Why You Are Physically Exhausted All The Time…

so if you think about what is the feeling of tiredness the feeling of tiredness is an amalgamation of all kinds of mental and physiologic signals so when we're talking about tiredness we have to remember that there are different dimensions of it right so tiredness can be felt sort of mentally right so like you can sort of feel fatigued at the thought of doing something like if I want to like write a book or if I want to you know move for example that's like a really good one it's like oh man I gotta move and

if you really think about it like the thought of moving is not doesn't actually cost a whole lot of energy it's not like you're actually moving it's the very thought of it that makes you feel fatigued but we do know that tiredness is not just in your head right we know that there's a lot of physiology that has to do with tiredness we know that tiredness is a measure of energy levels so for example if I haven't slept in 24 hours I'm gonna feel really really really tired and that has nothing to do with you

know whatever tasks I need to complete or things like that if I eat a really really heavy meal I'm gonna feel really tired afterward and that's actually physiologic in nature so now what we're going to do is look at tiredness from a different angle which is sort of the physiologic angle and this is oftentimes what people kind of think about when they're thinking when they're talking about tiredness they kind of think about okay there's something wrong with my energy levels and what should I do about it and so what I'd love to do today is

share with you all kind of like how I think about or organize looking at tiredness like kind of within you from a physiologic angle right so how can we understand the physiology of tiredness so a couple of kind of quick disclaimers or perspectives so the first is that you'll a lot of people will share or talk about basic science research as it relates to tiredness right so people will say things like you can look at like let's say a study that looks at eliminating let's say refined sugar from your diet and how that boosts energy

levels you can look at studies that correlate things like vitamin D with energy there are all kinds of basic science studies out there that will say this stuff makes people more tired this stuff makes people less tired these are primarily study studies that are done in a laboratory so the tricky thing for any one of those studies it may not apply to an individual per person right so for all those studies that show that let's say eliminating refined sugar from your diet improves tiredness it doesn't make tiredness completely go away a hundred percent in everyone

in the trial right some people actually get no benefit from eliminating sugar other people get some benefit from eliminating sugar some people get a lot of benefit from it and so then what we do in science is we average all those things together and then we kind of come up with a conclusion so generally speaking what I found works almost better as a clinician is when you're working with real human beings there are a bunch of different solutions but trying to figure out where do I start should I eliminate gluten should I eliminate Dairy should

I eliminate eggs should I do keto should I do intermittent fasting should I wake up every morning at 5am should I do you know should I go swimming should I do resistance training should I do yoga should I do tai chi should I do Qigong should I drink this special kind of coffee should I add the supplement to my diet there are a thousand different things and the answer to all of them is yes you'll find someone out there who will talk about a paper who will say yes to all of those things but practically

as a human being like what do you do if you are tired all the time so what I'd love to share with you all today is an approach to tiredness that incorporates all of that stuff when I think about tiredness I think about two buckets and this is what I've learned like working for years as a psychiatrist there's the Circadian bucket and there's the metabolic bucket and you may say okay like what do you mean by circadian so our body goes through various Cycles throughout the day we feel more tired at night some people feel

tired in the morning people have trouble getting out of bed people have difficulty with sleep so there's a lot of tiredness that has nothing to do with like metabolism has nothing to do with energy but has to do with cycles and sleep and things like that by energy I mean like you know ATP generation I don't mean like the subjective feeling of energy because there's a lot of stuff that will subjectively make you feel tired and is kind of related to the Circadian stuff so this is where I think about things like sleep daily Cycles

you know like afternoon crashes difficulty waking up in the morning so this is the Circadian bucket so we're going to talk about all that stuff in the metabolic bucket we've got different stuff okay so like let's not worry about the sleep and stuff but the other big dimension of tiredness and energy levels is what you put into your body and how your body responds to that the key to happiness is whatever is in the link in the description check it out so this is stuff like let's say homeostatic balance and like blood sugar nutrition things

like nutrient deficiencies but there's other stuff going on with metabolism as well like inflammation and so this is where all the stuff of like what should I eat when should I eat it and what effect is the food that I put into my body have that's the metabolic stuff that's completely different from like the Circadian stuff and so as a clinician when someone comes in into my office and says I'm tired there's also a psychological component or spiritual component you may say like what do you mean there's a psychological component like psychological component in terms

