Chronic Fatigue

Fatigue is probably the most common complaint my patients present with and discovering why patients are tired has always been an area of great interest to me.  For one person it might be just not having quite the level of energy they wish they ha;, while at the other end of the spectrum is the chronically exhausted patient who  becomes practically bedridden after only minor activity.

After treating chronic fatigue conditions for over 40 years it appears that most fatigue conditions are complex and multifactorial.  There is no "magic bullet" or universal treatment for fatigue. My basic approach is to discover and eliminate the cause and/or tree to deficiency. The majority of the time the cause or causes of fatigue can be discovered and treated.

Chronic fatigue conditions can involve multiple organ systems:

• Immune system-chronic low-grade infections, immune deficiency or hypersensitivity or a combination of both
• Central nervous system-brain especially autonomic nervous system
• Endocrine system-deficiency, overload, autoimmunity
• Cellular energy impairment-especially mitochondrial dysfuncti0ns, toxic metals

Assessment and Treatment of Fatigue Disorders

Testing and treatment for CFS patience varies with the individual, but these are some  common approaches:

• Allergy testing-Although not commonly recognized, fatigue is one of the most common manifestations of allergy.  Allergies are inflammatory reactions, which can cause generalized inflammation and fatigue.  This is similar to catching the flu when we feel tired and achy all over. These flu-like symptoms are not caused by the virus, but rather by our immune system  producing cytokines/inflammatory mediators to kill the foreign invader.

Allergy evaluation is an important part of our diagnostic evaluation of patients with fatigue, even though many of these patients have no suspicion that allergy could be causing their problems. This would mostly involve food allergy, but also include inhalants such as dust, dust mites, mold, pollen, etc

• Comprehensive stool/digestive analysis-We can learn a lot about a person of by doing these tests.  The gut is our largest immune organ and often the site of infection and/or inflammatory processes.  In addition, the gut and brain are intimately involved and effect one another.
• Thyroid function including normal free T3, free T4, TSH, thyroid antibodies and sometimes reverse T3.
• Routine blood tests-CBC, metabolic panel, liver function etc. if they have not been done within the past year
• Vitamin D including 25-hydroxy vitamin D and 1, 25-hydroxy vitamin D
• Venous blood gas-evaluates cellular oxygen levels, cell metabolism, metabolic acidosis
• EECP to improve cellular oxygen levels
• Hormone levels if indicated including testosterone, free and total, DHEA, estradiol, progesterone
• Nutritional assessment using Spectra Cell Analysis, which measures need for vitamins and minerals based on biochemical individuality
• Essential fatty acid testing
• Urine organic testing-evaluates cellular biochemistry
• Lyme disease and other tickborne infections if indicated
• Often a trial of vitamin B12 injections
• Many patients get major improvement with Myers cocktail
• Other patients get their best results with higher dose intravenous nutritional therapy

Chronic Fatigue Syndrome-CDC Criteria

The symptoms of chronic fatigue cannot be objectively measured.  That is the reason why the CDC developed criteria to establish the diagnosis of Chronic Fatigue Syndrome, a systemic disorder comprising a complex set of symptoms, which vary in duration, incidence and severity.  The most common characteristic is prolonged fatigue lasting 6 months or more resulting in substantial reduction in the patient's previous ability to participate in occupational, educational, social, and personal activities.

According to the CDC guidelines on CFS, the major characteristics are that the fatigue:

• Is persistent or relapsing in nature and of at least six months duration.
• Should not be lifelong.
• Cannot be explained by other physical or mental conditions.
• Results in substantial reduction of occupational, educational, social and personal activities compared to the patient's condition prior to the onset of this present condition.
• Should not be the result of ongoing exertion and is not relieved by rest.

The current CDC definition also requires at least four or more of the following symptoms:

• Impairment of short-term memory or concentration  severe enough to cause substantial reduction in previous levels of occupational, educational, social, and personal activities.
• Sore throat
• Tender lymph glands
• Muscle pain
• Joint pain involving more than one joint
• Headaches of a new type, pattern, or severity
• Unrefreshing sleep
• Fatigue lasting more than 24 hours after exertion