5 Causes of Fatigue Your Doctor May be Overlooking

5 Causes of Fatigue Your Doctor May Not be Looking For

by Chris Kresser

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Fatigue is one of the most common health complaints, but its cause is not always easy to determine. Read this article to discover five little-known causes of fatigue that should be ruled out if you’re eating right and getting enough sleep, but still feel tired all the time.

Fatigue is one of the most common symptoms that patients report to health care practitioners. In fact, one recent study found that nearly 40 percent of U.S. employees experienced significant fatigue in the previous two week period. (1)

This shouldn’t come as a surprise, given the diet and lifestyle that most people living in the industrialized world follow. The average American gets almost 70 percent of calories from flour, sugar, industrialized plant oils, alcohol, and dairy products. One-third of Americans get fewer than 6 hours of sleep per night, despite a mountain of evidence indicating that we need 7-8 hours to function properly. And according to the American Institute of Stress, 77 percent of people regularly experience physical symptoms—with fatigue at the top of the list—due to chronic stress. (2)

Poor diet, lack of sleep, and chronic stress are undoubtedly the most common causes of fatigue. But what about those who eat right, get enough sleep, manage their stress, and still feel tired all of the time?

In a conventional medical setting, these patients are often diagnosed with depression or anxiety and prescribed antidepressants. This is a fallback position that doctors resort to when they either don’t know what to do next, or don’t have time to do the necessary investigation.

Unfortunately, antidepressants are rarely successful because they fail to address the real underlying causes of fatigue in these patients. In a recent article called Why We Get Sick—and How To Get Well, I argued that there are 8 core pathologies at the root of most symptoms and diseases. Identifying and then addressing these pathologies is the key to successfully treating all health complaints and concerns, and fatigue is no exception.

With this in mind, let’s look at 5 lesser-known causes of fatigue that should be ruled out if you’re doing everything right but still feel tired.

#1: Chronic infections

Several studies have found that patients complaining of chronic fatigue have lab markers consistent with active pathogen activity and infection. (3) These include stimulation of lymphocytes (a type of white blood cell involved in fighting infections), abnormal patterns of CD4+ and CD8+ T cells (which are also involved in fighting infections), and lymphadenopathy (an enlargement of the lymph glands consistent with infection).

These infections may be either viral or bacterial. For example:

  • In one study of patients with chronic fatigue, nearly 80 percent had markers of reactivated Epstein Barr Virus (EBV), and almost 50 percent had increased antibody titers to Human Herpes Virus (HHV). (4)
  • HHV has been proposed as a causal factor in several diseases that are commonly associated with significant levels of fatigue, including Sjogren’s syndrome, systemic lupus erythematosus (SLE), and rheumatoid arthritis. (5, 6)
  • A review of studies found that 50% of patients with chronic fatigue and fibromyalgia were infected with Mycoplasma (an intracellular bacteria), compared to 10 percent of controls. (7)
  • Severe fatigue is a common presentation in patients who have been infected by Borrelia burgdorferi, the bacterium that causes Lyme disease, even many years after apparently successful antibiotic treatment. (8)

It is important to note that the presence of these pathogens alone is likely not sufficient to cause disease. 95 percent of the population has been exposed to EBV, and Mycoplasma and HHV infection are not uncommon—yet the vast majority of those infected are not sick.

Tired all the time despite eating right and sleeping enough? Find out why.

There are several explanations for this discrepancy. First, there may be differences in the various strains or subspecies of each organism. Second, genetic differences may predispose some people to be more affected than others. (9) And third, differences in diet, lifestyle, and other environmental factors affect susceptibility.

Unfortunately, diagnosing these chronic infections is challenging and fraught with controversy. This is in large part because these organisms are experts at evading our immune system, and thus difficult to test for. I will be discussing chronic infections in more detail in future posts.

#2: Biotoxin illness (and Chronic Inflammatory Response Syndrome)

A biotoxin is a poisonous substance produced by living organisms. They can be further classified into fungal biotoxins (e.g. mycotoxins), microbial biotoxins, plant biotoxins, short phytotoxins and animal biotoxins. These biotoxins are found in water-damaged buildings, marine or freshwater environments, and in microorganisms that infect humans.

Biotoxins are not a problem for most people. When we are exposed, the toxin is “tagged” and identified by the immune system and broken down and removed from the body by the liver.

However, several years ago Dr. Ritchie Shoemaker, a family physician in Maryland, identified a subset of the population that is not able to properly detoxify biotoxins. They have a particular set of HLA-DR genes that cause defects in antigen presentation. In laypersons terms, their bodies are unable to recognize biotoxins as toxins, and thus they are not tagged and removed as they should be.

The persistence of these biotoxins in the body then sets off a chain reaction of biochemical events, leading to a continuous upregulation of multiple inflammatory pathways, reduced blood flow, a dysregulated immune system, hormone imbalances, intestinal permeability, and disrupted neurological function. Dr. Shoemaker has termed this constellation of biotoxin-induced signs and symptoms “Chronic Inflammatory Response Syndrome”, or CIRS.

A full discussion of CIRS is beyond the scope of this article. For a concise description, see this page on Dr. Shoemaker’s website, Surviving Mold. There is a wealth of information available there, and Dr. Shoemaker is going to be a guest on my podcast in a couple of weeks, so make sure to catch that interview if you’d like to learn more.

At the California Center for Functional Medicine, we’ve been starting to test and treat CIRS over the past several months. I can tell you that it is extremely common in our patient population, which consists largely of people struggling with complex and difficult-to-diagnose chronic illnesses. I believe this is likely one of the most significant—yet least often explored—causes of fatigue and other chronic health problems.

#3: Impaired methylation

If you’ve been following my work for the past couple of years, you’re already familiar with methylation and its role in human health and disease. I’ve dedicated two podcast episodes to it thus far, and I’ll be writing and speaking about it more in the future.

Methylation is a complex biochemical process. Rather than dive deeply into how it works, I’m going to focus here on its role in chronic fatigue. If you’re new to methylation, listen to my Methylation 101 podcast (or read the transcript) to get some important background.

There are several reasons why impaired methylation can cause chronic fatigue:

  • Methylation is required to produce CoQ10 and carnitine, which are essential for producing cellular energy.
  • Methylation regulates gene expression (it turns genes on or off). Genes code for proteins, which are the building blocks of neurotransmitters, hormones, enzymes, and immune factors that are necessary for normal function.
  • Methylation strongly influences detoxification, and problems with detoxification can lead to fatigue.
  • Methylation regulates folate metabolism, and folate is needed for the synthesis of new DNA and RNA.
  • Methylation promotes normal immune function. Weak immune function and autoimmunity are both associated with fatigue.

Thus it should come as no surprise that studies indicate that genetic mutations which affect the methylation pathway are associated with chronic fatigue. (10)

Defects in the methylation cycle can lead to both low levels of the active forms of folate and B12, and changes in folate and B12 metabolism. B12 and folate deficiency cause fatigue, and supplementation with B12 has been shown to have a positive effect in patients with fatigue. (11)

#4: Mitochondrial dysfunction

Mitochondria are known as the “battery” or energy powerhouse of the cell. They are organelles inside of cells that take in nutrients, break them down, and create ATP (adenosine triphosphate), which is the fundamental energy unit of the cell.

In addition to their role in energy production, mitochondria are also involved in the production of reactive oxygen species (ROS), regulation of amino acids, metabolites, and enzyme co-factors, neurotransmitter synthesis, insulin secretion, and pyrimidine and lipid production.

Because of these numerous and important roles, any defect in the function of the mitochondria will have widespread consequences. Mitochondrial dysfunction has been linked not only to fatigue, but to a wide range of health conditions like cancer, diabetes, fibromyalgia, and serious mental disorders like schizophrenia and bipolar disease. (12, 13)

For many years mitochondrial disease was thought to be rare, and limited to serious and potentially fatal forms that manifest during infancy or childhood. However, we now know that a full spectrum of mitochondrial dysfunction is possible, ranging from relatively mild to life-threatening.

Mitochondrial dysfunction can be classified as primary or secondary. Primary mitochondrial dysfunction results from mutations in mitochondrial DNA (mtDNA), which are inherited from mothers. Secondary mitochondrial dysfunction results from the influence of environmental factors (such as toxins, poor diet, etc.) that can damage the mtDNA.

Since mitochondria are responsible for cellular energy production, fatigue is a hallmark of mitochondrial disease. (14) Studies of patients with myalgic encephalitis (aka Chronic Fatigue Syndrome) are more likely to have mitochondrial dysfunction than controls. (15, 16)

#5: Gut dysfunction

There are numerous pathologies related to gut health that are associated with fatigue, including small intestinal bacterial overgrowth (SIBO), chronic infections (bacterial, viral, parasitic), dysbiosis and fungal overgrowth, intestinal permeability, and food intolerances—to name a few.

There are several mechanisms that explain this connection:

  • Decreased absorption of nutrients required for energy production and normal physiological function
  • Abnormal immune function or response caused by disrupted gut microbiome
  • Chronic inflammation and oxidative stress
  • Impaired detoxification

For example, one study showed that infection with a parasite called Giardia lamblia is associated with an increased risk of chronic fatigue that persists for at least 5 years after the infection has been treated. (17) Another study found that patients with chronic fatigue had abnormally elevated levels of a yeast called Candida albicans in their stool. (18) Finally, intolerance of gluten and other food antigens is associated with fatigue. (19)

Summary

The problem with fatigue is that it’s such a non-specific symptom; it has numerous potential causes, and often requires a lot of investigation to determine the primary driver.

Unfortunately, the conventional medical system is not set up for this. It is based more on disease management or symptom suppression with drugs than it is on identifying the underlying cause of disease.

