Fatigue is one of the most common symptoms we see in functional medicine. Most patients have seen multiple doctors; have been told they are getting old, are depressed or need to exercise; are on multiple medications – antianxiety, anti-depressant, anti-convulsant, etc.; and have lost or almost lost hope. Often they have a diagnosis of Chronic Fatigue Syndrome or Fibromyalgia.
If you Google “cause of fatigue” Mayo Clinic says: Use of alcohol or drugs • Excess physical activity • Jet lag • Lack of physical activity • Lack of sleep • Medications, such as antihistamines cough medicines • Unhealthy eating habits • Acute liver failure • Anemia • Anxiety • Cancer • Chronic fatigue syndrome • Chronic infection or inflammation • Chronic kidney disease • Concussion • COPD • Depression (major depressive disorder) • Diabetes • Emphysema • Meralgia paresthetica • Grief • Heart disease • Hyperthyroidism • Hypothyroidism • Inflammatory bowel disease (IBD) • Medications and treatments, such as chemotherapy, radiation therapy, pain drugs, heart drugs and antidepressants • Multiple sclerosis • Obesity • Pain that’s persistent • Sleep apnea • Stress • Traumatic brain injury
Many of these causes of fatigue are associated with other symptoms that often are greater than the fatigue, such as shortness of breath with COPD and emphysema or diarrhea and abdominal pain in Inflammatory Bowel Disease. But what are the common causes when fatigue is the primary or only symptom.
So let’s look at some of the most common underlying causes of fatigue that are easily remedied. The first evaluation is to determine how well you are sleeping. Insomnia and Sleep Apnea will often cause daytime fatigue. If your brain does not have sufficient regeneration and replenishment time during the night, you can develop “brain fog” and other symptoms in addition to fatigue.
What about Hypothyroidism? If you have been told your thyroid blood studies are normal, this is usually based on 1 or 2 tests that are insufficient in making the diagnosis. If you have fatigue and other symptoms of hypothyroidism, you should have all 8 of the blood tests done to asses your thyroid function. Interpretation of these tests in light of your symptoms is very important. Most times the symptoms are not taken into account; if your tests are in the “normal” range, you are told your thyroid is normal. “Normal” is the statistical analysis of thousands of people, but you are an individual and every individual is biochemically unique.
Chronic stress can lead to Adrenal Fatigue. In early Adrenal fatigue, your cortisol levels are likely to be elevated giving you a “wired & tired” feeling. It is important to correct the underlying cause of your cortisol elevation to prevent you from developing later stages of adrenal fatigue and to prevent the associated conditions of and damage from high cortisol levels. Over time as your stress continues, your cortisol levels begin to drop and eventually fall below normal. At this more advanced stage you just feel tired and if your cortisol is very low, you may find it difficult to function or even get out of bed. Stress may be emotional, mental, spiritual or physical in nature. Managing stress, engaging in stress relieving activities, addressing the underlying causes and supporting adrenal function are important
Micronutrient Deficiencies are extremely common. If you eat the Standard American Diet (SAD), you likely have multiple micronutrient deficiencies. These are vitamins, minerals and all nutrients found in food. Macronutrient imbalances are equally important and substantially contribute to fatigue. Both categories of nutrients are critical for energy production by your biochemical pathways. And because of your biochemical and genetic individuality, treatment must be targeted to a functional analysis of your nutrient status, not just measuring nutrient levels in your blood. In addition to your diet, your gastrointestinal function and microbiome are important in
Specific genetic mutations can contribute to Fatigue. If your MTHFR gene has one mutation it decreases your ability to “methylate” by 40% and if it has 2 mutations your ability is decreased by 80%. “Methylation” is probably the most common biochemical reaction in your body and is extremely important. The 3 most common diagnoses associated with MTHFR mutations are Chronic Fatigue, Fibromyalgia and Depression all of which include Fatigue as an extremely common component.
If your anabolic hormones are low, low-“normal” or even imbalanced, you may be experiencing decreased energy, decreased motivation and a host of other descriptors of Fatigue. Your hormone balance is critical for not just your energy, but for your health, happiness and longevity. Your adrenal hormones, profoundly affect your energy state, metabolism and overall health. Your sex hormones affect much more than sex organs and function – they profoundly contribute to both youthfulness and energy, as well, as motivation and overall health.
Toxins such as heavy metals (especially Arsenic, Lead and Mercury) block the biochemical pathways that produce energy and determining your toxic exposure/accumulation may be the answer to your symptoms of Fatigue and other health problems.
As is clear from above, biochemical and neurochemical imbalances (i.e. MTHFR) can lead to depression, but they can also lead to anxiety and other “psychiatric conditions”, even psychosis. All of these conditions can lead to exhaustion and fatigue. Hormone, nutrient, genetic, toxin and other imbalances can be responsible for the biochemical and neurochemical imbalances. But also, if you have experienced profound or even persistent low grade emotional trauma, this too can lead you to low energy and fatigue.
These are some of the more common underlying causes of Fatigue that are rarely considered or are inadequately investigated by most doctors. Call our office at St. Petersburg Health & Wellness to make an appointment and begin improvement of your symptoms of Fatigue.