Spent?

Spent:
An Epidemic of Exhaustion

When the alarm rings, Emily groans and hits the snooze button. Lying there dreading the second ring, she feels dead on her feet before she is even on them. As she eases out of bed, she is aware of her stiff back, sore hips, and tight neck and shoulders. She shuffles to the bathroom to brush her teeth and, looking in the mirror, notices that her puffy eyes don't look as clear as they once did. Her hair and skin have become dull. She wonders if another cream or exercise regime might bring some life back into her. Then she heads to the kitchen for a bagel, a doughnut, maybe cereal with fruit and milk, or sometimes just a boost of caffeine. As she sips her coffee, she is assaulted with the daily TV or newspaper report of the latest tragedy, celebrity adventure, and clothes, cars, and products she should buy. Bolstered with caffeine, carbs, and sugar, or sometimes on an empty stomach, the daily scramble begins -- whether it begins with going to work or getting the kids off to school, there are a multitude of responsibilities facing her. She heads out the door already haunted by guilt over things that will be left undone. But she soldiers on, diving into a day that is sure to be spent at a frantic pace -- fending off and engaging with e-mails, phone calls, bills, employers and employees, children's schoolwork, family projects, and her husband's life.

Emily gets to work and her caffeine buzz might have her a little up, but an hour later she feels as if she has already been working for eight hours. Her thinking feels fuzzy. Her boss asks her a simple question, and even though somewherein her brain she knows she has the answer, she can't think of it. These days her memory is unreliable. And so is her ability to concentrate -- regular tasks take much longer to accomplish.

What does Emily do to deal with this debilitating combination of stress, fog, and fatigue? She does whatever it takes to get her through the day. She eats snacks full of sugar. She drinks -- more coffee or soda. She smokes. She takes a tranquilizer. She exercises. She calls her therapist to up her antidepressant. But none of these "fixes" seems to last very long -- a few hours or maybe a day. Maybe every once in a while she gets lucky and hits a combination that works for a week or so, but before she knows it, fatigue and stress are once again pounding on her front door.

At the end of the day, Emily drags herself home, too tired to take pleasure in her family, too beat to go out and enjoy the company of friends. In fact, just about everything feels like a chore these days. When the phone rings, it seems more like an imposition rather than an opportunity to connect. And nothing -- from a bath to a day off work -- seems to restore her. Things that used to energize her seem arduous or just supply a quick rush of adrenaline with no lasting sense of rejuvenation. And activities she used to enjoy -- even sex -- feel like too much effort. So Emily spends many of her evenings draped on her couch barely awake in front of the TV. Then, like a cruel joke, when it is time for bed, she can't fall asleep -- no matter how exhausted she is. Or, if and when Emily finally does fall asleep, she doesn't sleep soundly. The cycle continues. Instead of refreshed and alert, she wakes up the following morning feeling groggy and tired.

After a few months of this seemingly endless fatigue, unexplainable physical aches, and a few colds in quick succession, Emily decides to see her doctor. After running some blood and other diagnostic tests, he tells her there is nothing wrong. He says that she is just getting older and hands her a prescription for the latest anti-inflammatory pill. So she goes to another physician, who tells her that she has a "chemical imbalance" and perhaps a new kind of sleeping pill or a different antidepressant drug might help. When she tells him she has tried all these pills in the last few months and is actually feeling worse, he says she needs a vacation. But she knows something is not right even though both doctors give her a clean bill of health, and that's when she comes to see me. I tell Emily that I know what this bone-weary, awful funk is because I see it all the time -- and have been treating patients for it for more than twenty years.

Since I began practicing medicine in New York in the 1980s, I have noticed this alarming health trend. Despite being apparently disease-free and in the prime of their lives, people in their thirties, forties, and fifties have come to see me in disturbingly increasing numbers for help with similar complaints. An unbelievable 75 percent of the people I treat are overwhelmed, exhausted, and afflicted with this disorder that makes them feel decades older than their years. I call it Spent, because that is how you feel. You don't have enough wherewithal to live your life. You are running on empty. Your energy account is tapped out.

If you can identify with Emily's troubling picture and are wondering if you too are suffering from Spent, take this brief quiz.

ARE YOU SPENT?