of there's some tasks that just make you feel tired it's up here you just don't want to do it and spiritually like some people come into my office and they say I'm tired and what they really mean is like I have no zest for life everything just feels like a chore and then what happens is if they try to you know fix their sleep schedule like that's not the problem the problem is that like they've got nothing to look forward to during the day they can take as many supplements as they want to but that's

not going to fix it because it's not a metabolic problem so this approach is almost like from a differential diagnosis standpoint what's the differential diagnosis of feeling tired so it can be physiological psychological or spiritual and then in the physiology of it there's the Circadian branch in the metabolic Branch so let's talk about the Circadian Branch let's start with simple stuff and that is the pathology there are all kinds of things that can mess with your sleep so at the top of the list is sleep apnea so sleep apnea is a condition that probably affects

somewhere around five to eight percent of people in the world shockingly High results in periods of cessation of breathing during sleep so essentially what you do is drown or choke in the middle of your sleep as you drown or choke you don't get oxygen in then what happens is you start to drown physiologically that's the best word right so you're not getting oxygen so for 60 seconds you're gonna have like no oxygen and then what it does is triggers a survival response Rush of adrenaline you kind of reset your breathing apparatus and you start breathing

again but the problem is that the the rush of adrenaline and physiologic response is going to make you feel exhausted when you wake up in the morning right because think about what's happening like imagine like if you were to get thrown over overboard and we're underwater for 60 seconds before you came up without a breath imagine how exhausted you would feel after that people will have 20 30 50 60 100 120 apnic episodes per night and so physiologically when you wake up your body is ragged that's sleep apnea there are other things that we'll kind

of talk about there are other diagnoses that you can have but circadian rhythm disorders or other examples you can also have stuff like narcolepsy and and stuff like that but we're not going to talk about that so circadian rhythm disorders I think the other really really big one that I think is actually quite common and so what this what these kind of mean is if we think about a regular day right so let's say there's midnight there's 6 a.m there's noon 6 p.m and then midnight if we think about the activity level over time right

so most human beings their activity level is kind of like this right so you wake up at maybe six you go to work by nine kind of work until 6 PM you kind of wind down in your sleep by midnight now the problem is that some people their circadian rhythm is actually more like this and so what that means is that they're very exhausted when the rest of the world is working they're just when everyone else goes home for the day I'm just getting started and between 12 and 4 AM is actually my maximum productivity

and so if your body's clock which is what a circadian rhythm is is off-center from the rest of the world and you force yourself to wake up at 6am like everyone else this is your experience of life right so like I want you all to think about let's use calculus and calculate area under the curve for somewhere with a circadian this is the total amount of energy that they have during the day compared to a normal person this is the total amount of energy that they have during the day and so you look at quote

unquote normal people and you're like wow they're able to do so much and you look at yourself and you're like I'm exhausted all the time I can't do [ __ ] and that's because you've got a circadian rhythm disorder and you you can actually do the same amount it's just you're you're jet lagged compared to society so this is a circadian rhythm disorder there's also all kinds of really interesting research for example the Circadian rhythm of teenagers shifts later so there's data that shows that if you start school at 9 00 am or even 10

a.m instead of let's say like 8 A.M that teenagers will do a lot better because their circadian rhythm changes why does their circadian rhythm change because they're going through puberty and growth spurts and our body physically grows while we're asleep and I don't know if you all have noticed this but our body does a lot of growing when we're teenagers right so there's even data that shows that schools that start super early for teenagers those kids do worse in all kinds of different ways okay so there can be circadian rhythm disorders part of the problem

with circadian rhythm stuff okay so let's talk about solutions for a second one is if you've got sleep apnea the solution is actually medical care right so there are these things called uh cpaps continuous positive airway pressure they're different like medical devices that you can use that will keep you from having apnic episodes overnight and so like you just have to get medical care for that like if you're worried about okay how do do I know if I have sleep apnea I can't sort of diagnose you all over the Internet unfortunately but a really really

