Fatigue Expert: The Real Reason You’re Always Tired — and How to Fix It | Dr. Sarah Myhill

Jesse Chappus (0:00)

Coming up on today's show.

Dr. Sarah Myhill (0:02)

The starting point to tackle fatigue, because carbohydrates make us tired, is do a ketogenic diet. I always start with the diet and gut function. That is central. But assuming that that is in place, we then have to think thyroid. Diagnosing the underactive thyroid is not just predicated on abnormal blood tests. People who get into ketosis but still feel dreadful, that's often a sign of the underactive thyroid. We need thyroid hormones to be able to fat burn. If you haven't got the thyroid hormones to fat burn, then you fat burn with adrenaline instead. And fat burning with adrenaline is very uncomfortable because you're spiking your adrenaline all the time. And that gives us the wired but tired feeling. Can't sleep because you're spiking adrenaline regularly at night in order to be able to sleep. People who are really fatigued, I think the most efficient way to stay strong and to stay fit is to do isometric exercises. What makes us stronger and what makes us fitter are the number of mitochondria. And what generates the number of mitochondria is lactic acid burn.

Jesse Chappus (1:01)

Somebody has been tired for five years. They go to their doctor. Blood work looks normal. They're on the verge of giving up. What do they start with tomorrow to start rebuilding this?

Dr. Myhill, if you're working with somebody and they say to you, I'm sleeping well at night, getting the hours in, the quality is good, but I still wake up feeling exhausted and my energy throughout the day sucks too. How do you begin to uncover what's going on there?

Dr. Sarah Myhill (1:32)

Okay. That is typical symptom of poor energy delivery mechanisms.

And energy delivery mechanisms, the analogy I love to use is the car analogy. So for your body of a car to go, you've got to have the right fuel in the tank, and that's all about the diet and gut function. You've got to have some oxygen there. Then you need your mitochondrial engine.

But we also need the thyroid accelerator pedal, and that determines how fast your mitochondrial engine goes, and the adrenal gearbox, which allows you to gear up in response to stress. And I think we talked about the thyroid accelerator pedal today, so that symptom could be very typical of an underactive thyroid.

Jesse Chappus (2:17)

Okay, given all that, now we have a lay of the land, how do we begin to dig in further and uncover where the issue is?

Dr. Sarah Myhill (2:26)

The best diagnosis is always the response to treatment. And whenever you have a difficult question like that, always go back to evolutionary biology. And the paleo-ketogenic diet is always the starting point to treat absolutely everything. So before I even would think about testing or looking elsewhere, I always start with the diet and gut function. That is central. But assuming that that is in place, then there's a good chance your mitochondria will be working well. We then have to think thyroid. And diagnosing the underactive thyroid is not just predicated on abnormal blood tests. There is also a very typical clinical picture.

So what the blood tests tell us is it makes sure that person isn't overactive. And it tells us if there is biochemical scope for a trial of thyroid hormones. And then we have to look at the clinical picture. The symptoms that person has, the signs that they have and you have described some of them. And if that all comes together in a coherent way, then we do a trial of thyroid hormones. And it's the response to the thyroid hormones that is the definitive touch.

Now, the shameful thing is, doctors don't do it this way.

Doctors only do one thing. They just look at the blood test. They often just look at one part of the blood test, which is the thyroid stimulating hormone. And that misses so many cases of secondary hyperthyroidism and poor T3 conversion.

And even when they see the TSH, that is often misinterpreted as well. So for example, the TSH stands for thyroid stimulating hormone. The pituitary gland produces TSH, it kicks the thyroid gland into life. In America, the threshold for prescribing thyroid hormones is anybody who has a TSH above three. In this country, you won't get your prescription until it's maybe five, six, seven, eight, nine. So different parts of the world have different criteria for starting thyroid hormones, and it's often way down the line.

So many people are told by their doctors, we've got to wait till the TSH rises to four, five, six, seven, or whatever before they get decently treated, during which time they are hypothyroid, they are underactive. And that is a major risk factor, obviously for fatigue, but also for heart disease, cancer, and dementia. So getting the thyroid right is a vital part of being well and staying well.