Disclaimer: This content is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before making changes to your health regimen.
You wake up, you look at the list of things you're supposed to do to get better, and you feel nothing. Not resistance exactly. Just flat. If you've been sick for years and you cannot find the motivation to do the protocol that's supposed to help you, I want you to hear this: low dopamine in chronic illness is a measurable, physical problem, and it is not a character flaw.
I sat down with Dr. Sarah Zaldivar for an episode on this. She holds a PhD in Exercise Physiology and Nutrition from the University of Miami, she's a licensed dietitian and a certified exercise physiologist with the ACSM, and she's a professor whose doctoral research looked at exercise and chronically low baseline dopamine. What she laid out explained something I've watched in my practice for years. The people with the longest, hardest cases are often the ones with the least drive to do the work, and that is not a coincidence. It's biochemistry.
Why does chronic illness take your motivation away?
As Dr. Zaldivar put it in our conversation, "Dopamine is the motivation molecule. Dopamine is the anti-stress molecule. Dopamine is the foundation for life." She tied it to mental clarity, energy, memory, sharpness, cravings, even gut motility.
Here's the part that gets missed. There's a difference between a dopamine spike and your dopamine baseline. A cookie gives you a spike, what she calls a phasic response. Dopamine floods, then it drops back down. Your baseline is different. That's the level you live at all day, every day, and it's what determines whether getting out of bed feels possible.
When you're chronically ill, your baseline is where the damage happens. So you can have a perfectly good moment of pleasure and still wake up tomorrow with nothing in the tank.
Why does everyone keep telling you it's just depression?
Because brain fog, low mood, no drive and cravings look exactly like depression on a ten question screening form. I see clients who've been handed an antidepressant and sent home, and some of them have been handed four.
That's not conventional medicine being careless. It's conventional medicine looking at the output and not the input. Nobody asked what the mold in the basement was doing to their stress hormones. Nobody connected the SIBO to the vagus nerve to the neurotransmitters.
And then there's the other thing clients get told, usually by someone who loves them: you just need to want it more. That one does real damage, because the person already thinks it's their fault. Dr. Zaldivar said it plainly: a craving is a low dopamine state. Your brain is not weak. It's running a deficit and trying to close it with the fastest tool available.
What's actually lowering your baseline dopamine?
This is where it clicked for me. Your baseline is set by the number of D2 receptors on your brain cells. Dopamine has to be released from one cell and land on a D2 receptor on the next cell. No landing pad, no benefit, no matter how much dopamine you make.
Dr. Zaldivar walked through what cortisol does to that system during chronic illness, and it's a three front attack. Cortisol paralyzes tyrosine hydroxylase, the enzyme that converts the amino acid tyrosine into dopamine, so you make less. Cortisol downregulates the D2 receptors, so you catch less of what you do make. And cortisol hits DAT, the dopamine transporter that picks dopamine back up for reuse, so you recycle less.
Think of a radio station and a radio. Cortisol turns down the broadcast, breaks the antenna, and unplugs the recorder all at once.
Now stack your actual life on top of that. Lyme, mold, parasites, autoimmunity, every one of them is a cortisol driver. So is life stress. So is a controlling relationship. Dr. Zaldivar made a point about agency that I keep thinking about: every drop in control you feel over your own decisions drops dopamine and serotonin. Gut imbalances like SIBO feed into the same loop through the vagus nerve. In my practice we run an organic acids urine test and we see these neurotransmitter patterns constantly.
One more variable worth knowing. She described the research on reward deficiency syndrome, people born coding for roughly 30 percent fewer D2 receptors. Her framing: if a large share of the population has it, it isn't a terrible thing, it's common. It just means you start the game with a smaller tank.
What does this look like in your actual day?
You don't need a brain scan to recognize it. Dr. Zaldivar noted that a PET scan with a radioactive tracer exists but it's expensive and generally requires a research team. Functional medicine has dopamine metabolite testing. And then there's the symptom picture.
If you were building a dopamine questionnaire, the questions are: brain fog, low mood, no motivation, cravings, low energy, sluggish digestion.
It looks like a protocol sitting on the counter untouched. It looks like wanting something sweet at 3pm every single day. It looks like the exhaustion that doesn't lift with sleep.
And here's the cruel loop. Most of my clients have been to twenty doctors and failed twenty times. Every failure spikes cortisol. Every cortisol spike takes more receptors. The illness lowers the motivation you'd need to climb out of the illness.
How do you rebuild D2 receptors when you're already sick?
Dr. Zaldivar's answer surprised me with how simple it was: do something outside your comfort zone. Overcoming resistance is what signals your brain to build more D2 receptors over time. You can rebuild them.
But sick people cannot start where an athlete starts, and she was clear about that too. You lift the lighter weight first. Her instruction was to overcome a small amount of resistance today, micro dosed, then stack another one tomorrow. Once a habit stops feeling uncomfortable, you've absorbed the gain and it's time to find the next small thing.
For some of you, that's a walk. For others, as I said on the episode, it's sending the email you've been avoiding, or filming the thing, or standing up instead of scrolling. She pointed out that overcoming mental resistance counts, which means this is available to you even when your body is limited.
The sequence I use with clients: feed the body first. You need adequate protein for tyrosine, and you need some carbohydrate. Dr. Zaldivar noted that the enzymes producing dopamine, serotonin and acetylcholine need an insulin signal to work, and carbohydrate helps you recover from hard effort. This is also why I treat restrictive diets like carnivore as borrowed time. They can look miraculous in year one and shrink microbial diversity underneath.
Then remove the drivers. Infections and toxins are cortisol generators. Clearing mold, Lyme, parasites and gut overgrowth takes a foot off the hose. Then add the small discomfort, daily.
The part I want you to hold onto
If you've been told everything looks fine while you cannot make yourself do the simplest thing, you were not imagining it. What Dr. Zaldivar describes is a receptor problem driven by years of cortisol, infection and stress, and nobody ever handed you that map.
The thing about baseline dopamine is that it's built, not found. You don't need a hack. You need the infections handled, the body fed, and one small uncomfortable thing today. Tomorrow your baseline is a little higher than it was. That's how the climb back starts, and it starts smaller than you think.
What's the one small thing you've been putting off that you know would move the needle, the thing that feels impossible on a low energy day? Tell me in the comments. I want to know what you're up against, because naming it is usually the first step out of the loop.
This blog post is intended for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The information shared here reflects Dr. Jaban's clinical perspectives and is not intended to diagnose, treat, cure, or prevent any disease. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.