This is where a functional medicine approach can be so helpful, and why I am so passionate about and focused on training a new generation of clinicians in this framework. (If you’re interested in learning more about this training, check out this page.)

Now I’d like to hear from you. Are you suffering from chronic fatigue that has not resolved despite eating well, sleeping enough, and managing your stress? Have you investigated any of the causes I mentioned in the article? What did you find out? Let us know in the comments section.

191 Comments

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  1. I’ve discovered the main cause of fatigue is the frequencies in our air today. These weren’t prevalent in years past, so we don’t have the genetics to deal with it. I suspect 5.0 GHz, and worry that 6.0 GHz is even worse. These make our environment much more entropic(i.e. disorganized, a falling apart) than before, and the cure is to add energy to the system(i.e. your body). Distance is your best defense against strong emitters.

  2. I’m hoping to get a little guidance here. I have been struggling with fatigue for about 4-5 years. I’m 25 and I live a healthy and active lifestyle. I will get anywhere from 7.5-9 hours of sleep per night and feel tired until about 3pm after waking up at 7am. I have talked to doctors about fatigue but I feel they think it’s just all in my head. I’m not sure where to go from here. Are there specific tests I can request to help me get to the bottom of this?

    • Please take a food and allergy test. I eat an exceptionally good diet. I follow the Weston A price foundation Plan but was exhausted to the point I would just lay in bed and stare at the walls. I was too tired to get out of bed but yet still too tired to watch tv. I’ve always been a very energetic person. Anyway test results came back allergic to milk quit right away felt better right away. The raw milk is awesome for my husband and three young children just not for me.

  3. My Aunt and I suffer from extreme fatigue- I sleep 12-16 hours daily and she sleeps 20-24 hours at a time. She is 55, I am 30. Had a sleep study done- I’m healthy and ‘normal’. She and I have had blood tests, thyroid examinations, autoimmune tests, antidepressants, neurologist appointments, lifestyle changes, etc. Nuvigil worked temporarily for me and not at all for my Aunt. Does anyone have any ideas?

    My career is suffering- and I’d like to have children soon. We are both feeling discouraged.

    • Take a food and allergy test. Mine was milk as soon as I gave it up my energy came back and my brain fog lifted. Be very cautious with supplements. Always try to get your vitamins from whole lightly cooked Foods and raw fruit. You literally are what you eat.

    • I ended up inventing something that added energy to my body. My sleep and rest are rejuvenating. I also discovered that some fatigue is due to not eating something(I know!). The theory is that our environment is much more entropic than it used to be, and the way you deal with that is to add energy to the system(i.e. your body). I used to deal with some of it through herbs, vitamins, and homeopathic hormones. I then dealt with it with stones(rotating them). Through sheer luck, I discovered the invention I made(you still have to do your proper work, just to get that luck.).

  4. My 29 year old son is suffering from fatigue, brain fog, joint and muscle pain and dark circles under eyes — this has been going on for 2 years just after moving from CT to Los Angeles (prior to that he was 100% healthy, rarely sick as a child). We first thought he was suffering from mold exposure which was found when he tested his apartment (spent 5 months there before knowing about it). He moved but symptoms persist to this day (18 months later). Haemachromotosis is in the family, he also has an elevated Ige level of about 800 with no respiratory symptoms. Bloodwork shows: Serum Iron at 135, Ferritin at 205. Had a recent stool test and tested positive for low digestive enzymes and Dientamoeba fragilis. Is on a paleo diet (but now down to 144 lbs, 5’9″), tons of supplements and has even tried colonics.

    Any thoughts or feedback on this health puzzle would be greatly appreciated!

    • In LA it is possible to get what is known as Valley Fever which is caused by a dimorphic fungal species. It is on the weapons list – like anthrax – which means it can be very serious – although many people just get something like a cold. He should get tested. If his insurance or doctor balks one possibility is to go over the border and get tested. Living there it would be wise to learn about it anyway. It took 2 year of agressive treatment to save my daughter and her doctor caught in on the first visit – which is rare.

  5. My 29 year old son is suffering from fatigue, brain fog, joint and muscle pain and dark circles under eyes — this has been going on for 2 years just after moving from CT to Los Angeles (prior to that he was 100% healthy, rarely sick as a child). We first thought he was suffering from mold exposure which was found when he tested his apartment (spent 5 months there before knowing about it). He moved but symptoms persist to this day (18 months later). Haemachromotosis is in the family, he also has an elevated Ige level of about 800 with no respiratory symptoms. Bloodwork shows: Serum Iron at 135, Ferritin at 205. Had a recent stool test and tested positive for low digestive enzymes and Dientamoeba fragilis. Is on a paleo diet (but now down to 144 lbs, 5’9″), tons of supplements and has even tried colonics.

    Any thoughts or feedback on this health puzzle would be greatly appreciated!

    • Sounds like candida overgrowth. I’ve spent many years and thousands and thousands of dollars on every supplement you can imagine. I rarely recommend them. You should always try to get your vitamins and minerals from Whole lightly cooked Foods and raw fruit.

  6. I couldn’t figure out what was making me crash some days. I finally figured out that it happened when I took magnesium and even if I didn’t take it the next two days, I was still exhausted. I’ve since read that you can’t take magnesium when your adrenal glands are exhausted or compromised in some way. Is that true or is there some other explanation? I normally have trouble going to sleep before 3 am even if I’ve only had 3-6 hours sleep for a few consecutive nights, even though I’m quite tired all day. I try not to nap as I won’t get to sleep before 6 am.

  7. I work in a Sleep Lab and see all sorts of sleep disorders. Some made worse by conventional medications. Before you move on to the 5 causes you mentioned it is important to first rule out sleep disorders; snoring – indicates a partial obstruction of the airway during sleep, or sleep apnea – both degrees of breathing disruption. If you are not breathing well your body is under stress at night. Cortisol levels increase, hormones are disrupted, inflammation increases. You also put yourself at a much higher risk for developing high blood pressure, heart arrhythmias, stroke etc. Your blood oxygen levels are affected by pauses in your breathing which wreaks further havoc. There are also other issues occurring during sleep such as periodic limb movements, which keeps your brain more active than it should be during sleep. It can often be addressed by balancing your electrolytes, taking a magnesium supplement often helps to to calm muscle activity.
    Fatigue can easily result from poor sleep quality which these disorders cause. You may sleep 8+hours and still be tired. You can have these issues during sleep and be completely unaware they are occurring. If you are uncertain you can be referred for a sleep study. If your sleep truly is fine and by all measures should be restorative and of sufficient quality, then move on to looking at the issues mentioned in this article.

    Stress during sleep will cause inflammation affecting your gut. If you don’t correctly pinpoint the cause of the inflammation it will continue to occur.

  8. I was fatigued for years. Diagnosed with CVID in 2013. Treatment with IVIG did not help the fatigue. Scans revealed NLPHL. 6 months of ABVD-R increased the fatigue (not surprisingly) Finished chemo in May 2014, but still fatigued from the moment I get up to the moment I got to bed, slowly increasing over the day, with “waves” of intense fatigue at times – unpredictable.

    • My theory still holds true. If you live in a much more entropic environment, you have to add energy to a system(i.e. your body) to prevent it. Yes, it’s hard. Yes, none of what I did completely solved the problem, until I invented something that always adds energy to your body. But my theory still stands.

  9. I suffer from. fatigue. Mine is caused from GBS an auto immune disease. I have the ASMAN variant. I take aB complex with vitamin C and D3. These help. I have learned to not over do it. I eat healthy, exercise and get plenty of sleep.

  10. Fluoroquinolone antibiotics – cipro, levaquin, avelox and a few others – can cause debilitating fatigue. Of course they can – as antibiotics that disrupt the DNA and RNA replication process for bacteria (and mitochondria) they are like a nuclear bomb to the gut. Unfortunately, repairing the gut is difficult.

    Also, fluoroquinolones deplete mitochondrial DNA. In their April 27, 2013 Pharmacovigilance Review, “Disabling Peripheral Neuropathy Associated with Systemic Fluoroquinolone Exposure,” the FDA notes that the mechanism for action through which fluoroquinolones induce peripheral neuropathy is mitochondrial toxicity. The report says:

    “Ciprofloxacin has been found to affect mammalian topoisomerase II, especially in mitochondria. In vitro studies in drug-treated mammalian cells found that nalidixic acid and ciprofloxacin cause a loss of motichondrial DNA (mtDNA), resulting in a decrease of mitochondrial respiration and an arrest in cell growth. Further analysis found protein-linked double-stranded DNA breaks in the mtDNA from ciprofloxacin-treated cells, suggesting that ciprofloxacin was targeting topoisomerase II activity in the mitochondria.”

    Here is a story of a young woman who has experienced devastating fatigue after taking cipro – http://fqwallofpain.com/2015/08/17/sierras-story-cipro-poisoning/

    Hundreds of research articles about fluoroquinolones can be found here – http://floxiehope.com/fluoroquinolones-links-resources/

    • I have a close friend who is experiencing devastating fatigue and similar symtoms to the young woman’s who’s story is posted above. Originally doctors thought she had a urinary tract and bladder infection. Nothing showed up on test given she suffers from Adisons disease. She was given IV antibiotics for 7 days, 10 day rest period and another 3 days of IV antibiotic treatments. Following that was cystocostopy surgery to view her bladder. Everything turned up negative. Unfortunately the anesthetic from the surgery has now debilitated her. She’s bed ridden and without heavy doses of steroids, she wouldn’t be able to get out of bed just to go to the washroom. She can’t sleep let alone function as a human being. The medical system doesn’t achkowledge Adisons disease so doctors at the hospital typically dismiss her symtoms. Is there any hope?? Anything that she can do or take to get some quality of life back???

