Low on Energy? A Few Thoughts on Fatigue

One of the most common complaints I hear in my office is, “I have no energy. I just shouldn’t be this tired all the time.”

This seems to be pervasive in our culture.

If you simply search fatigue, you will get over 11 million results. There are also as many cures for fatigue as there are variations of this complaint. If you search for information on cures for fatigue, you will get over 9 million results. Clearly, this is an issue for many people.

There are many causes of fatigue. Most patients are convinced that their thyroid, blood sugar, iron levels, or hormones are low or not right. All you have to do these days is turn on your radio or TV and within fifteen minutes, you will probably hear a commercial for men about low T.

I do believe it is important to check on these things when appropriate, but rarely are these the cure for fatigue. Certainly, if you have low T or hypothyroidism, replacing these hormones can help with your energy, but most people have normal results.

Over the years, I have found the quickest fix for low energy for most people is to start an exercise program. “Motion is lotion.” You will simply feel better and have more energy. On the other extreme, if you are working out 7 days a week, taking a true Sabbath from your workouts will help.

I am also amazed at how little sleep many people get. We need to consistently get around 8 hours of sleep. Some people seem to do okay with 7 while other may need 9 hours of sleep. Those patients that routinely sleep less than 7 hours will usually push back against my suggestion for more sleep. They will usually say they have always only needed 5–6 hours of sleep. Of course, when asked how long they have been tired, they reject the association to lack of sleep to their fatigue even though they have been tired all those years.

Sometimes, the cure is more water. If you are chronically mildly dehydrated, it can cause fatigue. Our bodies are around 60% water. We need water!

Over the long haul, sugar is a zapper of energy. It will give you a quick burst of energy but usually leads to low levels of motivation and/or energy after the initial surge. Eliminate sugar and things that turn to sugar as much as you can.

I take a B-complex vitamin from Thorne Research called Methyl-Guard. It has B12, B6, and folate. I think it helps me. Whether it actually helps or if it is simply all in my mind, it works for me.

But the most common cause for fatigue that I have found in my 25 years of being a family doctor is stress. Stress comes disguised in many forms. Most people do not believe they are stressed. I think it is the “boiling frog” theory. They are so used to low levels of stress and as their lives get more complicated and stressful, they do not see the increase temperature of the water as they are slowly coming to a “boiling” point in their lives.

Our culture promotes stress. We have a tendency to get over involved in all sorts of things. Mostly, these are good things. Look at little league games these days. There was a time when a T-ball team would play 8–12 games in a season. Usually the kids would have the same hat and maybe T-shirt. Now, these kids are in $200 uniforms, and playing tournaments on weekends. It is nothing for an active T-ball team to play 35–50 games.

There is nothing wrong with T-ball. It is great for kids to be active and compete. What I see happening in our lives is lack of any margin. We cram as much as we can in our 24-hour day. When something unplanned occurs (and it always does), we have no margin, no breathing room, and that puts added stress to complete our scheduled activities such as work.

This often leads to stress in our relationships. Isn’t it true that we seem to take it out on those we love the most? Keeping our relationships healthy will dramatically improve our energy level. It will take energy to invest in those relationships, but we will get more back than we put in.

Another drain of our energy is the constant distractions that keep our minds buzzing with information. When was the last time you allowed your mind to be bored? With all of the technology that keeps us connected to our stressed-out world, we seemingly never disconnect. I believe one of the best “fixes” for fatigue is to disconnect and recharge your emotional batteries.

Disconnecting looks different from one person to another, but one of the keys is to allow your mind to get bored or at least not be distracted with all of the information we have available to us today. Take time to meditate. “Dwell on what is pure and noble.”

I have found exercise is one of the best ways for me to disconnect from the chaos and to recharge my emotional energy. Sometimes reading a good book will do the same thing. Take some time to figure out what it is for you that will help you stay emotionally energized. Plan for it and invest in it.

