Welcome back to the Healing Pain Podcast with Dr. Carri Drzyzga.
If you have struggled with chronic pain or you’re a clinician or a practitioner who treats those that have chronic pain, undoubtedly you realize they do, of course, complain about chronic pain and often things like tension and tightness, but there’s another symptom that almost 90% of the time will accompany those that have chronic pain. That is fatigue. Fatigue is one of those things that we think about it as that feeling in the morning where you can’t get up and going or your ability or your lack of ability to be able to be resilient throughout your entire day. I really am excited to talk about this on the podcast because I really want to boil it down real deep into what are the lifestyle reasons for fatigue and then what’s happening on the cellular level and how can we help fight fatigue.
I have a great expert today, her name is Dr. Carri Drzyzga. She is both a Chiropractic Physician and a Naturopathic Physician. She’s the host of The Functional Medicine Radio Show and she’s written a great book called Reclaim Your Energy and Feel Normal Again.
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Fight Fatigue and Reclaim Your Energy with Dr. Carri Drzyzga
Dr. Drzyzga, welcome to The Healing Pain podcast.
Hi, Dr. Joe. It’s such a pleasure to be on today.
I love your background, having both the chiropractic and the naturopathic degrees, which I’m sure you put a lot of hard time, a lot of effort. I think so many of us here in the functional medicine space, we have one degree and a certification or two degrees and a certification. How did you weave those two together?
Originally, my first degree was as a chiropractor. I practiced in Ontario. My husband, he’s also a chiropractor. At about five years in, I remember coming home one night and asking my husband, “Do you see yourself doing this for the next 20, 25, 30 years? I don’t see myself just doing this.” Chiropractors, they’ve gone so pigeonholed into treating back pain, at least definitely here in Ontario. I love chiropractic, but I didn’t love being a chiropractor. I didn’t like being pigeonholed like that. I really wanted to help my patients beyond treating their back pain. So I just started learning more.
As you were saying, a lot of us that are in functional medicine, we’re just perpetual learners, we’re very nerdy about wanting to understand as much as we can. I just started taking courses and then at some point I finally stumbled on to functional medicine. I think that was back in 2003 and I was like, “Functional medicine? That makes sense to me. That’s what I want to do. That’s how I want to practice.” Years and years went by, I’m fifteen years in a private practice as a chiropractor, came to this realization that I really need to go back to school and get a naturopathic degree in order to really have a full scope of practice within the constraints of Ontario to really practice functional medicine to its full scope.
I went back to school. I did my time. As you were saying, we all do our time in school. It was from there that I was really pushing myself hard. I like to say short term pain for long term gain. I went really hard through this program, 30 hours a week, plus I was flying back and forth from Chicago where I was in school back to Ottawa, Ontario to still have a private practice. That really burned me out. I knew it was just all the stress that I was putting myself under.
It’s so interesting how so many practitioners, whether it’s in school or whether they’re in the depths of their early years of private practice or they’re building their practice in there, doing everything they can from a practitioner standpoint as well as a business marketing standpoint, that they wind up with their own health problem while they’re trying to heal everyone else. How long did it take you to heal yourself, so to speak?
Once I started down the road, it probably took about a year. It was slow progressions over the course of the year. A lot of patients, they’re very savvy now as you know; they watch your videos, they listen to your podcast, they listen to mine, they read our blogs and whatnot. There’s so much great information out there. I think they have ideas. When they come to see a functional medicine doctor, all they have to do is take some adrenal support and it will be rainbows and glitter and all that, nothing to worry about. Again, it’s not an easy road to get your health back. It does take time.
I always tell people, we can make some really simple adjustments in the first probably one to three weeks where you’re going to say, “I’m feeling a little bit better.” But to really turn your health around to the place where you feel vital again and you have energy, they take anywhere between three to twelve months, depending on what the diagnosis is. That becomes a lifelong learning process for people.
Often we get to a great point and then we backslide. Then we’re going to get back up there and then we backslide. I’m no different than a typical patient.
On The Healing Pain Podcast, of course, we talk a lot about all sorts of different types of pain and what the causes of pain or the underlying causes, everything from the nervous system to nutrition. Fatigue often goes along with pain. In the simplest form, what is fatigue? How do you explain fatigue to a patient and how do you maybe describe fatigue to a practitioner who’s just starting to delve into it more than, “This person is more than just higher.”