    • This rings true as a child into my 30’schedule I was always sick with different infections, from streptococcus throat, to bronchitis pneumonia etc. Finally in 2006 I caught MRSA at work it took over 6 months to clear many I treatments. Along with Cipriani at home as well until finally I had surgery to remove it all. But I never recovered. I just got more fatigued with time. It was similar as when I would get bronchitis or pneumonia, I’d take antibodies be sick 3 weeks than go back to the doctors even worse for them to say it must be viral?
      Only this is like it never gets better?

      • Drop you cell phone usage, if you have fatigue. I fixed my torn meniscus(after they decided, due to risk factors, not to do surgery), and my knee ached until I removed my phone from my pants pocket, and put it 2-3 feet away. Now, I also invented something that fixed my knee.

  11. “#1: Chronic infections”

    Yes, please post more about this.

    It is very difficult (outside the US) to find:

    1) a good functional medicine practitioner who knows how to diagnose and treat

    2) Good books or DIY-hacks on how to find what’s the cause and how to manage it through lifestyle

    I’ve already read:

    – Paleo code, Chriss Kresser
    – Herbal Antivirals, Stephen Buhner
    – Antiviral Agents, Stephen Tyring
    – Herbal Antibiotics, Kasia

    I am usint BHT (butylated hydroxytoluene), various forms of zinc (blood tests come out ok), Lysine (lysine hydrochloride, but it messes up my electrolytes with constant use), wild mediterranean oregano oil, tea tree oil, upped my calcium (based on blood results, for nerve ending health) and even Acyclovir.

    I’m still getting constant cold sores, shingles and other symptoms.

    I’m almost 100% clean on my diet and strictly milk, grain and legume free. Have done GI Effects comprehensive profile, all possible IgA, IgG and IgE tests locally availble. I eat insane amounts of green leafy vegetables, all eggs are local and organic, all nuts are organic, as are the oils are use. I eat a limited amount of carbs, mainly from berries and organic fruit.

    I meditate every day. I have good sleep hygiene and sound sleep. I cant’ do strenuous exercise (or my immunity will crash and I will get a break out).

    I’m already living more healthily than 99% of the doctors I meet, but I’m still not feeling well. Better, but only managing.

    So yes please, do write more about these chronic infections and how to DIY hack them. Good ancestral-trained functional doctors are almost non-existent in most parts of Europe (and even more non-existent beyond US and EU).

    We have to rely on ourselves and each other for help…

    • Where you live?

      I’m a european guy and have same problems. EBV and HSV-1 w/ positive IgM e IgG, and high titers for CMV IgG.
      Without any personal help, i started trying some things. I’m feel better, but brain fog still here and some other problems.

      Do you need some prescription to realize the stool test?

    • Do an organic acids test (OAT) and find out what is going on. Great Plains laboratory do them. You may find you are high in oxalates like I did . I was eating what I thought were very healthy foods like nuts, berries and lots of greens including spinach…all very high in oxalates. What I didn’t know was that they were depleting my calcium levels and putting me at risk of kidney stones.

  12. I’ve been on prednisone twice in the last 6 months trying to control severe allergies. In the process I’ve been having bouts of really severe fatigue. When things got really bad, I refused to go back on steroids and figure out what was going on. Over the last month, I’ve removed a lot of inflammatory foods from my diet and finally got my allergies under control and holy cow, it was like a revelation. I love my doctors, but they never looked at my fatigue beyond simple labs. My magnesium was ok, do I was just told to “rest”.

  13. Chris: I am very interested to know if you have additional information about secondary mitochondrial dysfunction. You may not as there doesn’t appear to be a lot of information about it. I would welcome a diagnosis of secondary mitochondrial dysfunction, if this would help engage my health insurance company. I am interested in information about treatment options as there is even less understanding of mitochondria at the health provider level than even C677T. I am open to studies or clinical trials as there seem to be few treatment options.

    The real question in my mind is whether mitochondrial function can be normalized by creating a more mitochondria friendly environment by reducing ROS production through the use of mitochondria targeted antioxidants. I think the answer to this question hinges on the mechanisms used by mitochondria to repair mtDNA, which are quite different from nuclear DNA repair mechanisms.

    • My router used both the 2.4GHz and 5.0 GHz, and I always got so tired, after sitting within 3 feet of it(nowhere can I find out how strong the emitter is, other than it had to be modified stronger, in order to make you hotspot.), that I felt like I had to sleep. This was cured by having the technician bridge my router(which eliminates its WIFI capabilities). That’s my proof.

  14. I have been tested and treated by a functional medicine doctor, who is trained in parasites, biotoxin disease etc. It did not address the underlying problem for me, which was Primary Immune Deficiency: specifically CVID,(common variable immune deficiency). This is what can set the stage for all the issues you mentioned. Until tested and treated by an immunologist with immunoglobulin I did not get better. I would suggest that more people need to have their immune systems checked. 50% of people who are ill with some form of immune deficiency have not been diagnosed, and the average time from onset of symptoms to diagnosis is often up to 20 years. See primary immune.org for more information.

    • Of course I’m depressed! I fall asleep at red lights, on the freeway, in the middle of sentences, at my computer …. all the time! And no one can tell me why! But I don’t think it’s because I’m depressed!

  15. I have been sick all my life. Have seen to many doctors to count. I am still struggling with being ill. I have recently lost 50lbs. I am not trying to lose weight. Sure would love to go at least one day free of pain.

    • People say things like you, and they are unwilling to do things that their minds say can’t work. I suggest you pay attention to anything that makes you feel better, and do those things.

  16. These are some great things to looks for, from a biological point of view. I’d also like to add that fatigue can have a major emotional component too. Not dealing with past issues or feeling blocked in another part of life can take a lot of our energy. As can just being poor at managing the energy we do have – if you’re leaking your energy into a job you don’t like, pursuits that don’t build you up, and relationships that take more than they give, then of course you’re going to be fatigued. A great thing to do is to learn to manage the energy we do have sensibly, then as we work towards having more, we can use it to build a life we love and that will sustain us.

    Thank you for such a thought provoking post.

    • Very well put Samantha. Mental and emotional stress was a huge factor in my daily fatigue and poor sleep. Not to say it’s the only factor for people but it’s a massive one that flies under the radar for most people.

      Chris has stated that his articles on stress management are the least linked to and shared. I think many people assume that if you’re dealing with any emotional stress, that it’s somehow a reflection of your lack of will power or fortitude when in reality I think most people don’t get taught even the most basic stress management techniques.

      • I totally agree, Ian. Stress management and resilience are just so important on our health journey. I think Chris’ stress artcles might also be less linked and shared because dealing with those issues is often a bit harder than taking a supplimemt or getting a test done. Not that suppliments and tests aren’t awesome, but they can’t fix something that has a deeper emotional basis.

        In my opinion, it’s really impotant to be honest with yourself when assessing something like fatigue and explore the emotional/spiritual/mental side of things at the same time as addressing more physical pieces of the puzzle.

  17. I have very high levels of lead and mercury per a 6 hour DMSA urine challenge. I’m sure this is at least one root cause of my issues. What’s, generally, the best way to go about getting rid of these toxins? I don’t hear a lot about treatment for toxic heavy metals. I would love it if practitioners would talk about it more. Thanks

  18. Biolabs or Acumen in the UK do an excellent mitochondrial function test – you definitely need someone who knows how to interpret it for you because it is very complex though. I had mine done with Dr Sarah Myhill who is based in Wales but takes international patients for interpretation by letter. I found it very useful to see there was a real biochemical lesion causing my fatigue. It doesn’t tell you the cause though and this is where the other points are very interesting.

    I definitely had most of the problems on the list from Chris. I’ve tried getting the basics right but had to go radical on a few of them. I’m a poor methylator functionally and have a genetic problem with that too. On top of doing the basics right, I had to take B12 injections for a long time, even weekly IV myers (vitamins) for long periods just to get through the day.

    I’ve suffered with the most intractable gut problems all my life, in spite of paying really careful attention to my diet and supplementation. I recently did a course of fecal bacteriotherapy at the Taymount Clinic in the UK. I think it has helped. I actually had no bacteriodes, which you can’t get any other way than through a person to person transfer. It made me a lot less constipated and a lot more cheerful, which was unexpected.

    I suggest you also look at Chris’s pages on thyroid function as well.

  19. I have suffered from fatigue and fybromyalgia for about 10 years now.Post menopausal and some days I am totally wiped out in evenings.
    I am a carrier for Haemachromatosis but don’t have it.
    Take magnesium and b6, red clover, efamarine, and kiki auperfood and glucosamine but still feeling tired and very achy.My hands even hurt when I grip my steering wheel on my car!
    Any suggestions?

  20. I have EBV, HHV-6, CMV, Lyme, mitochondrial dysfunction, leaky gut, probably SIBO, Hashimoto’s autoimmune, constantly tired and totally brain fogged. I take tons of supplements. I think we are ALL being poisoned to death by the toxic environment, pesticides, chemtrails, EMF pollution, etc. The best thing we can ALL do is protest this government’s corrupt association with big Pharma, etc. and at least save our grandchildren from even worse fates. Americans have become too complacent. Other countries do not put up with this nonsense.

    • How and where can you find out about mitochondrial distinction and the other problems and how to treat it? I am fed up with my doctors.! Thanks for any advice.

    • Please go get tested for CVID from a legit immunologist. I had the exact same profile as you and got better with immunoglobulin. It’s a simple blood test.

  21. I was diaganosed w Lyme and Lupus… Had extreme fatigue for years.. I feel 98% cured – took me many years(7-8). Heres what helped the most: eliminate as much stress as possible, veggie juice cleanse fasting, mega probiotics, armour thyroid, SamE, ginseng, chlorella, rhodiola, oregano oil, and zymactive ( proteolytic enzymes).. Took patience and total self love and surrender. Hang in there and always believe “this too shall pass”. The emotional and spiritual and self love pieces to this are HUGE in the healing.

