Chronic Fatigue: Tools to Help Recover

April 10, 2017 | Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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Chronic Fatigue: Tools to Help Recover
Bone-weary, chronic fatigue is a challenge for many. It may seem like a herculean effort to get through the day or even to accomplish the simplest tasks with chronic fatigue. Chronic fatigue is a symptom, usually related to more than one thing. Each person has different reasons for this, but there are key underlying areas to address that can make a substantial difference in energy production and health restoration. Knowing where to start and how to empower yourself when the medical establishment often fails can make the difference between mere survival or participation in life.

[Jump to: Nutritional Options]

Common chronic fatigue scenarios may include parents of young children with constant sleep disruptions, a college student in the midst of final exams recovering from mono, athletes struggling with overtraining, or the businessperson struggling with deadlines and international travel. Chronic fatigue may be related to cancer treatment, mold exposures, fibromyalgia, Lyme’s disease, thyroid-adrenal dysfunction, chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), or other autoimmune disorders, traumatic brain injury, heart disease, COPD, congestive heart failure or other numerous other scenarios. It should be noted that chronic fatigue is not the same as Chronic Fatigue Syndrome, but many of the principles described here can be utilized to help illness management and recovery.

Once a person is locked into chronic fatigue that is not relieved by quality self-care with sleep, diet, and exercise, it becomes an issue of addressing the underlying causes. Chronic fatigue and loss of health usually occur because of a disruption in fundamental areas. It is usually not just one thing that causes the chronic fatigue. Rather than dismissing chronic fatigue due to stress and age, focus on these key areas to help bring back vitality.

This article is laid out in sections. The information provided builds on top of the recent article on managing basic fatigue, “Feeling Fatigued? Jump-Start Your Energy”. Section 1-4 focuses on the essential daily physiological processes related to anemia and oxygenation, blood sugar, blood pressure, and gut. This is the first place to make sure these key areas are working healthfully to avoid the pitfalls of chronic fatigue. Any disruption here sets the tone for other systems to struggle. Section 5 pertains to mitochondria. Virtually any condition that causes fatigue and degeneration involves mitochondrial dysfunction. Section 6-9 focuses on big triggers, such as infections, toxins, and hormones that lock in chronic fatigue. While inflammation may not be discussed in the various sections, it is an underlying, contributing factor.

1. Anemia and Oxygenation

In any type of chronic fatigue, it is essential to ensure our tissues receive oxygen properly. We clearly need oxygen to live, but subtle changes due to anemia lead to fatigue and exhaustion. Poor mental energy, sluggishness, stressed thyroid and adrenal function, exercise intolerance, heart stress, poor detoxification, stressed mitochondria, compromised metabolism, and even increased cancer risk may occur because of poor oxygenation. Pallor, cold intolerance, shortness of breath, cold hands and feet, brittle nails, sore tongue, fast heartbeat, headaches, and lightheadedness are common findings. Daily activities will feel like they take enormous amounts of energy, while feeling winded or short of breath.

There are several types of anemia, many of which are related to nutrient insufficiency. Iron deficiency is extremely common and is often focused on the exclusion of other nutrients. Serum ferritin levels provide the earliest measures of insufficient iron intake. Other nutrient deficiencies causing anemia includes vitamins B1, B2, B6, B12, folate, vitamins A, C, E, magnesium, zinc, and copper.

Vegetarian diets, pregnancy, growing children, heavy menstrual periods, limited diets, and gut inflammation may increase the needs for these nutrients. Correction of the underlying anemia will take the stress off the entire body. It is always essential to have your provider identify what type of anemia and why the anemia developed in the first place. Supplementation with a high quality multiple vitamin and mineral formula provides great prevention support. If iron replenishment is needed, iron bisglycinate is gentle on the digestive tract. It is very easily absorbed and non-constipating compared OTC or prescription ferrous sulfate.

In addition to anemia, several disorders such as asthma, COPD/chronic obstructive pulmonary disease, sleep apnea, and cardiac disorders like congestive heart failure affect tissue oxygenation. These disorders are worsened with anemia and mitochondrial stress.