When your emotional energy is good, you will find your physical energy will follow. It may not happen simultaneously, but it will correlate. Allow your mind to occasionally be disconnected from all of the chaos we live in every day. The world will not stop rotating if you do not check in on Facebook or Instagram every day!

Wishing You an Amazing Life,

Curtis Brown, MD

Mission Trip to Livingston, Guatemala

I am involved with a ministry in Livingston, Guatemala. Livingston is a small community in Guatemala that is the home of 10,000 to 12,000 people with little or no healthcare. Healthcare in Guatemala is essentially free through the government. However, there is essentially no real healthcare available. The government clinic has not been able to pay their nurses and there are little or no medicines available.

Miguel Gonzales is a young pastor with a big vision for Livingston. He started a house church with just a few believers and had a big vision for ministry that included starting a clinic. Through various circumstances, some friends and I have become involved and support the clinic. There is a local Guatemalan doctor who works daily in the clinic.

Pastor Miguel has trained a new pastor who is now leading the ministry, Enrique Blanco. He is a dynamic leader and is growing the church and clinic.

My friend Brian Banks and I took a team and had a medical clinic. We saw about 450 patients and dispensed over a thousand prescriptions over the three-day period. We also were able to provide an EKG machine for the clinic. It is the only 12 lead EKG for many miles and will make a tremendous difference in the health of the local Guatemalans. The EKG was donated by Mercy Hospital.

20 Pounds in 2017

It's that time of the year that most of us at least start thinking about goals for next year. I try to be realistic and not set unachievable goals like starting for the OKC THUNDER at point guard. Still, I usually struggle with staying connected to my goals.

If you are like me and are thinking about dropping about 20 pounds in the year 2017 (did not make it in 2016), one of the first questions to ask yourself is not what diet or exercise plan, but why. Why do you really want to lose weight? What is your true motivation?

The sad truth is that for most of us, losing weight because we know it will be good for us and improve our health simply isn’t enough for when times get tough and we are in the messy middle. The messy middle is when you have been at it for a little while but the finish line is still weeks if not months away. There is always a messy middle.

I have found that a major event in one's life is great motivation for about 6 months. Most of my patients who have had a heart attack or stroke are really motivated for rehab for about 6 months. Then the messy middle shows up. The pain and loss suffered becomes a fading memory and many revert back to the same lifestyle and habits that got them to the event in the first place. Their motivation wanes. Only about 1 in 7 will stay with it and change their lifestyles long-term.

I am the same way. I know that dropping 20 pounds will lower my cholesterol and improve my blood pressure. I know that I will feel better and have more energy. I know it all intellectually, but here I am again trying to lose those same 20 pounds from 2016. So what can I do to be that one in seven that sticks with it? Where can I find my motivation in the messy middle?

I think there is a lot that goes into reaching your goals. But, I believe the most important question is to ask why. Why do I really want to lose the weight? Yes, I know in my mind that it is good for me, but I have proven that simply knowing so doesn’t tend to motivate me enough in the messy middle.

I am somewhat embarrassed to admit that I need something more tangible and more rewarding than simply knowing that it is really good for me, but that is the simple truth. I am a simple person. I need simple answers to the whys.

My plan is to set up some rewards along the way. I have not yet decided what they will be, but I know they will be simple. If I lose 5 pounds I will (fill in the blank). I am also going to set a timeline. I think a goal without a timeline is simply a dream; however, that is another topic.

I would love to hear from you if you have some good ideas for my simple solution for the messy middle. Also let me know if there is a certain health or wellness topic you would like to learn more about.

The Season for Sneezing

It's that time of year all over again. The pollen count is high and the winds are changing daily. The cool air is starting to stay longer, but we have yet to have a good freeze.

Allergy sufferers dread this time of the year! The itchy eyes, runny nose, cough, congestion, drainage, fatigue are just some of the symptoms people are complaining of and I should know because I have allergies too.

