 Welcome to Happiness Isn't Brain Surgery with Doc Snipes. This podcast was created to provide you the information and tools Doc Snipes gives her clients so that you too can start living happier. Our website, docsknipes.com, has even more resources, videos and handouts and even interactive sessions with Doc Snipes to help you apply what you learn. Go to docsknipes.com to learn more. Hi, everybody, and welcome to Happiness Isn't Brain Surgery with Doc Snipes, practical tools to improve your mood and quality of life. We're going to continue with our segment on causes of depressive symptoms and ways to address them. In the first section, we really talked about what depression is, what depressive symptoms are, and why it's not a one-size-fits-all that we can just give you a pill or suggest some sort of treatment that works for everybody. Well, it just doesn't work that way. In this section, we're going to address one of the symptoms of depression, which is fatigue. A lot of people with depression have overwhelming fatigue. So we're going to talk about what might be causing that, talk about how it contributes to feelings of depression, and identify interventions that may help improve energy and motivation. Now, some of these things are very biologically based, very medical in nature. So I'm going to suggest talking with your doctor about different ways to address it for you. For example, chronic fatigue syndrome. There are a lot of different ways you can address that, just like there's a lot of different ways you can address depression. So we're not going to go into that in depth. So some of the medical stuff I will defer to your physician, but I do want to bring it up and help you understand that it may be causing fatigue, and when you feel fatigue for long enough, it can cause you to feel hopeless and helpless, which can cause you to feel sort of depressed. So first cause of fatigue is the obvious, poor sleep. And I've done videos on sleep, so you can go back and review some of those. I will do another shorter video on sleep in this set of podcasts, but it's important to understand how sleep affects you. Not everybody needs as much sleep. There are recommended guidelines for how much sleep you're getting. I personally love my sleep and I need sleep in order to feel energetic and all that kind of stuff. So I know for me that making sure I'm getting quality sleep and enough quality sleep is imperative to keeping my mood and happiness where I want it to be. One of the things that you can do to monitor your sleep, obviously you can go have a sleep study done. I can get expensive and it's only a snapshot in time. But if you know you're having sleep problems, that might be something to consider. Another thing you can do is get one of the fitness trackers. And there are a lot of different companies that make fitness trackers that do track your sleep and tell you the different stages of sleep. So when you're getting deep sleep versus light sleep, that can help you kind of track and understand how your body works. For example, caffeine has like a 12-hour half-life, or it's supposed to. But I know that if I've had caffeine and from watching how my sleep patterns go throughout the months, I know if I've had caffeine after about 10.30 in the morning, my sleep that the next night is going to be really mucked up. And it's not just until after 10.30 that night. My sleep is not going to be quality for quite a while, or maybe even all night long. We'll talk more, well, when you ingest certain chemicals like caffeine, caffeine has a six-hour half-life, which means it takes six hours to get out of your system half the way. It takes 12 hours to get completely out of your system. Now, for me, looking at my sleep chart for whatever reason, and that's more than I'm really concerned about right now, I know that my sleep is usually messed up even if it's been 12 hours since I had caffeine. Know your own tendencies. There are a lot of other things that can contribute to poor sleep. Like I said, wait till that segment. We'll go over that. If you're fatigued, rule that one out first. There are a lot of other things if you're, for example, a new mother. You may not get quality of sleep because you're sleeping a lot more lightly. So you can hear this new baby when it rolls over in bed. I know I didn't sleep well at all when I had infants in the house. And now that they're older, I sleep like a rock. Poor nutrition. I said in the last presentation, crap in equals crap out. If you eat junk food, you're probably not getting the proteins and the complex carbohydrates and the kinds of things that your body needs in order to fuel the processes that make the neurotransmitters and help keep everything running in your body. It would be like putting diesel into a gasoline-based engine. It just doesn't work. It's important to remember that vitamins are like spark plugs that help your body use the proteins and energy to make things like your neurotransmitters, serotonin, and your hormone melatonin, which is the one that helps you sleep. Again, think about an engine. You can have great gas in your lawnmower. But if the spark plugs aren't working, no matter how much gas you put in there, it ain't going to turn on. So you need to have vitamins, which come in like real foods. And you also need to have the energy. So good nutrition, I'm not saying fanatical, but good nutrition is really important in order to make sure that your body can use the good food that you're taking in. So if you're eating donuts and pizza for every meal, yeah, I might want to check that. Every once in a while, sure, I'm a big fan of both donuts and pizza. However, that's not something that you want to live on every day. Anemia. And there are a lot of things that can cause anemia. Basically, you want to look at your nutrition, make sure you're eating iron-rich foods, your green vegetables, your red meats if you're not against eating red meat. If you think you might be anemic, have your doctor do a blood test. Generally, they'll look