common sign of sleep apnea is waking up in the morning despite sleeping enough so if you went to bed and you got like eight or nine hours of sleep but you wake up and you're exhausted and it feels like you didn't get any sleep at all you need 12 hours of sleep 13 hours of sleep that you should probably talk to a doctor about that another really common sign of sleep apnea is snoring so what part of the reason that will become apnic is sometimes we have our soft palate and our like epiglottis and like

some of the stuff in our oropharynx literally like clamps down and prevents us from breathing so it'll like block our Airways from like this oropharynx area and we also know that for example having a lot of like Mass around here so if you've got like a really thick neck or obesity can increase the risk of sleep apnea so even weight loss can be a treatment for sleep apnea depending on what the physiology is okay so if you snore a lot and if you feel very tired in the morning despite getting Out full night sleep Public

Service Announcement talk to your doctor about it in the case of circadian rhythm disorders things are a little bit more complicated so part of the reason that I think we have circadian rhythm disorders increasing in our society is because we aren't quite as bound to the Sun and the Moon as we used to be this doesn't mean like we're Druids or we're no longer Druids this means that like literally we have you know this is where all the blue light kind of stuff comes in so blue light suppresses melatonin production actually it's this is the

right symbol from the pineal gland and then melatonin helps us sleep and keeps us on schedule which is why people will use melatonin to adjust for jet lag so what we've got is like we'll take melatonin to help us get on a good sleep schedule but here we are using blue light and technology that actually does the opposite of taking a melatonin tablet it shuts off melatonin production and so this kind of stuff the availability of the Internet you may say well what do you mean by that it means that at midnight you know I

want you all to imagine 10 000 years ago what could you do if you were a human between the hours of midnight and 4 AM what can you do that you can't do anything nothing to do everyone's asleep but now we have all kinds of stuff to do stuff is available all the time they're 24-hour eateries we can get food brought to our doorstep there's going to be some degenerate noobs that are queuing at 3am for whatever game you want to play and so there's all kinds of crap that you can do and that all

interferes with your circadian rhythm it allows you to get circadian rhythm adjusted like you can become an absolute degenerate when it comes to your circadian rhythm but it turns out that aside from these kinds of things there are a couple of other things which people don't realize about circadian rhythm so we're going to talk about that the first is that your circadian rhythm is a natural cycle and that there are particular times of the day where you're good at particular things so this isn't actually what the Circadian rhythm looks like what the actual circadian rhythm

looks like it's not like this but probably like this so This maybe is like nine nine to ten a.m this is noonish noon to three this is like four to seven and sometimes this is like nine to eleven so if you actually look at our activity and this should be flat by the way but if you actually look at our activity we actually have like fluctuations in our activity and this is conserved throughout the mammalian Kingdom so if you look at like the idea of a siesta or a nap in the afternoon like even in

some countries in Europe like things will shut down around like 2 p.m and they'll like open up again in the afternoon late afternoon so if you look at most mammals like you look at monkeys monkeys are awake at like you know 5 a.m or even earlier and then they kind of chill out around 10 and then they're like quiet during the hottest part of the day and then around dusk they become active again same is true of like gazelle and Impala so humans are probably the same way there's even some evidence that for example cognitive

activity between the hours of 4 and 6 a.m is very very like productive so if you look at religious tradition across the world they all wake up and pray or meditate at like 5 a.m and why do all the religious Traditions do that it turns out that there's probably a circadian rhythm there's like something about our mind is more at peace at that time and the other really interesting thing is I'll I'll work with some people who think they're night owls and then I'll ask them what do you mean like like so help me understand

the details of what do you mean by your night owl well I get started kind of sometimes around midnight and then at 4am sometimes I'll like do my best creative work I'll write music you know like I'll write prose poetry inspiration like it comes at like three in the morning four in the morning which is actually consistent with our circadian rhythm so it's not that they're night owls it's that they're like mourning people like really really morning people early morning people which is consistent with most of the mammalian Kingdom another consideration for circadian rhythm which

