Chronic Fatigue Syndrome
Chronic fatigue is one of the most common complaints we see today in our practice. Generally, chronic fatigue syndrome is described as extreme fatigue that has lasted longer than 6 months and is worsened by exertion. Oftentimes, fatigue accompanied by brain fog, poor concentration, myalgia, non-refreshing sleep, toxicity and inflammation. Fatigue of this degree is life altering and makes day to day life difficult. Calming inflammation in effective ways may bring about dramatic improvements in quality of life.
Fatigue is usually a result of the mitochondria in the cells of the body and brain not functioning optimally. Mitochondria are the powerhouse of the cell and create energy in the form of ATP (Adenosine TriPhosphate). Usually, these mitochondria have been affected by inflammation and oxidative stress which causes impaired energy flow through the membrane channels in the mitochondria. Improving this complex process involves many improvements in toxicity levels, supplemental support and decreased environmental exposures. Furthermore, learning how to build resilience to psychological stress can help as well. Improving all of these is usually necessary to improve symptoms of chronic fatigue syndrome.
Sources of Chronic Fatigue
Fatigue is usually a result of multiple issues, or what we call “multifactorial”. Inflammation and adrenal issues are often associated with chronic fatigue. Sources of the inflammation often include toxicity and/or nutrient deficiencies or chronic underlying infections or mold exposure. Finding and removing the main issues involves looking in many different places for answers and possible causes. Solving fatigue root causes often allows patients to begin functioning more normally and dramatically improves their quality of life. The process is difficult and intense and takes time and effort for both the patient and functional medicine practitioner.
Evaluation of Chronic Fatigue
To begin the process to evaluate fatigue, we begin with looking at the lifestyle and nutrition of our patients. We create a timeline of life events that may give us clues as to what may be contributing to deficiencies, toxicities and inflammation. This timeline is a building block to allow us to test the most appropriate tests to uncover sources that may be acting as a root cause. Many times, there is an underlying cause of inflammation that is uncovered through testing that leads to a path of possible solutions.
Some common associated conditions include the following:
- Insomnia and non-refreshing sleep
- brain fog/depression/anxiety/poor concentration
- gut bloating
- muscle and joint pain
- muscle twitches
- food allergies
- genetic detoxification issues
- mold exposure
- chronic infections- bacterial, viral, parasite- Lyme, EBV
- Thyroid issues/autoimmunity/Hashimoto’s/ low free t3 due to inflammation
- Hormonal dysfunction
- Obstructive Sleep Apnea
Testing involved in Chronic Fatigue Evaluation
The above first four symptoms are often found in combination when dealing with fatigue. Gut symptoms often suggests underlying process in the gut. In my practice, I usually will test the microbiome and food allergies/sensitivities to see if there are inflammatory issues that can be removed easily. Also, a comprehensive laboratory panel looking at nutrient deficiencies, hormones, inflammation and thyroid as well as routine lab panels are performed. Then, we usually will replace essential nutrients and correct deficiencies sometimes through testing a NutraEval.
Other Causes of Chronic Fatigue
Mold, heavy metals and EMF
CIRS (chronic inflammatory response syndrome) is a condition that may occur when patients have had exposure to water damaged buildings and/or mold. CIRS is a more difficult process to correct, especially if the mold is not removed from the home environment. Mold is also a common cause of fatigue/brain fog/inflammation and dementia. The condition with mold and mycotoxins from water damaged buildings is more pronounced and severe with many patients becoming debilitated and sometimes suffering from Multiple Chemical Sensitivities.
I also always ask my patients to decrease their exposure to electromagnetic radiation. Radiation has been shown to impair the flow of energy through mitochondrial channels. This can be due to wifi, cell phones, smart meters and other wireless sources of microwave radiation. There is also evidence that electromagnetic radiation may activate mast cells further contributing to inflammation. All of these things are sometimes needed to help reverse the underlying process causing chronic fatigue.
Other sources of toxicity include heavy metals like lead, mercury, arsenic and cadmium. High heavy metal burdens can contribute to toxicity and inflammation/fatigue.
Leaky Gut and Chronic Fatigue
Long standing or frequent antibiotic usage often leads to dysbiosis and inflammation in the gut which then acts as an inflammatory source. When the gut has unhealthy populations of bacteria this can result in chronic inflammation. Chronic inflammation in the gut can promote gut permeability or what is referred to as “leaky gut” and then lead to inflammation in the body and sometimes brain. These microscopic small amounts of bacteria can be measured through detection of LPS molecules or zonulin. There are many different tests available now to identify leaky gut. Reversing and correcting leaky gut can help with the path to healing chronic fatigue.
Fatigue, Inflammation and the Microbiome
It is said that most autoimmunity begins in the gut from immune system over-activation. This can be through artificial/toxic non-organic foods and unhealthy populations of bacteria or even by over-consuming grains or mold containing foods. One test that I usually always run on my patients is a test for the microbiome. The microbiome testing tells us what types of bacteria are growing in the gut. The good bugs help us produce nutrients, neurotransmitters and toxin removal while the bad “dysbiotic” bugs create inflammation! Chronic sustained inflammation leads to fatigue and usually pain/fibromyalgia.
After leaky gut gets established, many patients begin to struggle with food allergies and sensitivities due to the increased immune response in the gut. This immune response is always meant to protect you, but it gets overwhelmed in the scenario of leaky gut. What then might happen is called “loss of tolerance” to normal things, foods and chemicals. When this happens it is very important to get things back on track to prevent autoimmunity and more serious conditions. Fatigue patients often have sensitivities to many different things in their air and food and skin products.
We know that many with fatigue have genes that do not allow them to enzymatically make products of energy as well. One gene that is very commonly identified is the MTHFR gene. The MTHFR gene does not allow the proper methylation of folic acid. Without methylated folate, we cannot make energy appropriately, or as fast as we should, in our cells mitochondria. The good news is we can now supplement with methylated folate and correct this simple defect to restore normal functioning of the energy cycle.
Another genetic problem can be difficulty with controlling inflammation and toxicity. Genes like COMT, Cyp-450, MTHFR, and many others can contribute to higher levels of toxicity in the body. When the body becomes toxic, inflammation can begin and self propagate itself. We often encourage detoxification strategies to help with chronic fatigue strategies and reestablish tolerance in the immune function.
If you are feeling chronic fatigue, it is very possible that a functional medicine practitioner might be able to get you moving in the right direction. The process is involved but well worth it when patients get their life back! It is one of my favorite things to see patients happy and enjoying life like they were meant to do!
Come see us to help you with your functional medicine needs today! Reach out to us on our contact page for more information.
Contact us here: Kessmann Clinics Contac
disclaimer: None of the information here is considered to be replacement for/nor intended to diagnose or treat any condition that should be properly evaluated by your personal medical professional. If you feel that you need urgent attention please seek attention immediately at an emergency or urgent type facility.
- Updated NICE Guidance on chronic fatigue syndrome
- https://doi.org/10.1055/s-0042-121259 CFS : A Critical Review
- https://doi.org/10.1159/000493531 Chronic Fatigue Syndrome
- https://doi.org/10.7326/0003-4819-121-12-199412150-00009 The chronic Fatigue Syndrome: A comprehensive approach.
- https://doi.org/10.1016/j.jcv.2006.08.013 Chronic Fatigue Syndrome
- https://doi.org/10.1177/039463201002300402 Chronic Fatigue syndrome/myalgic encephalomyelitis