By Richard Malik, ND
As published in the Lakeville Journal, Millerton News, & Winsted Journal
22 February 2007

Fatigue, or low energy, is one of the most common complaints that patients have. The way fatigue is experienced can vary substantially between patients. There are many different types of fatigue: muscle fatigue, mental fatigue, fatigue that occurs after eating, and global fatigue that effects all or most body systems.

Physiologically, fatigue is a sign of impaired function. Something is hindering optimal energy metabolism or function of body tissue. The challenge for a doctor is to determine and address the cause of your symptoms.

A very common cause of fatigue is anemia, which is easily diagnosed with simple blood tests. Anemia is, by definition, a decrease in the oxygen carrying capacity of the blood. With less oxygen, cells all over the body find it more difficult to produce energy; fatigue is a main symptom of anemia. Many things can cause anemia, but the most common are nutrient deficiencies. (including iron, vitamin B12, and folic acid). The nutrient dosages for correcting nutrient deficiency anemias are very high and should be done under medical supervision to prevent harm.

Hormone changes can also cause fatigue. Thyroid and adrenal hormones most strongly affect energy and metabolic rate. Blood tests are commonly used to identify obvious low thyroid function and the standard treatment is a prescription of thyroid hormone.

Departing from the mainstream medical perspective, I think that patients can have low thyroid or adrenal function but still have normal laboratory diagnostic tests. I see patients who have multiple symptoms of low thyroid function, normal laboratory tests, who still benefit from treating the thyroid gland and encouraging higher thyroid hormone levels. Whenever addressing hormone concerns form this perspective, it must be done very carefully as high levels of these hormones can cause serious problems.

Standard blood tests are used to check for severely low adrenal function. Other alternative and more sensitive tests are available for identifying mild or moderate adrenal dysfunction. Nutrients including vitamins C and B6 are important cofactors in the formation of adrenal hormones - they can be used to encourage adrenal function. Interestingly,the contraceptive pill can seriously lower B6 status and cause fatigue in some women. Licorice root helps to increase body levels or cortisol and other adrenal hormones. However, licorice use can cause increases in blood pressure and should be monitored by a physician.

Impaired blood sugar regulation may also be a cause of fatigue; it is diagnosed with a fasting blood glucose test and a glucose tolerance test. Chromium is a nutrient that has been shown to improve blood sugar regulation whether blood sugar levels tend to be too high or too low. However, dietary and lifestyle changes are usually the most affective steps for initially addressing problems with blood sugar regulation.

Other possible causes of fatigue include: chronic infection (including Lyme Disease); chronic inflammatory states; food allergy and sensitivity; digestive dysfunction; sleep disorders; side effects from medication; and depression and other psychological conditions. Obviously, the path taken for identifying the cause(s) of fatigue can be long and winding. Sometimes no explanation is found, or problems may be identified and corrected without complete resolution of the fatigue.

When other explanations for fatigue are not found, Chronic Fatigue Syndrome (CFS) may be the label applied to some patients’ conditions. However, the diagnostic criteria for CFS are very specific: the fatigue is of new or definite onset; is not a result of ongoing exertion; is not alleviated by rest; and results in substantial reduction in previous levels of activities. CFS may be accompanied by difficulty concentrating, sore throat, swollen lymph nodes, muscle pain, arthritis, headaches, disturbed sleep, and intense fatigue brought on by exertion that lasts more than 24 hours.

If your symptoms seem to fit with the description of CFS, it is a good idea to get help from a healthcare provider. CFS is a complicated syndrome with many possible causes and many therapies that may provide relief.