a lot of people forget is that we have these things called sleep cycles so if you look at sleep it's stage one to four sleep and then we have REM sleep after that but what people don't understand about sleep architecture and so you basically go through these five stages okay the problem is that different stages of sleep do different things for us so at the beginning of the night let's say this is stage one sleep this is stage two sleep this is stage three sleep this is stage four sleep this is REM sleep and at

the end of the night stage one is short stage two is short stage three is short stage for let's say is a little bit shorter and REM sleep is actually really long so the more the longer you sleep the more your brain changes What stages it spends its time in so you'll actually go through a sleep cycle where you'll go through all five of these and then you go through them again then you go back to stage one sleep now one thing that people don't realize is that if you wake up in the middle of

a sleep cycle you will feel really groggy and I don't know if this has ever happened to you all but you may find that's kind of weird but like if I sleep eight hours I will feel tired when I wake up if I sleep eight and a half to nine I'll feel really good or if I sleep four hours or six hours I'll feel really good it's easier for me to wake up with six hours of sleep than it is for me to wake up with seven to eight hours of sleep if y'all ever observe

that like it's really weird like I'm actually getting less sleep but I feel more rested when I wake up and it's because you have to wake up during the right time of your sleep cycle then you won't feel groggy but if you wake up during like the middle of your sleep cycle it's gonna be a mess this is also why and in the progression of sleep staging is actually really really important because we know that for example a lot of the good stuff in sleep happens in rem and to this day if anyone tells you

they know exactly what's going going on in our brain and sleep they don't know what they're talking about because no one really knows pay attention to your sleep cycles and recognize that you may not need eight how did we get the number eight eight hours of sleep a night is what the doctors recommend what they did is they took a thousand people and they took these thousand people and they asked okay who here is healthy and these four people raised their hands and then they asked them how much do you sleep at night one person

said ten one person said eight one person said seven one person said 7.5 they averaged all these numbers together and they decided okay 7.5 is the healthy amount of sleep that you need so this is really weird if we use this system to make clothing recommendations everyone would wear gray smocks that were like medium to large we're like okay Doctor what should I wear today and they're like well let me ask 10 people what they're wearing average their sizes average their colors average their cuts and that's the answer this is how we do medicine this

is how we do basic science research we just average a bunch of people together right so when we look at Daily caloric intake how did we get that number we got it the same way why is it 2 000 calories a day well we just asked people who are healthy how much they ate and now you have papers that come out that show that mild calorie restriction like 1800 calories a day actually leads to Better Health outcomes over the long term so it turns out that that number that we got by just averaging all the

crap together turned out to actually not lead to the best health fascinating who would have thought that if you just ask 10 people what works for them and average it all together that that's not actually the right answer of what works for you okay so be aware of waking up in the middle of your sleep cycle and remember that one of the reasons that you may not be uh you could be like tired from a circadian standpoint is if you're not getting enough sleep progression throughout the night so we don't want to just sleep you

know with a low amount of REM sleep but we can't it's not like it's the first two hours of sleep in the last two hours of sleep give us different benefits now a good way to transition to metabolism is by talking about caffeine so what does caffeine do caffeine the simplest way to describe what caffeine does is it suppresses adenosine receptors in the brain so we have this thing called ATP which is our basic unit of energy in our cells and when you use up an ATP you end up with an adenosine byproduct so this

is like when we have very high levels of a dentist ATP this means that we have lots of energy and we have high levels of adenosine this means that we've got low energy and then what we have is we have something that measures this so we're measuring our our adenosine to ATP that doesn't oversimplify and so what caffeine does is it blocks the signal of low energy it does not actually give us energy it just makes our body numb to energy or the lack of energy right so it's like it's like the equivalent of like

if we were taking met medication that suppressed our hunger or suppressed our thirst that's analogous to what caffeine does so it numbs our body's ability to detect fatigue which is why we feel more energized but we're not actually energized right it also does other things like suppress appetite and things like that which gets really interesting the key thing about caffeine is as we use caffeine it's going to make us feel more energy without actually having more energy now there are other effects of caffeine as well so like it increases heart rate for example so it

