Dr. Amy Shah, I'M SO EFFING TIRED
“Fixing fatigue is not about doing less. Look, we did less during this past year, and we were more tired than ever. It’s not about doing less. It’s actually about doing more of the things that actually recharge you.” Double board certified doctor Amy Shah, MD, talks with Zibby about how she set out to fix the burnout she felt in her own life after a life-threatening car crash and why she wants to offer what she’s learned to others. Amy explains how to find time to recharge during the day, implement small calming rituals that only take a moment, and protect yourself from energy-suckers.
Transcript:
Zibby Owens: Welcome, Amy. Thank you so much for coming on “Moms Don’t Have Time to Read Books.”
Amy Shah: Thank you so much for having me. This is so my life. I’m a mom, and I don’t have time to read books.
Zibby: Your title is also just perfection, I’m So Effing Tired. It’s the most perfect title. It just completely encapsulates how we all feel and at least makes me feel like I’m a little bit less alone in that.
Amy: When I first looked into the data on it, I was so shocked to see that so many of us are feeling like this. It’s almost not talked about much. We talk about a lot of other topics for women, but we really don’t talk about this real fatigue and burnout epidemic as it relates to food and lifestyle and habits and mindset and things like that.
Zibby: It’s so true. First of all, you’re a double-certified, amazing doctor. Craziness. Amazing. I’m so in awe. My brain just does not work that way, so whenever I meet someone with that capability…
Amy: Part of it is just our lives. Part of it is what we are asked to do. I think you’ll appreciate this. When I was in medical school and trying to get into medical school, I was really busy and I was tired, but I wasn’t to the point where I was having anxiety and mood changes and GI symptoms and burnout symptoms. I think the really big thing that changed was children. Having children put on a backpack of responsibility and expectation that I had never had before. I start the book talking about trying to excel at all of it. I had a new practice handed to me. Meaning, they were just like, here Dr. Shah, this is going to be your baby. You have to grow it as a physician on your own. I literally was like, oh, my god, I don’t know how to grow anything. I’ve never run a business before. Then I had these two little rug rats who were so beautiful, but they would literally be in my mind at all times, especially when I wasn’t with them.
I would be thinking, I’m not a good mom if I don’t constantly think about how I can make their lives better. They were really little at the time and really dependent on us to help. I had called up my parents for support. We had help. It still was overwhelming. Basically, that’s when I really felt the symptoms of burnout, fatigue to the point where I thought this was unsustainable, but I couldn’t stop. It was this train I was on, that we all are on. We know something’s off. We know something has to change. We don’t know how to pause or how to change it, so we just keep going. That’s what I did until I got into a very life-threatening car accident that forced me to pause because I couldn’t go to work. I couldn’t take care of my children. I couldn’t do any of the things that are on my to-do list. That really changed everything for me because I said, wow, I need to do something. I need to fix this problem. As I fixed it, I failed a ton. A few things that I found that worked for me, I share in the book.
Zibby: All your advice with eating, it doesn’t seem like it would be that hard to follow. I’m like, but I don’t really know that I want to eat those leafy greens. Those aren’t my favorite foods. What about all the sugar that I eat? It seems very easy to follow. I love your plan, but I feel like I internally have such resistance to adopting it. I’m sure you face this from people all the time, right? What do we do?
Amy: People keep asking me, what’s the magic pill there? If we can’t do all these things, what is the pill that we can take that can kind of replace all of that? I get it because I wish there was too. I wish there was a pill that could replace all of the greens and the fiber that we need to take. Honestly, if you automate it — Zibby, that’s what I did. I started to automate at least my vegetable intake a little bit. I still have days I struggle. Same with my circadian fasting. I started to build a life that just included those things. Then it doesn’t become as big of an effort anymore.
Zibby: Tell me a little about this high-cortisol state. I feel like I must have that one. I live a life of stress. Tell me about the effects of basically always making too much cortisol and living like you’re under the gun all the time and the detrimental long-terms effects of that. By the way, are they reversible, or am I doing permanent damage to myself?
Amy: I know, a multipronged question. If you think about it, even a hundred years ago there were many practices built into our culture to kind of counteract some of those stressful days in religion or cultures and how life used to be for women and for men. There were built-in moments of parasympathetic activation, which means our rest and relaxation mode. Now we’ve basically taken that all out because we say we have to be productive all the time. We have twenty-four/seven access to computers and phones, and so you could be working all the time. We’ve lost these habits that used to counteract the cortisol. That’s why we are in such a bad place. For example, a person like what you’re describing, when you have so much stress all the time, when it approaches night, your body actually becomes really sensitive to light and to food and to stressors. It’s thinking, is there a danger for Zibby right now? Should I just stay awake because she’s running from a tiger? That’s how our bodies are wired. She’s very stressed. If it senses that you’re really stressed, that you’re looking at bright lights, that you are giving the signal of danger to the body, the body will be like, okay, I’ll stay awake. We’re not going to start the repair and renewal processes. We’re going to just focus on getting blood flow to your legs, to your heart so it can beat faster, and to the part of your brain that you need just to focus on safety.
