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?
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.
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.
In my clinical work, I’ve found that CIRS is extremely common in my 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
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)
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#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
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.)
Better supplementation. Fewer supplements.
Close the nutrient gap to feel and perform your best.
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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.
How do you know that the Vits were the cause? Did you take more than the recommended dose?
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.
dr bell in lyndonville, ny for mitochondrial dysfunction as root of chronic fatigue syndrome. sumone u ought to intrrview!
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.
Chris can you speak to fatigue associated with ITP and post splenectomy?
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?
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.
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
Hi! I live in Portugal and I started re searching paleo late 2012! I recommend you this functional doctor: http://anti-envelhecimento.blogs.sapo.pt check the link Of his Facebook page on the Blog: there is a phone number in Facebook info that you should call to make an appointment with him in Lisbon or Oporto. He is very requested. You might have to wait! (Sorry I’m using my iPhone, here’s the mobile link, hope it works: https://m.facebook.com/profile.php?id=109585891821 )
Have you tried some new (in Portugal) Detox anti-parasites supplements like ‘diatomaceous Earth’ powder food grade: http://www.terraancestral.pt/epages/960492285.mobile/pt_PT/?ObjectPath=/Shops/960492285/Products/PR031.DES.HU.UI.XS or buy from this organic supermarket in Lisbon: https://m.facebook.com/biomiosotis/photos/pb.413501388708670.-2207520000.1437680922./834577146601090/?type=1&source=42
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.)
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.
I second that. Excellent suggestion.
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.
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.
Hi Jane,
What is the main take away on the book?
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
What killed the MRSA for you, Jane?
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.
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…
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.
I suggest Magnesium (not the oxide or carbonate types) to help sleep, not that antidepressant pill.
Magnesium is simply not appropriate for all humans, especially those with heart issues.
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.
If you are low on energy, you need to add energy. It’s that simple.
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”.
Thank you for catching those Greg, they’ve been updated.
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
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
Thank you for your feedback, I’ll get my doc to test again.
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.
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!
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.
Google Dr l wilson. He believes the right Foods with very little supplements will almost heal any disease.
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.