increases our pulse so we get kind of amped up you can sort of get the Jitters with caffeine right so it does like all kinds of other things but this is where a lot of people will combat this kind of stuff like sleep apnea with things like caffeine so when I have patients who have sleep apnea sometimes I'll ask them do you feel tired in the morning they'll be like yeah absolutely and then I'll ask them okay what do you do when you wake up it starts with two cups of coffee I'm like wow okay

so now this person has two things going on not only do they have sleep apnea but now they're blocking all of their energy signals and then what happens is they don't actually take rest when they need to so then like then they start running their car starts running on empty which creates all these other problems so generally speaking a lot of people like caffeine there's some evidence that shows that a moderate amount of caffeine which may have more to do actually with the other things in caffeinated beverages so if you look at things like green

tea or coffee there are all kinds of like phenols and like other things that probably have positive health benefits that a modern amount of caffeine intake per day actually can be fine or even healthy but what you've got to be really careful about is if you're tired and you're drinking caffeine especially if you're drinking a lot of caffeine chances are what's happening is that the caffeine is suppressing your body's ability to detect fatigue and so you can't take care of it the way that you should so as an example caffeine also suppresses appetite one of

the reasons why people like it if they're doing intermittent fasting if I'm using an appetite suppressant and I'm running on a caloric deficiency that's going to cause my energy to crash so we use caffeine to feel less tired and we end up making ourselves more tired because of all kinds of other things so let's move on to the next thing on metabolism which is glucose balance so remember it's an appetite suppressor right so now here's what we got to understand about glucose balance we've got two hormones insulin and glucagon there's basically a balance between these

two things insulin is an anabolic hormone what does anabolic mean anabolic means it builds things up so when we have high levels of insulin we've got a lot of available energy and we're going to use that as storage or building stuff like cellular Machinery so generally speaking when we're doing this process our energy is not there to be used for activity it's there to store away and build up Machinery if you all play games like rts's or you know turn-based strategy games insulin is like your expand hormone it's like okay we're not going to build

military units we're going to boost up our economy so we're going to invest our resources in having more resources later but what this actually does is makes us feel tired so insulin makes us feel tired and actually activates the parasympathetic nervous system and what is a parasympathetic nervous system do it rests and digests this is also responsible for food Comas and now we're going to see a very common thing that we're seeing now more and more with the digital generation which is I'm a star of myself for a while because I'm drinking caffeine and I

get distracted by technology and then I'm going to get so so so hungry that I feel super super hungry I'm gonna eat a ton of food I'm gonna eat like 1500 calories in one meal it's going to lead to a surge of insulin and The Surge of insulin is going to put me into a food coma and then I'm going to feel really really really really tired and now we understand how improper sugar balance can lead to feeling tired now there are all kinds of other things to keep in mind here now we get to

see a lot of why um a lot of the healthy things that people are touting like how they work the first thing is a low carb diet leads to low insulin levels so the trigger for insulin is carbohydrates so you can eat a ton of fat and protein and your insulin levels will still be low what this sort of means is that if we don't have activation of the parasympathetic nervous system people are going to feel less tired so if you talk to people who are on ketogenic diets they'll say like yeah at the beginning

it was rough but now I have so much energy throughout the day my energy level is actually way higher and I feel way better and why is that it's it's all mediated through insulin so now we can see why low carb or keto is pretty good next thing that we're going to talk a little bit about is let's say like intermittent fasting so if you look at things like fasting has its own whole situation going on but let's talk about that very quickly so the first thing to understand is that we have glycogen which is

essentially our sugar stores and they last about eight hours after we run run out of glycogen then we start burning fat even breaking down protein and then we're going to turn this we're going to use these to generate glucose we're going to make sugar because we've run out of our sugar stores so for example the brain requires sugar or ketones it can't use other forms of like it can't use fats so we have to make glucose the thing is converting sugar to fat is very efficient converting fat to sugar is very inefficient it's like the

efficiency of this process is I'd say less than 10 percent 1 16 or whatever that is so it's like six percent efficiency or five percent efficiency let's say six percent efficiency and so what that means is that when when people like we or live in such a calorie dense society that in order to be healthy what we need to do is start really inefficiently burning calories like imagine for a moment what your life would be like if instead of needing 2 000 calories a day you needed 12 000 calories a day right like there's like