1. Do you wake up in the morning and not feel refreshed?
2. Do you feel unusually tired most of the time?
3. Do you need coffee, soda, or sugary snacks to get going and keep going?
4. Although you feel physically exhausted, does your mind continue to race?
5. Do you feel as if you are aging too quickly?
6. Do you have gas, bloating, constipation, and/or indigestion?
7. Is it a struggle to lose weight in spite of dieting and exercise?
8. Do you have achy muscles and/or joints or tension in your body -- particularly your neck and shoulders?
9. Do you have a diminished sex drive?
10. Do you often feel depressed or have trouble concentrating and focusing and remembering things?
11. Have you found that little or nothing seems to rejuvenate you?
12. Do you lack motivation to accomplish even small tasks?
13. Do you find that you get sick more frequently and that it takes longer to recover?

If you answered yes to more than three of these questions, you are more than likely Spent. As the name suggests, you are burned out -- physically, mentally, and spiritually -- and you need help. If you don't address this problem, you will continue to suffer and probably begin to feel even worse. The good news: this book is here to gently and safely guide you to a healthier, more vibrant, and happier you.

There Is a Solution

Over the last two decades, I have developed a program that has revived many thousands of people who seemed hopeless. I've witnessed countless people who've been transformed from weak, overwhelmed, sick, and tired to energized, inspired, strong, and profoundly healthy. My patients repeatedly tell me that after they've followed this program, their friends and colleagues suddenly start asking them what exactly have they done that has made them look so good -- did they have a face-lift? Why are their eyes sparkling? Have they just returned from a great vacation? How did they lose weight?

Let me tell you right now, what you are feeling is not part of the "normal" aging process. Although you feel run-down and exhausted, it is within your power not only to make yourself feel better but quite possibly to feel better than you've ever felt. Moreover, this process of healing Spent is not as complicated and unpleasant as you might think. On the contrary, it is highly likely that once you incorporate this program into your life, you'll find so much to enjoy that you will become inspired and excited by your life. You might even end up inspiring others.

Getting Back into Rhythm

Each of us comes into the world endowed with essential energy. This energy operates as a kind of bank account and supplies us with the power to grow and regenerate ourselves daily. We are meant to supplement this original endowment of energy with what we can manufacture from eating, breathing, sleeping, learning, working, playing, and relationships. Each day we make withdrawals and deposits. But when the balance of the scales tips to our using more than we put back, we're in the red, with the prospect of getting further and further behind. Then we are forced to dip into our savings. When we continuously withdraw from our savings account, alarms begin to sound telling us that our survival is being challenged. These alarms are known to us as symptoms such as fatigue, apathy, depression, insomnia, brain fog, lowered resistance, stiffness, digestive problems, and signs of aging. These are our body's way of telling us that we are mentally, emotionally, and physically Spent. When we are Spent, our body is doing everything it can to tell us that it is time to slow down, rest, detoxify, repair, replenish, and restore.

Our bodies were not built to be sedentary or run marathons, exist on nearly no sleep, live without sun and nature, eat bizarre combinations of processed foods, or subsist on no-fat or no-carb diets. Nor were our brains wired to handle profound amounts of mental and emotional stress. We get Spent because our modern lifestyle has removed us from nature and we have become divorced from its rhythms and cycles.

We evolved over thousands of generations as beings who lived and worked in harmony with the seasons, and as a result these rhythms became imprinted in our genes. They are part of every aspect of our body's inner workings. Dr. Sidney Baker, one of the fathers of functional medicine, describes more than one hundred rhythms that form our internal body clock. This clock has what are called circadian rhythms, which reflect nature's twenty-four-hour cycle of day and night and govern most of our physiological processes. "Circadian" comes from the Latin circa, meaning "about," and diem, or "day," thus "about a day." Each rhythm influences a unique aspect of body function, including body temperature, hormone levels, heart rate, blood pressure, even pain threshold. Every system in the body is affected by circadian rhythms. And just as "official" clocks are set precisely to Greenwich Mean Time, our body clocks are set precisely to these natural rhythms. Science has shown clear patterns of brain wave activity, hormone production, enzyme production, cell regeneration, and other biological activities, each linked to these daily rhythms.

As Homo sapiens, we are physically and mentally designed to eat natural and seasonal foods from our nearby environs and exercise in spurts -- exert, rest, recover, exert, and so on. We are meant to have fresh air, sun, and water. We are built to sleep when the sun goes down and wake when it rises. And very few of us are living this way. Though I am not suggesting that everyone give up their homes and go live in a hut fashioned of sticks and mud, I firmly believe that if we don't move back in the direction of our genes, we will all ultimately end up Spent. In other words, we need to move back to our body's innate natural biochemical rhythms and genetic design because in our genes and biology we are still our ancient ancestors -- yet we are living at a pace and rhythm that are completely foreign to our genes and biology. Fortunately, when prompted correctly with natural light and good food at the correct time, the right supplements, appropriate exercise, and exposure to nature, our genetic clocks can reset themselves.