Fortunately, there are many treatments available over the counter. The non-sedating antihistamines such as Claritin, Allegra, and Zyrtec were at one time available by prescription only. They now are OTC and have generic equivalents available for a fraction of the cost. Many people can treat their symptoms with these medications and do well. Others need more help and recently two of the prescription nasal steroids went OTC, Nasocort and Flonase. They do not have generics but are usually available for around 20 dollars a month. They do have competitors that are available with a prescription, but they do not offer any tremendous advantages over what you can purchase OTC.

I often recommend saline nasal sprays to help clean out your sinuses. It is especially useful if used right after coming in from being outdoors. Some patients use colloidal silver rinses and report good results.

Benadryl has been the gold standard and is what most things are compared to. One of the main problems with Benadryl is that it is sedating. It is what is in several OTC sleep aids.

Hang in there, all those who are suffering with allergies! We are going to have freeze soon and the pollen counts and other allergens will start to decline. Now if you suffer from allergies year around, you might consider getting skin testing to see what it is you are allergic to. The best treatment is to avoid those things.

Ditch the Blood Sugar Blues

If you’re looking for a way to combat your constant cravings and fight fatigue, this article is for you. Perhaps your diabetes isn’t as well controlled as you would like it to be. Or maybe you’re simply looking for some tips to help you eat and feel better. Blood sugar control is important for EVERYONE interested in better health, not just for those with diabetes. 

Skipping meals, over-consuming carbohydrates, stress and illness are a few factors that can cause major swings in blood sugars; also known as the blood sugar rollercoaster. Our bodies function best when blood sugar remains within a certain range. While it’s normal for blood sugar to fluctuate before and after a meal, it's best to prevent major spikes and crashes.

The blood sugar rollercoaster can leave you with constant cravings (especially for carbohydrates), unstable moods, and it can be the reason behind your sluggishness after a meal. Over time, this rollercoaster creates a stressful environment for your body, making it difficult to lose weight even if you’re eating very little.

It’s not just WHAT you eat that matters, it’s also important to consider WHEN you eat. Aim for a combination of protein, carbohydrate, and fat at each meal. Keep it simple by classifying each food based on what macronutrient it predominantly contains. For example, almond butter contains a combination of fat and protein. I would suggest counting it as a fat, as it is a richer source of fat than protein. See the list below for more clarification of carbs, proteins, and fats. 

Carbohydrates break down into sugar in the body, raising blood sugar—this is what makes them a good source of quick (but not lasting) energy. Keep in mind that while vegetables are in the carbohydrate category, many contain far fewer carbohydrates (i.e., non-starchy veggies), thereby having little to no impact on blood sugar. In fact, non-starchy veggies should make up about half your plate at each meal! Protein and fat keep you full longer than carbohydrates, are a good source of longer-lasting energy, and help buffer the impact of carbohydrates on blood sugar. For these reasons, it’s important to avoid eating a carbohydrate-based food by itself.   

For example, a piece of fruit (carbohydrate) will not keep you full very long. Instead, enjoy a piece of fruit (carbohydrate) alongside a fat like almond butter. Or pair it with a protein like a hard-boiled egg. Try starting your day with a balanced meal like a veggie omelet (protein) cooked in coconut oil (fat), served with a side of fruit. 

Keeping your blood sugar in check is a great first step toward better health. For more simple tips, see 3 Steps to Better Health. See below for a list of carbs, proteins, and fats as well as simple meal and snack ideas. Ditch those blood sugar blues and see how much better you can feel!