if you're really really inefficient then you could eat all the hamburgers and crap that you want to the problem is that we're not that inefficient we're actually quite efficient which means that when we eat 2 000 calories we're going to gain weight 2100 calories 2500 calories we're going to gain weight so in order to counter that what we need is some of these things like intermittent fasting the reason that intermittent fasting is so good is because we run out of our sugar stores and then for the next eight hours we're in this state which is

actually the first state of starvation we're in the early stage of starvation and we're burning fat very very inefficiently to maintain our glucose levels but this causes us to lose weight and then we get to the third thing which is inflammation so when it comes to what to eat and your energy levels there tends to be all kinds of crap that causes low-grade inflammation so examples of things that cause low grade inflammation obesity gluten Dairy eggs all kinds of minor food allergies now note that this is not celiac disease celiac disease is a true allergy

to gluten but there's even like a very very interesting cases that I I've worked with people who are like this who will feel really really bad if they're eating gluten they cut out gluten and then they start to feel more energetic and they start to feel better they have like more energy their mood is improved things like that the really interesting thing is that there is one guy in Austin Texas who uses a strain of wheat that is a thousand years old so he's like somehow found some kind of wheat that is grown somewhere or

he grows it himself and so this strain of wheat has not been modified or been selectively bred for the last thousand years I know people who have gluten sensitivities who can eat wheat from his bread and be totally fine so something about the way that because if we look at it like gluten sensitivity is increasing why is that so what else has happened like why are human beings suddenly becoming so and we talk about sensitivity what we're talking about is there's actually particular proteins in gluten that trigger an immune reaction so what's changed over the

last thousand years we've selectively bred wheat even to the discovery of dwarf wheat is a Nobel prize-winning Discovery because we conquered world hunger with the discovery of dwarf dwarf wheat and so the that's probably some kind of chemical change there that triggers some kind of immune reaction in some percentage of the population so this low levels of inflammation also come from things like processed foods and there's all kinds of other stuff so like refined sugars will cause inflammation all kinds of stuff causes inflammation like the crap that we eat data is really unclear on how

much stuff causes what percentage of inflammation in what percentage of human beings so you've got some people who are like super super into natural and anti-gmo and stuff like that I think that GMO is the worst things in the world right natural is better and there's probably some evidence that some of that's true pasture raised is better than farm raised and this and that like there's probably some some benefit to that but we don't we don't really know how much but when it comes to the metabolic stuff reducing these low levels of inflammation so there

are other things that we also know like eating fresh fruits and vegetables reduces inflammation you may say how does this reduce inflammation it all has to do with gut bacteria so the kinds of so this is what what's happened okay in a quick summary two minute summary so here's a human being let's say 50 000 years ago the human being has a certain diet this is the diet of the human being 50 000 years ago the human being develops a symbiotic relationship with bacteria and we developed this relationship for 50 000 years because the bacteria

helps us digest these things and since we've lived with this bacteria for a very long time our immune system thinks that this bacteria is a good dude like hey these are friendly bacteria we do not need to kill them they're not threatening meanwhile over here there's another bacteria and this bacteria causes let's say this is anthrax and Anthrax hurts us so when the immune system sees this this is like this is a bad dude let's kill it now as our diet changes to let's say just circles we start to select for a different kind of

bacteria because that's the bacteria that the bacteria that can digest just the circles is going to grow in our gut now the problem is that this bacteria is different from this bacteria and our immune system looks at this and it's like well it's not really bad but it's not very good it's not a friend it's like kind of suss and then this leads to inflammation so what we see is when people eat foods that we've been eating for a long time it tends to reduce the inflammation in the gut and so what this kind of

comes down to oh there's also other things so exercise is not something that we talked about but exercise affects insulin metabolism in a very positive way sugar metabolism so it sort of fixes this it also affects the kind of food that We crave right so I'll ask you all a question you know who here likes to have a milkshake with a burger and fries if you enjoy having a milkshake with a burger and fries raise your hand who here whenever they exercise for an hour craves a milkshake at the end of the hour right when

