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Fatigue

Five Likely Causes of a Common and Debilitating Problem

By Kimberly Pryor

Fatigue is one of the most common complaints that patients present to their doctors. For anyone who suffers from this condition in its varying degrees—from mild to moderate to bed-confining severe—obtaining an accurate diagnosis can be as frustrating as the condition itself.
The underlying cause behind fatigue is one of the most difficult things to diagnose. This is because there are many diseases and other factors that can cause lack of energy. Often clinicians must rule out a variety of conditions before they can pinpoint the most likely cause of the fatigue. Also, symptoms tend to overlap. For example, patients who suffer from chronic fatigue syndrome (CFS) also exhibit hypothyroid symptoms, leading many to suggest that hypothyroidism is in fact the cause behind CFS.
This article, while not an exhaustive listing, is meant to explain some of the most common causes of fatigue. It will also explain the difference between CFS and “normal” fatigue.
Allergies
Both seasonal allergies and hidden food allergies are a common cause of fatigue. Allergic rhinitis (seasonal allergies) is associated with sleep disturbances that cause daytime sleepiness and fatigue. Nasal congestion related to allergies causes disordered breathing in sleep and immune mediators affect sleep patterns, depriving sufferers of a good night’s rest and draining daytime energy.1-2
Hidden food allergies can compound any problems that result from seasonal allergies. Regardless of whether an individual suffers from allergic rhinitis or is independently affected by food allergies, this can take a huge toll on the body. Hidden food allergies erode away our health over time, causing fatigue and other health problems.
There are two ways to address fatigue caused by seasonal and/or food allergies. The first step is to identify the delayed food allergies through the use of the ELISA immunoassay testing. Using home test kits, individuals can identify 96 different foods reactions ranging from dairy, wheat, corn, fish, vegetables, fruits, sugar cane, numerous nuts, eggs and other commonly consumed foods. Within a couple of weeks, results are sent back directly to the patient’s home. These results indicate low, moderate or high reactions to different foods. Avoiding the offending foods can help restore energy levels and reduce fatigue.
While histamine is usually associated with seasonal allergies, research indicates that histamine also plays a role in food allergies.3 Therefore, consuming histamine-lowering substances such as quercetin, bromelain and vitamin C can help reduce allergy-related fatigue, regardless of whether the source is pollen or peanuts.4-5
Sleep Disorders
Between family and job obligations and other responsibilities, carving out the seven, eight, or more hours of sleep that most of us need to feel our best can be difficult. Furthermore, as we age, levels of the sleep hormone melatonin decline, making it even more difficult to obtain a restful night’s sleep.
Insomnia is one of the most common reasons for sleep loss and resulting daytime fatigue. Although it is commonly considered a sleep disorder, in reality, insomnia is a symptom of another condition. Insomnia can be caused by sleep disorders (such as sleep apnea or the circadian rhythm sleep disorders experienced by night shift workers), emotional factors such as fear, stress, anxiety, and a mind that won’t calm down, medications, and caffeine. Dietary allergies, hyperthyroidism, and physical pain may also cause insomnia. Whatever the cause, this condition is one of the main culprits behind daytime sleepiness and fatigue.
The reason why sleep loss causes fatigue is due to the hormonal disruptions that occur as a result. Sleep loss can lead to decreased melatonin secretion as well as to increased cortisol levels. In one study of helicopter pilots who reduced their sleep times from 7-8 hours when off duty to 6 hours or less when on duty, cortisol levels were elevated by as much as 80 percent and stayed elevated for two days after the pilots left duty.6
If possible, finding out the trigger behind insomnia can be the first step to solving the problem. In 112 older adults self-identified with daytime sleepiness, fatigue, or insomnia, there was a high prevalence of sleep apnea.7 Medications, such as some antidepressant drugs, also have been shown to cause insomnia.8
Sleep apnea occurs when the soft tissues of the throat collapse inwards and block the free passage of air during sleep. This causes snoring and periodic episodes of awakening during the night, leaving the sufferer exhausted in the morning. Some clinicians have found that one natural approach to sleep apnea isMSM, which can help support and strengthen the health of the soft tissues of the throat.
