Fatigue is the single most common health complaint in our office. It’s not always the “chief complaint”, but it’s almost always in the top 3. Why are we so tired today? What can you do about it? Is it your thyroid? Your adrenals? Your hormones? Your MTHFR? Toxins? Do I have “Chronic Fatigue Syndrome”, is it ‘just stress’, or is this like my doctor said, “everything is normal”?

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I don’t feel normal!

Chronic Fatigue is relatively rare to “get the diagnosis”, but understanding CFS or TATT helps you to understand where MOST PEOPLE READING THIS ARE AT - not necessarily feeling the need to go to Mayo Clinic to get a CFS diagnosis, but also not feeling the energy you think you should have at your age, struggling through the day, wanting to take a nap, having brain fog, and needing caffeine to function.

Whoever you are reading this, you probably know the feelings of being exhausted, of missing out on sleep, of being “out of it”. What if that was your everyday life all the time? What if it didn’t matter how many hours you slept? What if coffee, tea, or medications didn’t help? What if you just literally couldn’t get out of bed this morning? What if the doctors didn’t know what was wrong with you?

This is what people go through who suffer from Chronic Fatigue Syndrome (CFS), or the more generalized diagnosis Tired All The Time (TATT) Syndrome. It goes beyond normal fatigue to sheer exhaustion, often they can’t execute a full day’s worth of activities, they struggle with concentration, and can’t exercise without feeling like they were hit by a truck for the next few days. I’ve had patients who would say their kids would come to their bedside because they knew that was where to find mom. I’ve had patients who needed 3 days to recover from vacuuming their living room! I’ve had many patients lose tolerance to exercise and not be able to recover. I’ve had patients who completely reversed their fatigue and got their lives back, and I’ve had patients who didn’t recover.

Over 1 million people in the United States have a CFS diagnosis, which requires symptoms lasting 6 months or longer and consisting of 4 or more of the following:

Impaired memory or concentration
Post-exertional malaise, where physical or mental exertions bring on ‘extreme prolonged exhaustion and sickness”
Unrefreshing sleep
Muscle pain (myalgia)
Pain in multiple joints (arthralgia)
Headaches of a new kind or greater severity
Sore throat, frequent or recurring
Tender lymph nodes

The CDC states other common symptoms include:

Brain fog (feeling like one is in a mental fog)
Difficulty maintaining an upright position, dizziness, balance problems, or fainting
Allergies or sensitivities to foods, odors, chemicals, medications, or noise
Irritable bowel syndrome symptoms like bloating, pain, constipation or diarrhea
Chills and night sweats
Visual disturbances (sensitivity to light, blurring, eye pain)
Depression or Mood Problems (irritability, mood swings, anxiety, panic attacks)

There is no known cause or solution for CFS in the medical field. Fatigue is incredibly common, so CFS is very hard to diagnose, but it’s basically the name they put on your disease when they don’t know what it is. Experiencing Chronic Fatigue or being Tired All The Time is not a ‘disease’ as much as it is a ‘description’ (it’s like Irritable Bowel Syndrome - “Thank you, I know my bowels are irritated, can you please tell me why?”) Because of this broad ‘description’, chronically fatigued patients often get the medical run-around - which means by the time they get a CFS diagnosis they are chronically fatigued of going to doctors offices and being referred to the next specialist. CFS regularly presents alongside fibromyalgia, hypothyroidism, adrenal fatigue, migraine, stress, depression, and more….it’s a wild goose chase going symptom by symptom treating with medication after medication.

Although the medical system provides very few options, functional medicine provides many potential solutions for fatigue, because we don’t “treat” the fatigue, we look for the root cause mechanism(s). When you take this approach and give the body what it needs, over time the body can restore its normal function. Fatigue has many complex underlying mechanisms, including but not limited to:

Anemia (iron anemia and B12 anemia)
Thyroid Deficiency or Imbalances (hypothyroidism, Hashimoto’s, etc)
Microbiome Dysbiosis
Leaky Gut
Adrenal Hormone (HPA Axis) Dysregulation (‘adrenal fatigue’)
Hormone Imbalances
Mitochondrial Energy Production
Blood Sugar Dysregulation (diabetes, insulin resistance, hypoglycemia)
Circadian Rhythm Disruption and Poor Sleep
Sleep Apnea
Autoimmune Disease(s)
Methylation Defects (MTHFR and other genes)
Toxic burden (heavy metals like mercury and lead, endocrine-disrupting chemicals)
Hidden infections (Mold toxicity, Lyme Disease, Epstein-Barr Virus (EBV))

Uncovering the underlying mechanisms causing fatigue can require complex functional medicine testing, including:

Routine blood work (anemia, MCH, MCHC, MCV, TSH)
Mitochondrial function (Organic Acids)
Thyroid and Adrenal Hormone Testing
Microbiome (gut) Stool Testing
Heavy Metals Testing
Mold (Mycotoxin) Testing
Methylation Testing
Genetic Testing

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When you uncover the underlying mechanisms, you uncover potential SOLUTIONS. The treatment protocols are so specific and numerous that I’m not going to list them in this article, but our goal is to identify these underlying mechanisms and SUPPORT THEM NATURALLY, using lifestyle and targeted supplement protocols. Often there isn’t one “single cause”, but we might find that someone has: microbiome imbalances leading to GI inflammation leading to absorption issues leading to low B vitamins and low iron leading to cellular energy (methylation, mitochondria) deficiencies leading to impaired detoxification leading back to more inflammation….mix in a little chronic stress, low thyroid hormone, and a poor diet….the point is that fatigue is a very complex puzzle and our goal is to untangle the web and help you solve the puzzle.

Fatigue is an epidemic today, and there is nothing we love hearing more in our clinic than “I’ve got my energy back.” It can be quite a complex puzzle, and each puzzle is unique and different, but our goal is to help YOU put YOUR puzzle together one piece at a time.