How I Discovered the Importance of Rhythm

Soon after I graduated from medical school in Johannesburg, South Africa, where I grew up, I began treating patients in the rural areas of KwaNdebele. Although it was only about two hours north of Johannesburg, the biggest city in South Africa, it was like being in the middle of nowhere. Despite facing the harsh realities of poverty-stricken lives, the people didn't present symptoms of insomnia, depression, or anxiety. Women would carry their babies on their backs all day, walking long distances with buckets of water or other heavy loads balanced on their heads, yet they rarely came to the doctor complaining of back pain or fatigue. In many ways, this community was healthier than the patients I was seeing at my other job in a private practice in one of the wealthy suburbs of Johannesburg. Sure, they had some disease (mostly from poor sanitation and untreated water) and came to the hospital with broken bones or pneumonia, but they did not suffer from fatigue, headaches, digestive problems, or the general aches and pains that my more sophisticated urban patients did. Since there was no electricity, people were forced to live with the rhythms of nature. Day and night dictated what was done when, and being synchronous with the seasons was essential for survival. Community, music, and dance also played an integral role in bringing rhythm into their lives. It was during my time with these people that I began to be aware of the importance of nature's rhythm and its powerful impact on our health.

I wanted to bring what I had learned about these healthy communities living in touch with nature and one another in KwaNdebele to my patients in Johannesburg, who were a lot like Emily. As a young clinician who had recently finished medical school, my training focused upon hospital-based patients who were acutely sick or critically ill -- heart attacks, acute asthma attacks, cancers, broken bones. These are the problems that Western medicine is designed to treat. But the subtle symptoms such as fatigue, anxiety, insomnia, and low-grade chronic complaints that I was seeing in my urban outpatients were not well addressed by my medical training. I found it very ironic that these vague complaints commonly expressed by urban patients were the very ones that conventional Western medicine does not have any good solutions for.

As I did not want to work in a hospital setting, I thought to myself, "There has to be a better way." I was trained to help people. I took the Hippocratic Oath, which declares, "First, do no harm." I felt that dispensing drugs was a quick fix, a Band-Aid solution that was not helping my patients in the long term and was potentially harmful. So I began what has become a lifelong journey to explore alternative methods to deeply, truly help people.

Soon after working in KwaNdebele, I emigrated to the United States. After doing the required internal medicine residency, I began a rigorous study of Chinese medicine, which turned my world inside out. Instead of symptoms being seen as something to suppress with drugs, they became a clue to some imbalance in the body -- a sign that the body was out of rhythm. Within this picture, the role of the doctor was to re-create balance and restore rhythm, which, after my experience in rural South Africa, resonated with me. This completely different philosophical outlook led me to a radically new way of regarding and treating the body.

I learned that with acupuncture, it is possible to unblock congestion and restore flow, reestablishing a healthy homeostasis or balance in the body. Initially, this was a hard concept for me to grasp. But as I worked with more patients, I saw the difference between people who were in rhythm and balanced and those who were not. People who were in rhythm had a stronger pulse; clear eyes; a clean, healthy tongue; clear, robust skin; and were focused yet relaxed -- they felt good, both to me and to themselves.

My Chinese medicine teachers taught me to see the body as a garden and myself, the doctor, as a gardener. When a plant is sick or not doing well, it is crucial to look at the environment in which the plant is growing: What is the quality of the soil? Is it getting enough nutrients? Does it have enough sun, water, and so on? Which is exactly how we are going to look at you in this book. As a creature of nature, you too need light, nutrients, and healthy soil to thrive.

On my journey, I also discovered functional medicine, where I learned about the importance of the environment and its effect on gene activity. I had been taught in medical school to think that your genes are carved in stone and that the diseases you get are determined by them. We now know that for the most part this is not true. The new science of epigenetics has shown that genetic activity is determined by your responses to the environment. In other words, how you live your life determines how your genes are expressed. You may have a genetic predisposition to a disease, but the environment you bathe your cells and genes in determines how those genes are expressed. This means that there are lots of potential versions of you. Whether you become Spent is determined by the unique way your genes interact with the many variables in their environment. So what you eat, how much chemical and toxic exposure you have had, what stresses you have tolerated, how you think, how much love you get, and how you move are critical. Like a computer, our cells, and therefore our organs, are programmable -- their health is determined by what information they download from the outside and what information you feed them.