For insomnia caused by stress, anxiety and emotional concerns, valerian, hops, L-theanine, lemon balm and passion flower offer synergistic support. Melatonin, the hormone that regulates the sleep-wake cycle, may also help individuals who experience insomnia of all causes. In a doubleblind, placebo-controlled study of normal subjects who had difficulty falling asleep, when subjects were given 5 mg of melatonin, they fell asleep faster and reported being less sleepy and fatigued than they did while taking placebo.9
In cases of hyperthyroidism-caused insomnia, iodine (Iodoral®) can resolve the iodine deficiency thought to be responsible for a hyperactive thyroid, thus improving
sleep quality.
Hypothyroidism
It has been estimated that 40 percent of the adult population suffers from subclinical or overt hypothyroidism. In patients suffering from hypothyroidism, fatigue is often accompanied by other seemingly unrelated symptoms. These symptoms include poor concentration, mental confusion, memory disturbances, cold hands and feet, obesity, difficult weight loss, menstrual problems, dry skin, thin hair, and low energy levels. Hypothyroidism also is linked to migraine headaches, hypertension, depression, hypoglycemia, atherosclerosis, diabetes, infertility, and acne.
Because blood tests for hypothyroidism are notoriously inaccurate, the best way to determine whether symptoms are related to this condition is to use a far more accurate test created by Dr. Broda Barnes. According to Dr. Barnes’ method, body temperatures immediately upon awakening in the morning (while still in bed) should be between 97.8 to 98.2 degrees Fahrenheit. He believed that a temperature below 97.8 indicated hypothyroidism. Consequently, anyone who suspects their fatigue is a result of hypothyroidism can take their temperature and resting pulse immediately upon awakening (before getting out of bed in the morning). If the temperature is below 97.8 and the pulse rate is below 70 beats per minute then hypothyroidism may be indicated.10
Hypothyroid patients can ask their physicians to prescribe Armour® thyroid. In addition, hypothyroid patients often find that they feel substantially better and have more energy after consuming iodine (Iodoral®) since iodine deficiency has been linked to the development of hypothyroidism. A urine test can analyze precisely how much iodine each patient needs in order to establish whole body sufficiency of this important nutrient.11
Adrenal Dysfunction
The adrenal glands regulate the body’s energy level largely through their role in the production of the stress hormone cortisol. Normally, the adrenals signal the body to produce cortisol when a stressful circumstance is encountered. When the stressor is taken away, the adrenals signal the cortisol levels to drop. However, if a person experiences chronic stress, the adrenals may stop signaling cortisol levels to decline. Cortisol levels then climb higher and higher until the adrenals become “burned out” and are no longer able to produce sufficient quantities of cortisol to deal with stress.
Known as adrenal insufficiency, this is a common cause of fatigue and exhaustion. In a study of 59 patients presenting with fatigue, the majority of them had low morning cortisol levels.12 Low cortisol levels also have been observed in patients with different stress-related disorders such as chronic fatigue syndrome, fibromyalgia, and posttraumatic stress disorder.13
In addition to fatigue, symptoms of adrenal insufficiency include muscle weakness, weight loss, low blood pressure, headaches and darkening of the skin. An effective and accurate saliva test, which determines levels of cortisol and DHEA, can indicate whether adrenal insufficiency is a potential cause of fatigue.
Various methods can be used to support the adrenal glands and restore the body’s energy levels. Stress reduction—in the form of exercise, meditation, and yoga—can serve as the first step in a multidimensional adrenal support program. In addition, eating healthy, low-glycemic meals that don’t raise blood sugar levels can further help the adrenal glands.
At the initial stage of adrenal insufficiency, when cortisol levels are excessively high, AdaptaPhase® I, Cortisol Control Formula, and DHEA can all help nourish the adrenal glands and lower cortisol levels. When the adrenal glands have been squeezed dry of cortisol, supplementing with licorice (Glycyrrhizic Acid) and adrenal powder (as found in CortiTrophin®) can help replenish depleted cortisol levels. Licorice should only be taken for several weeks at a time, then discontinued for a couple weeks before resuming.
