a biofilm disruptor. So it breaks up the hiding places of other infections. And so when somebody comes to see me and they have pain on the bottom of their feet, usually misdiagnosed as plantar fasciitis, they’ve got muscle cramps, usually in the calves, usually at night, they have sleep problems, maybe some anxiety, maybe some depression, and they’re cold all the time, that, the infection that causes that generally is one called Bartonella, which is found in upwards of 50% of all domestic animals. So if you’ve ever been scratched by a cat or licked in the face by a dog, you know, you potentially have had this kind of exposure. And so when somebody has those symptoms, I don’t know if they’re from Bartonella itself or whether they’re from COVID because sometimes COVID can kind of get into the, the muscles and the nerves and cause these symptoms. And sometimes COVID is causing disruption in the biofilm, releasing the Bartonella, and then the Bartonella becomes opportunistic.

Dr. Evan Hirsch [00:05:25]:
And then there’s things like babesia, which can cause you to be, feel hot all the time. You know, sometimes you’re, you’re even sweating spontaneously. That also leads to really bad sleep and really bad mood issues like anxiety to the point of panic attack and depression to the point of suicidal thoughts. So there are characteristics associated with a number of these infections that can really show us where the, uh, what infections are potentially present because the lab testing is imperfect. And I know your community loves testing, and we can definitely talk about that, but there definitely are some challenges and nuances.

Nick Urban [00:06:02]:
I’m with you on that. I think testing can give a false sense of confidence or conversely on the other end, a false sense of, of doom. And it like really is more than just throwing everything at the wall and seeing what sticks because you test enough things, you’re gonna find statistically something that’s out of reference range or that’s like perfectly in reference range that shouldn’t be.

Dr. Evan Hirsch [00:06:24]:
It gets really expensive too. Absolutely. Yeah, I actually do a, a lot less testing now since I’ve been doing this over the last decade. It seems like the longer I work, the less I test.

Nick Urban [00:06:33]:
I saw on your website that you mentioned over 90% of your cases can be determined by the case history and the symptoms of the patient alone.

Dr. Evan Hirsch [00:06:43]:
Exactly. Yeah. And we’re looking at over 30 different causes. But, you know, this is actually something that I learned in conventional medical school that was true. You know, there’s some things that weren’t so true, but this one definitely was, you know, that, you know, your, your diagnosis or determining what causes you have can really be determined by your history and your symptoms, fortunately. So you don’t have to spend $7,000 right off the bat in order to determine what causes you have.

Nick Urban [00:07:14]:
Obviously it’s personalized. If someone comes to you and they’re wondering, okay, I have all this like really large constellation of symptoms, they seem random, there’s probably patterns and correlations between all of them that you would be able to figure out. How do you help them navigate if they don’t have the means of either working with you or going and getting someone on their case?

Dr. Evan Hirsch [00:07:47]:
So you’re talking about, like, no to low-cost options that are, like, big bang for the buck. The way that I look at illness really is kind of in different levels. Where if you have a level 1 issue, it means that it’s resolvable by adjusting your lifestyle habits. So if you start drinking 3 liters of filtered water per day and you start getting 7 to 9 hours of sleep a night, going to bed earlier than you think you should, and if you’re starting to get your Goldilocks dose of movement, which basically means the amount that doesn’t make you feel worse.

Dr. Evan Hirsch [00:08:47]:
With food, it’s more about what you don’t eat than what you do eat. So avoiding gluten and dairy and sugar and alcohol and processed foods. Those are level 1 problems. Then when we go on to level 2, this is if you’ve done level 1, you continue to do level 1, and then you start replacing your deficiencies. We’re looking at things like hormones, adrenals, thyroid, sex hormones, mitochondrial function, which are found in every cell in the body except for red blood cells and produces about 70 to 90% of our energy.

Dr. Evan Hirsch [00:09:52]:
Vitamins, minerals, and then mindset. And then the people who come to see me have done all those things generally, and they’re still not better. And so this is a level 3 problem, and this is the toxic 5. This is addressing the heavy metals, the chemicals, the molds, the infections and the nervous system dysfunction. I’m gonna keep hammering it home because these are what I have found to be the real root causes because they actually cause 80% of the deficiencies.