Carbohydrates

• Beans
• Corn
• Fruit
• Grains
• Hummus
• Lentils
• Milk
• Oatmeal
• Peas
• Potato/sweet potato
• Quinoa 
• Bread
• Pasta
• Cereal
• Rice
• Squash (winter)

Non-Starchy Vegetables

(low in carbohydrate à less impact on blood sugar)

• Artichokes
• Asparagus
• Beets
• Broccoli
• Brussels sprouts
• Cabbage
• Carrots
• Cauliflower
• Celery
• Coleslaw
• Cucumber
• Eggplant
• Green beans
• Jicama
• Leeks
• Mushrooms
• Okra
• Onion
• Peppers
• Radishes
• Salad (lettuces)
• Spinach
• Sugar snap peas
• Summer squash
• Swiss chard
• Tomatoes
• Turnips
• Zucchini

Protein

• Beef (Fresh or Dried)
• Chicken
• Cottage cheese
• Deli meat (turkey, ham, beef,
• Chicken, etc.)
• Eggs
• Fish/seafood, fresh
• Hamburger
• Pork
• Tuna/salmon, canned
• Yogurt, plain

Fat

• Butter
• Extra virgin olive oil
• Coconut oil 
• Nut/seed butter
• Salad dressing
• Mayo
• Sour cream
• Cream
• Half & Half
• Cream cheese
• Nuts
• Olives
• Seeds
• Cheese
• Avocado

Sample Balanced Meals

• Eggs (protein), spinach and tomato, cooked in coconut oil (fat), side of fruit (carbohydrate)
• Tuna (protein), avocado (fat), cucumber, side of fruit (carbohydrate)
• Meat (protein), zucchini sautéed in butter (fat), sweet potato (carbohydrate)
• Salmon (protein), garden salad with dressing (fat), sprouted quinoa (carbohydrate)
• Chicken salad (protein) with mayo (fat), celery, and grapes (carbohydrate)

Sample Balanced Snacks

• Apple (carbohydrate) with almond butter (fat)
• Grapes (carbohydrate) with cheese (fat)
• Plain yogurt (protein) with blueberries (carbohydrate)

Big Hairy Audacious Goals

Do you have a BHAG? BHAGs are Big Hairy Audacious Goals. They are something that will stretch you, challenge you, and make you get out of your comfort zone. I think they are essential for leading an amazing life!

I was in Chicago the first time I heard the term BHAG. I was listening to Bill Hybels speak at a Christian leadership conference. I’m not sure if he made up the word or if someone else did, but the word and the idea resonated with me some twenty years ago.

I try to set BHAGs for the four main areas of my life: spiritual, family, physical, and work. I think the best time to set them is usually at the first of the year or if you are going through a transition in life. I do like to review my goals every so often to see how I am progressing. I may not always reach my goals, but I usually fall forward trying!

I think having BHAGs are critical for living an amazing life. Having BIG HAIRY ADACIOUS GOALS will keep you focused and energized. I see so many people that are depressed or stressed out to the max; almost all of them do not have any direction or goals in their lives.

Having BHAGs will keep you focused outwardly (providing you set healthy goals) instead of inwardly all the time. They usually will give you a framework for making decisions. It helps you learn to say no to some opportunities that might be good but maybe not best for you. They usually make you learn a new skill or experience something in a different way.

One of my favorite memories of a BHAG was running my first marathon. I was never much of a runner and the thought of running 26.2 miles was overwhelming. With the help of some friends and encouragement from my family, I survived. I can still recall the feeling of crossing the finish line for the first time. I felt as if I could do anything that I set my mind to accomplish. I made new friends, learned a lot about myself in the process, and I am still running today.

Some BHAGs are easy to think of, while others are not so simple. I usually struggle with my spiritual ones. I think these are the hardest for me because I like to be in control. In all honesty, I don’t have a spiritual BHAG at the moment. I think spiritual BHAGs should be something big, something challenging, and something that I cannot do on my own. They should be so big, that the only way they can be accomplished is if God shows up!

So the next time you are feeling overwhelmed or anxious, consider your BHAGs. (Oh, by the way, you are never too old to have BHAGs!) Do you have something in your life that is challenging you? Are you out of your comfort zone (a little anxiety can be a good thing)? Do you have something in your life that is pushing you to become better? What are your BHAGs?

How Does Caffeine Work?

Have you ever wondered how caffeine works? How does it help keep you awake and more alert?