Then what happens is Zibby can’t sleep. She feels like her heart’s beating really fast. You’re feeling anxious. You can’t think clearly. Don’t even ask us a complicated problem because our brain is only hyperfocused on the tasks at hand. You basically cannot sleep. You didn’t get the repair and renewal processes that you needed for your hormones and your gut and the rest of your body. You wake up. You’re exhausted. You’re anxious. You basically told your body that it was too dangerous to fall asleep. That makes sense. We as a human species, we’re built to protect ourselves from danger. That’s why in high times of stress, I’m sure you had it with your book launch, your body can’t tell the difference between a tiger endangering you and a deadline or a big book launch where you’re expected — we interpret those things as dangers. Our brain does. Our hormones stay in cortisol-crazy mode, which makes us exhausted. It depletes our body’s ability to restore our other hormones.
Why do people have all these thyroid issues? Then their cycle’s completely off. It’s because it affects all of it. To add insult to injury, women are especially sensitive to stressors. We have this hormone in our brain that’s pulsating. It’s called GnRH, gonadotropin-releasing hormone. That pulse stops when there’s a lot of danger in your life or stress in your life, whether it’s exercise stress, whether it’s emotional stress. When that pulse stops, the entire hormonal system pauses. There’s no ovulation that month. That means that a lot of women will skip their period. That means that they will have symptoms of hormonal imbalance because your GnRH was like, whoa, I need to pause this because there’s a lot of stuff going on that we need to tend to. We think it’s because our body’s protecting us from getting pregnant during a time of severe stress. You can imagine during a severe famine or during a severe drought or during a severe war, the body’s protecting you from being fertile. In turn, even if you weren’t trying to get pregnant, you have the fallout from that.
Zibby: Wow. I actually haven’t heard infertility described in that way. That’s essentially what you’re saying. That’s so interesting. Okay, digesting all of that. As you mentioned in your book also, you talk a lot about the impact on mood because it’s so inextricably linked. Of course, any woman knows, with your hormones, that can throw your mood off a hundred percent every month or whatever. In fact, in your book there was this quiz which now I feel like has changed my entire marriage. I was sitting there with my husband. I was like, “Let’s do this quiz together. On a scale of one to ten, how would you say your mood is?” He’s like, “I’d say my mood’s a five all the time,” the top of the — I was like, “Really? I don’t think I would put your mood that high.”
Amy: That’s the problem with the culture that we live in right now. The culture we live in is like, you work so hard and you’re rewarded by saying — you’ll say, I have worked so hard that I can’t even sleep. I’m so stressed that I can’t even do the things. People are like, wow, that’s so great. In your mind, you’re like, I’m doing a great job. Then you burn out. Say you go to a quick vacation, a weekend away, a spa day, whatever it is. Then you come back to this insane life again. There is this thought that you can just take a day off here and there when you’re burnt out. What I am challenging people to do is fix your daily life. Fixing fatigue is not about doing less. Look, we did less during this past year, and we were more tired than ever. It’s not about doing less. It’s actually about doing more, more of the things that actually recharge you. When our cell phone is low on battery, we don’t just use it less. You put it on the charger and you recharge it. You do the things that you need to do because you know that if you leave it on low battery and just use it less, that’s really not the way to get that battery back.
The same thing, we cannot just say, oh moms, just rest a little more. Just figure out a way to do less. That actually is worse advice. It’s the opposite. Do more of the things that give you that energy and fire, and recharge from inside. That’s the key. Just like you said, it’s not about drinking the smoothie and working out. It’s about creating spaces in your day, in your week, in your month, in your life that actually bring you joy, that recharge you, that put your body in this parasympathetic mode, which is our more relaxed, creative mode, which can be done in various ways. Build that into your life. That’s why I give tips. I understand that’s very cerebral. People might be like, what are things that would actually do that for me? That’s why I talk about maybe going for a nature-based workout in the morning and giving your body some natural sun that basically tells the body it’s daytime, it’s time to be energetic, it’s time to think complex tasks, and tells your metabolism, time to get to work. You get all these benefits, not only mood boosting and also relaxing, but also helps with your circadian rhythm. Building in these small things throughout the day can really, really help. If you could do one thing, that’s what I would suggest.