you exercise what kind of stuff do you crave you can feel really really really hungry most people just want to drink water so exercise helps with all this stuff too so if y'all are tired couple things like what do we do if we're tired the first thing is pay attention so this is also where like complex carbohydrates so eating a cookie and eating like a piece of fruit is going to be different because complex carbohydrates have something called a lower glycemic index which is the amount of insulin that is released in response to this food

so if I eat an apple this is actually not going to lead to a very big insulin Spike if I eat a grape that's going to lead to more insulin release if I eat a cookie that's gonna release even more insulin and if I eat a white flower cracker like not whole wheat flour cracker that'll lead to more insulin so generally speaking the higher the glycemic index your diet is the more tired you will feel number one so you can also do intermittent fasting or ketogenic diet sometimes people will do both whatever and now we

understand why these things will make people less tired other thing is like eat fruits and veggies because fruits and veggies have a really interesting thing when you eat high fiber diets what ends up happening is I don't know if this kind of makes sense but if you're starving and you eat an apple you're no longer starving but you're still kind of hungry but you can't really Gorge yourself right so like if I'm really really starving and I don't know if this kind of makes sense to y'all if I'm starving if you give me 1500 calories

that is packed very densely I can eat them if I'm like really really hungry but if you give me an Apple first and let's say an apple is let's say like 180 calories let's call it 200 calories after eating the Apple I'm not gonna eat a 1300 calorie meal I'm gonna eat like a 700 calorie meal does that make sense oh gaw RL is rating with a party of 279 thanks for the thanks for the raid girl we're talking about metabolism I don't know if it's the most exciting topic is it 200 uh so so

that's a good question so this is enough there's so much to learn so that's because our hunger so people are asking okay why doesn't Apple make you feel full if it's not only calories so our perception of hunger is an integration of all kinds of circuits so it's an integration of our blood sugar but it's also an integration of things like mass in the stomach this is why a stretch receptors so even like how much our belly is stretched and how much weight is in there correlates with our hunger so this is why people will

like you know talk about rice cakes is pretty filling they're super low calorie but they have some volume I don't know how much they actually create stretch in your stomach so I'm not really sure if this is a great example but like if you eat some low calorie dense food that has a lot of volume you can't eat very much of it like you can eat 1500 calories in one Burger but I don't know that you can eat like 1500 calories of broccoli right like you just can't do it's like physically like you're not gonna

feel hungry it'll be like eight heads like you're just gonna the stretch receptors are gonna be like enough does that make sense there are also different kinds of hormones at play here like ghrelin and leptin so if you're tired pay attention to the glycemic index of stuff by all means reduce your carbohydrate intake or be careful when you eat so another thing going back to this and I'll kind of integrate this so let's kind of like integrate all this stuff so let's say that you wake up at 5am so usually when I wake up first

thing in the morning I don't eat something because I find that if I eat something right away I get an insulin Spike and I'm not very productive so if I wake up at 5am I'm gonna go two hours maybe I'll have tea but I'll go two hours without any food then I feel very hungry so seven to eight I'll eat a meal and I'll usually have a pretty heavy meal so today for example I had two breakfast tacos and the thing is when I have two breakfast tacos I know that I'm gonna need enough calories

so I do this on purpose so I know that like if I eat well actually so today I woke up at seven it's different with kids so let's do this actually so if I eat at eight o'clock between 8 and 10 a.m I'm not going to to be very productive because now I'm going to be digesting so this is my digestion phase so I'm not going to do much work then I'll kind of get a second wind sometimes I'll even take a nap here so if I eat I'll share with you all an interesting technique

one of the best ways to avoid after food after meal fatigue is to lay down on your left side for 20 minutes so I'll lay down like after I'll try to have a decently heavy meal I'll lay down on my left side for about 20 minutes and close my eyes often maybe I'll doze a little bit I won't actually sleep so let's say 10 30 I wake up then I'm gonna do some kind of like random work between 10 and 4. this is going to be stuff like meetings emails other kinds of like low cognitive

