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Written by
Deborah Freudenmann BHSc
Fatigue is a common ailment affecting millions of people worldwide. Unfortunately, the root causes of chronic fatigue have evaded modern medical practitioners for years. Besides resulting from other illnesses or nutritional deficiencies, the causes of fatigue remain unidentified and therefore go untreated.
Due to the elusive nature of fatigue, pinpointing specific causes for patients can be challenging and time-consuming. All too often, patients make multiple visits to various healthcare providers, leaving them with too many bills.
Fatigue can have debilitating effects on those affected. Not only does it result in patients suffering physically, but it can also have damaging effects on relationships, careers, mental health, and overall well-being.
Looking at fatigue from a functional medicine approach, many potential drivers and sustaining factors may be correlated with fatigue. Therefore, a systematic and comprehensive approach is required when assessing patients with fatigue.
Anaemia, a lack of red blood cells, is one of the most common underlying causes of fatigue. Red blood cells deliver oxygen to cells throughout your body with the help of the protein haemoglobin. Proper consumption of foods containing iron, vitamin B12, and folate are necessary for producing this protein. With low levels of haemoglobin, oxygen is unable to be delivered efficiently, leading to a state of fatigue.
Healthcare professionals can conduct iron tests, vitamin B12 tests, and serum folate tests to see if patients have any nutrient deficiencies that would cause anaemia.
Also other deficiencies such as magnesium, Vitamin B complex, Vitamin C, Vitamin D, zinc, Omega3s, can play a role in fatigue.
Maintaining a well-balanced diet is important to sustain proper nutrient levels in the body. A diet of carbohydrates, proteins, and fats contain the necessary vitamins and minerals our bodies need for proper functioning.
Diet Tips:
*Food intolerances can lead to inflammation in your gastrointestinal tract, free radical damage, and a reduced ability to properly absorb nutrients. All symptoms from food intolerances converge to a compromised gut barrier.
For those suffering from sleep-related issues, changing sleep patterns and the environment are proven to be an effective combatant to restless sleep.
The importance of sleep cannot be understated, as proper rest is vital for a strong immune system. When asleep, T-cells and proteins called cytokines are released, both of which play important roles in a strong immune system. Getting an average of 8 hours of sleep per night, increases your immunity to the common cold by 32%, compared to individuals who sleep 5 hours or less per night.
A properly functioning immune system is essential in fighting fatigue, and that starts with adequate sleep.
Recommendations for better sleep:
Fatigue is a comorbidity of many mental health conditions. It’s important to consider the possibility of any mental health issues such as depression, anxiety, and addictions as possible contributing factors to fatigue. Some patients may find holistic, individualized mental wellness programs extremely beneficial for combatting mental health disorders. Such programs include meditation, yoga, breathwork, and support groups. Further developed and serious mental health issues may require treatment or consultations from a mental health professional.
Chronic stress dysregulates the immune systems’ normal functionality via pro-inflammatory responses. Even if we have an exceptionally healthy lifestyle in regards to exercise, diet, and sleep, stress negates those positive factors. Elevated stress levels will always alter our immune system’s ability to function properly, which may drive us towards fatigue.
Metabolic dysfunction is another common factor contributing to prolonged fatigue. This may happen in multiple ways. Unregulated blood sugar levels, whether from insulin resistance or hypoglycaemia, can be a primary factory in fatigue and feelings of weakness. Inconsistent and fluctuating levels of blood sugar and insulin may disrupt the hypothalamic-pituitary-adrenal (HPA) axis, resulting in the onset or worsened state of fatigue. Obesity is another common condition associated with chronic fatigue. Obesity may cause fatigue from various methods such as being a common procurer to diabetes and sleep apnea.
Chronic conditions like myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), can often result from an incomplete or inadequate cell danger response (CDR, rather than a biological stressor. Dr. Robert Naviaux, a mitochondria researcher, has identified the CDR and shown it’s cascading cellular healing process. This process is how a cell heals itself and restore its functionality after being injured by toxins, infections, or other inflammatory agents.
Mitochondria, the powerhouse of the cell, plays a vital role in cell communication, immunity, and the regulation of the cell’s healing cycle via the CDR.
As fatigue can stem from an improper CDR, therapy should be aimed at assisting the function of mitochondria, thereby improving the healing cycle of the cells.
A promising candidate for mitochondrial treatment is Magnesium, a necessary component of mitochondrial function and production. Another foundational nutrient in treating mitochondrial conditions is co-enzyme Q10. Taking a daily dose of 300mg of coenzyme Q10 has been shown to reduce mitochondrial fragmentation and enhance intracellular ATP levels in patients affected by chronic fatigue and fibromyalgia.
Patients with ongoing fatigue often have dysregulation in sex hormones, thyroid axis, or adrenal axis. Unfortunately, it’s tough to determine whether fatigue or hormone dysregulation preceded the other. However, we do know once both are present, they become intertwined with each other. Both issues interact with the immune system’s ability to function properly, which leads to sustained states of fatigue.
Continual dysregulation of the body’s stress hormones is a major contributor to chronic fatigue. When dealing with chronic stress, the body becomes overwhelmed and cannot effectively maintain allostasis, the process of regaining physiological stability. With this defunct ability to maintain allostasis, the HPA can also become dysfunctional.
Wrapped up in a state of chronic stress, the brain attempts to reduce cortisol production to protect the hippocampus from being negatively affected by cortisol. This results in a state of low cortisol and/or adrenaline output which patients describe as “burnout”.
Using adaptogenic herbs like Ashwagandha, Holy Basil, Rhodiola, or Ginseng can help the body restore the hormonal axis’ homeostasis. Finding ways to reduce stress is vital to fighting the overproduction of cortisol.
Chronic infection is a likely contributing factor to the disease burden in some patients already struggling with ME/CFS. Chronic infection occurs when a pathogenic agent (Epstein Barr Virus, Lyme Disease, Ross River, Hepatitis, HIV, CMV) is persistent in the body. The immune system struggles to fight off the pathogen effectively, leading to chronic infection. Although still functioning, the immune system is incapable of completely eradicating the pathogen.
Over time, this ongoing fight leaves the immune system exhausted and dysfunctional. It can no longer compete with pathogens. Other factors like heavy metal toxins and environmental toxins like pesticides contribute to a suppressed immune system.
While these toxins are present and the prolonged fight with pathogens unfolds, our bodies remain in a state of chronic inflammation, unable to completely heal itself. This may lead to sickness behaviour response, an evolutionary reaction where the body’s energy resources are directed towards resolving the persistent inflammation. Chronic inflammation can also interfere with the hippocampus’s ability to function properly, further exacerbating the dysregulation of the hormonal axis.
To effectively treat this state of an exhausted immune system, it’s vital to determine which infections are the driving factors. Once the mystery is resolved, the proper steps to reduce the pathogenic load can be implemented. Ridding the body of heavy metals and other environmental toxins can free up the immune system giving it more capacity to fight the pathogen.
One promising treatment is Ozone Therapy which has been a proven method for activating the immune system.
Chronic inflammation and immune exhaustion are not irreversible, luckily. Once the body rids itself of any pathogens, homeostasis can be achieved again.
To properly fight fatigue, a step-by-step treatment protocol must be followed. However, basic nutritional and lifestyle factors must be met first. Proper eating, exercising, and sleep habits are essential to maintain a healthy body.
If fatigue is still persistent, the investigation of potential mitochondrial dysfunction, hormonal dysregulation, toxicity, and chronic infections should be conducted.
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