  22. Dehydration where the body has not or is not absorbing water-eventually depleting hormones and creating disease like cancer

  23. Hi Chris, I’ve been a life long sufferer of chronic fatigue, starting when I was a teenager. When I was 20, I had a glucose tolerance test. The 6 hour kind, and I had severe hypoglycemia. But the most concerning part was my fasting glucose level was 25. Normal being80-110. The clinic repeated the test three times because they thought their equipment was malfunctioning. Same result. The Dr asked me how I was feeling because the textbooks said that I should be in a coma. I told him I felt this way all the time. Or normal for me. Forty years later, this is what I learned. I started taking vitamins and minerals to excess, at an early age, say 13 or 14 years old, thanks to a well meaning, but mislead mother. Taking vitamins in high concentrations can cause severe liver and drenal damage as evidenced by my glucose test. And not just the fat soluble ones like vit. A or vit. E. The B vitamins cause severe damage too. Chronic disabling fatigue and suicidal depression were in my case, caused by taking vitamins. How many other people are being affected, I have no idea. Food for thought.

      • NsThose are both excellent questions Janet. I’ll start with the recommended amounts. I was a teenager in the 70’s. Attitudes about vitamins were very different back then. They were still somewhat new and there were tons of books written extolling there benefits. The authors were very liberal in their recommendations and the taking of “mega doses” of vitamins was common. Dr. Linus pauling. Famous for his research in vit. C suggested that you take vit. C by the gram until you got diarrhea. That’s when you knew you had enough in your system. Other doctors were doing research on taking massive doses of niacin for the treatment of schizophrenia. The RDA was never really mentioned as something to follow. Manufacturers regularly sold B Complex with 100 mg.s of all the b vitamins, and people were advised by the various books and the friendly people working in health food stores to take 3/day or more. Vitamins were considered completely safe, since what your body didn’t use was simply flushed out. Later, it was learned that the fat soluble vitamins were dangerous because they were stored in the liver and could damage it. So, in answer to your question, I took mega doses of vitamins because it was recommended by lots of people and doctors through there books. If a little was good, more was better, was the thinking at that time. After I had the glucose tolerance tests, my Dr (chiropractor) put me on a very expensive and high dosage vitamin regimen, including adrenal, liver and pituitary extracts. The more I took the worse I felt, but being “brainwashed” by everything I read and was told that vitamins were safe, it took years for me to finally make the connection. A few months after I started with the new vit. Regimen, I was feeling so bad, I went to a different Dr, and had a blood test that determined the levels of all the vitamins that were actually in my blood. I’ll never forget what he said when I went in for the results. 38 years ago! He said, you’re so damn deficient in EVERYTHING I dont know what to do with you. All the supplements I was taking weren’t even being absorbed, or my body in its wisdom, identified them and their amounts as toxic, and rebuked them. Soon after, I was at a seminar where a medical Dr who specialized in hypoglycemia, said that in his opinion, the rampant rise in hypoglycemia was simply due ti people taking too many supplements PERIOD. especially the B vitamins, because he said they damage the liver and adrenals. He alsoxplained that the body has several mecha.nisms to keep the blood sugar at proper levels. So by the time you have full blown severe hypoglycemia, your liver and whole endocrine system is really messed up. To this day, my body reacts very severely if I take supplements of any kind. Through the process, I learned to listen to my body and to trust in its healing ability. For me, thru proper, nutitious food and exercise. My thinking process was completely skewed, almost like I was in a cult. If I was sick, it was because I was deficient in something, and I would read read read and try to find the magic vitamin that I was missing. I put with decades of. fatigue, depression, brain fog, etc. Beause I didn’t listen to findand respect my body. One of the worst side effects was “burning scalp syndrome” which is the worse chronic pain I ever eexperienced. And it went away when I finally got it, and stopped all supplements. I found a blog with people just like me. Who also took vitamins and had the burning scalp. Google “topix forum-burning scalp syndrome” and you can read other people’s stories just like mine

        • To follow up, I’m not opposed to anyone taking supplements. Dr Oz had a show recently about a woman who was constantly tired. She took handfuls of vitamins every day. She stopped most of them, ate a better diet and felt great. My main concern was to share my story, if you take vitamins and still are tired and feel lousy, maybe they’re not helping. And if you’re like me (and I hope not!!!” Maybe they’re the cause.

    • People should only take supplements as a last resort. I believe our body uses vitamins like pharmaceutical drugs. We should try to get our vitamins and minerals from Whole organic lightly cooked foods and raw fruit.

  24. dr bell in lyndonville, ny for mitochondrial dysfunction as root of chronic fatigue syndrome. sumone u ought to intrrview!

  25. Low iron is often an overlooked cause of fatigue.
    Especially in those of us who enjoy exercise, and especially in women. I was told 15 years ago that I had chronic fatigue. Now I realise that I actually had low iron.
    I had done a lot of research into this, and one of the many things that I discovered, is that the results from the ferritin test are not accurate readings of your actual iron stores, but they are general indications of them. This was from the findings of a clinical testing research.

    I have come to learn that the levels for normal ferritin iron stores in England, are far too low, especially for women. It is my view, that the normal range, just like that for the B12, is far too low. And that if your ferritin levels are on the low end of the scale, your fatigue may be a result of low iron. In a article by a Canadian doctor who works in England, he said that our normal level in England is much lower than in Canada. Ours is around 30, and theirs is 50. He also says that even for those at that level who are still experiencing fatigue, once their stores reach 100 they feel better.

    This has been my own personal experience also.
    What is interesting is that is it such a common issue especially among women, yet so far, it seems that there is no quick easy way to build up iron stores! Which I think is astonishing really in this day and age, and given the number of women who suffer from this.

    I would encourage anyone who has low energy to have their iron ferritin levels checked. Especially if you are a women and your period leaves you fatigued. And when you get it checked, even if the doctor says it is normal. Make sure you find out the numbers, so you can see if you are on the low end or not.

    I think that because some people can have a condition where their iron gets too high, there is a concern about this. And unfortunately, a lot of articles warn about taking too much iron. Mostly written by men. Because naturally, they don’t loose iron each month! But it is rare that a women who is menstruating would have such a concern. And a women who looses blood each month, AND is exercising a lot, has a much higher requirement for iron. And would need to get tested if experiencing fatigue.

    I wish I had known this twenty years ago, when my doctor said that I had chronic fatigue, and ruled out my iron as being “normal”. Because I KNOW now, from going through this again, that it is because of low iron stores. And that this was not picked up before because the normal levels are simply not high enough. We have to not just look at the numbers, we have to look at the whole picture. If you are a women and get fatigued from your period, your iron is low. And needs building up, it takes a long time to do and once you do, keep taking the iron or your stores will fail again over time!

    Take iron with vitamin C for absorption, as well as B complex,

    Common sense maybe, but if one person is helped by this information, it makes sense.

    • An interesting thing that I have noticed happens when iron gets low, other than the fatigue. Is that one becomes very sensitive. To things they would not normally affect you. Chemicals, pollen, etc.

      Also, you become more sensitive to fluctuations in blood sugar. You become hungry all of the time. Really hungry. And more sensitive to low blood sugar than ever before. I guess this is all to do with the processes which iron are used for.

    • Sounds like me here. I was vegan for a while and found that I had pernicious anemia. I have low stomach acids and IBS-Class D. It’s tough to manage; especially with a hectic schedule and social life.:/ I feel much better when I eat a low-residue diet. No fiber, but plenty of dairy and fats. No deficiencies or mood problems now.:)

    • Low iron was one of my problems, as well, and was just recently diagnosed. I’m now taking an OTC iron supplement and starting to get some energy back. It’s certainly worth checking into.

    • I had the same experience with iron! I think there are some genetic factors involved, because there are people who seem to be perfectly fine at a ferritin of 30, while a subset of people develop all sorts of strange symptoms. Along with fatigue, I had hypothyroid symptoms, and a a phase delay in my sleeping pattern. It’s interesting, because in a subset of people with ADHD, and also Restless Leg Syndrome, their symptoms are apparently caused by low levels of iron in certain brain regions. Meanwhile, other people with these diseases have a different pathology.

      From what I’ve read, it’s best to get an iron panel, or at least 2 different iron tests, eg: ferritin and iron saturation. According to labs where I live, a ferritin 90 can actually contribute to insulin resistance.

      Unless you have gut issues, iron levels should actually be easy to increase by taking a high dose supplement for about a month, but I took it for 3 months with barely any change, plus I tried a high iron diet (liver, kidney, etc) for 2 years, and that also barely changed anything. According to some hemotology articles I read, if your iron deficiency is refractory to supplementation, you should be tested for atrophic gastritis, H. pylori, and Celiac, but I didn’t have those. I finally found that eating beef with some kelp and black rice worked, but it’s still an extremely slow process, so I’m looking into SIBO and prebiotics, since I’ve seen comments where people fixed their iron absorption just using prebiotics. Some of us with poor iron absorption also have beeturia, so that can be a quick indicator of whether the prebiotics are shifting the flora to a more healthy pattern, maybe (?).

      Anyways, it’s great to hear from someone who had the same issue as me, since many people were dismissive of it, despite all the documentation indicating that some people really do need to be at >50 ferritin. I guess this is why we need personalized medicine.

      • *typo: 2nd paragraph should read transferrin saturation, not iron saturation.
        Also, part of my comment is missing: in the 2nd paragraph, it should read, “According to labs where I live, ferritin 50 but 90 could contribute to insulin resistance.”

        I will reiterate that many people are perfectly fine at a ferritin of 30, and their fatigue or RLS or w/e has nothing to do with their iron. It is something that should be ruled out, though.