activity work and then between four and seven or sometimes between seven and nine here sometimes I'll do more creative work like I'll do writing or whatever and then it's bedtime so the key thing about like maintaining your energy level throughout the day is like this afternoon crash is oftentimes if you don't eat enough for breakfast and you're starving at noon and you eat very heavy at noon you're going to have an afternoon crash you're gonna have an afternoon crash why so there are three reasons why you have the afternoon crash number one we're hungry because

rushed in the morning I'm rushed in the morning reason number two had caffeine in the morning right I wake up I have my cup of coffee it's an appetite suppressant right and four hours later the caffeine starts to wear off a little bit so not only do we like start to feel that tiredness but then this appetite suppressant makes us even more hungry and then we eat a really big meal so this plus this equals big meal once we have a big meal big insulin Spike makes us feel tired then what happens is now let's

say two hours later so six hours post caffeine the caffeine's really starting to wear off so this is going to make me tired and on top of that it's now 2 P.M and what do the monkeys do it too on top of that roll in circadian rhythm you're going to be more tired this is why people crash in the afternoon right because everything aligns and so if you say okay I'm tired in the afternoon what should I do well you can do all kinds of stuff one is you could just take a nap second thing

you can do is eat something with your coffee third thing you can do is cut back on your caffeine intake fourth thing you can do is when you eat a big meal make sure it's low carb fifth thing you can do is have a snack at 10 A.M so that you're not starving when noon comes around sixth thing that you can do and I don't know if you all have done this is have more coffee so I know we covered a lot of stuff and unfortunately like that's if you're tired it's not simple so if

you think about what is the feeling of tiredness the feeling of tiredness is an amalgamation of all kinds of mental and physiologic signals insulin leptin ghrelin inflammation glycogen stores fat stores circadian rhythm stuff there's stuff going on in your brain in your reticular activating formation that is causing you to lay down or calm down or feel tired your vagus nerve is active or inactive depending on what's going on even the way that you breathe Eve will affect your fatigue level and so people are struggling with tired everyone's more tired why is that when I work

with people I tend to split into two buckets there's the Circadian stuff which has to do with your body's natural rhythms and how we may not be aligned with those kinds of natural rhythms how if we get interrupted sleep or if we don't sleep enough or if we sleep too much how we'll be tired the next day and in the most unlucky cases what we're talking about is actual pathology like sleep apnea so the Circadian stuff is kind of like sleep but then there's another whole piece to this which is metabolism which is our actual

energy level and how our level of fatigue throughout the day is going to be dictated by all these different kinds of metabolic hormones and sugar balances and stuff like that which is why everyone will say like oh I cut out gluten and now I feel so much more energetic I'm doing keto I'm doing intermittent fasting I feel so much better I feel so much better I feel so much better and there are all kinds of physiologic reasons for that and so what everyone is doing is they're saying like Okay so which one of these should

I do should I do keto should I do intermittent fasting should I cut out Dairy like should I become vegan should I get one of those little watch things that monitors my sleep level what should I do should I take melatonin should I take this supplement should I drink more coffee should I drink less coffee should I drink a special kind of coffee should I drink more expensive coffee everyone's wondering like how do we do this stuff like what's the right answer and I don't know how to say this but like if any of that

stuff works super super super well it would eliminate everything else from the market right like that's what happened with antibiotics if you look at like the alternative medicine that's out there there's very little alternative medicine for the stuff that we do really well with regular medicine right like even people who are super into alternative medicine like I these are a lot of my patients if they get sick they'll take a course of antibiotics because it works really well so there's a really interesting principle from the history of medicine that when there is one treatment that

works if you have 10 treatments for something all of them don't work well when you have one treatment that that exists that's because it works really well it's just darwinian it's like the theory of evolution and natural action so you have all these thousand diets in which one should you do it comes down to these factors it's not about one diet it's not like this one is the thing that works they all work to some degree the question is which one fits for you what's your particular pattern of tiredness are you tired first thing in

the morning when you wake up what's your caffeine consumption like do you crash in the afternoon do you really hit your stride at 7 pm because the more that you understand yourself the more that you'll be able to leverage any of these individual things and figure out what kind of plan works well for you if you found this video helpful check out Dr K's guide we've spent hundreds of hours writing and filming to help people understand their mind so that they can build the lives that they want so check out the link in the description

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