at that when you go in for your annual physical. Not enough calories. And this kind of goes with not enough quality calories because you can eat 20,000 calories of potato chips and not have the vitamins and stuff you need in order to fuel the processes in your body. So that's one point, but not enough calories because there's a lot of people who are consistently or on and off on diets and they restrict their calories to the extreme. So they're not getting enough energy to fuel their body. You need to make sure your body has enough energy. A good nutritionist and some physicians are comfortable consulting with you on that, but a good nutritionist can help you figure out what your nutritional plan should be. Now I want to emphasize here that in most states and every state that I know of, but I haven't really researched it super in depth, but I know in most states providing nutritional prescriptions, nutritional advice is restricted to licensed or registered dietitians and licensed nutritionists. So personal trainers and people who have a certification from somewhere in nutrition, while they can provide you education, knowing what works for you and making a nutritional prescription really needs to be done by your physician and or nutritionist. I say that because I too often hear personal trainers and coaches making meal plans for people and that just can be so dangerous, especially if people have certain biological needs. Insulin resistance means your body doesn't process carbs like it should. And again, there's a fair number of reasons for that. A lot of that is because we eat highly processed foods. But this is something that if you tend to eat lunch and then shortly afterwards feel really crappy. You might want to talk the same thing with any meal, but you might want to talk to your doctor about whether you've become insulin resistant and if there's anything you need to do about that, because insulin resistance in some people can be a precursor to diabetes. So you want to check in on it sooner rather than later. But if your body's not processing carbs, which are your instant energy, if you will, then you're going to feel fatigued. So you need to make sure that if you give your body fuel, it can actually use it. Caffeine overload. Now, I am a huge fan of coffee, but I learned the hard way that too much caffeine for too long is not good. It causes your body to basically run on air when it's supposed to be running on energy. And you're artificially causing your body to run hotter or run longer than it's really supposed to because it's not and you're throwing everything out of whack. So cut back on caffeine and it's hard. It's not something that most people are going to do overnight. It's a weaning process. Again, you can get headaches, you can get all kinds of side effects from this, but you will probably find that if you're able to back off on your caffeine in a sensible way, that your energy levels are more constant throughout the day instead of being really high and then really low and then really high and then really low. So pay attention to that if you think that's an issue for you, something to consider working with your treatment team. Food allergies. Some people who have gluten intolerance or other food allergies find that when they eat those foods, not only do they get an upset belly, but they also feel extreme fatigue, partly because a lot of your nutrition is absorbed through your GI tract. And if it's all mucked up because of this food allergy, then you're not extracting the nutrition you need to from your foods. There can be a lot of food allergies. I would say start simple, talk to your doctor. Most doctors will tell you to do what we call an A-B test. Eliminate one food at a time if you feel better than keep it out of your diet. You know, that's going to be between you and a nutritionist and or your doctor. What you feel you can actually eliminate versus what you need to cut down on or modify in some way. Dehydration. You wouldn't think about it, but dehydration actually causes not only fatigue, but foggy head. One percent dehydration can actually cause you to have difficulty making decisions. Well, I drink plenty of fluids throughout the day, you might be telling me. Well, that's wonderful. But we need to look at those fluids. Since I haven't been drinking caffeine, I noticed when I go to restaurants for lunch that a lot of restaurants, everything they offer besides water often has either high levels of caffeine or high levels of sugar or both in them. And caffeine contributes to dehydration. So you don't want to go out and be drinking a bunch of caffeine and say, well, I'm hydrated. Actually, it's just the opposite. You just reduced your hydration even more. When I was little, I used to go out on the boat with my father. And that's a misnomer that a lot of people in Florida kind of get wrong. When they go to the beach or when they go out on the boat, they bring alcohol and diet coke or some other caffeinated beverage, both of which are diuretics, both of which will reduce your hydration. So when you have your normal 64 ounces of water, if you're even getting that much, that's great. But if you've had caffeine or alcohol, you need to drink more in order to read more water, not more caffeine or alcohol. You need to drink more water in order to compensate for that. Some people say a one to one ratio. So if you drink eight ounces of a caffeinated beverage, you want to drink eight ounces of water to go with it. Options switch to something decaffeinated. Look for options that you can bring with you to the beach or wherever you're going that will help you stay hydrated. Stress and anxiety also causes fatigue. Well, why partly because it impairs sleep. If you're stressed out, you're probably going to toss and turn and dream and have difficulty getting to sleep and all that kind of stuff. So what do you want to do? First thing is work on some distress tolerance skills. And there are other videos on that, so I'm not going to go into it super deeply. But