Dr. Evan Hirsch [00:10:57]:
And you have to ask yourself, well, why are these things deficient? Why do I feel better when I take these things? And it’s because there are things that are draining your body’s energy that are compromising your mitochondrial function, your hormone function. And those are always going to be the toxic 5. That’s the why under the why.

Nick Urban [00:11:15]:
Let’s go more into those because I think people know the basics. Everyone knows the basics this day and age. But then there’s still something more for a lot of people. And it seems that a lot of the toxic 5 even, like, they can overlap.

Nick Urban [00:11:46]:
Like, if I have an issue with mold, perhaps I’m gonna also sequester more heavy metals and have other issues related to that. So how do I even disentangle where to begin there?

Dr. Evan Hirsch [00:11:58]:
One of the ways that I get them to the finish line is by treating all of the Toxic Five. I don’t want to miss anything. I used to do a ton of testing, and I’ve been fooled. There were times when people did not come back with any mold, heavy metals, or chemicals in their urine. And so I didn’t treat it. And then 12 months later, I’m scratching my head being like, okay, well, why aren’t you better? What I have found is that it saves time, energy, and money to go through a process that’s going to address all of the heavy metals, all the chemicals, all the molds, all the infections, and the nervous system dysfunction, and detoxify at a rate that the individual’s body can tolerate.

Dr. Evan Hirsch [00:12:56]:
Everything that I do is 100% natural. Half of everything are in tincture form, which basically means we increase by a drop at a time so that we can see, okay, like if I’m increasing something by a drop at a time and you feel worse, I know what that thing is addressing. That’s better data for me than any blood test out there.

Nick Urban [00:13:23]:
That makes a lot of sense. That’s a good approach to it. It’s nice to hear that you have a different way of approaching it where you’re starting gently and gradually changing variables to see what actually improves symptoms and what worsens them.

Dr. Evan Hirsch [00:13:59]:
In my 4-step process, step 3 is all about mitigating feeling worse. We make sure that all the detox pathways are open, these exit pathways out of the body, the liver, the kidney, the lymph, the neuro lymph, the gallbladder, the intestines, all of them have to be patent. They have to be open so that when we go into step 4 and start removing the toxic 5, they have a place to go. If you feel worse, we then pivot back to step 3. We increase your die-off or what’s called Herxheimer support.

Dr. Evan Hirsch [00:14:50]:
And then you can go back into step 4, continue to ramp up on that tincture, but maybe you ramp up a little bit more slowly so that you can do this process more gently.

Nick Urban [00:15:17]:
If someone came to you and they said that they had recently taken a test and it came back positive for mycotoxins, would you still be concurrently treating all the different toxic 5 at the same time?

Dr. Evan Hirsch [00:15:35]:
When we get into step 4, everybody gets treated for molds. We do mold and then we do heavy metals and chemicals, then we go into all of the infections, and you’re doing nervous system retraining from day one. Once you have introduced all of the tinctures, there’s probably about 10 tinctures and supplements that are going to cover all of those toxic 5. All of these toxins and infections are bound up in what I call a toxic matrix. When you start to remove one of them, other things are going to get removed.

Nick Urban [00:16:28]:
Yeah, it gets pretty complicated.

Dr. Evan Hirsch [00:16:30]:
It definitely can, but by doing this stepwise, one drop at a time layering it on top of things and making sure that we’re addressing all the causes, I feel like that’s kind of made it simple for me.

Nick Urban [00:16:52]:
How do you rule out someone taking one of the tinctures and just having a bad bio-individual response to it?

Dr. Evan Hirsch [00:17:07]:
Generally we’re going to know because that person is already sensitive to supplements. The symptoms that are caused by an infection are going to be the same ones that are caused when you’re killing that infection. Sometimes there’s what I call the whack-a-mole effect, where if we’re killing Bartonella, all of a sudden another infection pops out.

Dr. Evan Hirsch [00:18:06]:
If I’m killing Bartonella and then all of a sudden people start sweating a whole bunch and they feel like they’re getting a panic attack, that’s Babesia that’s popping out. Because they have these different personalities, we can determine what’s happening.

Nick Urban [00:18:30]:
For these things like Babesia, do you often see a concurrent infection with something like COVID or the remnants of COVID?

