Dr. Pedram Shojai

Episode Description:

Dr. Pedram Shojai addresses one of the most common yet dismissed complaints in modern medicine: chronic fatigue that conventional doctors can’t diagnose or explain. He reveals why standard medical tests fail to identify this multi-system breakdown and presents a comprehensive, phased recovery approach spanning 6-24 months. Drawing from his experience treating thousands of patients, Dr. Shojai explains the seven interconnected systems involved in energy production—from mitochondrial function to gut health to nervous system regulation—and why treating just one piece never works. This episode provides specific interventions for each recovery phase, realistic timeline expectations, and testing recommendations to help listeners systematically rebuild their energy from the ground up. If you’ve been told “everything looks fine” while feeling bone-deep exhaustion, this roadmap offers the answers conventional medicine can’t provide.

Listen to the episode on Spotify here or on your favorite podcast platform and check out the Urban Monk Academy here.

Podcast show notes:

Introduction: The Invisible Illness Epidemic [00:00:00]

• Fatigue as the number one complaint backing every chief complaint in medicine
• The difference between “I’m tired” and bone-deep, soul-crushing exhaustion
• Why waking up more tired than you went to bed signals something deeper
• The devastating cycle: normal test results but profound dysfunction

Why Your Doctor Can’t Help You [00:04:00]

• Conventional medicine’s focus on single-system pathology and disease states
• The problem with “normal” lab values (bottom 10% of normal still feels terrible)
• Battlefield medicine origins: designed for acute conditions, not chronic dysfunction
• The fundamental limitation: tests are measuring the wrong things

The Seven Systems of Energy Production [00:05:00]

System 1: Mitochondrial Function (Cellular Energy) [00:06:00]

• Mitochondria as cellular power plants producing ATP
• Signs of dysfunction: exercise intolerance, post-exertional malaise, muscle weakness
• Common causes: chronic inflammation, nutritional deficiencies (B vitamins, CoQ10, magnesium), oxidative stress, environmental toxins, chronic infections (Lyme, COVID)
• The “revving engine in a closed garage” analogy of oxidative stress

System 2: HPA Axis (Stress Response) [00:08:00]

• How the hypothalamic-pituitary-adrenal axis regulates cortisol
• Classic pattern: low morning cortisol, high nighttime cortisol
• Symptoms: can’t handle minor stress, blood sugar instability, waking between 2-4 AM, “wired but tired”
• Root causes: chronic stress, poor sleep, blood sugar imbalances, inflammation

System 3: Thyroid Function (Metabolic Regulation) [00:09:00]

• Thyroid hormones as the body’s “Federal Reserve” for metabolic rate
• Signs of dysfunction: cold intolerance, weight gain despite calorie restriction, hair loss, constipation, brain fog
• Why TSH might be normal but you still have problems:
  • T4 not converting to active T3
  • Elevated reverse T3 (brake pedal stuck on)
  • Thyroid receptor resistance
• Standard tests miss these crucial markers

System 4: Gut Function (Nutrient Absorption & Inflammation) [00:10:00]

• 70-80% of immune system lines the gut
• Gut as the production site for neurotransmitters (90% of serotonin)
• How dysfunction manifests: nutrient malabsorption despite good diet, chronic inflammation from leaky gut, neurotransmitter depletion
• Number one or two driver of brain fog
• Common culprits: dysbiosis, SIBO, parasites, low enzymes, low stomach acid, food sensitivities

System 5: Sleep Architecture (Recovery & Restoration) [00:11:00]

• Deep sleep for physical restoration
• REM sleep for emotional processing and memory consolidation
• Non-restorative sleep: spending hours in bed without actual recovery
• Contributing factors: inflammation, blood sugar crashes, mistimed cortisol, undiagnosed sleep apnea
• The vicious cycle of robbing Peter to pay Paul with caffeine

System 6: Inflammation (The Master Disruptor) [00:13:00]

• Acute inflammation heals; chronic inflammation destroys
• How elevated cytokines cause “sickness behavior”
• Direct effects on mitochondrial function and all other systems
• Sources: gut dysfunction, food sensitivities, chronic infections (Epstein-Barr, Lyme), toxin exposure, chronic stress

System 7: Nervous System Regulation (Stress Capacity) [00:14:00]

• Sympathetic (fight or flight) vs. parasympathetic (rest and digest) balance
• Getting stuck in sympathetic overdrive: hypervigilance, anxiety, poor digestion, inability to restore
• Root causes: physical or emotional trauma, chronic stress, poor vagal tone, inflammation affecting the brain