Caffeine has been shown to help with many types of brain problems. There have been studies that show caffeine consumption may benefit Parkinson’s disease, Alzheimer’s disease, depression, migraines, and may even enhance memory.

Caffeine has many reported benefits and several modes of action. Caffeine can block phosphodiesterases, promote calcium release from intracellular stores, and interfere with GABA-A receptors (these can affect our moods and concentration).

The longer we are awake and the more we use our brains, the more adenosine (a chemical manufactured by our brains) builds up in our brains. Adenosine binds to adenosine receptors on glia cells. Glia cells are a type of brain cell that triggers sleepiness when activated by adenosine.

The way caffeine works on the brain to keep us awake and more alert is by blocking adenosine receptors on glia cells. Caffeine is structurally similar to adenosine and will latch on to the adenosine receptors. It blocks the adenosine from binding to these sites. Caffeine, however, does not activate the receptors—it just blocks them.

Our bodies are fearfully and wonderfully made. After a few days of consuming caffeine, our glia cells start to manufacture more adenosine receptors. It then takes more caffeine to block the receptors and we develop a tolerance to the effects of caffeine.

If you stop caffeine for about three or four days (on average), the adenosine receptors return to the baseline. Then the next time you drink caffeine, you are more likely to notice the buzz.

So the next time you drink a cup of coffee, remember it is blocking your adenosine receptors in your brain. I am sure this information is extremely valuable to you! Who knows, maybe it will help you answer a trivial pursuit question.

Do Anxious People Live Longer?

As I write this post, we are in the heat of summer here in Oklahoma. The heat index has been setting records this week. It has ben HOT!

The heat does funny things to people. I have seen a dramatic increase in patients suffering from essentially anxiety. Generally, they do not openly say they are anxious. It is usually disguised in a somatic complaint such as chest pain, dizziness, fatigue, or shortness of breath.

Anxiety is a part of human nature. Human nature has the tendency to take a thought and go to the darkest place with it. A headache can quickly become a tumor or stroke in some people’s imagination. I am not immune to this tendency.

A few years ago, I had a spell of vertigo. Vertigo will cause you to get dizzy with just about any kind of motion. For a few moments, I was convinced that I must have had a blood clot that would eventually lead to a stroke! To say the least, I survived, and it made me slightly more sympathetic to my patients with vertigo.

In the book The Longevity Project, the authors found that having a little bit of anxiety or concern correlated to longer life. They dismissed the theory that the happy-go-lucky guy lives the longest. It seems that those who have some level of anxiety tend to make healthier choices. For example, maybe they do not take that extra drink or start smoking. They are a little more reserved with their choices.

So it would seem that a little anxiety is probably healthy for you, but too much anxiety can make you ill. I have seen people worry themselves into ulcers or heart attacks. Proverbs 12:25 says, “Anxiety in a person’s heart weighs him down, but an encouraging word brings him joy.”

I think that anxiety and fear are very similar. Most anxiety is caused from fear of loss. We tend to be anxious when we fear loss of health or loss of an opportunity or loss of a relationship or loss of material things.

Some fear is healthy. For instance, fear of falling will keep most people from leaning over the edge of a tall building. Our fears do tend to set limits for us.

I have a slight fear of heights. Anything passed the second rung on the ladder is orthopedic height (you fall, you break!) for me. I will never work on a high-rise building. Fear of getting a speeding ticket and having my insurance rates go up keeps me from driving too crazy.

“The fear of the Lord is the beginning of wisdom.” My fear (or respect of God) sets limits on my choices. It keeps me from doing stupid things. It sets healthy boundaries for me. It gives me a framework from which to make choices.

Some fears can be paralyzing. These usually occur when I have high levels of anxiety, or fear of loss of something. When I drill down on this, I find when I am overly anxious, I have placed that something in the center of my heart. It consumes me and becomes a horrible master. Anything in the center of my heart other than Jesus (the fear of the Lord) will tend to lead to some level of unhealthy anxiety.