        • Hi Chris, is there a problem with my comments? Part of them seem to be missing. Can you let me know what the issue is? Thanks.

        • My 2nd paragraph has been altered again, so for anyone who is reading, just ignore the quoted section. It’s just referring to the biochemical individuality of a reference range, so I’m not sure why the censoring. Any clarification on that would be great.

    • Sarah,

      Thank you very much for your post. I might be one of the people your post helps. I’ve had chronic fatigue for 12 years and have tried so many strategies to help alleviate symptoms and get to the root cause. My ferritin levels are quite low and I have significant problems with blood sugar levels but most doctors do not see a connection to iron stores.. Can you suggest a website or book that would explain how I go about increasing my iron stores? Is there a particular form of Iron that is better then others? Should I consider this a life-long issue I need to manage? I see you also mention taking I think vitamins B and C (sorry I can’t pull up your post while I write this reply). I suppose my basic question is – Is it a fairly straightforward but long process to increase iron stores or should I seek our a functional medicine doctor or further support in accomplishing this? Thank you so very much!

      • If you are low in energy, you have to add energy. Yes, low glucose levels result in low energy, but my first statement still stands.

    • Do you have a link to the article by that Canadian doc? I’m in Canada and am reviewing my ferritin results from 2013 as i recently starting feeling very fatigued, along with restless leg syndrome and waking after an hour or two of sleep…my results are measured in ug/L and i wonder if the numbers i read on american sites refer to the same units of measure…my reading was considered normal at 54 with a ref value of 13-150.

      • Google ‘transferrin saturation RLS’. Your doctor should have ruled out iron deficiency as a cause of RLS by doing an iron panel, not just ferritin.

        The units under discussion are the same.

      • Low magnesium can also result in restless legs. Many are deficient in it. Try taking a supplement for 2 or 3 weeks and see if you find an improvement.

  26. I’m from Wales, U.K and was diagnosed with multiple food allergies, Chronuc Urticaria and Angioedema over 15 years ago. My diet is restricted but healthy but my condition has worsened resulting in my pursuit for new information in trying to find both a reason and possible cure. I suffer from fatigue some days more than others and believe histamine Intollerance is contributing and has resulted from intestinal damage from gluten allergy. Elimination diet has proved that I seem to react to most foods of various kinds and some cause bad migraines and chronic fatigue. I’m supplementing with Acidophilus, digestive enzymes, L-glutamine, vitamin C and just started trial of Diamine Oxidase supplements to see if that helps. I’m at a complete loss, Doctors and Specialists here just prescribe anti histamine and anti depressants with no attempt to understand the root cause. I am a believer that the route lies with commencement of my illnesses, following a period of significant stress, repeated cystitis and kidney infections that almost put me on Dialysis and the prescribing of 5 consecutive courses of anti biotics. My gut seems to be sick but how do I repair the damage and rid myself of the above problems?

  27. Chris, I’m really disappointed to read that you’re treating ‘biotoxin’ illness. There really is no validation for this illness and treatment and no Scientific consensus between researchers who’ve looked into it (Brewer, Shoemaker Hope). I strongly encourage you to research MCAS as it shares all the same immune markers, symptoms and triggers and has been validated by many universities worldwide.

    • From someone with Biotoxin illness (CIRS) I can assure you that from mine and hundreds of thousands of patients getting better from it, it is real.
      MCAS is a symptom. Not a root cause.
      There are thousands of documented cases now of CIRS and all our labs follow the biochemical pathway healing set out by Shoemaker. There are many ways to get well from it, he is by no means the only authority. But to say this is not real shows a lack of knowledge.
      People with CIRS and chronic/late stage lyme show a difference in their HLA gene, meaning that they cannot detox mold or/and lyme biotoxins. This is modern environmental illness – our environment meeting our unique genetic blueprint and individual toxic burden/threshold. It is hugely important we all stay open to this emerging field rather than discounting something as not real, because there is no consensus. Science only moves forward through challenge and lack of consensus, so this is a nonsensical argument really. Of course there won’t be ultimate consensus – it is a fluid and dynamic learning curve for researchers as science grows to understand the intricate interplay between organism and environment that is making us such a sick species.

  28. I live in CAscais, Portugal and have had EBV and 3 or 4 other forms of chronic herpes, starting when I was 20 and got glandular fever (mononucleoisis). Since I got severe case of Lyme Disease and related pathogens in 2001 I have never gotten well, just up and down from years of brain fog, fibromyalgia, and other. I have been using books and websites for many years to slowly get batter, but am very isolated for access to up-to-date functional medicine professionals. How can I get access to a good quality test for Stool Analysis and Parasitology?
    Thank you for all your website info, which has been very helpful to me over the last year.
    Alice Frankel, Cascais, Portugal

  29. Hi Chris,

    Great article, very timely. I’ve been diagnosed with a reactivation of EBV, and I’m managing it with a paleo/Wahl’s protocol type of diet, stress management, big doses of your liposomal vitamin C, and ozone treatments. So far so good, but I will admit that I’m really pushing it as I am training for an Ironman race. I can do the workouts, but not as fast or as strong as I’d like. It definitely takes longer to recover, and I have to be uber-vigilant about sleep. Still waiting to get my tests results from 23andme.com regarding methylation. After seeing the symptoms of others here, I can see that I am very lucky. (Thank you, God.)

  30. I hope that in your future posts discussing chronic infections, you will include at least some mention of the serious problems (like heart attacks) that can be caused by chronic infections in root canalled teeth.

  31. Hi Chris,

    I’ve struggled with chronic fatigue since high school (39 years old now) but have also had a couple of incidents of dehydration and low electrolytes that had me hospitalized. Once I even got hyponitremia that led to seizure and unconsciousness for several days. This is despite the fact that I hydrate and eat very well. It’s scary and confusing and no doctor except for one in Nicaragua who suggested an infection and gave me a week long dose of antibiotics that helped a ton, has ever known what is wrong with me. Monday I was in ER all day getting IV fluids and had low potassium. Again, how strange since I eat a very potassium rich diet. Something is causing my body to leak these things. Tomorrow I have an appointment at Seattle Integrative and will ask them to look into these things on your list. Thank you.

    • Serum electrolytes are tightly regulated by the body, and not good indicators of nutritional status of electrolyte minerals.

    • Ask for celiac blood panel.

      If it is helpful, I had electrolyte imbalances for years including low potassium. Finally discovered I have celiac disease, thanks to a doctor that threw every test in the world at me. Thousands spent on CT scans, ultrasounds, MRI and adrenal testing etc. when a simple blood test explained it all! I was not absorbing nutrients like potassium! Then 3 years later I developed hyperparathyroidism. Tumor on the parathyroid which set behind the thyroid. Parathyroid controls calcium flow in ALL your cells. Effects cardiac function, nerve function, muscle strength – everything. I am convinced my malabsorption of nutrients over the years led to the tumor growing. I have eaten gluten free since celiac diagnosis but it took 2.5 years for my gluten anti-bodies to come down which, when they reach normal shows that your gut is healing.

  32. We have learned all of this – but from separate individuals and over a span of 6 years time. To have one practitioner embrace all of this, is amazing. We work with Dr. Amy Yasko for methylation, but still struggle to find a practitioner who can effectively help treat Lyme and co-infections in our area. Our other issue was with bacterial identification. It can be done, but it takes almost a miracle to have the bacteria identified correctly. That is the most important piece. Then, finding a practitioner who has done what you have, is the other piece. We need more people who understand not only the leaky gut piece, but how your genetics play into your illness with respect to chronic bacterial infections as well as high metals, and other environmental factors. It’s encouraging to see this coming together, but accurate bacterial identification remains difficult.

    • Have you read Stephen Buhner’s comprehensive book on Lyme and co-infections? A very good place to start and possibly end your search for relief.

        • Buhner is, I think to say very simply, an herbalist. I have many of his books and have read all but the one I have on Lyme. I have never, thankfully, had Lyme, but I did have MRSA, and I would put that in the past tense, thanks to Buhner, and his work with natural healing and plant based “antibiotics”. While his work may be a little far out for some, as it deals with what we call “plant intelligences”, his work with herbal antivirals, antibiotics and Lyme is well cited and referenced. Here is the link to his Lyme books on Amazon and he is on Facebook, should anyone want to see that. Hope this helps a little! http://smile.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=stephen+buhner+lyme

            • I came at it from every direction I could find after many hundreds of hours of research. I was battling this for both myself and my then two-year old son. The doctors here were not only condescending but totally uninformed of this phenomenon. All they could offer were more anti-biotics, which would do nothing but exacerbate the situation further. I believe we contracted this second-hand from a family member, who contracted it during a surgery. Long story short, I did many things, but a couple of things were, rubbing alcohol and tea tree essential oil for topical needs and Buhner’s recommendation of Bidens and Cryptolepis. Still further is that I flooded our system with probiotics. I think this was imperative to out-run the MRSA infection. And by flood, I mean, if the bottle said take three, we took six, or ten, at least three times a day. I perceived no ill-effects from this in either of us but did see a marked improvement fairly rapidly. While I love fermented foods and believe those could be equally helpful, I wanted to ensure that we were really going after this, full bore.

  33. Thank you for the wonderful information you imparted on
    Causes of Fatigue. Forgive me if I overlooked information, but I wanted to add that dehydration can cause fatigue and not getting adequate sleep. Also,
    If you go to sleep after 11:00 p.m. you will not obtain your best sleep. You can check articles on the sleep cycle. If you are one to consume an abundance of carbohydrates,
    you will be fatigued. And stress
    adds to fatigue. Lack of exercise causes decreased endurance and will cause
    fatigue upon exertion. If I miss a Daily Vitamin, my body knows it and becomes fatigued. Thank you for listening…

  34. Do not forget about those of us with chronic pain and connective tissue diseases. I found 1/2 of an older antidepressant tablet at bed helps me sleep.