Dr. Evan Hirsch [00:18:39]:
Absolutely. Sometimes it’s COVID that’s causing the symptoms, but sometimes it’s COVID that’s disrupting the biofilm and allowing the Babesia to come out. Now since 2020, there’s more people getting diagnosed with Lyme disease and these co-infections like Babesia and Bartonella. As part of our program, we treat COVID and then we’re also treating all of these as well.

Nick Urban [00:19:25]:
You’ve mentioned biofilm several times. I want to make sure that it’s clearly defined for anyone who’s listening.

Dr. Evan Hirsch [00:19:33]:
Biofilm is a collagenous jelly-like material that exists on our mucous membranes, so mouth to anus. Infections like to live in there, heavy metals and chemicals, all these toxins. The infections will actually swap DNA with each other and create kind of superbugs. I came up with this term called bordnesia, which is basically this idea that Bartonella, Babesia, and Borrelia are sometimes all in combination. We’re combining a lot of these different herbs which allows us to be more successful against these superbugs.

Nick Urban [00:20:46]:
Are these the actual root causes?

Dr. Evan Hirsch [00:21:00]:
That’s the hill I’m gonna die on, is that the Toxic Five are the real root causes of long COVID, chronic fatigue syndrome, autoimmunity, cancer. There’s research on all of this. It’s incredibly important to have that understanding that we are complex. It’s never just one thing.

Dr. Evan Hirsch [00:21:32]:
You don’t have to just feel badly because you’re quote-unquote getting old. The reality is that you’ve been accumulating this crap in your body over decades, and you are going to feel better when you remove it. But you have to remove it at a rate that your body can tolerate.

Nick Urban [00:22:00]:
Is it once you are hit with a stressor of some kind that the stress bucket overflows and then you start experiencing the symptoms?

Dr. Evan Hirsch [00:22:19]:
Absolutely. There’s generally a stressor. That’s the straw that broke the camel’s back. All of these are stressors. The physical, the mental, the emotional, spiritual stressors.

Dr. Evan Hirsch [00:22:34]:
There’s so many stressors that end up affecting our body over decades where finally the body’s like, this is a little bit too much. Sometimes it’s moving into a place that has mold where 6 months later you feel like crap, you’ve got brain fog, you’re exhausted. It’s having that awareness and understanding what the chronology looks like.

Nick Urban [00:23:08]:
It’s an interesting realm because I feel like there’s a lot of people who are not diagnosed with these things. Perhaps they just have a little bit of low energy.

Dr. Evan Hirsch [00:23:33]:
There was a study done on 265,000 people who got COVID, and 35% of them 6 months later had a new mental health diagnosis. So any new symptom that you’ve had since 2020, you have to consider COVID.

Dr. Evan Hirsch [00:24:32]:
You don’t have to have chronic fatigue syndrome in order to need help. You don’t have to have Long COVID and qualify for a diagnosis. If your tiredness is negatively affecting the quality of your life, then it’s time to get help.

Dr. Evan Hirsch [00:25:25]:
If you are more tired, if your tiredness is negatively affecting the quality of your life, then it’s time to get help. You don’t just want to keep pushing through.

Nick Urban [00:25:40]:
How often do you see people just wanting a little more energy that don’t actually have these types of underlying factors? Perhaps everyone has some degree of each of these.

Dr. Evan Hirsch [00:26:26]:
It just builds up over time. 10 years from now you may have a whole bunch more symptoms. It’s all about those exposures that we have, how our nervous system and our immune system relates to them. When you have crap in your body, your immune system gets distracted. Infections can become opportunistic. How much of the longevity is from these toxins and infections building up over time is really significant according to the research.

Nick Urban [00:27:17]:
If we don’t actually address chronic fatigue or these symptoms, what happens in the long run?

Dr. Evan Hirsch [00:27:31]:
All of these underlying causes are also causes of autoimmunity and cancer and Alzheimer’s. The sooner that you start removing the toxins and infections out of your body and retraining your nervous system, the better off you’re going to be in the long term. My favorite research agent these days is Perplexity AI because its links are so much more accurate.

Dr. Evan Hirsch [00:28:41]:
It’s really important to get this stuff out of your body so that you can live your best life for as long as you possibly can and then die quick, so that you’re not suffering.

Nick Urban [00:28:56]:
Are there any other factors that you’d say explore this to see what impact it has that you can do right now?