In both Chinese medicine and functional medicine, I also learned that one could improve the functioning of organs. This concept was never addressed in Western medicine; you had either a healthy liver or liver disease -- nothing in between. Western medicine offered no ways to improve the function of the organs before they became diseased. In Chinese and functional medicine, one could use acupuncture, herbs, nutrition, supplements, certain breathing techniques, or exercise to improve the functioning of various organs as a means of treating and preventing disease. This meant that my treatments would not only provide immediate relief but also offer a lasting change for my patients. (To learn more about Chinese medicine or functional medicine, go to www.spentmd.com.)

But first I had to find the best means of merging all of these modalities -- my Western training, my Chinese medicine and functional medicine studies -- to foster enduring balance and rhythm. I became the ultimate guinea pig. Restorative yoga, interval training, alternative diets, juice fasts, supplements, tonics, meditations, dance, different types of bodywork, healing with music, and sweats were all part of my experimenting. You name it, and I've probably tried it. Out of this personal research as well as from the many thousands of people who have been helped through my work, I developed a comprehensive system for getting people back into rhythm -- and a more refined system for healing Spent.

Your Total Load

One of the most influential ideas I have come across in my research and that has shaped the way I practice and work with Spent is the concept of a person's total load. A person's total load is the total amount of physical, psychological, and environmental stress on his or her body. In the last thirty years, this total load on the human body has quadrupled. As I mentioned in my earlier discussion, our bodies were not genetically designed for this modern life load, making it much more difficult for us to stay healthy and avoid being Spent. On a daily basis, most of us don't get enough vital nutrients, sleep, or appropriate exercise. We sit too much, watch too much TV, and eat too much. And then there is the cocktail of hundreds of man-made toxins -- from our cleaning products to the products we put on our skin to the chemicals in our food and water. Our natural habits have shifted from living close to and in sync with the earth to coming in contact with and consuming quantities of warping ingredients, confounding our ability to cope successfully. In an endless variety of ways, we are distorting our natural genetic blueprint for living.

The buildup of these multiple assaults on our bodies adds to our total load until a tipping point is reached and we become Spent. Everyone's tipping point is different, and now you have an opportunity to tip the balance in the other direction.

Some factors that add to our total load are within our control (diet, lifestyle choices), while some are ubiquitous and out of our sphere of influence (plastics in our environment, the air we breathe, the stimuli we encounter daily). This book is about taking charge of what we can change and those changes acting powerfully to rehabilitate us. It's about maximizng our adaptive capacities and turning ourselves around. You can literally lighten your load.

Actually, the fact that we are not all Spent is really a testament to how extraordinary our bodies are -- their capacity to adapt and evolve. My philosophy is, if our bodies can adapt to this kind of toxic environment and survive, what would happen if we gave our bodies a garden to flourish in? Because there are so many factors that contribute to our total load and therefore our health and well-being, my program for healing Spent takes the gardener's approach: create -- from the soil up -- an environment in and around the body that will foster abundant health and growth. I look at the earth, the roots, trunk, limbs, encroaching weeds, lack of nutrients, potential poisons, water, light, air. And I make sure that everything going into and around the body is working to support your life and health. In this book, I will not only help you nourish yourself with the right food at the right time but also assess your physical activities and environment. I'll help you find ways to cope with the enormous mental and psychological stress that affects most modern lives. Even if we are doing everything right physically and dietwise, mental stress alone can bring on Spent. To calculate your total load, go to www.spentmd.com.

My program for healing Spent is a day-by-day guide to helping you regain your mind and body's natural rhythm. You will learn to work with your body's natural rhythms and not fight them. No matter how long your rhythms have been unbalanced, this is "a situation subject to change," as one of my patients says. No matter how sick you are, resetting and restoring rhythm is a completely doable -- and enjoyable -- process.

How We Will Work

Everyone's life is different. Everyone's body is different. And everyone heals differently. This is even more true when a person is Spent. A Spent body -- no matter what kind of body it is -- cannot endure quick, drastic changes, as this only throws the body even more out of rhythm. Rather than giving you an aggressive program of dos, don'ts, and shoulds, I am offering you a sane guide for how to heal over time. These suggestions are based on my almost thirty years of experience with Spent and patients like you, along with my constant engagement with the latest research and my relationships and conversations with some of the best practitioners around the world. The Spent program will help nudge you and your unique body back into rhythm.