The Cascade Effect: Why It’s So Difficult [00:15:00]

• How systems interact and failure cascades
• Example pathway: Chronic stress → cortisol dysregulation → poor sleep → increased inflammation → gut dysfunction → nutrient malabsorption → mitochondrial dysfunction → profound fatigue → more stress (completing the vicious cycle)
• Why single interventions fail: you can’t fix it all in one place
• The magic word is lifestyle

Urban Monk Awareness Training: Reading Your Energy State [00:16:00]

• Interoception: Sensing inward—where do you feel fatigue? What’s the quality (heavy, depleted, wired, numb)?
• Proprioception: How you feel in space—posture, muscle tone, ease of standing
• Exteroception: External senses and sensory tolerance—lights too bright, sounds overwhelming
• Key insight: Your body knows what’s wrong; the question is whether you’re listening with enough sophistication

The Recovery Framework: Four Phases

Phase 1: Stabilization (Weeks 1-4) – Stop the Bleeding [00:18:00]

Goal: Stop making things worse and create baseline stability

Priority 1: Sleep Architecture

• Same sleep-wake time even on weekends
• Basic sleep hygiene: dark, cool, quiet environment
• No screens one hour before bed
• Magnesium glycinate 300-400mg before bed
• Short-term sleep support if needed (work with practitioner)
• Critical foundation: Nothing heals without sleep

Priority 2: Blood Sugar Regulation [00:19:00]

• Eat within one hour of waking (include protein)
• Never go 3-4 hours without eating
• Protein with every meal or snack
• Eliminate refined sugars and processed carbs
• Quickest way to stabilize cortisol and energy

Priority 3: Reduce Inflammatory Load [00:20:00]

• Remove obvious triggers: processed foods, seed oils, refined sugar
• Eliminate gluten and dairy for at least two weeks (test response)
• Add: bone broth, wild-caught fish, colorful vegetables
• Proper hydration
• Consider gut permeability and food sensitivity testing

Priority 4: Nervous System Support [00:20:00]

• 10 minutes daily breathing practice
• Qi gong and meditation
• Gentle movement only (tai chi, gentle walks)—no intense exercise yet
• Vagus nerve activation: humming, singing, cold water on face, diaphragmatic breathing, vagus nerve stimulators

What to Track Daily:

• Morning energy (1-10 scale)
• Afternoon energy (1-10 scale)
• Sleep quality
• Digestive function (gas, bloating)
• Brain fog
• Stress resilience (saying yes to events you’d normally decline)

Expected Results by Week 4: 10-20% improvement in baseline energy (this is huge and statistically significant)

Phase 2: Foundation Building (Weeks 5-12) [00:22:00]

Goal: Address root causes through testing and targeted interventions

Functional Medicine Testing to Consider:

• Comprehensive thyroid panel: TSH, free T3, free T4, reverse T3, thyroid antibodies
• Cortisol awakening response: 4-point salivary cortisol throughout the day
• GI Map: comprehensive stool analysis
• Oral Biome: comprehensive oral microbiome analysis (cross-correlate with gut)
• Gut permeability and food sensitivity testing
• Nutrient status: RBC magnesium, vitamin D, B12, iron panels
• Organic acid tests: mitochondrial and neurotransmitter function

Mitochondrial Support [00:24:00]

• CoQ10: 200-400mg daily
• B-complex: high quality, methylated forms
• Magnesium: continue from Phase 1
• Alpha lipoic acid: 300mg daily
• L-carnitine: 500-1000mg daily (supports muscle building and mitochondrial function)

Gut Healing:

• Multi-strain high CFU probiotics as needed
• Digestive enzymes if low
• L-glutamine for gut lining repair
• Bone broth daily if possible
• Address specific issues: parasites, SIBO, mast cell activation, histamine intolerance

HPA Axis Support [00:25:00]

• Adaptogens: ashwagandha, rhodiola, holy basil, ginseng
• Continue blood sugar stabilization
• Stress management practices (not just meditation—full lifestyle integration)
• Phosphatidylserine for high nighttime cortisol
• Gentle yoga and Qi gong in evenings

Expected Results by Week 12: 30-50% improvement

• More stable energy
• Fewer crashes
• Better resilience
• Remember: 12 weeks ago you were in terrible shape—don’t expect 100% yet

Phase 3: Building Capacity (Weeks 13-24) [00:26:00]