  35. I have +/+ SNP for the SOD2 A16V. SOD2 is your oxidative protection in the cell at the mitochondria. Mutations affecting this antioxidant enzyme can lead to increased free radical activity, cell damage and fatigue because SOD2 is not doing its job enough. The man free radical generated within your cells is called superoxide which needs to be reduced in ordered to protect the mitochondria and its generation of ATP. In order to help, the antioxidants have to get within the cells and at the mitochondrial level. I’ve only heard of one product called MitoQ (CoQ10) that can actually make its way to the mitochondria but I don’t know if actually works to reduce superoxide. I’ve read about things to help express the gene but I’m looking for something that can actually get to the mitochondrial level and can mimic SOD2 if it is not in fact not doing its job because of this SNP and help with my chronic fatigue. Does anyone know of a specific food, supplement, etc. that has actually worked with issue and their chronic fatigue? Thx.

    • Eric,

      The factual evidence:
      – MitoQ has been shown in studies to reduce superoxide production in complex i, ii, and iv of the electron transport chain.
      – MitoQ does not reduce superoxide production in complex iii as cytochrome c is used as the electron transporter.
      – MitoQ is very expensive.
      – I am heterozygous for at least 3 SOD2 SNPs.
      – I am homozygous for C677T and C699T.

      My own anecdotal evidence for the efficacy of MitoQ:
      – I believe that I have secondary mitochondrial dysfunction due to mtDNA damage caused oxidative damage due to my – SNPs in combination with poor nutrition.
      – After radically altering my diet to control both C677T and C699T I feel much better, but I still feel fatigued.
      – I find that my fatigue seems to be lessening with the following mitochondrial support:
      + MitoQ: 4 to 6 pills per day
      + Kaneka QH ubiquinol: 600 mg per day
      + pantethenic acid: any amount as more isn’t necessarily better – I use part of a capsule – keep in mind that this likely increases ROS by driving ATP production
      + hydroxocobalamin: any amount as more isn’t necessarily better – I break a sublinqual tablet into fourths and I don’t take every day

      My personal speculation:
      – I believe that deficiencies in critical cellular processes such as methylation and ATP production can create a host of macro-level dysfunctions such as atherosclerosis, dementia, immune dysfunction, etc.
      – I believe that aging is primarily a product of nano-level derangements. Address the nano-level issues and you will treat the macro-level symptoms.
      – Anecdotal support: I suffered from peripheral edema for many years. Many people take diuretics to deal with this macro-level symptom. Before finding my SNPs I avoided table salt instead of taking diuretics. After finding my SNPs I addressed my methylation and ATP generation issues and now I MUST consume an appropriate amount of table salt to balance my potassium intake on a daily basis. I have no hint of swelling even after long duration car or plane travel.

      Other points of interest:
      – My knowledge of biochemistry is poor, but it seems that metabolizing fat for energy produces less reactive oxygen species than glucose metabolism.
      – There is little information about therapies for secondary mitochondrial dysfunction at this time. Notice that this article contains some information about treatment in many sections, but not in the section about mitochondria.
      – There are other mitochondria targeted antioxidants. Mito-Vit-E is vitamin E that has been treated in the same way as the CoQ10 in MitoQ. SkQ1 or plastoquinone is being evaluated in clinical trials. I haven’t found a supplier for Mito-Vit-E.

      Good luck.

  36. In section #5: Gut dysfunction, there is an error in this sentence: “Giardia lamblia is associated with an increased risk of chronic fatigue that persists for at least 53 years after the infection…”

    The study (http://www.ncbi.nlm.nih.gov/pubmed/23399438) indicated “as long as five years”, not 53. We would be very discouraged if it really was that long…

    There are a few other minor typos in the article, e.g. “A review of studies found that 50% oftients with chronic fatigue”.

  37. So wonderful for future generations that there will be more “Chris Kresser’s” in the country. I hope that someday these practitioners will accept insurance so that middle class or lower can get the help they need.

    • It’s a shame (a sham?) that health care (care of one’s health) doesn’t include those who aren’t monied. Some of this investigative work takes loads of time and loads of money. And one has to trust that the money is going to be used wisely, because there is, for some, very little of it. Tsk

  38. Excellent summary, there’s a lot of debate with HHV-6 and EBV as to which one came first, the chronic fatigue or the virus?

    Irregardless of which came first, once they are reactivated, they are their own beast that need to be addressed.

    Monolaurin is excellent for EBV, HHV-6 and others you didn’t mention like Cytomegalovirus (CMV). Often times there will be Candida involvement as well – the common link between them all being the widespread immunosuppression – very common in Fibromyalgia, CFS, and Lyme patients.

    Glad that you mentioned the biotoxins as well because killing some of these bugs too fast too soon can exacerbate fatigue and so sometimes slower is better as your body flushes out the waste….and sometimes you need to pay attention to detox support as you expertly noted with methylation.

    Thanks Chris, for yet another knowledge drop!

    • @ Alexander, how does one know if their EBV has been reactivated?. I had EBV 25 yrs ago, and my doctor told me it can’t be reactivated. Can you explain how it happens.
      Thank you

      • The exact mechanisms of reactivation are actually not well understood. From the research I’ve looked at, we only know physical/mental stress, as well as some of the immune changes that naturally occur with aging (a gradual shift to Th2 immunity). Classically, you check EBV IgM. Some docs would argue that IgG levels that are 3-5x the normal may indicate a chronic infection – but classically IgG indicates you’ve been exposed in your life, not that it is active or reactivated.

        When it comes to autoimmune risks associated with chronic EBV….it seems to be related to epigenetic effects of co-infections.

        EBV material lives and lies dormant in the lymphocytes, If you trigger an immune response from a co-existing infection -the other infection can increase extra production of lymphocytes. When that happens, byproducts of the co-existing infection can interact with EBV and potentially lead to reactivation/autoimmune complications.

        Epigenetic changes such as impaired methylation has been proposed as a mechanism as to why EBV could be “reactivated” in one person but not in another.

        Lastly, nutritional/lifestyle factors such as low Vitamin D can increase your risk for reactivation and autoimmune complications

  39. If your fatigue is relatively recent, you seem to heal (minor injuries) slowly, and bruise easily, ask your doctor about possible leukemia. I had all three symptoms, with the fatigue getting worse over the course of a few months. My primary care physician added them up and sent me to an oncologist, who, with a simple blood test to confirm, diagnosed me with Hairy Cell Leukemia. She said I’d probably had it in a sort of dormant stage for 5-10 years! After one week of chemotherapy and a very few weeks of recovery, it was tested as gone. That was eight years ago, and I haven’t been fatigued since. The bruises went away, too, and I’m back to healing minor injuries quickly. Hairy Cell is relatively rare ( only about 800 cases in the U.S. annually, but other leukemias and lymphomas can also cause fatigue, and should be ruled out.

  40. I have debilitating chronic fatigue resulting from a brain injury 14 years ago. I don’t know of anyone who knows what causes this or how to treat it. L-carnitine helps, to a degree. I take amphetine salts, which I can only tolerate in low doses, and that helps, to a degree. I have eliminated caffeine, wheat and corn from my diet, have experienced modest improvement. I tried B-12, but it didn’t help.

    Do you have any thoughts about this?

    • Brainwave Optimization through a BrainState Tech provider helped a friend of mine who had excrutiating headaches. It has helped people with concussions and much more. Something for you to consider.

    • Hi Carol- I have done a lot of reading about chronic fatigue. There is a strong connection to GI dysfunction and increased intestinal permeability ( leaky gut syndrome). It might be possible that the leaky gut is causing or contributing to your fatigue. If you google “brain injury leaky gut syndrome” there is a lot of information there. Good luck!

  41. I have Sjogrens, Raynauds, and depending on which doc, a host of other ailments at 29. Docs said I had EBV, don’t recall a specific occurrence. I have had MRSA requiring PICC lines for 8-12 wks. Tons of “bizarre” infections. Considered MS as I have many symptoms that don’t correlate to my diagnosed disorders – but lumber puncture and MRI negative. Major problems with urinary and fecal incontinence – tests showed urinary tract, bladder, etc good. I find noisy/crowded situations to give me sensory overload.

    Did started AIP in Jan 2014. Stayed on it since… insomnia, joint pain, incontinence issues improved but the fatigue did not improve at all. I started logging all my food – to make sure I was hitting my targets for D, Magnesium, B12, protein, etc. Tried increasing protein and probiotics, decreasing incidental sugars (fruit) – no changes. I have 12-16oz of organic coffee most mornings (before 8am), NO caffeine after that.

    Tried “pushing” thru the fatigue on the treadmill. Didn’t make a difference if I went really slow, really intense, short or long – 15-20mins post workout, I could not budge. I have actually curled up in the back seat of my car bc I couldn’t drive the 1.5miles home. Also tried adjusting diet before/after workout. Hoped that it would improve, even after a loss of >80lbs, no difference in the fatigue.

    I read the study about D-Ribose and fatigue with MS. Gave it a shot and it did help. It was subtle – but after 10 days of daily usage, I noticed a little improvement. I still have to take Adderall to even nominally function – I freaking HATE that I have to.

    Unfortunately, the medical resources available to me now suck. I have been labled “non-compliant” because I refuse anti-depressants and steroids. Yes, I am depressed because I am exhausted just getting dressed. My house is disgusting it is so messy – i have “killed” numerous vacuum cleaners trying to lift them, the stress of just the home is awful. I have been fined by my county for my yard many times – I just can’t manage mowing. And I can’t afford to see a doctor, much less a yard service or maid service. I have depleted my 401k and hate trying to apply for disability because my current medical care providers are useless. (One was taking my “history” while looking at another chart – I said I had chronic prostate problems and he didn’t even pick up on it.) Many days, a simple trip to the Farmers Market wears me out and I am in bed for several days afterwards. I live alone and don’t have anyone who can advocate for me to doctors.