basically distress tolerance skills help you take whatever stressing you out and kind of box it up and push it away for now. Realizing you may not be able to change it right now and helps you put yourself sort of in a different place through guided imagery. Or even just actually taking a little vacation, you know, getting out of the office for 15 minutes. Vulnerability prevention also helps with the sleep. Don't drink too much caffeine or alcohol before going to bed. Make sure you're getting enough sleep. Anything that contributes to your stress and anxiety is probably going to impair your sleep. So that's a vulnerability. You want to look at, OK, what things caused me to toss and turn or not be able to get to sleep? Let's start marking those off. If you know that you get on social media or if you go and start reading the news right before bed, it gets you all fired up. Guess what? Don't do it. Set another time during the day to do those things if you feel you have to do them so you aren't going to get yourself all worked up right before bed. Stress and anxiety also keeps you idling. If you're stressed out, you stay on this higher level of alertness, kind of like a car in idle. Have you ever watched your gas mileage? I'm obsessive about my gas mileage, but when you go through the city and if you have to sit at stop lights for a long time, you can watch your gas mileage go down because you're spending energy and you're wasting energy by sitting at those stop lights. So stress and anxiety are kind of the same way for your own personal energy and remember fatigue means there's no energy. So if you're using all your energy idling at stop lights to use this sort of analogy, then you're going to feel fatigued and you're probably not going to have the energy to do the things you want to do, which can be depressing. What can you do about it? Be mindful. If you find that you're stressed out throughout the day or even if you don't know, mindfulness means nothing more than checking in with yourself and I tell people to do it at mealtimes because we all eat before your meal. Check in with yourself and go, how am I feeling? Am I stressed out about anything? What can I do about it? What do I need right now? Pretty simple. It's not brain surgery. You don't even have to write it all down. Just do a check in with yourself and if you notice that you're stressed out about something, figure out what you can do to either fix it or box it up and put it on the shelf until you can do something about it. And purposeful action. Purposeful action means doing just that. Taking whatever's bugging you and saying, all right, I have only this amount of energy. How do I want to spend it? And is it worth using my energy worrying about this or trying to change something that can't be changed? Maybe you find out, and this is just an example, find out that your house was built 10 feet over the property line. Well, that could really stress you out and you could be all concerned about it. Not going to be able to move the house at this point, no matter how much you push your shoulder into it, no matter how many bulldozers you get. I mean, if you get bulldozers, you're probably going to destroy the house. So purposeful action means figuring out the best way to use your energy to deal with that problem and then doing it. And sometimes it's going to mean putting it on a shelf because there's nothing you can do about it at the moment. And worrying is not going to change the situation. If you get a, when you have to go into the doctor and they take tests or they do a biopsy on something, that's stressful for anybody. No doubt. And you can worry about it until those biopsy results come in 24, 48, 72 hours later. But did worrying change the results? No. Did worrying impair your sleep and use up energy that you could have been using to do something fun? Yeah. So understanding how you're using your energy, being mindful of how you're using your energy and choosing how to use it effectively. Staying with the energy analogy and fatigue when I drive, like I said, I am a freak about gas mileage. So being mindful when I'm driving, about when I push the accelerator and how hard I push it versus when I can coast. Because in Tennessee, we've got a lot of hills. You can get some good speed going. That's my purposeful action when I'm driving because I want to maximize my gas mileage. Stress and anxiety can also just lead to exhaustion and feelings of hopelessness and helplessness, which is, you know, your prime, prime symptom of depression. You know, if you're exhausted all the time and you don't have the energy to do the things you want to do and you don't feel like you ever will, that can be pretty depressing. Some things that you can do to address it, radical acceptance. You know, sometimes, like in the example of getting a biopsy, things are as they are and you've just got to accept that you're going to have to wait. Worrying about it's going to do no good. Calling the doctor's office every 30 seconds is not going to do any good. So accepting that things are as they are, it may suck. I'm not saying it doesn't, but there's nothing you can do to change it at the moment. So what can you do to improve the next moment, which is where purposeful action comes in? If you're worried, sticking with the biopsy example, if you sit around your house and you're not occupied doing other things, you may worry about it. So choosing how to use that energy instead, maybe go to a movie or get up and do something else or use some guided imagery. There are a lot of other things that you can do to help distract yourself until you can get the results and then use your energy to figure out how to address them if anything needs to be addressed at all. Insufficient or excess physical activity. A body in motion tends to stay in motion and a body at rest tends to stay at rest. That's one of Newton's laws, but the same thing is true with us. Like I said earlier, when I was on bed rest with my daughter, I felt achy all over and it was really, it