Fatigue: A Guide to Solving a Common Health Concern

By Chris D. Meletis, ND Fatigue is one of the most frequent health concerns I hear about from my patients in clinical practice. Although many turn to energy drinks, which, when rich in nutrients, are a better alternative to coffee, in reality this is only a temporary solution. It’s better to find the reason behind why a person is fatigued in the first place. By eliminating each of the possible causes, the real culprit will be found. In this article, I will describe the most common reasons for fatigue and what steps can be taken to increase energy levels once the underlying cause of the exhaustion is pinpointed. Overt Disease When looking into the reasons behind why a person is so tired, it’s helpful to first determine whether he or she is suffering from a disease that could be causing the fatigue. For example, in one study, all patients with heart failure complained of daily chronic fatigue.(1) High blood pressure also is associated with increased fatigue as are autoimmune diseases and chronic infections. Therefore, it is important to undergo a thorough checkup to eliminate a specific health condition. Once specific diseases are ruled out, then the less obvious energy drainers mentioned below can be explored. Adrenal Dysfunction One of the first steps is to conduct a salivary hormone test (adrenal function panel). This test monitors a person’s morning, afternoon, and evening cortisol levels as well as DHEA levels in order to determine the health of the adrenal glands. Adrenal burnout and the associated imbalance in cortisol levels is a frequent cause of fatigue. Under conditions of stress, the adrenal glands produce cortisol and other stress-related hormones. A perfectly balanced body will learn to cope with stress and return rapidly to a resting state when the stressor is eliminated. However, the capacity to cope with stress is limited, highly individualized and worsens with age. Consequently, a person’s body may not realize that a stressful event has ended and continue to produce the high levels of cortisol triggered by the event. This over production of cortisol ultimately leads to exhausted adrenals where the glands are no longer able to produce sufficient levels of this important hormone. Adrenal dysfunction may be manifested by an excess or inadequacy of cortisol and DHEA and loss of sensitivity of the hypothalamus and pituitary to the normal, inhibiting effects of these hormones. In a recent study of 78 working subjects, researchers used a salivary test to measure the daily variations in cortisol in both the non-exhausted subjects and the exhausted subjects. The researchers found that the exhausted subjects experienced significantly lowered morning cortisol levels. In the non-exhausted subjects, the morning cortisol levels were normal.(2) “The results would support the notion that exhaustion is associated with hypothalamus-pituitary-adrenal (HPA) axis hypoactivity as assessed by salivary cortisol,” the study authors noted. Morning cortisol levels also have been found to be lower in female chronic fatigue patients compared to controls.(3) A salivary hormone test (adrenal function panel) can help determine whether disturbed cortisol levels are the reason behind an individual’s fatigue. When test results indicate low cortisol levels in the morning this generally is indicative of adrenal burnout, and supplementing with a formula that contains glycyrrhizic acid from licorice combined with adrenal powder and potassium can be very helpful. Glycyrrhizic acid mimics the effects of cortisol and helps burned out adrenals recover. Glycyrrhizic acid should be taken for several weeks at a time and then supplementation should stop for a period before resuming again. Individuals with high blood pressure should monitor their blood pressure daily when using licorice. Individuals whose adrenal function panel indicates their cortisol levels are chronically elevated often find it helpful to consume a supplement that contains Relora®, a proprietary blend of an extract from Magnolia officinalis bark and an extract from Phellodendron amurense, and Sensoril®, a patented Ashwagandha (Withania somnifera) root and leaf extract. Each of these substances has been shown to balance cortisol levels.(4-5) In my clinical practice I also find that SeriPhos™ is helpful in controlling elevated cortisol levels. Mood Disorders Fatigue and depression often present with similar symptoms. One review of the medical literature established that chronic fatigue syndrome is underdiagnosed in more than 80 percent of the people who have it and that it is often misdiagnosed as depression.