Just go outside in the morning. If you have time for a walk or a twenty-minute workout, great. Otherwise, just spend a couple of minutes out there. Reflect on your life, on your energy. Do a prayer. Do humming. In fact, humming, the word Om, the hum at the back of that is known to activate the parasympathetic system. These sages thousands of years ago, when they picked these songs and these hymns — if you look at most religions across the world, there’s a form of humming. That’s a way to activate the vagus nerve and counteract that stress mode that you’re talking about. If you’re like, hey, how do I counteract that stress mode? There’s two easy ways. One is hum. It could be Om. It could be a humming song. It could be just humming. The second one is to do this slow exhale out. The slow exhale out is often also called the physiological sigh. It’s a way for us to counteract the stress in our body, the stress hormones. Doing a few slow sighs out — you breathe in, breathe out — that would be something super easy you could do outdoors in the daytime, get some sunlight, and go on with your day.
Zibby: I’m going to add one thing to that. You tell me if it counts. When you were describing it, that is what I get when I do podcasts. I have little thirty-minute things that I sprinkle throughout my days where I sit. I’m not running around. I can relax. I can chat. I use my brain. I use my creativity. That is how I recharge. People ask me, where’s your energy from? How can you do all these podcasts? I haven’t been able to articulate some of the benefits, but that’s just it. This is how I recharge, but ironically also how I lose energy because of all the associated work.
Amy: That’s a great way, doing creative work, whatever that is. Art, dance, singing are all amazing ways. Like I said, these were built into cultures, into lives. Now it’s considered play. Really, that’s supposed to be part of human life.
Zibby: Wow. What does your human life look like? How did you fit in writing a book on top of everything else? How do you get everything done? When do you do it all?
Amy: Great question. I’m a mom just like so many of us are. I’m busy. I’m a doctor. I have a clinical practice. I’m super into fitness and nutrition, as you know. The way I did it was that, for me, writing was my creative outlet. When I was healing myself from this intense burnout and I knew I had to do something, I actually started reading and writing more. I had to search deep inside. Everybody has to do this work themselves. What is it that gives you that recharge? It doesn’t have to be the same as someone else. For me, it was creative. All this time, I had been so interested in nutrition and health. I felt like in my clinical practice, I wasn’t able to use it in that creative way. I was feeling really almost stunted in what I thought I could offer. The best thing ever happened to me. When I was healing myself, I was in the car listening to a podcast, “The Rich Roll Podcast.” I don’t know if you’ve ever heard of it. It’s a health and wellness — it had just started. I had read his book, Finding Ultra. I was just listening to his podcast. He had Jason Wachob, who was the creator of mindbodygreen, on the podcast. This was almost ten years ago. He said, “Anyone who is anyone in wellness or interested in wellness would know mindbodygreen. Jason, you’re accepting submissions, right?” Jason said, “Yeah, we’re accepting submissions from any listeners in the health and wellness world.” That day when I got to work, in between patients — I had been writing here and there for fun. I just created a blog post. I submitted it.
Lo and behold, about two days later, I got a message. It was a really simple email. It was like, “Thanks for your submission. This is a cool post. We’d like to post it.” For me, it was this permission. Okay, my creative outlet can reach more people than just my personal diary. I started to write more and write more. I was submitting a few posts a week every single week. That was my outlet. That’s how I basically stumbled upon this whole social media world, this wellness world. At some point, they were like, “Hey Dr. Amy, people are asking how to get in touch with you, but all we have is your phone number, your email, and your practice information.” I went on Google like a lot of people do and I learned, how do you make a website? Then that’s how I started into this world. It wasn’t until just a few years ago that I actually entered the social media space because I realized that would be a really nice way to send out smaller messages than blog posts would do. That’s how I got to writing my book. The daily grind of it was insane. I basically had to really lean upon the things I had learned through my burnout journey. What I do is I sat a very strict morning and evening routine. I automate at least two of my meals.
Zibby: What does that mean?
Amy: Automate means I picked something I really love, and I have it every day over and over and over again. It’s not like automating in the sense of you’re eating from this portion-controlled Tupperware that’s full of broccoli and chicken. No. What I’m talking about is picking something you love. For me, it’s a series of things that I love to eat in the morning that make me feel good, that are healthy enough but also tasty. I don’t like to give too many instructions, but you want to get to the point where you’re eating something that’s good for you but also slightly enjoyable, but not enjoyable so much so that you would eat a whole box of it. Don’t pick a donut as your automated if that’s a trigger food for you.
Zibby: Like oatmeal or something?