    I am at the end of my rope – I have tied a knot and holding on, hoping that somehow things will improve – but I don’t know where else to turn.

    • You need to use the last bit of your energy to get to the right doctor. Is there anyone you can move in with so that you can spare some money to pay for a doctor and the proper tests you need? You’re so young, the investment in your health now will pay back hundreds of times. Good luck!

      • I wish I did, but that is not an option. Having had experience with competent healthcare before, it is pretty frustrating now. Unless I have a broken limb or need stitches, etc, I won’t even bother to go to the doctors.

        • Check out the Wahl’s Protocol. It was used to reverse her own MS symptoms but now also with fibromyalgia patients and other auto-immune diseases. I believe it directly addresses fatigue. She lays it all out and it is no harder to implement than AIP. You might even be able to get a copy at the library, and pretty sure the paperback just came out.

          You’ll figure it out! Don’t lose hope!!

    • Did you try to go completely raw….the low-fat FRUITARIAN style?? Give it a try for 7 days. Seems like you’ve got nothing to lose – but a lot to win. Monomeals of one type of fruit till satiation are best. Also take a look at youtube videos of TANNYRAW. She healed herself from a TON of ailments including fatigue. All the best.

      • Knowing how negatively my body responds to the sugars in higher-glycemic fruit and honey, I don’t think that is a direction I should try… but I will investigate.

    • Might be worth reading Dr D. Perlmutter’s new book “Brain Maker”. Might have some answers especially around fecal transplants. You might have to go outside the US to get one or youtube the do it yourself way.

    • I agree with Dr. Jeff, Dr. Perlmutter has wonderful information available.

      Aside from everything mentioned in the article, I would recommend looking into oxalate. The AIP diet can be high in oxalate, and if you have a problem with it, it can cause a multitude of conditions. The urinary and bowel incontinence seem to be pretty common symptoms for some people. I have also heard people with Sjogren’s have improved on a low oxalate diet. The Trying Low Oxalates yahoo group started by Susan Costen Owens is the best source of information that I’ve found.

      Also, for the fatigue, it might be worth adding CoQ10, magnesium, and l-carnitine to the d-ribose. According to Dr. Steven Sinatra these four things are needed for mitochondria to produce ATP. Dr. Sinatra’s focus is usually on heart health, but I would think this option would be helpful for general fatigue, as well.

      I hope that you are able to find healing soon.

      Dee

      • Dr. Sarah Myhill (U.K.) adapted Sinatra’s mitochondria-feeding regimen to treat patients with chronic fatigue syndrome. I’ve found it has helped increase energy levels. In addition to the aforementioned d-ribose, Co-Q10 (ubiquinol may be better), magnesium (any chelate except magnesium oxide, which is poorly absorbed) and l-carnitine, she adds niacinamide and a good multivitamin/mineral supplement. She advocates a similar diet to what Chris recommends. The page http://www.drmyhill.co.uk/wiki/CFS_-_The_Central_Cause:_Mitochondrial_Failure has good information, as does her website (much of which is aligned with what Kresser and others are saying).

      • BC of the urinary issues, I have kept oxalates low and, thankfully, those incontinence issues cleared up after about a year of AIP.

        I do a fair amount of supplements to make sure I am hitting nutrient goals – including CoQ10, Mag (chloride – but get at least majority via food), and L-Carnitine… I plan my meals ahead of time, so I know what I need to adjust nutritionally as well as sun exposure.

        I know the stress over all of this is only adding fuel to the fire and unfortunately, the friends/support systems I trusted have disappeared for various reasons. It makes it challenging to acknowledge everything.

        I will definitely look into niacinamide, Drs Myhill & Perlmutter. 🙂

    • Get yourself some diatomaceous earth…I guarantee that parasites is a BIG part of your problem. It is $9 for 5 lbs/organic food grade. Also check out vibactra plus. These two things alOne will change your life…if you can afford silver add that. The bigger bottle you buy the cheaper per ounce. Then stop eating wheat flour and sugar. Instead of sugar use stevia. Also use a waterpik and you should see a bunch of change. A little iodine in the waterpik every day and you will see the infections disappear. Blessings to you!!!

      • AIP is a more rigid version of Paleo – I don’t even touch Stevia.

        I am familar with DE – have used it for fleas/bed bugs as well as taken it myself. I had parasites several years ago – cleared it up with pumpkin seeds and pineapple – have not had issues since.

        Thank you for the suggestions.

        • Personally, I wouldn’t rule out parasites. You could have picked up another one since then. Likely, many people have parasites but they can be kept in check by a strong immune system. I would improve the quality of your mag supplement if you can. Are you taking digestive bitters, Hcl and/or digestive enzymes? You could be hitting your targets but not absobing much. You may not be breaking down protein very well or absorbing certain vitamins or minerals due to methylation defects. Look into methylated b vitamins or beneficial yeasts.

    • …I really feel sorry for you-esp. since the medical problems are not being treated. Too bad you don’t live in Canada-where all medical is FREE-even waiting in line is better than nothing-My nephew dropped dead of a heart attack while waiting in line-he was only 40-JM

    • Native, I would start with herbs, since they are usually low cost. I, then used stones, rotating them(stones may only be good for 20 minutes, before needing a 4-hour rest, or charging.). See how those work. I ended up attracting people of low energy, when I would raise my energy(I’m an empath.). I was very lucky, and I invented something that gave me energy at all times. I just had to keep working on my situation, and it actually helped me to have what people would call misfortune(e.g. low-energy people, etc.). My work required me to have energy also, as the amount of work remained the same, no matter what energy I had.

  42. Given how often the vicious circular cycle thing works, I was wondering if sleep apnea and other physical problems can be caused by some of these issues? I have a host of them (sleep apnea, overweight, high cholesterol, high blood pressure, tendonitis, arthritis, chronic pain, allergies, etc.) It would be wonderful to find a better starting point than “lose weight” given fatigue, pain, etc interferes so much with that.

    • Hi Chris,

      I like Pam have sleep apnea, and I have been wondering if it could be the result of some of these mentioned? However, being tested it looks like my airway is very shallow (my lower jaw is too far back) and I’m not overweight or anything else. All conventional ways like CPAP and oral appliences have not worked. It looks like surgery is only option….unless it could be from one of these guys above??

    • Yep, it would be very interesting to know what impairs central nervous control of breathing during sleep for sleep apnea. Haven’t found any helpful information yet. Losing weight seems to be a starting point that makes a difference for some people. My father had no weight problems and 2 things have helped him get from severe sleep apnea to mild sleep apnea (he’s pissed he didn’t get it away completely yet ;-):
      – Making sure to not lie on your back (he uses a selfmade positional device)
      http://www.ncbi.nlm.nih.gov/pubmed/20572416
      – Tongue, mouth and throat exercises
      http://www.youtube.com/watch?v=RB3nCDA1uic
      http://www.ncbi.nlm.nih.gov/pubmed/19234106

    • Pam, I know for a fact, that if you are working on your feet, losing weight helps. I’m not trying to convince you of anything. I’m just stating a fact.

  43. Hi Chris
    As a colon hydro therapist I have worked with many people over the past 15 years struggling with ill health and un-wellness. I have seen many do all of the things you have suggested in your posts and while many feel better and empowered for a period of time I have not seen success in the long term (10 years). Often times, my clients will report that it is because they have not “adhered” to the sometimes pretty extreme or radical protocols, however most of these protocols are suggested as short term interventions, not as ways of living (because they are unsustainable and have lead to deficiencies later on). What is your personal experience for your own health and that of your clients after 5 years and then going into 10 years? I am a firm believer in the human potential and integrative medicine but have witnessed real life limitations when it comes to using complementary alternative therapies as a cure. I’m also beginning to wonder if we are confusing cause and effect when it comes to some of these new tests and their results ie. parasites, bacteria, and fungi in people not feeling well. The only reason I have this doubt is because of the inconsistency I see in the results of treating them. And lack of long term stable wellness. Would love to hear your thoughts on this. Love your work.

    • Matter is not everything. We are multidimentional beings.There is mind, emotions, spirit that comes into play, too. What we believe, what we can’t accept on an emotional level or our Spirit (soul, inner child trauma) is trying to get our attention through bodily symptoms (somatic) = all must be considered when it comes to healing. Healing is a journey to wholness.

    • Kate, let’s keep it simple. If you are low on energy, you have to add energy. If you have problems after doing that, then maybe you should investigate some of what is mentioned here.

  44. Hi Chris,

    You and I have worked together and picked away at the various challenges to my health and vitality. CIRS, Lyme, methylation issues, etc are all part of my picture. I’m so happy you’re sharing more information about CIRS here and in an upcoming podcast. For people like myself who have been digging and unable to get to the bottom of their health challenges, this is a crucial area to look at, I believe. I was not making any of the expected progress with so much of the good I was doing for myself. Thank you for your work and continuing to shed light on topics like this.

  45. I have been diagnosed with CFS/ME. I have found that changing my diet to paleo and taking a number of supplements inc VitB12, vitD3 and magnesium have made the biggest impact on increasing my energy levels and reducing my pain levels

  46. While I thought the article was great, the question “So, to whom to to now?”. Does a physician know where I can be tested to find out which factor is relevant?

    • You could try looking up Breakspear Clinic in Hemel Hempstead, Hertfordshire. Might be able to help you with this testing but not totally sure.