2. Blood Sugar

Low blood sugar, blood sugar swings, and elevated blood sugar contribute to trouble managing energy. Daytime hypoglycemia from skipping meals, stressed adrenals, inadequate protein, fat, or a poor combination of foods can easily impair energy production. If you feel a significant improvement in energy after you eat, hypoglycemia is likely an issue for you. Individuals with low blood pressure and chronic fatigue may find hypoglycemia worsens their symptoms.

Nocturnal hypoglycemia or low blood sugar levels in the middle of the night may cause cortisol or adrenaline to elevate. When cortisol spikes at night, it arouses us out of sleep. As a result, one experiences insomnia, night sweats, or restless sleep. This path leads to morning sluggishness and fatigue that can persist through the day. High stress and poor diets are often to blame for simple case concerns. In that case, relaxing activities, stretching, and skipping the ice cream or alcohol at night may be all that is needed.

More complex nocturnal blood sugar difficulties may be related with type 1 diabetes with low insulin levels. It may also be seen in type 2 diabetes with poorly managed blood sugar and excess insulin intake. Adrenal fatigue or insufficiency, primary hypoglycemia or insufficient dietary management (skipping meals or grazing, inadequate protein, carbs, or fats) can trigger nocturnal hypoglycemia.

Support and correction of this sleep-blood sugar disruption depends on the situation. In general, consume at least 20-30 grams of protein, vegetables, fruit, and quality fats of a different variety at breakfast, lunch and dinner. Eliminate white flour, white sugar, and processed foods. Many people find adding in a small serving of complex carbs like brown rice, squash, or quinoa with dinner is helpful for a stable blood sugar.

Often, the issue of food quality and stress management takes care of many minor concerns with nighttime hypoglycemia in prediabetics and type 2 diabetics. Individuals with type 1 diabetes, severe adrenal fatigue and severe hypoglycemia may need a small snack (100-200 calories) one to two hours before bed. However, many find that as adrenal health and daytime blood sugar management improves, this is not needed. Discuss this with your health care professional to see if this is appropriate for you.

Conversely, if daytime energy crashes and you find yourself going into a “food coma” one to three hours after a meal, it is likely that insulin resistance and blood sugar swings are a concern. Clean up the diet, ensure adequate protein to turn on wakefulness, reduce carbohydrate intake, and make leptin and insulin management a top priority. Implement the Five Rules of the Leptin Diet as a daily guideline.

Helpful blood sugar nutrient support includes chromium, cinnamon, omega-3 fish oils, whey protein, lipoic acid, magnesium, B vitamins, and vitamin D. To help nighttime blood sugar management, take cinnamon, magnesium, vitamin D, and fish oil supplements prior to bedtime and make the necessary dietary changes.

3. Blood pressure

Low blood pressure can cause significant, subtle and even unrelenting fatigue. It can be accompanied by mental fatigue, exercise intolerance, lightheadedness, poor concentration, and cold intolerance. Low blood pressure may produce symptoms at 100/60 and lower. Low blood pressure may be related with adrenal fatigue, disorders like Postural Orthostatic Tachycardia Syndrome (POTS), multiple sclerosis, Parkinson’s disease, cardiac disorders, and excessive hypertension medications. Anemia concerns will worsen low blood pressure. Use nutritional support such as choline, pantethine, tyrosine, and adaptogenic herbs to help the adrenal glands and nervous system improve low blood pressure. High blood pressure is often silent and usually does not cause fatigue.

4. Gut Health

Next in line is to ensure healthy gut function. Anyone who has had the stomach flu realizes first hand just how exhausting it is. Scale back the intensity of symptoms to more subtle difficulties of intermittent or chronic diarrhea, constipation, malabsorption, and poor digestion, etc. Fatigue is a common symptom with candida/yeast or bacteria overgrowth, Celiac disease/gluten intolerance, and food intolerances.

Day after day symptoms brought on by gut dysfunction create tremendous amounts of stress and extra work for the whole body. Not only does the chronic inflammation affect the gut, it dumps numerous toxins into the blood stream that the liver has to deal with. If not managed well, it leads to an entire cascade of symptoms of chronic fatigue, brain fog, lethargy, hormone imbalances, autoimmune reactions, skin problems, pain, and more.