Amy: Yeah, oatmeal’s great. I love berries and nuts or a smoothie, chai. I basically do this concoction of things that I take every single day with me to work. I fast overnight. Say I start a fast at seven PM. Then seven AM, I’ll go for a workout. Then around eight thirty or nine, I will have my first meal. That’ll be automated. Usually, I automate that plus my lunch meal, which again makes it easy. It’s nourishing. It’s enjoyable. On weekdays, it works. On weekends, I kind of let it go. I keep a semblance of a morning and evening routine no matter where I am or what I’m doing. It was easy during pandemic because we weren’t going anywhere. Before that, even if we’re traveling, I would make sure that I would do a semblance, meaning like a mini version, of the morning and evening routine every day.
Zibby: I love that because then you don’t have to waste the time thinking about it.
Amy: Exactly. Automate as much as possible. I wear the same clothes to clinic every single day. Not the same physical clothes, but the same outfits.
Zibby: Yes, cut time out of your life by not doing the laundry, says Dr. Shah.
Amy: I have a set of five things that I wear every single week. That, to me, feels freeing. I don’t have to think about what I’m wearing. I wear a white coat, like a lab coat, in my clinic. It kind of frees up what you wear underneath. I just basically make it fitness wear. Just like so many moms, I’m running from one thing to the next. I want to always be ready for a workout even if I’m not going to be doing a workout, just in case. I wear really comfortable shoes. I felt like, for me, for some reason, my energy was being sucked. When I examined my life, so much of my energy was being sucked out from wearing clothes that were uncomfortable and shoes that were uncomfortable. I was like, well, I wear a lab coat. I can wear any shoes I want. I don’t understand why I have this idea in my head of what I should be looking like when it’s really up to me, what makes me happy, and what energizes me. I chose to really build in things into my life that actually make it recharging, to take out the time and energy-suckers. I talk about even the people in your life, not just activities or foods or clothes. There’s people. If you examine your life, you’ll find people that are constantly sucking the energy out of you. You control your life and your energy and your time. Maybe you start to push those people to the periphery and you bring other people into the center. This is your room. You get to control it.
Zibby: So you’re saying I can take one of my four kids and push them out.
Amy: They can be at the periphery.
Zibby: Yeah, right. Energy-sucks, no, but they give me so much joy. I’m just kidding. Obviously, I love my kids.
Amy: Obviously. There are people who message me. They’re like, my whatever, mother-in-law or mother, whatever it is — what I say is it’s not this combative thing where you’re going to go up to them and say, I hate you and I don’t want your energy. It’s not like that. Say it’s your mom or your mother-in-law. You in your mind decide that you’re not going to engage with the negative conversation or the things that really bring you down. You get to control how you interact. Maybe you only focus on subjects that are neutral. Maybe you remove yourself from situations where it’s uncomfortable or draining for you. You don’t have to be a martyr for every single person on this planet. Setting up boundaries was something that I’ve learned. I didn’t know that they were called boundaries until recently with social media. I was like, oh, yeah, that’s what I’ve been trying to do all these ten years when I was trying to fix my burnout, put up boundaries with people, with things so that I can save a little bit for the work that I want to do.
Zibby: At least for me during the pandemic, it became very clear, the people who I wanted to keep in close touch with and those who maybe weren’t as additive as I had thought. It shined a spotlight on some of those relationships that I hadn’t taken time to really think through before and how to best manage it. Amazing. What’s coming next for you? You’re so busy all the time, I know. I will look for you at every workout class I ever go to from now on.
Amy:
Zibby: Amazing. Sorry, I think I’ve said amazing like twenty times because everything you’re saying, I’m just like, yes, that resonates with me too. Yes, that also. Sorry about that.
Amy: I love it.
Zibby: What advice would you have for aspiring authors?
Amy: Oh, this is a good one. I just love the whole book process. Yes, I agree with you — I read your essay about how it shouldn’t be two years. I agree. With medical science, two years is dated. Your science is already old. My advice to new authors is use as a creative outlet, just like we were talking about — don’t think of this as somebody’s judging your work. Think of it as that you are using the creative forces inside of you to create something. Once you create it, it’s gone from you. Just like if somebody was going to insult a painting or a song that you made, you’d just be like, oh, that was one of my works of art, but I have a lot more. That’s how you should think of any creative work. Put your creative work out there. If someone doesn’t enjoy it, you can be like, it’s fine. It’s not a personal attack on yourself. Just treat it like that.
Zibby: Perfect. Amy, thank you so much. I’m so glad we finally connected. I would love to continue this in person in some way, shape, or form. I feel like there’s so much more to discuss. Thank you for coming on my podcast. Thank you for spreading your message to help so many women, which is just really — I’ll say it one more time — really amazing.
Amy: You are amazing, Zibby. Thank you so much for having me. I’m enjoying all your content. It’s one of those things, everything you say, I’m like, yeah, I agree with that. Love finding online, like-minded people.
Zibby: Me too.
Amy: Can’t wait to meet you.
Zibby: You too. Take care. Thank you. Bye.
Amy: Take care. Bye.