Goal: Gradually expand your window of what you can do without crashing

Progressive Challenge Approach:

• Slowly increase activity duration and intensity
• Track responses carefully every 24-48 hours
• Capacity builds at 10% at a time, not 100%
• Patience is critical—rushing causes relapse

When to Add Advanced Interventions:

• Cold plunge
• Time-restricted eating
• Advanced breathwork
• DON’T add these until Phase 2 is solid

Strategic Exercise [00:27:00]

• Mitochondrial biogenesis through short intervals
• Resistance training starting with light weights
• Continue building mitochondrial capacity
• Gradually expand nervous system stress capacity

Key Mindset: Your body is like a child that’s been abused—it’s waiting for the next thing to crash it. It doesn’t trust you yet after 50 years of being run ragged. Build slowly.

Continued Focus:

• Build vagal tone
• Community and social connection engagement
• Continue addressing gut issues and bringing down inflammation

Expected Results by Week 24: 60-80% back

• Still not “normal” but dramatically improved
• Realistic assessment after treating thousands of patients

Phase 4: Optimization & Sustainability (Months 6-24+) [00:28:00]

Goal: Fine-tune, optimize, and personalize for long-term thriving

Deeper Investigation:

• Peptide therapy
• Hormone optimization
• Advanced interventions and “fancy cocktails”
• These become relevant once you’re 60-70%+ recovered, not at the start

Long-term Success:

• Energy management becomes a lifestyle
• You’re no longer recovering—you’re thriving
• You know your limits and honor them
• This becomes your sustainable new normal

Key Takeaways

• Chronic fatigue is a multi-system breakdown that conventional medicine isn’t designed to see or treat
• Just because standard tests can’t find it doesn’t mean it’s not real
• Recovery is possible but requires 6-24 months of systematic work
• You cannot rush this process—rushing causes relapse
• The magic word is lifestyle: all systems must be addressed
• Testing is crucial for targeting specific dysfunctions
• Your body knows what’s wrong; learn to listen with sophistication
• Start with Phase 1 (stabilization) before moving to advanced interventions
• Expect realistic improvements: 10-20% by week 4, 30-50% by week 12, 60-80% by week 24
• You are not broken—your system is depleted and dysregulated, and that can be healed

Community Insights [00:29:00]

• Gina’s success with FIT 176 test revealing bloating causes and identifying overtaxed pathways
• Dr. Shojai’s personal experience: eliminated egg yolks, beef, honeydew, almonds based on testing six months ago
• Six months later, most issues resolved except almonds (kept eating them by mistake)
• Quantifiable energy improvement after removing identified food triggers
• “That is energy 101”

Announcements

• Content calendar to be posted after the holiday showing upcoming topics
• Gene Keys book reading planned for end of January (not too late to get the book)
• Find book reading information in left-hand column under “monthly book readings”

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RESOURCES MENTIONED

Testing:

• FIT 176 (Food Inflammation Test)
• Comprehensive thyroid panel
• 4-point salivary cortisol test
• GI Map stool analysis
• Oral Biome analysis
• Gut permeability testing
• Food sensitivity testing
• Organic acid tests

Supplements:

• Magnesium glycinate (300-400mg)
• CoQ10 (200-400mg)
• B-complex (methylated forms)
• Alpha lipoic acid (300mg)
• L-carnitine (500-1000mg)
• L-glutamine
• Probiotics (multi-strain, high CFU)
• Digestive enzymes
• Adaptogens (ashwagandha, rhodiola, holy basil, ginseng)
• Phosphatidylserine

Tools:

• Vagus nerve stimulators

Books:

• Gene Keys (upcoming book club reading – end of January)

Dr. Shojai’s Content:

• Interconnected documentary
• Gut Check documentary
• Gateway to Health
• Temple Grounds practices
• Urban Monk training
• Recent podcast on mitochondrial function with Dr. Sherr

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HASHTAGS

#ChronicFatigue #FunctionalMedicine #EnergyRecovery #GutHealth #MitochondrialHealth #HolisticHealth #RootCause #Fatigue #HealthOptimization #ThyroidHealth #InflammationReduction #SleepOptimization #HPAAxis #StressManagement #FoodSensitivities #LeakyGut #Microbiome #VagusNerve #ChronicIllness #InvisibleIllness #HealthJourney #WellnessWarrior #HealingJourney #NaturalHealth #IntegrativeMedicine

This episode is for educational purposes only and not intended as medical advice. Consult with qualified healthcare practitioners for personalized guidance.

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