Chronic Fatigue Syndrome
One of the most debilitating forms of fatigue is chronic fatigue syndrome (CFS), also known as chronic fatigue immune dysfunction syndrome (CFIDS). To diagnose CFS, doctors usually must exclude other causes of fatigue since there is no simple diagnostic test for CFS. To be classified as having CFS, patients must experience a number of symptoms and factors including:
1) Overwhelming exhaustion, both mental and physical, made worse by exertion and not relieved (or incompletely relieved) by rest.
2) A fatigue state lasting for at least six months.
3) Muscle pain, joint pain (without joint swelling or redness), headaches (particularly of a new type, severity, or duration), lymph node pain, sore throats, and abdominal
pain as well as bone, eye and testicular pain, neuralgia and painful skin sensitivity.
4) Cognitive problems including forgetfulness, confusion, difficulty thinking, concentration difficulties, and "mental fatigue" or "brain fog.”
5) Hypersensitivity to light, sound, and some chemicals and foods, including an increase in allergic-type sensitivity to foods, scents, and chemicals.
6) Low grade fever or poor temperature control (feeling too hot or too cold), possibly due to involvement of the hypothalamus, which regulates body temperature.
7) Emotional lability, anxiety, depression, irritability, and sometimes an emotional "flattening" (most likely due to exhaustion).
8) Disturbances in the autonomic nervous system such as low blood volume, dizziness and light-headedness, especially when standing up quickly.
9) Hormonal abnormalities including hypothyroidism and/or low cortisol and reduced ability to respond to physiological
and emotional stress (Table 1).
Chronic Fatigue

Some of the most interesting new research on CFS indicates that patients who suffer from this condition have a reduced number of natural killer cells.14 Furthermore, CFS patients have reduced levels of perforin, a protein found within natural killer cells that is influential in the destruction of viruses and bacteria.14 This indicates that a yeast fermentation product known as EpiCor™,which has been shown to increase the killing efficiency of natural killer cells, can help support the health of CFS patients.
In addition,many CFS symptoms overlap with those found in hypothyroidism. Consequently, testing for iodine deficiency is warranted in all CFS patients. If the body temperature and pulse rate are low, supplementing with Armour natural thyroid along with iodine (Iodoral) can help boost energy levels and nourish a sluggish thyroid gland.
Although no definitive cause of CFS has been established, some doctors believe that CFS patients suffer from immune dysfunction caused by exposure to allergens, ranging from food allergies or intolerances to pollen and dander allergies. Pinpointing these specific allergies through a food allergies test may therefore prove helpful so that the patient can avoid allergic triggers.
In some CFS patients, mitochondrial disturbances also have been found, indicating that mitochondria-resuscitating supplements such as coenzyme Q10, creatine, Dribose, aurine, acetyl-L-carnitine and (R)-lipoic acid may provide additional support.
Researchers have found that cortisol levels are often low in chronic fatigue patients.15 Periodically supplementing with licorice and adrenal cortical extracts can therefore help increase levels of this hormone in CFS patients.
Melatonin is another hormone found to be low in CFS patients. For three months, researchers gave 5 mg of melatonin per day to CFS patients with disrupted circadian rhythm synchronicity. Researchers assessed subjects’ responses to a questionnaire measuring the severity of personally experienced fatigue during a 6-week interval immediately before the treatment and once after 3 months’ treatment. After treatment with melatonin, the total fatigue score and the sub-scores for fatigue, concentration, motivation and activity improved significantly. The fatigue score normalized significantly in eight of 27 patients during treatment. In the patients with delayed melatonin secretion, the total fatigue score and the scores for fatigue, concentration and activity improved significantly more than in the patients who secreted melatonin earlier.16
The fish-oil derived omega-3 fatty acid known as eicosapentaenoic acid (EPA) is another substance of interest to CFS sufferers. Researchers treated chronic fatigue syndrome patients with an essential fatty acid supplement that contained high amounts of eicosapentaenoic acid. The treated patients experienced improvement in their symptoms
within eight to 12 weeks.17
Other causes of CFS that have been proposed include ear, sinus, dental and other infections. Celiac disease or gluten intolerance is known to cause CFS-like symptoms in some individuals, as does vitamin B12 or vitamin D deficiency.