I do think having some anxiety is just part of life. If you are human, you will have some anxiety. It would seem a little anxiety might lead to a longer life. The next time you are feeling anxious, do a heart check. Make sure that you truly have Christ in the center of your heart and I believe He will give you peace that surpasses all understanding.

Summer Challenge: Revisiting the 10-Day Diet Challenge

I started the 10-Day Diet Challenge last summer, and it has been well received by many people. Hundreds of people from all over the world are trying this diet. I have even had people from Russia take up the challenge. This week, I had a patient that lost an amazing 16.6lbs in 10 days. He was very faithful to the plan and reported 3 inches lost on his waist! He was feeling more energetic and was confident he could continue to eat clean. 

It was about day five that he thought he would actually survive the plan! Almost everyone experiences carb withdrawal symptoms at some time during the challenge. If you stick with it, your energy will rebound and the brain fog will clear! On average, most men are dropping 6–8 lbs and women are dropping 4–6 lbs. This plan is easy and reproducible, and did I mention it was free?

The secret is getting off the insulin roller coaster. When your insulin level moves, up or down, it can trigger hunger. Cravings are often triggered by insulin swings. High glycemic carbohydrates (bread, potatoes, pasta, rice, and sugar) start the insulin roller coaster and create more appetite. There is a reason you can’t eat just one chip!

Protein will blunt the insulin response. Always eat some protein when you are eating even healthy carbs. A small bite of peanut butter can flatten the insulin curve from your daily fruit.

I am a believer in PGX and its benefits. It is a fiber product that can flatten the insulin curve and create a sense of fullness. I try to consume it twice a day.

If you have never tried the 10-Day Diet Challenge, give it a try. It is found on my website and is really simple to start. If you have tried it before but not recently, I want to challenge you to do it again. I like to repeat the challenge about every six weeks or so. I do not always do it for 10 days, but I always feel better for doing it.

I have found this plan to be simple to follow and an effective way to maintain a healthy body weight. It helps with my energy level and also helps eliminate brain fog!

Golden Years: Big Gain in the Future

Have you ever thought about how long you want to live? Most people I know want to live to a good old age as long as they have their mind and can take care of basic daily needs. Most people are more afraid of having a debilitating stroke than a crippling heart attack.

Nobody really enjoys thinking about our golden years and how we want to end our time hear on earth. Our future selves will thank us if we do start thinking and planning for our golden years. I had a patient tell me the only thing golden about his golden years was the front of his underwear!

The problem for most of us is that we are always going to start tomorrow, and tomorrow really never gets here. I judge other people by what they do, but I tend to judge myself by what I intend to do. I have really good intentions like learning Spanish, but . . . I will start tomorrow!

I want to encourage you today to start thinking about the “future you” and consider developing a plan to not only “go long” but to thrive. I do think it is possible to make some small changes now for big gains in the future.

I am currently reading a book, The Longevity Project, and have found it fascinating. It is based on a study started by Dr. Terman in 1921. He started following thousands of California children in grade school. He developed an extensive questionnaire for the kids, their parents, and their teachers. He wanted to look at personalities and see which ones tended to be more successful in health and life. He followed them until he retired and then others took up his work. All of the participants are now deceased.

The main takeaway from the book is that “Personality is an excellent predictor of health and longevity, often in counterintuitive ways.” It was not the carefree, "enjoy life, grab all the gusto while you can" personality type that lived the longest or for that matter was the happiest. “The findings clearly revealed that the best childhood personality predictor of longevity was conscientiousness—the qualities of a prudent, persistent, well-organized person, like a scientist-professor—somewhat obsessive and not at all carefree.”

Our personalities are difficult to change, but with some thoughtful effort we can make some differences. I tend to be an introvert. (My family may say to the extreme.) I can, however, function as an extrovert. It is not my natural self, but I can pull it off for a while. I think the same is true with other parts of our personalities.

I want to encourage you to think about your golden years and start coming up with a plan.