A recent study points to the fact that changes in the gut flora or microbiome has been linked with atherosclerosis, hypertension, heart failure, chronic kidney disease, obesity, and type 2 diabetes. It does not matter what the diagnosis is, if the gut is not healthy, it robs the body of energy.

Basic gastrointestinal support includes probiotics, fiber, and digestive enzymes. Here are some resources that explore this topic:

Healthy Poop: What is Your Digestive Tract Telling You?

Leaky Gut Syndrome

Gluten Intolerance, Gut Problems Linked with Roundup Toxicity

Candida Overgrowth Linked with Inflammatory Bowel Disease

Germ Gangs Block Weight Loss – The Leptin Diet Weight Loss Challenge # 5

5. Mitochondria

Mitochondrial injury has been an intense area of research in the last several years. The mounting evidence points to the fact that aging, fatigue, neurodegeneration and virtually all disorders with any type of fatigue relate to cumulative strain to the mitochondria. The boundless energy of youth is a large part due to very healthy mitochondria. Mitochondria dysfunction occurs either as inherited or acquired.

Key nutrients to consider for mitochondria include PQQ, coenzyme Q10, acetyl-l-carnitine, B vitamins, magnesium, zinc, iron, copper, astaxanthin, glutathione, r-alpha lipoic acid, selenium, N-acetyl-l-cysteine, vitamin C, vitamin E, taurine, and melatonin.

Here are some resources to help understand more about mitochondria.

Mitochondria Take Center Stage

Mitochondria – Drugs that Injury and What Mitochondria Injury Looks Like

Atrial Fibrillation, Cardiac Disorders Linked with Mitochondrial Dysfunction

PQQ: Champion Protector for Heart Health, Mitochondria, Triglycerides

Macular Degeneration: Chronic Inflammation, Blue Light, Mitochondria, and Blood Sugar

Managing Brain and Nerve Health, Oxidative Stress, and Mitochondria in CFS, FM, and Lyme Disease

Mitochondria and Osteoarthritis: An Exciting New Frontier

6. Adrenals, Thyroid, and Other Hormones

Chronic stress of any type strains hormone function, especially the adrenal glands and thyroid gland. This is an extremely common problem. Adrenal stress may be felt as “tired and wired”, physical and mental exhaustion, feeling spent, lethargy, anxiety, depression, cognitive decline, and temperature intolerance, blood pressure, and blood sugar stress. Adrenal and thyroid symptoms overlap with fatigue, weight gain, temperature intolerance. The thyroid quiz may help discern some of the differences.

Adrenal stress and fatigue is not the same as Addison’s disease or adrenal insufficiency. Medicine recognizes only Addison’s disease, which is failure of the adrenal glands. Dysfunction of the adrenal hormones and homeostatic stress response is what adrenal stress and adrenal fatigue refer to. New onset allergies or worsening allergies often correspond to adrenal fatigue. Gut, blood sugar and mitochondria dysfunction, pain, infections, lack of sleep, poor quality food, exhaustive exercise, mental stress, and deadlines are common things that deplete adrenal glands.

Adaptogenic herbs like holy basil, cordyceps, eleutherococcus/ Siberian ginseng, rhodiola rosea, ashwagandha, and other nutrients like pantethine, B vitamins, magnesium, vitamin C, zinc, and coenzyme Q10 provide excellent support for healthy adrenal function.

Thyroid disorders cause significant disruption to energy production. Autoimmune thyroid inflammation can be triggered by various infections, toxins, and food intolerances. Lack of adequate nutrients stresses thyroid function too. It is always essential to calm down autoimmune inflammation that has disrupted thyroid function at the same time as thyroid support. Vitamin D, glutathione and glutathione supporters like selenium, manganese, NAC, magnesium, vitamin A, beta carotene, quercetin, and curcumin are helpful. There is a wealth of information about thyroid health management on our website. Take the thyroid quiz 41 to help check your status.

7. Infections

Chronic fatigue can develop as a result of an acute infection like pneumonia that took months to fully recover from or chronic low grade infections. These may include chronic lyme disease, chronic active Epstein Barr virus, hepatitis, CMV, H. pylori, candida, chronic mold/CIRS, HHV 6A, B or 7, or other. It is best to work with your health care professional for proper identification.