Dr. Evan Hirsch [00:29:21]:
Removing a lot of the toxins that you have in your life, in your environment. Mindset is a really big one and it’s free. I’ve got a 4-step mindset practice: looking at 3 things that you’re grateful for every day, having a vision for your life, doing affirmations or flipping limiting beliefs into empowering beliefs, and asking yourself empowering questions.

Dr. Evan Hirsch [00:30:01]:
Ask yourself an empowering question like, how can I love myself more today? How can I connect more with the people around me? It changes your life, and just these 4 steps, if you do them every day, it will change your nervous system and I guarantee it will change your life.

Nick Urban [00:30:43]:
So is this your methodology behind the nervous system regulation side of things?

Dr. Evan Hirsch [00:30:49]:
That’s part of it. With nervous system retraining, we do a top-down and a bottom-up approach. Top-down is this mindset work, changing your mind to change your nervous system. The bottom-up approach is using things like vagal toning: gargling, humming, breathwork, breath holds.

Dr. Evan Hirsch [00:31:18]:
You don’t notice anything day 1 or day 10 or day 30 or day 90 oftentimes, but then all of a sudden everything clicks. We incorporated this into our program about a year ago and the results have really been significant.

Nick Urban [00:31:51]:
That’s one of those areas where it pretty much improves anything else that you’re working on at the same time.

Dr. Evan Hirsch [00:31:58]:
Absolutely. And if you did a standalone nervous system retraining program, it’s like $100 a month. For people who haven’t done it, who are struggling, it’s a wonderful opportunity for getting better at very low cost.

Nick Urban [00:32:33]:
Even the small quick wins can enable someone to actually be able to do more of the habits that get them healthy.

Dr. Evan Hirsch [00:32:50]:
In step 2, we replace the deficiencies. I call the adrenal, the mitochondria, and the thyroid the big 3 because they’ll give people that little bit of an uptick, take you up to about a 5 out of 10 and you’ve got less crashes. Nervous system retraining plus replace some deficiencies is just a good recipe for success.

Nick Urban [00:33:28]:
What do you think will happen if someone takes a peptide and targets their mitochondria, but skips over some of the foundational basic stuff?

Dr. Evan Hirsch [00:34:06]:
I don’t see that working. It’s the same thing with stem cells, high-dose IV vitamin C, ozone, hyperbarics. Peptides and those things are really great at the end as cleanup and repair. With things like ozone and hyperbaric oxygen, if you haven’t opened these pathways, you’re going to have die-off or a Herxheimer reaction where you feel worse.

Dr. Evan Hirsch [00:35:00]:
If you’re doing cold plunges, if they’re not too stressful on your body, they’re great. Grounding, circadian rhythm stuff, going out in the sun, all those things are incredibly helpful. With peptides, is it the biggest bang for the buck? That’s what I’m always trying to give people.

Dr. Evan Hirsch [00:36:00]:
You could always test something out by taking it for 3 months, see if you notice a difference. If you don’t, it’s probably not the biggest bang for the buck.

Nick Urban [00:36:14]:
Would the timeline depend on how long someone’s had chronic fatigue?

Dr. Evan Hirsch [00:36:28]:
I was just talking to someone in Australia who’s about 35, had long COVID, 6 months into the program and everything is 80% better. For those who have long COVID, sometimes they can get better faster. But I generally tell people that it takes at least 12 months to get better.

Dr. Evan Hirsch [00:37:14]:
It’s really about the total body burden, how much of each of the Toxic Five do you have, and your response to treatment. Most people are fine with 12 months because they’ve been struggling for years. The body likes small changes. Slow and steady really wins the race.

Nick Urban [00:38:11]:
What are the big common things in lifestyle that are draining energy?

Dr. Evan Hirsch [00:38:28]:
Do you wake up and immediately look at your phone? There’s EMFs, the stress of news, comparison on social media. It’s the perfect opportunity to go into the 4-step mindset practice to live from a place of gratitude. Where gratitude lives, anxiety and fear cannot live. Are you drinking a liter of water? What are your food choices? Do you have your recycling button pushed in your car so you’re not exposing yourself to gas fumes from other cars?