    • Hi, I have had the Doctor’s Data GI tests done by my Functional Medicine GP (Dr Chatterjee, I see him privately). If you just want access to the test (rather than further help/diagnosis) I think there are quite a few nutritionists who can help and might be cheaper… Good luck! Eva

    • Check out Dr. Sarah Myhill’s (U.K.) website, she has a lot of information about testing (she has treated many clients in the U.K. for CFS).

  47. It would be great to hear more about chronic infections. I have often a sore throat or ear but no other symptoms. My doctor always wants to give me lozenges but that’s just fighting symtpoms. I wonder whether these are “flare ups” of something. Since I’ve stopped eating gluten it has become massively better but lately it has become worse again (I am still off gluten and eat mostly primal). No gluten intolerance or anything has ever been found though.
    Further they’ve found Borrelia burgdorferi but appearently they are not “active”. I never understood what that means and have it now monitored annually. Nothing has ever come out of that.

  48. This is an excellent article for sharing with clients. Thank you for writing such a clear concise piece that, I’m sure, will help so many people find and answer to their chronic conditions.

  49. Chris, have you experimented with high dose thiamine for fatigue? There are at least 9 really interesting studies with wonderful results, although most are just case studies, but still.
    Here they are: http://www.ncbi.nlm.nih.gov/pubmed/?term=Costantini+A%5BAuthor%5D+thiamine

    I have SIBO, H. Pylori(hopefully, I got rid of it with last Abx course) and likely mild IBD, and I have found HUGE improvement in fatigue with sublingual methyl-B12 supplementation, hopefully high dose thiamine will help as well and give me strength to fight these problems until they’re solved.

  50. Greetings from Australia! Your article is spot on Chris. Major turning point for me was an accurate parasite test for D fragilis. Eradicated with antibiotics, antiparasitic herbs, healed leaky gut, went AI Paleo, continue with good pre & pro biotics, corrected low stomach acid, mthrfr supps and feel a new woman. Being diagnosed with a parasite and clearing it was a major turning point for me 🙂 strong gut health is the basis of all health. big fan of yours. another great article thanks 😉

      • Any chance that this type of testing is available in the UK, Emma? I live in London.
        I know my fatigue is gut-related, but it’s impossible to have tests like these on NHS (our health system). Doctors just look at you blankly and say there’s no funding.
        Thanks

        • HI Terry, the test uses PCR which is a DNA test so it picks up parasites whether dead or alive. Austrlalia invented it so I am not sure if it’s available in the UK. Best to go to Dr who is a parasite expert. Or phone up some pathology labs and ask them if they do it. it has been very helpful for us. I hope its available elsewhere as it changed our lives. After 7 years of bad health i finally got an answer. good luck ; )

        • Try Breakspear Clinic in Hemel Hempstead, Hertfordshire but you do need to be able to pay quite a lot, might need to postpone your next holiday to pay for the treatments. A holiday lasts two weeks, good health is going to last much longer! Regards, get well soon. Christine

      • VIVA BRAVO Australia,
        Discovering H. Pylori, FODMAPs, FAILSAFE, Fed UP,
        And now an accurate Parasite test!
        WOW ~ Beyond Hat Trick!
        We love you, Keep up all that great GE work…
        Geraldine

      • this service by QML pathology is only available in their area,ie,QLD/northern NSW,which is only a small part of Australia;eg,Sydney and Melbourne,the 2 largest population centres of Australia,can’t access this service.

  51. I’ve had chronic daily headaches with no known cause or trigger for 18 years- since I was 15. They began after a trip to Zimbabwe. I was on a flight that was grounded in Chicago where I had tons of tests and almost passed away from several complications. The only tests that showed anything were a sinus infection and slightly elevated Ebstein Barr titers.
    The pain is now mainly in my occipital nerves. Neuro said these were damaged from the severity of the infection. It also gives me fatigue and occasional dizziness.
    I’ve tried alternative therapies like chiropractic, accupunture, etc. I would love any kind of solution!

    • I also a healthy eater, exercise regularly, never smoked etc. I vaguey remember one doctor discussing heavy metal toxicity with my parents so I had metal fillings replaced with amalgam.

      • Rule out Salicylate induced reactions, migraines, hypo-glycaemia? Try the Failsafe diet with qualified supervision?

        “How many people are salicylate intolerant and don’t realise it? Research shows that about 20% of adults with asthma(1), 60% with of people with food-induced itchy rashes, headaches or migraines, 70% of people with irritable bowel symptoms(2) and 75% of children with behaviour problems(3) may be sensitive to salicylates. In my experience, most people with salicylate intolerance have no idea what could be affecting them. How many people are salicylate intolerant and don’t realise it?”<<<
        http://fedup.com.au/factsheets/addit…ts/salicylates

    • A few weeks ago another letter writer recommended books by Dr. John E. Sarno, MD. Since then I have read “The Body Mind Prescription” and “The Divided Mind”. Research lead me to a work book by Howard Schubiner,MD. I am very impressed with their research and the results I am experiencing. Your case sounds similar to case studies detailed in these books. Best wishes. I hope you find relief! And even if this is not the answer to that particular need this research is definitely worth knowing about.

  52. Hi Chris,

    I have been following you, Jordan and Steve for some time now, thanks for your valuable information, I really appreciate it!
    I am 35yo male that has struggled with chronic fatigue, low energy, brain fog, anxiety and depression since about 2006 that just slowly gets worse each year. So it hasn’t been all my life. My mother is the same.
    I have been diagnosed with pyrole disorder and also MTHFR C677T heterozygous. I also had high inflammation markers in a stool test as well as persistent Neutropenia . I am currently waiting on results for a Organic a acids test. I am wondering if it’s worth doing a 23andme gene test? I had very low zinc, B12 and Vitamin D for a Long time. So I’m sure I would have leaky gut too. I also have mold in my house that I am trying to deal with. Is it possible to get a test to see if I am breaking down the biotoxins? If so what is the test called?I also have sinus, and eye irritation Which I know could be gut,inflammation or mold I guess.
    I am trying to take a real functional approach now days, as the tests are expensive, but throwing money at endless supplements aimlessly at my problems in the long run will be more expensive.

    Thanks so much in advance for any reply!

    Cade

    • I have have Multiple Chemical Sensitivity (MCS) after moving into a brand new home full of chemicals. It has left me chronically ill and has disabled me. Several years later, I had exposure to mold toxins. I can tell you as long as you are in that house with mold, your body will not recover. The sinus and the eye irritation seems consistent with what Suzanne Somers husband experienced when he was exposed to mold after moving into a rental in CA. Her symptomology was distinct from his. My brother was exposed to mold also. He began experiencing heaviness in his legs, sinus, migraines, and then developed mild MCS. He only began to improve when he left the unit with mold problems. Nevertheless, is there a way you can hire a professional to determine how to handle your mold situation? If it can’t be resolved soon, you must leave that place at once for your body to heal. You do not want to get to that point of no return when no matter how many supplements you take, it will be for naught. Finally, I’d take as many antioxidants as you can to support your nervous system/neurological system. Please do not delay re: mold

    • This might be an obvious question but DID you already try to cut out ANY KIND OF GRAIN (Gluten and non gluten) and also ANY KIND OF DAIRY? I would guess it makes a huge huge shift in your health. Me and my mum had similar paths at similar ages as well, just as you described. I managed to go GRAIN FREE and DAIRY-CASEIN-FREE (mostly raw fruits and some cooked vegetable and really turned my health around. It’s so so easy – you just have to know, and my mum did not know, neither did I for many years. All the best.

  53. I was diagnosed with fibromyalgia almost 20 years ago. After years of being told I had depression and anxiety. Since then a number of physical
    Practitioners have told me it doesn’t exist. I should exercise more etc. I had an updated diagnosis when looking to see if I actually had ankelosing spondylitis instead. Came back negative for that but most likely for fibromyalgia. I have experienced chronic fatigue and muscle pain since I was a child and am now 50. I’d like to think that I could still get a handle on this. Any ideas on where to start?

    • A study of 40 women with fibromyalgia and 40 controls found that those with FM had, on average, the same blood levels of mercury, but only one-third the urine level of mercury. This implies that those with FM are less able to excrete mercury, leading to a buildup of mercury in the organs such as the thyroid, adrenal and pituitary glands. Low levels of mercury can affect mitochondrial function, which as Chris points out, is one cause of chronic fatigue.

      Rosborg, I., Hyllén, E., Lidbeck, J., Nihlgård, B., & Gerhardsson, L. (2007). Trace element pattern in patients with fibromyalgia. Science of the Total Environment, 385(1), 20-27.

  54. Following my contracting mononucleosis in 1980, I’ve had what I call ‘recurrent’ fatigue. The most consistent way to bring on a relapse is exercise of an unpredictable frequency or intensity–generally 12 to 36 hours later. (I say unpredictable, because sometimes just walking around the block can trigger symptoms.) Over the last 35 years relapses have gradually become less intense and of shorter duration–but a number of long (8-10 mile) walks earlier this year triggered a relapse that is now in it’s 6th week. It feels like gravity has been turned up, and I can sleep 10-11 hours a night–with a crushing need to take a 2 or 3 hour nap mid-afternoon.

    I’ve been ‘paleo’ since 2010 (vegan for 18 years (!) before that) but doesn’t seem to have had much positive effect on my problem.

    • I too had mono in the 1980’s and it reactivated three years ago when I was exposed to toxins in NY while I worked through hurricane Sandy disaster. I’m also celiac and now have recurring sibo. The biggest help for me, who was bed basically bedridden for three days after any daily activity was using l carnitine. 3G/day divided doses. I was severely deficient.

  55. Hi Chris. Yes, I am one of those ppl who seem to be doing right and are still suffering with extreme fatigue and a slew of other symptoms. I know on thing I didn’t do is check the gut for parasites and bacteria, and after reading this post I think its time. My question is: what do you think of using the Bio Health Lab instead of Genova? Thnx:-)

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