Beyond Fatigue

Fatigue is one of the primary complaints that doctors hear from their patients, day after day, week after week. Not only is it a symptom of many health conditions, it is also a result of lifestyle factors such as poor diet, dehydration, high stress and too little sleep.

Thus, it is not surprising that reporting fatigue as a symptom often sends both practitioners and their patients on a scavenger hunt for a diagnosis, especially when fatigue occurs in conjunction with other generalized symptoms such as pain, trouble sleeping and “brain fog.”

But chronic fatigue is very real, as is chronic fatigue syndrome (CFS). Just ask the more than one million American adults (approximately 80% of which are women) that the Centers for Disease Control and Prevention (CDC) now believe may be affected by CFS. Add to that over five million adults (as reported by the CDC in 2005) who may suffer from chronic fatigue associated with fibromyalgia syndrome (FMS). And the millions more that have symptoms of chronic fatigue but do not quite meet the CDC guidelines for a CFS diagnosis. (See “What’s in a Name?”)

As of 2013, Dr. Jacob Teitelbaum, who specializes in the treatment of both CFS and FMS, estimated that the combined incidence of CFS and FMS is in the range of 12 to 24 million Americans. That statistic represents a lot of lost productivity, both socially and economically, not to mention a severe hampering of personal quality of life.

Why So Much Fatigue?

In The Fatigue and Fibromyalgia Solution, Dr. Teitelbaum explains that a modern day “perfect storm” of energy-draining circumstances has created an epidemic of fatigue. First and foremost, he points out that the average American consumes a high-calorie, low-nutrient diet. We are “both obese and malnourished, for the first time in human history.” Dr. Teitelbaum continues “Dozens of nutrients are critical for our energy-producing machinery, and without these, fats and other calories cannot be converted into energy. This leaves people both overweight and exhausted.”

The second energy drain is sleep deficiency, says Dr. Teitelbaum. With the advent of electricity, light bulbs, television and computers that keep us awake after dark, the average night’s sleep has been reduced from over nine hours per night to under seven hours per night. We are pushing our bodies to do more, with less sleep. In addition, “restless leg syndrome and sleep apnea are also much more common in people with CFS/FMS,” according to Dr. Teitelbaum, further diminishing good solid sleep.

An overburdened immune system is the third factor contributing to Dr. Teitelbaum’s “perfect storm” scenario. Our ancestors did not have to deal with the abundance of environmental toxins that now exist, and which constantly bombard our immune system. Any “foreign invader” triggers the immune system to respond, gradually depleting our adrenal glands, potentially to the point of exhaustion.

Compounding both the nutritional deficiencies and a burdened immune system is poor digestion or absorption due to the use of antibiotics and acid blockers, “leaky gut” due to candida overgrowth, and other gastrointestinal flora imbalances. Dr. Teitelbaum recognizes hormone imbalances or deficiencies as another major factor contributing to the fatigue epidemic. He notes that increased stress not only exhausts our adrenal glands, but also suppresses the hypothalamus, which is the hormone control center. “In CFS/FMS, hormone problems are widespread,” according to Dr. Teitelbaum, even when the lab test results come back “normal,” as they often do. (See “But My Hormone Lab Test Results are ‘Normal’…”)

The “perfect storm” is a combination of factors that can lead to a major “energy crisis” throughout the body, causing the hypothalamus to eventually shut down, which Dr. Teitelbaum calls the biological equivalent of the circuit breaker “blowing a fuse.”

How Do You “Cure” Fatigue?

Considerable research over the past 50 years supports a theory that acquired mitochondrial dysfunction (as opposed to inherited or genetic mitochondrial dysfunction) may be an underlying cause of not only CFS and FMS, but also a wide range of seemingly unrelated disorders including but not limited to diabetes, Parkinson’s disease, coronary artery disease, Alzheimer’s disease, migraine headaches, epilepsy and hepatitis C, as well as mental disorders such as bipolar disease and schizophrenia.

As you might remember from biology class, mitochondria are the “power supply” part of the cell that turns fuel into energy. The mitochondria convert nutrients into energy so that the various cells in the body can do their jobs.

Cells harvest the energy stored in food through a multi-step biochemical process called cellular respiration. In simple terms, cells burn food in the presence of oxygen to produce a “high-energy” molecule called adenosine triphosphate (ATP), the primary energy “currency” in the body. The chemical energy stored in ATP molecules is used to drive various metabolic processes such as biosynthesis and cell division.

If the mitochondria are not healthy or are damaged by toxins from infections, heavy metals, pollutants and solvents, the energy supply suffers, the cells don’t function properly, and fatigue sets in at all levels—from the cellular level on up.

Damaged mitochondria require additional energy to “heal” or repair, adding to the mitochondrial dysfunction and further compounding the energy crisis. In this way, “mitochondrial dysfunction can result in a feed forward process, whereby mitochondrial damage causes additional damage,” according to an article in Experimental and Molecular Pathology.

Protocols Supporting Mitochondrial Function

Dr. Sarah Myhill, a leading authority on CFS and FMS in the United Kingdom, has had considerable success treating her patients with a protocol based on improving mitochondrial function. This protocol essentially involves:

1. Eating a Stone Age diet (similar to a Paleo diet).
2. Taking nutritional supplements, including CoQ10, acetyl-L-carnitine, D-ribose, magnesium and niacinamide (Vitamin B3).
3. Getting a good night’s sleep on a regular basis.
4. Achieving a balance between work, exercise and rest.

Dr. Teitelbaum’s S.H.I.N.E. protocol, which also promotes healthy mitochondria, purports to have a remarkable success rate of over 80% among his patients. His approach is similar to Dr. Myhill’s, but it also includes specific attention to hormone balance. The S.H.I.N.E. protocol involves:

1. Sleep, with the goal of eight to nine hours of solid, deep sleep per night.
2. Hormones, with the goal of optimizing the adrenals (cortisol and DHEA), thyroid (T3 and T4), testosterone, estrogens and progesterone, using bioidentical supplements as needed. Dr. Teitelbaum also notes that vitamin D, which is actually a hormone, is “critical for regulating immune function.” A vitamin D deficiency can trigger autoimmune illness and increase the risk of infection, also contributing to reduced energy.
3. Immune Support, with the goal of clearing the body of yeast, candida and fungal infections that can lead to a “leaky gut,” and adding probiotics to keep the gut healthy. Dr. Teitelbaum suggests that anyone with CFS should also be checked for bowel parasites and viral infections that can affect the gastrointestinal tract.
4. Nutrients, with the goal of optimizing the body’s healing powers by eating a healthy diet of whole foods, avoiding processed foods and sugar, taking vitamin supplements and fish oil. Dr. Teitelbaum recommends D-ribose, CoQ10 and acetyl-L-carnitine to “jump start” the mitochondrial energy production.
5. Exercise, as able, with the goal of reconditioning, so that the body of someone with CFS or FMS can gradually make the energy needed to do conditioning exercise.

The S.H.I.N.E. protocol is described in further detail in an easy-to-read, “do it yourself” manner in The Fatigue and Fibromyalgia Solution: The Essential Guide to Overcoming Chronic Fatigue and Fibromyalgia, Made Easy! There is a chapter devoted to each of the five areas, complete with questionnaires and worksheets to guide patients through the protocol.