Dr. Evan Hirsch [00:40:05]:
What soaps are you using? Are you sitting at a desk all day? What kind of movement are you getting? Are we turning the shower to cold at the end? Are we doing lymph brushing? Do we have toxic relationships? What time are we going to bed? All of these things play a role in living an intentional life.

Nick Urban [00:41:27]:
Watching the news first thing in the morning sets you up for a tough day. And last thing at night, that’s going right into your subconscious before you sleep.

Dr. Evan Hirsch [00:41:44]:
I get Ground News and just look at the headlines so I’m informed, but I’m not diving in. Before bed, I like listening to sports commentary. I’m a Seahawks fan. We just won the Super Bowl. Finding something fun like that can be really supportive.

Nick Urban [00:42:34]:
Reintroducing the element of play makes a difference in outcomes.

Dr. Evan Hirsch [00:42:45]:
Play is so important. Now I sing a lot more. I’m doing competitions in musical theater. When I’m singing, I’m not thinking about anything else. That’s play for me. In my clients, it’s an incredibly important part of this process.

Nick Urban [00:43:58]:
When you’re doing those things, you’re toning the vagus nerve when singing and humming, and oxytocin when you do things with family. That helps keep your stress bucket emptier.

Dr. Evan Hirsch [00:44:19]:
Absolutely.

Nick Urban [00:44:21]:
You said EMFs play a role. Is that in one of your other non-five toxic elements?

Dr. Evan Hirsch [00:44:32]:
Some of the other ones outside of the toxic five are EMFs. Oftentimes when people have sensitivities to it, it’s because they have the other Toxic Five. It is ideal to decrease the amount of exposure. EMFs damage DNA, increase inflammation, and exponentially increase inflammation when you have mycotoxins in your body.

Nick Urban [00:45:51]:
It’s a prudent thing to do whenever we can just make a simple change one time. Put the Wi-Fi on a timer. Get a water filter, an air filter. These are set it and forget it things.

Dr. Evan Hirsch [00:46:39]:
How are you getting exposed to things? What are you breathing in? What are you eating? What is your air looking like? Obviously if you’re in an apartment complex, you’ve got a lot of different Wi-Fi signals versus living rural or off the grid.

Nick Urban [00:47:15]:
Do you have any final thoughts? If you could have a billboard up in New York City with a message related to your work, what would it be?

Dr. Evan Hirsch [00:47:27]:
It’s the Toxic Five. That’s the hill I’m going to die on. I’ve never met anybody who has addressed their Toxic Five completely and hasn’t gotten rid of their symptoms. If that’s overwhelming, just take baby steps. Talk to AI and say, give me a step-by-step protocol of how I can remove the toxins out of my life over the next 12 months. There’s so much you can do by getting the right filters to remove your ongoing exposures. That’s a wonderful place to start.

Dr. Evan Hirsch [00:48:21]:
The Toxic Five and then the mindset component of the nervous system retraining.

Nick Urban [00:48:27]:
What about the people who say that detoxification is a myth and your body naturally detoxifies?

Dr. Evan Hirsch [00:48:47]:
That’s not what the research says. Our bodies are meant to detoxify, but it is very hard to detoxify when our detoxification pathways are full of stuff. The more toxins and infections you have, the harder it is actually to detoxify.

Nick Urban [00:49:17]:
Where do you want to send people? Any resources?

Dr. Evan Hirsch [00:49:25]:
I’ve got a little assessment at myfatiguescore.com. It’ll give you your fatigue score. From there you can watch my latest masterclass. And if you want to see if we’re a good fit, I have free calls. About a third of the time I’ll tell people that we’re not a good fit. I always want to make sure that if I’m working with somebody that I can get them to the finish line. So myfatiguescore.com would be the place to go.

Nick Urban [00:50:12]:
And you have a podcast as well. Evan, thanks for joining me. It’s been a pleasure chatting with you, all things energy, chronic fatigue, and so much more.

Dr. Evan Hirsch [00:50:23]:
Thanks so much for having me on.

Nick Urban [00:50:25]:
Thanks for tuning in to High Performance Longevity. If you got value today, the best way to support the show is to leave a review or share it with someone who’s ready to upgrade their healthspan. You can find all the episodes, show notes, and resources mentioned at outlier.com. Until next time, stay energized, stay bioharmonized, and be an outlier.