Conclusion
This article provides an overview to the most common causes of fatigue. Experimentation may be necessary to pinpoint the exact cause of exhaustion. Identifying the source of the problem is, however, half the battle, and will ultimately lead to an improvement in energy levels and an increase in optimal health.
References
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2. Fisher L, Ghaffari G, Davies M, Craig T. Effects of poor sleep in allergic rhinitis. Curr Opin Allergy Clin Immunol. 2005 Feb;5(1):11-6.
3. Ortolani C, Pastorello EA. Food allergies and food intolerances. Best Pract Res Clin Gastroenterol. 2006 Jun;20(3):467-83.
4. Braun JM, Schneider B, Beuth HJ. Therapeutic use, efficiency and safety of the proteolytic pineapple enzyme Bro elain-POS in children with acute sinusitis in Germany. In Vivo. 2005 Mar-Apr;19(2):417-21.
5. Middleton E, et al. Quercetin: an inhibitor of antigen-induced human basophil histamine release. J Immunol. 1981;127:546-50.
6. Samel A, Vejvoda M, Maass H. Sleep deficit and stress hormones in helicopter pilots on 7-day duty for emergency medical services. Aviat Space Environ Med. 2004 Nov;75(11):935-40.
7. Bailes S, Baltzan M, Alapin I, Fichten CS, Libman E. Diagnostic indicators of sleep apnea in older women and men: a prospective study. J Psychosom Res. 2005 Dec;59(6):365-73.
8. Hermesh H, Lemberg H,Abadi J, DaganY. Circadian rhythm sleep disorders as a possible side effect of fluvoxamine. CNS Spectr. 2001 Jun;6(6):511-3.
9. Kayumov L, Brown G, Jindal R, Buttoo K, Shapiro CM.Arandomized, double-blind, placebo-controlled crossover study of the effect of exogenous melatonin on delayed sleep phase syndrome. Psychosom Med. 2001 Jan-Feb;63(1):40-8.
10. Barnes B, Galton L. Hypothyroidism: the Unsuspected Illness. New York: Thorruss Y. Crowell Co., 1976.
11. Brownstein, D. Iodine—Why You Need it; Why You Can’t Live Without It. MedicalAlternative Press, 4173 Fieldbrook,West Bloomfield, Michigan 48323, 2004.
12. Greenfield JR, Samaras K. Evaluation of pituitary function in the fatigued patient: a review of 59 cases. Eur J Endocrinol. 2006 Jan;154(1):147-57.
13. Fries E, Hesse J, Hellhammer J, Hellhammer DH. A new view on hypocortisolism. Psychoneuroendocrinology. 2005 Nov;30(10):1010-6.
14. Maher KJ, Klimas NG, Fletcher MA. Chronic fatigue syndrome is associated with diminished intracellular perforin. Clin Exp Immunol. 2005 Dec;142(3):505-11.
15. Jerjes WK, Cleare AJ, Wessely S, Wood PJ, Taylor NF. Diurnal patterns of salivary cortisol and cortisone output in chronic fatigue syndrome. J Affect Disord. 2005 Aug;87(2-3):299-304.
16. Eur J Neurol. 2006 Jan;13(1):55-60. Influence of melatonin on fatigue severity in patients with chronic fatigue syndrome and late melatonin secretion. Van Heukelom RO, Prins JB, Smits MG, Bleijenberg G.
17. Puri BK. The use of eicosapentaenoic acid in the treatment of chronic fatigue syndrome. Prostaglandins Leukot Essent Fatty Acids. 2004 Apr;70(4):399-401.
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