Fatigue is really on a spectrum. Fatigue can just start with, “I’m tired” and there can be very worthy reasons for being tired through the day. Maybe you’re working too many hours, maybe you’re not getting enough sleep at night, but it self resolves. It’s a temporary thing. The more stress and strain you put on your body, that could be of course external stressors like mental, emotional stress from jobs and families and relationships and finances and all that kind of stuff, but then there can be internal stressors that can happen as well, things that are happening inside our body that we might not know about. Things like hidden underlying infections, they’re slowly robbing you of energy. Things like hidden food allergies and sensitivities. Things you might think are really healthy and you’re eating on a daily basis slowly sapping your health; toxins, metals, hormone imbalance, lots of different things. Over time, some people will transition out of this, “I’m just tired and it’s just a temporary thing,” to feeling tired on more consistent daily basis, then they transition to fatigue. Some people would say exhaustion.
Of course, on the opposite end of the spectrum would be a full out chronic fatigue syndrome, which I believe the diagnostic criteria for the syndrome is you have to have fatigue for at least six months with other symptoms including in that, and that it’s debilitating. It has a debilitating impact on your life in some way, shape or form. It’s really a broad spectrum.
When you say debilitating, meaning you can’t go to work in the morning one day or for two days over the last month, the fatigue was so bad and debilitating that you had to call-in sick basically.
It impacts your life in some way, shape or form, either from work or from going out with friends and family or some other way.
Versus some people who can, I don’t want to say push through the or fight fatigue because that’s not what they should be doing, but some people live with that for years. When a patient comes to you and you start having a conversation with them about fatigue, what’s the one thing or the few things maybe that they try to do on their own to cure or fight fatigue but is actually making their fatigue worse?
One thing is that fatigue patients, they’re all very unique. A lot of patients, when they do finally come in to see me, they’re usually taking a certain amount of supplements that they read about on the internet. Number one, they’re self-prescribing. They have good intentions, everybody has good intentions, but sometimes you’re taking supplements that are not kosher for your body. Maybe you’re actually taking the exact right supplements, but you’re not taking that at a high enough dose. They have a therapeutic effect. A lot of people also get very overwhelmed, especially this topic of hidden underlying infections. They read about yeast and they read about candida and they take these online questionnaires. It’s like, “I scored X, Y and Z so that means I probably have candida.” Then they just started self-treating for that.
I actually hear this also not just from patients, but from the other practitioners that they’ve seen. “That naturopath found out I had candida and so they treated me.” I said, “Have they ever tested you? Has anybody ran a stool test to see like do you actually have yeast or not? Or do you have some weird bacteria or a parasite or something like that?” “No, I’ve never had a stool test done, but I’ve done three yeast cleanses, I’m on the candida diet now for five years.” I know you have good intentions but there’s only so much assuming you can do when you’re practicing and then you go down the wrong way. I like to test, not guess.
What would be some of the tests that you use with the patient that comes in who has that chronic fatigue? Maybe they’ve been diagnosed with chronic fatigue syndrome. Are there a couple of tests that you would use first as your go-to?
Yes, at the top of the list, the first two tests that must be ran are a CBC, complete blood count. You want to rule out anemia, but not just anemia but also test to see where are their iron levels and where are their B12 levels. That’s the first thing. Then the second thing is, do they actually have hypothyroidism? That’s always the first step that needs to be done. Most of the time, Dr. Joe, when patients come in to see me, they’ve already seen their family doctor, they’ve already had a good amount of tests ran including those two to rule out the big things, but everything comes in as normal and their doctor’s like, “I don’t know, maybe you just need a vacation. Maybe you need to take three months off of work. Maybe we need to start you on antidepressants.” By the time they come in to see me, those things are usually ruled out. Of course, we can dive deeper into thyroid, because as you know thyroid, there’s the normal range and then there’s the ideal range. We always look into that.
Then above and beyond that, it really just depends on a patient’s history. I like to really dive deep into the history. Think about how long ago has it been since you had a really great energy? Then when do you think it really started to shift? What happened around that time of your life? Were there any major stressors? Did you have any major illnesses, accidents, concussions? We go through a whole bunch of things. Map out the timeline of their history and where their symptoms started. A lot of times, that will lead me in a certain direction of, “They had a major food positioning.” In Canada, we call it a gastro. It’s basically a 24-hour flu. Six months after that, all symptoms started happening. Then I think, “There’s probably something going on in the gut.” Then we usually have a discussion about doing a stool test or a SIBO Breath Test or something like that.