(6-7) Fatigue is often a symptom of seasonal affective disorder (SAD), a depressive disorder that occurs in individuals who are sensitive to the decreased sunlight that occurs in winter. The onset of winter may lead to more severe bouts of depression that can interfere with ones ability to function at work or in the home. This reoccurring form of depression usually begins in the fall, increases through the winter holidays, and doesn’t let up until the return of spring. Symptoms of seasonal affective disorder include extreme fatigue and lack of energy, increased need for sleep, sleeping much more than usual, carbohydrate craving and increased appetite and weight gain. Clinically, when I note that a patient’s fatigue is worse in winter and associated with “the winter blues,” I find that the use of 5-HTP, L-theanine and vitamin D3 together with maximizing outdoor time and light therapy can help significantly. Thyroid Health The thyroid gland is a major controller of metabolic activity in virtually every body tissue. If fatigue is accompanied by other symptoms such as weight gain, hair thinning or loss, cold hands and feet, low body temperature, depression, slower bowels and dry skin, then hypothyroidism should be suspected and testing for levels of the thyroid hormones free T3 and free T4 as well as TSH is a good approach. In fact, one of the reasons for the strong connection between depression and fatigue mentioned above may be that individuals who present with both conditions may be suffering from underactive thyroid. Meanwhile, in individuals who exhibit fatigue along with weight loss, rapid heartbeat, and nervousness, hyperthyroidism should not be overlooked. In addition to a complete thyroid panel, an iodine sufficiency test can help determine whether iodine status is playing a role in thyroid health and overall energy levels. Guy Abraham, MD has found, in a number of studies, that supplementing with a special combination of iodine/iodide known as Iodoral® can improve the health of both patients with hypothyroidism and hyperthyroidism. Dr. Abraham noted that whole body sufficiency for iodine was associated with a sense of overall well being, lifting of “brain fog,” feeling warmer in cold environments, increased energy, needing less sleep, achieving more in less time, experiencing regular bowel movements and improved skin complexion.(8) Sleep Restorative sleep is essential to optimal energy levels. Fatigued individuals should therefore look to their sleep habits as a possible cause of low energy levels. Snoring and waking frequently during the night can be an indication of sleep apnea and this issue should be addressed. Additionally, anyone who finds it hard to fall asleep or to stay asleep, who suffers from restless legs syndrome or who wakes up with heart palpitations may have sleep issues that are causing fatigue. One of the major causes of age-related sleep disturbances is a reduction in the amount, and alteration in the timing, of melatonin production by the pineal. Supplementation with melatonin has often been shown to ameliorate these disturbances in the sleep-wake rhythm. In a study of elderly women, 35.7 percent of investigated subjects noted an improvement in general sleep quality and in such sleep parameters as sleep initiation, the amount of time it takes to fall asleep, number of awakenings episodes, and wake time after sleep onset.(9) In addition to improving sleep, melatonin has been shown to act directly on reducing fatigue in patients with chronic fatigue syndrome.(10) Allergies Allergies—both allergic rhinitis and delayed food sensitivities—can be another fatigue-causing factor. Recently, GeorgetownUniversityMedicalCenter researchers noted there is emerging evidence to suggest that food allergies appear to be an important triggering event in chronic fatigue syndrome and fibromyalgia.(11) In my clinical practice, I also have noted that energy levels often increase in fatigued patients who eliminate offending foods from their diets. Consequently, I always recommend that anyone suffering from fatigue take a food allergy test for “hidden” food sensitivities. Delayed food allergies can contribute to digestive problems, body aches, headaches and symptoms typically not associated with classic allergy symptoms. Food allergies/sensitivities also play a large role in the amount of suffering a person experiences with seasonal allergies. This is because it is the total burden on an individual’s system that ultimately determines how readily the body releases histamine and inflammatory substances that lead to many of the miserable symptoms of allergic reactions. The combined environmental and food allergen burden results in total susceptibility to succumbing to allergic symptoms. Testing for hidden food allergies helps identify delayed IgG immunoglobulin allergens. This technology that I have used for years in my clinical practice has now been