seemed to get harder and harder to get up out of bed and do that kind of stuff, you know, even just daily activity, daily activities of daily living. The longer I was on bed rest and part of it was, you know, stress about, you know, what was going on, but part of it was just the fact that I wasn't moving and your body naturally kind of stiffens up. If you've ever had shoulder surgery or something, you know that they get you into physical therapy as soon as possible because they don't want your joints to quote freeze up. So they want you working through range of motion. Well, you've got a lot of joints, you got to move them. So if you're sitting too much, if you're laying in bed too much, you may actually get stiff. Now if you've got physical conditions. Pain chronic pain, anything like that before you start jumping out of bed and trying to exercise or do something obviously check with your doctor. But knowing, you know, looking at what's reasonable for you. If you've normally been a couch potato what's reasonable maybe simply getting up and Doing some stretching exercises or walking around in your yard, not even around the block walking around in your yard a little bit. So look at what's reasonable for you. Don't go from zero to 50 overnight. Ensure enough recovery time, especially if life is otherwise stressful. So if you're already working out great, but you can actually work out too much. I had a personal trainer tell me one time, your muscles are as recovered as they're going to be after 48 hours. Well, that's true if you're resting during those 48 hours for me, I lift on one day and then I do an endurance run on the next day. So my muscles are not completely resting. Now bodybuilders will like freak the freak out that I'm doing that because it prevents some muscle growth. There are a lot of different theories on fitness. But you want to make sure that your body has time to rest and repair. And I say that because even if you're just lifting three days a week or exercising three days a week. It may take you a little bit longer to recover if life is otherwise stressful. If you've got things that are keeping you from getting enough sleep. If you've just got a lot of stuff going on if you're spending a lot of time cleaning the house. You only have so much energy and you know we're just going to quantify it by whatever I'm holding right here. You've got to figure out how to use that energy and if you use some of it to work for working out great. Your body is going to have to use some of that for recovery and if you don't a lot. If you've got too much going on and your body can't a lot energy to recovery. It's going to take a little longer doesn't mean it's necessarily a bad thing, but you've got to listen to your body. If you don't feel like working out one day because you're still achy or something take it easier or maybe skip that day. That's going to be between you and your health team. Which takes us to chronic pain. Some people have chronic pain, fibromyalgia. They were in a car accident. They were injured some other way. And chronic pain can be frustrating because pain tells your body you are the weak link in the herd and you're probably the one that's going to be eaten by the lion. You know, if you want to go back to primitive times, your body hasn't kind of caught up with the fact that there's no lions anymore. So you tend to have more cortisol. You tend to have worse sleep if you are in pain. Now sometimes you can't get pain to go away completely, but there are things that you can do to address chronic pain with your care team. Talk with them about starting yoga. Talk with them about mild exercise or stretching. Massage or acupressure can be helpful for some people. Acupuncture can be too. That's a choice that you can look at. Guided imagery is another one that has been used a lot for people who are recovering from substance abuse issues who do have chronic pain. There are also medications out there. I obviously intentionally did not put those in here. But with the work of your multidisciplinary care team, if you've got chronic pain, you're probably working with a pain specialist and a physician and and maybe a physical therapist. It's important to talk about what your options are to help you feel the best. If your chronic pain is something that's short term, if you will, maybe you had shoulder surgery. I've heard it's six to eight months before the pain really goes away. That's chronic. So you might want to talk to your care team about how can I best manage my pain during the recovery period. The other one I want to talk about that causes fatigue is Lyme disease. Now some people mistakenly get diagnosed with chronic fatigue syndrome when they've actually got Lyme disease because you know, a lot of times we haven't talked about that, especially if you're not in an area where there's a high propensity of Lyme disease. And I got this infographic from the CDC where it's dark up here in the northeast is where you obviously have a whole lot more Lyme disease. And you also have some over here. However, Lyme disease antics have been moving slowly south and westward. So places like Indiana and Illinois and Ohio, Tennessee, Kentucky, Virginia are all seeing a lot more cases than they did back in 2010 when this infographic was created. So this is seven years later. It's about time for a new infographic. If you've been bitten by a tick or had a tick on you, whatever you want to call it, even if you don't still have that tick, which you may not. Maybe it was four or five years ago. Do a little research on Lyme disease. Not everybody gets the bullseye rash. Don't you love it when there's just not a definitive way to say whether it's there or not. If you have chronic fatigue type symptoms and you've been bitten by a tick, you can get a blood test to see if you're positive for Lyme disease. And there may be a different treatment course than you're currently on if they discover that that's the case. If you do get bitten by a tick now and you don't have chronic