Chronic Fatigue/Chronic Fatigue Syndrome
CAUSE
This is one of the most frequent challenges we treat, and successfully in many/most cases. The difficulty in addressing chronic fatigue is that virtually every disease process of any significance is going to include some degree of fatigue. Brain injuries, poor sleep, overwork, lack of most any hormone, a bad tooth, poor gut function, cancer and a host of other disease processes are usually associated with chronic fatigue. Thus, it is a bit more difficult to point a finger at only a few possible causes. That being said, I will list some of the more frequent causes/contributors to chronic fatigue that we see.
Hormonal imbalance.
Undiagnosed low thyroid function.
A chronic infection that might not be recognized. One example would be an infected root canal that is not painful or can be a nagging soreness. But X-rays might be read as normal. Other examples: lyme disease, other tick born or rickettsial diseases, or parasites.
Post viral infection syndromes. A frequent example of this category is a person that had mono some time back but has never really felt well after the illness.
Food allergies
Sleep issues including sleep apnea
Toxins such as a moldy house
Traumatic brain injury. This be due to a mild concussion, a severe concussion, strokes or other brain bleeds, and war/military injuries.
Use of drugs/alcohol
Medications are frequently a contributor to fatigue. Not only do medications cause fatigue, combinations of medications can augment negative effects from the drugs. Some of the most likely to cause fatigue include medications for cholesterol, older antihistamines, blood pressure medications, drugs for depression and anxiety, and cough medications.
Iron deficiency is an often overlooked cause of chronic fatigue in a menstruating woman.
And fatigue accompanies diseases like kidney failure, liver failure, inflammation of the gut, MS, cancer, anemia, and many other.
TREATMENT
Balance the body’s natural/normal hormones. In women this includes estrogen, progesterone, testosterone, and DHEA. In men the balance can include lowering the amount of estrogen, increasing the testosterone and helping the DHEA.
Thyroid: Routine thyroid testing is often inadequate, in my opinion. Most frequently, a single test is done, the TSH or Thyroid Stimulating Hormone, and that is not actually a thyroid hormone. It’s the hormone/message from the boss of the thyroid which is the pituitary gland. Normally, if you have too little thyroid hormone, the pituitary is supposed to begin “shouting” at the thyroid to wake up and get to work. Thus, the TSH is elevated above the lab normal range. A high TSH is interpreted as being THE way to diagnose low thyroid function. Many doctors in integrative/functional medicine would argue that this test is only one of the several factors that need to be evaluated in deciding on whether the thyroid function is low or not. This evaluation would include a more comprehensive panel of blood tests including TSH, the relatively inactive thyroid hormone T4, the active thyroid hormone T3, the “anti-thyroid hormone” Reverse T3, testing for autoimmune thyroid disease; and one should seriously consider the history (the story of the patient) as that tells us a lot about the possibility of thyroid dysfunction; and the physical exam can give several clues as to whether one is in fact hypothyroid. A thorough evaluation for possible low thyroid function thus includes at least a thorough panel of lab tests, the physical exam and the history. Making the diagnosis only based on the TSH is not adequate in my view. Treatment is fairly easy once we are clear on whether this is an issue or not.
Chronic infections: A complete answer would be too lengthy to attempt here. Hidden infections are, well, hidden. Thus it’s not necessarily straight forward finding the answers. But it is usually possible. This may include more intensive dental testing including a Cone Beam CT Scan. It may require testing certain immunological reaction. One may need to do a trial of therapy at times and see what happens. Even though finding an answer is not always easy, there are usually ways of finding what the cause might be.
Post Viral Fatigue: There are tests which can helpful. The Epstein Barr Virus (mono) is a common cause of chronic fatigue and we can test for this as a potential cause. If we believe it is a post viral syndrome, the best treatment is with high dose Vitamin C IVs. They will usually help nicely.
Food testing with avoidance of the positive reacting foods, or doing an elimination diet eliminating the most common food allergens very carefully for 3 weeks can often help a lot. The most common problem foods are: Gluten, Dairy, Sugar and fake sweeteners (pure stevia is usually ok), Eggs, Soy, Corn, and perhaps peanuts. Check out JJ Virgin’s “The Virgin Diet”.
Sleep is often helped by a number of things. Melatonin (some kinds work better than others). A very dark room. Avoiding electronics for a couple hours before bed. Not eating shortly before bed. And there are many other potential methods of achieving great sleep.
Toxins would have to be discovered and eliminated both from one’s environment and one’s body.
TBIs are more important than is usually recognized. And, thankfully, there are many ways to help fix the damage done.
Drugs and alcohol clearly need to be avoided if these are causing the issues. There are ways to help.
Reviewing your current and recent medication schedule can provide clues which can be discussed.
Iron status needs to be thoroughly evaluated and appropriate replacement initiated when indicated.