Nutritional support to consider includes olive leaf extract, Lauricidin monolaurin, oregano oil, mangosteen, noni, arabinogalactan, vitamin A, C, and D with glutathione support.

8. Toxins

Heavy metal toxins, xenoestrogens, vaccine injury, toxic drugs like Tylenol/acetominophen, cholesterol lowering statin drugs, and other environmental compounds can dramatically impede energy production. These agents interfere with mitochondria and thyroid hormone. They stress the liver and can create autoimmune inflammation and loss of immune tolerance. The end result is fatigue and the sick get sicker.

These concerns are often overlooked in medicine. Modern living is filled with these risks. Removal of the risks is a great place to start. If things fail to respond, get appropriate help. Basic support includes silymarin, r-alpha lipoic acid, I3C and DIM, N-acetyl-cysteine, zinc, magnesium, selenium, chlorella, and oat bran fiber.

9. Miscellaneous

There are many other facets of fatigue that may need to be addressed with debilitating chronic fatigue and even Chronic Fatigue Syndrome. Circadian rhythm disorders, methylation disorders, neurotransmitter imbalances, drug side effects and nutrient depletions, obesity, poor posture, chemo brain, deconditioning, professional burn-out, neurodegenerative disorders, nerve injury, etc may be present.


Identify what areas may be the most problematic of these nine areas of focus. Start from the top concern of anemia and oxygen and work your way down through the different concerns. Focus on two or three of the most problematic areas and then build on as needed. It will be too overwhelming to work on everything all at once if you have a long list of concerns. B vitamins, vitamin D, magnesium, fish oil, coenzyme Q10, probiotics, chromium, pantethine, curcumin and adaptogenic herbs like ashwagandha, holy basil, and cordyceps provide broad array of support for many chronic fatigue sufferers.

Chronic fatigue is complex and is a result of layers upon layers of straw that breaks the camel’s back. These nutritional tools provide immense support to fatigue management and make a substantial impact in day-to-day life. When someone is chronically fatigued, it is often difficult to understand what to do and how to go about it simply because the energy is not present to think well. Life doesn’t have to be about when the next nap is, dragging yourself though the day, or being housebound. Learn how to refocus and take care of you with these key areas of energy production, combined with appropriate rest and gentle exercise as tolerated. Recovery from chronic fatigue takes time, diligence, and expertise, just as Rome was not built in a day.

Nutritional Options

Pantethine – Pantethine is the active form of vitamin B5. Pantethine breaks down in the body into “coenzyme A” which is a cofactor for numerous energy producing pathways in the body. It affects mitochondria, hemoglobin, fatty acid and carbohydrate metabolism, detoxification, and the citric acid cycle. It is often taken first thing in the morning to help the adrenals. It helps support physical and mental energy. Combine it with a B complex and adaptogenic herbs when in need of significant energy support.

Cinnamon – A standardized cinnamon extract can be very helpful for blood sugar management. It may be taken during the day with meals to stabilize daytime swings or at night for healthier blood sugar management. Cinnamon is also helps reduce germ overgrowth concerns with yeast and bacteria.

Tyrosine – This amino acid is essential for thyroid hormone formation. It is also essential for the adrenal glands. Low tyrosine levels in the body are associated with low blood pressure, low cortisol, low body temperature, and underactive thyroid. It is helpful for making the dopamine neurotransmitter.

Adaptogenic Herbs – Holy basil, ashwagandha, cordyceps, eleutherococcus, and rhodiola rosea are adaptogenic herbs. These herbs have been used for thousands of years to help tonify, strengthen, and bring homeostasis back to the body when vitality is lost. They are often used to help support energy production, immune system balance, respiratory, nervous system, gut, adrenal, thyroid, mitochondrial, and antioxidant support.

PQQ – PQQ is an immensely powerful vitamin-like antioxidant found in plants. It is 5,000 times more potent than vitamin C. PQQ helps strengthen mitochondrial health and promote youthful cellular function. It helps reduce lactic acid formation, helps heart cell function and blood flow, and nerve health.

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