Sometimes it’s more hormonal related and we want to do more of a saliva panel. A lot of times, patients come in and they’re already doing what I think are appropriate diet changes. A lot of people already come in and they’re doing a gluten-free diet, a dairy-free diet, maybe they’re already Paleo and they’re just like, “I’m doing this diet. I should be feeling better, but I’m not.” Maybe we start looking for food sensitivities. It really is a very individual thing at that point.
You mentioned people self-medicating with supplements. When you run tests, I don’t know if you’re doing Organic Acids Test, things like that, when someone has chronic fatigue, are you finding some more common nutrient deficiencies in those with chronic fatigue let’s say than someone coming in with a different diagnosis?
Pretty much across the board, we see a lot of vitamin D deficiency and that’s regardless of fatigue. We’re in Canada, everybody has vitamin D deficiency up here. For some people, that really impacts more of their pain levels and for others it really impacts more of their energy levels. I’m always looking at B12. I had read in a book by Dr. Alex Vasquez that B12 really should be at a minimum 600. It’s rare that I see patients even in the 300’s with their B12 test. I always look at that. When it comes to other nutrients, magnesium is something that I think is also universally very often deficient and actually one that I really don’t test for. I usually just supplement that into bowel tolerance. Those are the usual things that I’m looking for.
When it comes to iron, because iron can be a little bit tricky, so I would say for the practitioners listening or watching this, I’ve learned over the years to look at the CBC, test for anemia, look at the MCV MCH MCHC, but also on top of that to test the ferritin and to look at the Serum Iron. We have to remember that looking at that number alone can be misleading because ferritin can add as an acute phase reactant. If that patient has underlying inflammation from wherever, that ferritin can look normal, but it’s actually a false normal because it’s elevated because of inflammation. Their iron levels might tell you a different story. I look at all of those different factors.
It’s amazing to me how many primary care physicians don’t run a ferritin on patients and don’t really look at it as a marker of inflammation or underlying inflammation that could be longstanding on someone’s body and their physiology. You mentioned people come in and oftentimes they’ve tried different types of diet. Nowadays, everyone is on multiple version of elimination diets or they’re on the Paleo or they’re on the Paleo autoimmune or they’re on whatever diet there is. How would you approach someone who hasn’t tried a nutritional approach yet?
I actually just had a new patient in my office on Friday. She drove in from five and half hours away to see me. She didn’t have fatigue, but she’s got eczema all over her body. She’s been suffering with this for, I think, since she was ten years old, now she’s in her 30’s. Her quality of life hugely is suffering. She said that if she has to go out to eat, she’s going to go through the drive-through. She does not want to go out in public and see people or have people see her having all these eczema. For me, I’m just looking at her, it didn’t look too bad, but we’re so hard on ourselves. I asked her, “What have you tried?” Really, she was one of these patients that has really only tried the traditional medical route.
I said, “What about diet? Have you tried any diet changes?” “No, Dr. Carri. I know I should go gluten-free, but it’s super scary and I’m really scared about that.” I said, “I was really scared too. For three years, I was really scared about going gluten-free, but this is how I did it.” I just worked on one meal at a time. I just started with my breakfast. It took me maybe two or three weeks to figure out, “How do I master eating a gluten-free breakfast?” Once I did that, then I went to lunch. I figured out, “How do I master gluten-free lunch?” Then I showed her all kinds of stuff on the internet. You just do a Google search of quick and easy gluten-free breakfast recipes and two million web pages show up.
I really just chunked it down and you could see them have that light bulb moment, “I could probably do that.” I said, “Really what I would like you to do is start with gluten-free and dairy-free 30 days, that’s all. I just want you to try it for 30 days.” Chunk it down, step by step. Once you get to 100% then the 30-day clock starts. On day 31, you’re going to go crazy eating a ton of gluten and dairy. We’re going to see what happens.” She actually came in with her husband. I looked at him and I said, “How do you feel about this?” He said, “I’m totally ready to support her.” I said, “Does that mean you’re also going to eat what she’s going to eat?” He said, “Yeah.” That was perfect. It was the perfect scenario, but it usually is not that easy.
Usually it’s, “My husband eats a lot of cookies and this is going to be really tough for me to go 100% gluten-free. My kids are having crackers for breakfast. I’m really going to have to change the entire family,” which sometimes that’s actually the sweet spot. Actually, everyone’s health gets better, not just your own.