Lao-tzu, the father of Taoism, said, "To attain knowledge, add things every day. To attain wisdom, remove things every day." This sums up my philosophy of medicine and is also a good way to look at and talk about treating Spent: removing and adding and adding and removing to help the body shift and find its natural balance and innate wisdom.

I've divided this book into forty-two digestible daily actions -- Daily Beats -- that will remove burdens from your body's total load and add things that will help your body heal more quickly and, most important, make you feel better. Over the course of the next six weeks, these Daily Beats will make the process of restoring your body and mind to their normal rhythm relatively easy. Some days we will remove, and some days we will add.

You may be wondering what exactly you will be removing and adding. Because Spent is multifaceted, we will be working to restore your mind and body from many angles, including sleep, diet, exercise, supplements, meditation, and relaxation. For instance, one exercise suggestion will be for you not to work out like a maniac. One relaxation suggestion is to listen to certain types of music, such as reggae or certain classical compositions. This kind of music physiologically entrains your body to slow down and relax. Dietwise, I will give you an in-depth preview of the eating program in the next chapter. But for now, know that I will be suggesting that you eat more whole, organic foods and cut out white sugar. This said, there will be absolutely no calorie or fat counting.

At the end of each of these Daily Beats, there is a Pulse section. This section is your backup, helping you integrate each suggestion into your life. Each suggestion will be repeated for a few days to help you find your pace. And then I will follow up a few times in the following days and weeks so that you can make this part of the program and healing your own. For instance, when I ask you to make a dietary change in the program, I will include that new change in the Pulse for several days in a row, to help get you started, and then I will give you a few days to play with it before I come back and talk about it again. After the Pulse, there is a Sleep Beat section, which is focused on your sleep life. How you sleep is as important as how you live during your waking hours. When we are Spent, one of our essential needs is sound sleep. These sleep recommendations will teach you how to improve your bedtime habits so that you will truly sleep like a baby. As with the Pulse, the Sleep Beat will remind you of new sleep tips for a few days and then give you a few days to explore and play with the suggestions before I ask you to think about them again.

Though I have organized these suggestions and sections for adding and subtracting into a six-week schedule, go at your own pace. If the program feels great, follow each beat by the calendar day. If you find you are getting overwhelmed, rather than giving up completely, stay on whatever day you're on, "shop around" a little in the book for something that looks as if it will feel really good, and stay there for a while. This said, I have been honing this system for years, and the add and remove days have been carefully calibrated so that you will not take too much out or add too much, thus taxing your body even more. This program is about relieving stress and restoring energy, not giving you more to do and making you even more exhausted. Listen to your life and body. For instance, if you get five actions done in a row and then have to go on a business trip or your child gets sick, do your best to adhere to the program, but don't be obsessive about it. Adhering to the eating program will be beneficial and, more than likely, easier. For instance, I will be asking you to give up caffeine for three or four weeks, which can be excruciating unless you do so in the suggested phases and with the other suggested actions to support your body and mind. And once you're off the stuff, you'll feel so much better that you will probably stay off it.

Healing Spent is as much about listening and paying attention to the ebb and flow of your life as it is about a specific diet or exercise. At first you might not even know what I mean by "listening to your body," but if you take the suggestions one day at a time, you will most likely find out that you can hear your own rhythm, the beat that your body and mind need to feel healthy and strong again.

Start where you are. Take an action. Listen. Pause if you need to. Come back to the work. Maybe begin again or start where you left off. The best results will come with effort, and that part is your responsibility. If you falter, don't use this as an opportunity to beat yourself up. Practice shrugging your shoulders and saying "oh well," and get back on the horse. In fact, if you learn only that, you'll be way ahead of the game. The results will come, you can be assured of that. Your body, mind, and spirit will heal. And you will soon be living in a healthy home again.

This process of returning to your natural genetic rhythm is not a thirty-day lose-weight, look-great-for-a-party trick. It is about making a profound change. A patient described how the process felt to her this way: it was as if her body were a glass of muddy water and every day we stirred it up, took out a teaspoon, and added a teaspoon of fresh pure water. Each day the glass became a little clearer, and eventually she had a glass of fresh, sparkling water.

In the words of Khalil Gibran, "You work that you may keep pace with the earth and the soul of the earth. For to be idle is to become a stranger unto the seasons, and to step out of life's procession." So let's get to work to get back into life's procession. And let's see what happens when you give your body a garden to flourish in and get its natural rhythm back. I think you will be astounded by how good you will feel before you are even halfway through.

Copyright © 2009 by Dr. Frank Lipman