fatigue syndrome, do be aware that Lyme disease is out there and it's increasing in prevalence. What we do at our house is we pull it off, we put it, kill it, put in a little plastic baggie and then keep it on hand. And then if the bullseye rash develops or people start feeling flu like symptoms, we have the tick available because we're in an area where there's not a high rate of Lyme disease right now. So we don't necessarily go to the doctor every time we get a tick on us, but that's one thing that you can do. Hypothyroid can be biologically based. You may have thyroid disease. You may have something else going on. This is an easy thing for docs to test for from blood work and be able to work with you on. There are some nutritional cases of people not getting enough iodine. Because most places have gone to non iodine salt, they've switched over to sea salt. A lot of people are using sea salt and they don't eat shellfish and other food that's high in iodine. As I always say, don't supplement until you've talked to your doctor, because a lot of times the supplements way overdo how much you need. And that might not even be the issue. So talk to your physician ahead of time, make sure he or she knows if you're not using iodized salt and they can make a More educated judgment call from there, but iodine is needed to support the thyroid. So if you're not getting enough, then you may start experiencing thyroid issues. Hormone changes, especially related to estrogen and testosterone. Anyone who's had PMS can tell you what hormone changes can do to your energy levels. You know, I'm not a guy, so I don't know what low T feels like, but low T is also associated with fatigue. Easy to do a blood test to measure those kinds of levels, figure out what's going on. Now, low estrogen or low testosterone could also be symptoms of something else. So figuring out what's causing that condition in you is going to be important. Diabetes. Now, doctors don't exactly know why diabetes causes extreme fatigue in some people, but it does. So if you are from a family, if you have a high risk of developing diabetes, if you already have diabetes or you have hypoglycemia, it's important to be aware of how that's affecting your energy levels and make steps nutritionally or medically to take care of yourself as best as possible. Heart disease is another thing that causes fatigue. Your heart pumps your blood, your blood delivers oxygen through oxygenated cells throughout your body. If the ticker ain't working, if the pump ain't pumping enough, you may not be getting enough oxygen throughout your body and you may be feeling fatigued. This is one of the kind of least common causes of fatigue, especially in younger people, but it's one to be aware of. If you've got a family history of heart disease, if you are personally having a lot of risk factors for heart disease, it may contribute to fatigue. Another thing that contributes to fatigue is just plain obesity. If you are carrying a lot of weight, it can be exhausting. So there's something to be said, not only for heart disease and diabetes prevention, but also just to increase your energy levels so you can use that energy to do other things for, you know, reducing your body fat percentage to something that's in the healthy range. Poor sleep almost always causes fatigue, but fatigue is not always caused by poor sleep. Regularly feeling fatigued can cause feelings of hopelessness and helplessness, which a lot of people call depression. If you're feeling fatigued, not on your A game, you may, your body may perceive this as a threat and raise your cortisol levels because it doesn't want you to be that, you know, weak link in the group that gets eaten by the lion. As your cortisol levels go up, you probably will feel more irritable, burn more energy, constantly stay on a moderate alert state, which causes you to feel fatigued over time. Chronic stress can cause fatigue. If you're under stress all the time, you're probably idling almost constantly. It's important to understand that. What would that do to your gas mileage if you just left your car idling all day and all night? Yeah, it would go into the toilet. When a chronic stressor cannot be stopped, sometimes your body's just going to cut its losses and go, you know what, we're not going to be able to fix this. So it pulls back and there's a whole webinar that I did on the HPA axis and how the body responds to chronic stress. But basically the short version is if you've got a chronic stressor, eventually your body may just say, you know what, can't win this and pull back all your fight or flight energy and save it for another occasion, which can cause you to feel depressed. Addressing fatigue means looking at your whole body and your lifestyle to identify what can be causing your fatigue. So do an assessment for yourself and then take it to your doc, take it to your treatment team and go, this is what I've got going on. This is what I think might be contributing to it. Let them look at it because they were trained in it in their own specialties and they may have ideas on things you can do to reduce your fatigue, improve your mood and improve your motivation. There are some resources that you can look at to get more information about some of the things we talked about today. If you like this podcast, please subscribe on your favorite podcast app, join our Facebook group at docsknipes.com slash Facebook, or join our community and access additional resources at docsknipes.com. Thanks for tuning into happiness isn't brain surgery with Doc Snipes. Our mission is to make practical tools for living the happiest life affordable and accessible to everyone. We record the podcast during a Facebook live broadcast each week. Join us free at docsknipes.com slash Facebook, or subscribe to the podcast on your favorite podcast player. And remember docsknipes.com has even more resources, members only videos, handouts and workbooks to help you apply what you learn. 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