It’s hard to get everybody to buy into that idea if they’re not suffering with their health. Difficult patients, as you probably encountered too, Joe, are the ones that they seem to be doing everything right with their diet, they’re hitting a brick wall. It’s difficult to figure out what is the right diet for them. I started to think more outside of the box. I started thinking about do they have a histamine intolerance? Should we try a low histamine diet? Do they have a sulfur intolerance? Should we try low sulfur diet? Is it oxalates? Should we do formal blood work to look for food immune responses, triggering food sensitivities, like really immune mediated reactions? Sometimes it really is an underlying infection in the gut that totally needs to be cleared out.
Earlier in the podcast, you mentioned stress and psychological causes of stress like family, financial problems, all sorts of issues that people come into contact with in their life when they’re going through health challenges or maybe something that lead them into that health challenge. Can you talk about how negative thoughts and how emotional psychological stress leads to fatigue?
I know that there’s a lot of research on this. Dr. Robert Sapolsky, the PhD at Stanford, he’s done a ton of research on the effects of stress, cortisol in particular on the brain. What we know is that stress, of any shape or form, will trigger cortisol to get out of balance and then that has a hugely detrimental effects on the brain, basically atrophy in the hippocampus. That has all these down streamed effects. When it comes to stress, I find when I really go back in the history it usually is the first domino that fell was some stressor. Sometimes we have control over these things, but a lot of times we don’t. If it’s death or illness of a loved one or if it’s a huge financial struggles, a loss of a job or whatnot.
I always try and figure out when we’re working with patients having these conversations about where their stress is now. If they’re under a huge amount of stress now, I could give them handfuls, boatloads of supplements, I could do everything right. If they’re under huge amounts of stress right now, we’ll just hit a wall. If there are things in the past that are still unresolved that need to be dealt with, not that I’m the professional to do that, but who’s the appropriate referral to send them to maybe for some EMDR or hypnosis or something like that. A lot of patients, just to help them figure out that stress management is an important part. I think people just don’t take it that seriously. Five minutes of deep breathing, every little bit counts. It’s just trying to figure out for them what are they willing to do, how much time and effort are they going to put into it. Not everybody wants to journal, but some people are more open to doing some light meditation. It’s probably just about figuring out for that patient what’s going to work for them.
It’s funny because you mentioned five minutes. I think oftentimes, people want things that are easy and fast. You say, “I just want you to do some deep breathing just for three to five minutes once or twice a day,” which is easy and fast. People say, “That can’t possibly do anything. There’s no way that just some deep breathing is going to fix all these problems.” The truth is that’s a relaxation response. When you initiate the relaxation response, it has systemic changes throughout your entire body in almost every single system including the systems that are most associated with fatigue, which are your nervous system and your musculoskeletal system. Can you talk a little bit about, talking the nervous system and musculoskeletal system, mitochondria is most dense in nerve tissue and muscle tissue. Can you talk about the relationship between mitochondrial dysfunction and damage and fatigue?
For non-practitioners that are out there, mitochondria, if you remember from science class, you learn about the body and the body is made up of organs and organs are made up of collections of tissues and tissues are made up of collections of cells. Inside each and every cell are tiny little organs called organelles. One of those is the mitochondria. The job of the mitochondria is energy production. We take the food that we eat, it gets broken down into glucose and amino acids and whatnot. That gets absorbed into the cell and it’s the job of the mitochondria to take that glucose and transform it into ATP, which is pure energy. It’s like those spark plugs in your car, it gets the motor running. Without a certain amount of energy, it takes energy to heal. A lot of people don’t realize, you lose energy, but then it takes energy just heal to rebuild, to repair.
I was just at a seminar over the weekend, a symposium, one of the speakers spoke about, and this was new to me, measuring IGF 1 to get an idea of growth hormone levels and then measuring the free energy index too, which is about a ratio between testosterone and sex hormone in any ways. To get an idea, is this patient in a catabolic state or are they in an anabolic state? She was saying one of these ideas for these really tough cases when it comes across your desk to look at something like this, and she said that and I was like, “That makes sense.” If they’re in a catabolic state, their body is continuing to breakdown and you can’t heal from that, then how do we switch them to an anabolic state so they get back to healing? The big part of that is just mitochondrial health. There’s so much research right now on mitochondrial dysfunction, mitochondriopathies. The difficult thing is it’s hard to test for mitochondria. The only test we really have that’s easy for patients to do is an Organic Acids Test. Really, the gold standard is a muscle biopsy and it’s not something that most patients want to do.