applied to home test kits, available here, that can identify reactions to 96 different foods. The results indicate low, moderate or high reactions to different foods. Avoiding offending foods will produce dramatic results, but for times when food allergen exposure cannot be avoided, GI Cell Support, Digestive Enzymes, probiotics (Culturelle® or BioPro™) and Lectin Lock™ can help support the body’s overall health. For seasonal allergies, the combined use of bromelain, vitamin C and quercetin can provide additional support. Nutrient Deficiencies and Environmental Toxicity When the body is not receiving enough of a particular nutrient or is overburdened with environmental pollutants, this can take a huge toll that compromises energy levels. Therefore, in my clinical practice, I recommend all my fatigued patients take an organic acid test that also checks for environmental pollutants. Organic acid testing, which I also routinely use to help my patients, is also available here, and is important for those seeking to fine tune or increase a supplement program’s effectiveness. The patient receives specific recommendations of vitamins, minerals, nutrients and amino acids and dosage suggestions. Depending on overall health status and medications taken, either implementation or discussion with one’s physician or nutritional supplement expert is recommended. The clinical benefits seen when the body’s unique needs are addressed can be the difference between modest clinical results versus a significant metamorphosis.  The organic acid test also looks for detoxification markers that provide insights into the capacity and success of the body to process and cope with an increasingly toxic environment. Other Factors Fatigue can be a side effect from various pharmaceuticals such as statin drugs, blood pressure medications and antidepressants so checking the cautions that accompany the prescriptions is important as are doctor-patient discussions about this topic. Additionally, a diet overloaded with processed food, refined carbohydrates and sugar can make a person feel sluggish. Dehydration is another important factor in low energy levels. Drinking 64 ounces of water every day is essential to enhance energy levels. Conclusion When trying to determine the reason for fatigue, the only approach one can take is to begin eliminating potential causes. By playing detective and looking at all the factors mentioned above, the reason why a person is fatigued will likely become apparent and steps can then be taken to eliminate exhaustion. References 1. Jasiukeviciene L, Vasiliauskas D, Kavoliūniene A, Marcinkeviciene J, Grybauskiene R, Grizas V, Tumyniene V. Evaluation of a chronic fatigue in patients with moderate-to-severe chronic heart failure. [Article in Lithuanian]. Medicina (Kaunas). 2008;44(5):366-72.  2. Lindeberg SI, Eek F, Lindbladh E, Ostergren PO, Hansen AM, Karlson B. Exhaustion measured by the SF-36 vitality scale is associated with a flattened diurnal cortisol profile. Psychoneuroendocrinology. 2008 May;33(4):471-7. 3. Nater UM, Maloney E, Boneva RS, Gurbaxani BM, Lin JM, Jones JF, Reeves WC, Heim C. Attenuated morning salivary cortisol concentrations in a population-based study of persons with chronic fatigue syndrome and well controls. J Clin Endocrinol Metab. 2008 Mar;93(3):703-9. 4. LaValle J, Hawkins, E. Relora—The Natural Breakthrough to Losing Stress-Related Fat and Wrinkles.North Bergen NJ: Basic Health Publications; 2003: 16.  5. Bhattacharya, S. et al. Anti-stress activity of sitoindosides VII and VIII, new acylsterylglucosides from Withania somnifera. Phytother Res. 1987;1: 32-37. 6. Griffith JP, Zarrouf FA. A Systematic Review of Chronic Fatigue Syndrome: Don’t Assume It’s Depression. Prim Care Companion J Clin Psychiatry. 2008;10(2):120-8.   7. Arnold LM. Understanding fatigue in major depressive disorder and other medical disorders. Psychosomatics. 2008 May-Jun;49(3):185-90.   8. Abraham, GE. The safe and effective implementation of orthoiodosupplementation in medical practice. The Original Internist. 2004; 11:17-36. 9. Pawlikowski M, Kolomecka M, Wojtczak A, Karasek M. Effects of six months melatonin treatment on sleep quality and serum concentrations of estradiol, cortisol, dehydroepiandrosterone sulfate, and somatomedin C in elderly women. Neuro Endocrinol Lett. 2002 Apr;23 Suppl 1:17-9. 10. van Heukelom RO, Prins JB, Smits MG, Bleijenberg G. Influence of melatonin on fatigue severity in patients with chronic fatigue syndrome and late melatonin secretion. Eur J Neurol. 2006 Jan;13(1):55-60. 11. Bellanti JA, Sabra A, Castro HJ, Chavez JR, Malka-Rais J, de Inocencio JM. Are attention deficit hyperactivity disorder and chronic fatigue syndrome allergy related? What is fibromyalgia? Allergy Asthma Proc. 2005 Jan-Feb;26(1):19-28.