A lot of times, when we have tough cases, we want to get back down to the cellular level and look at mitochondria. The other thing that I wanted to say too about mitochondria when it comes to patient history that mitochondrial issues get passed from mother to children. When we’re conceived, we get half our DNA from mom and half our DNA from dad, but when it comes to the mitochondria, we get our mitochondrial DNA only from mom. I like to go back and say, “What health issues did mom have? Does that give me any clues as to potential mitochondrial issues too?” Think if mom had chronic pain, fibromyalgia, if mom had chronic migraines, I’m thinking there might be some mitochondrial issues going on here.
It’s a really good point. I don’t think most people make that connection. When you’re going through some of those Organic Acids Test or some of the other tests, the functional medicine test you’re on, you mentioned, D, B12, magnesium, iron. Are there other nutrients that would help support mitochondrial function?
One of the things that I learned in this seminar over the weekend, which I didn’t know before, is curcumin. Curcumin or turmeric is one of the most researched supplements out there right now or herbs and spices, however you want to say it. What I didn’t know is that it helps to balance mitochondrial health. Just like we have adrenal adaptogens, turmeric or curcumin is a mitochondrial adaptogen. I was like, “I’m going to start using a lot more curcumin in my practice.” Turmeric or curcumin, we want to help with the membrane of the mitochondria so that those are healthy fatty acids, DHA, Phosphatidylcholine. Also some of the other key nutrients to help with the electron transport chain, which is the whole domino effect of how we make the energy. There are many different nutrients required for that; a lot of different B vitamins, CoQ10 is a major factor, magnesium. For some of the viewers out there and listeners, a lot of supplement companies are making mitochondrial formulas specifically to just supplement mitochondrial health. It’s not going to be the “be all end all.” Chronic health conditions, that’s something to look at. I think a lot of practitioners forget about that point.
I think formulas are great because I think obviously, if you’re deficient in D, then we need to give you D. So often and more often than not in the body, there are many, many types of chemicals and compounds and components that are all working synergistically that give you health on a daily and yearly, weekly basis that we often forget about. Everyone’s looking for that, like you said in the beginning, you said it perfectly, everyone’s looking for that one supplement, “What’s the one thing I can take that’s going to fix my energy or my pain?” Oftentimes, it’s really not. It’s a combination of many, many different things. You have a great book, can you tell us about your book?
My book is called Reclaim Your Energy and Feel Normal Again! Fixing the Root Cause of Your Fatigue with Natural Treatments. This book came out of my whole experience of going back to school, burning myself out and then building myself back up. The plethora of patients that were coming in with fatigue as one of their symptoms and just not feeling that they were getting any help through their other health practitioner, so just knowing that. Fatigue is like a black hole when it comes to conventional medicine. They just don’t know what to do besides put you on antidepressants. The joy of people is not what they need.
In my book, I talk about my story and the story of four other patients that I worked with. Everybody is just really unique in figuring out what do they need to get better. There are different fatigue factors, some of them we’ve spoken about already: anemia, thyroid, hormones, underlying infections, allergies and sensitivities of foods. Just talking about these different things and plain and simple everyday language so that the lay person can understand it.
I think you covered probably more than eight points in the podcast. You’ve given some great takeaways for both the patient and the practitioner when it comes time to treating energy problems or fight fatigue issues and those that have chronic pain or other chronic diseases because oftentimes when you have a chronic disease, pain is oftentimes the number one symptom. I want to thank Dr. Carri Drzyzga for being on The Healing Pain Podcast this week. You can grab a copy of her book at ReclaimYourEnergyBook.com. Of course, you can find her on her podcast, The Functional Medicine Radio Show as well as at her website, DrCarri.com.
About Dr. Carri Drzyzga
Who is Dr. Carri? Dr. Carri Drzyzga (Driz’ ga) is known internationally as ‘The Functional Medicine Doc’ – the go-to expert on finding the root causes of health problems so you can feel normal again. She is a chiropractor and naturopathic doctor, host of the popular podcast “The Functional Medicine Radio Show”, and author of the hit book Reclaim Your Energy and Feel Normal Again! Fixing the Root Cause of Your Fatigue with Natural Treatments. Dr. Carri is creator of Entrepreneurial Fatigue: How to Fuel Your Brain & Body for Entrepreneurial Success. Her private practice is Functional Medicine Ontario located in Ottawa, Ontario.
Connect with Dr. Carri:
- www.DrCarri.com
- [email protected]
- Facebook.com/DrCarr
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If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at [email protected]. Experts from the fields of medicine, physical therapy, chiropractic, nutrition, psychology, spirituality, personal development and more are welcome.
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