Our society often feels exhausted and worn out. Living at a constant on-the-go speed, managing ongoing health challenges, dealing with stress, and maintaining unhealthy lifestyles have left many Americans feeling fatigued. Fatigue is one of the top 10 reasons individuals seek care from their primary care providers. This state of being can be challenging, making it hard for you to carry out activities of daily living. Exploring the underlying causes of your fatigue with the help of healthcare professionals can provide comprehensive insight and complementary options for support.
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What is Fatigue?
Fatigue is a state of impactful tiredness that results in diminished energy and can have both physical and psychological implications. There are three critical classifications of fatigue: physiological, secondary, and chronic. Having too much on your plate and not getting enough rest is an example of physiological fatigue. If this or other demanding life circumstances are ongoing, with little rest, for more than six months, it can result in chronic fatigue. Secondary fatigue is due to medical conditions that impact your body in various ways. Two examples of medical conditions that can result in secondary fatigue are hypothyroidism and fibromyalgia.
What Are The Possible Causes of Fatigue?
There are numerous implications to fatigue. Here are some of the most common factors that may contribute to experiencing fatigue.
Lifestyle Factors
Imbalanced and unhealthy ways of living can be a leading factor contributing to fatigue. Sleep, diet, mental stress, movement, and environmental exposures play a dynamic role in maintaining health. Sleep helps regulate your circadian rhythm and assists the body in recovering from both mental and physical strain.
Specific sleep disorders like insomnia, sleep apnea, narcolepsy, and restless leg syndrome can all contribute to sleep deprivation and chronic fatigue. Your diet can significantly impact your health. Not getting adequate nutritional intake, especially B vitamins, can result in low energy and fatigue. Stress can impact every aspect of your life, including mental fatigue. Prolonged stress can put your body into a state of “fight-or-flight,” which, over time, may lead to feelings of exhaustion. Research on the topic suggests that there is a bidirectional relationship between stress and fatigue, meaning one impacts the other. Both components may need to be addressed to support well-being.
Movement is important for energy production and managing fatigue. One study showed that maintaining daily activity with limited prolonged sedentary time frames could support energy levels and help manage fatigue. What we are exposed to in our environment can also impact how we feel daily. Lead and mercury are two heavy metals we should be aware of that, when present in high amounts, can have adverse effects.
Medical Conditions
Various medical conditions can contribute to fatigue. You may already have a diagnosis of one of these conditions, but if not, assessment for the underlying causes of your fatigue can help you manage the exhaustion you are feeling. Here are some categories of conditions that have components of fatigue.
Infectious Disease
Mental Health
- Depression
- Anxiety
- PTSD
Autoimmunity
- Hashimoto's Thyroiditis
- Lupus
- Type 1 Diabetes (T1D)
- Multiple Sclerosis (MS)
- Rheumatoid arthritis
- Sjogren’s
- Myasthenia Gravis
Cardiac and Lung Conditions
- Postural orthostatic tachycardia syndrome (POTS)
- Heart Disease
- Chronic obstructive pulmonary disease (COPD)
Medications
While your state of health may require you to take a prescription medication, the side effects may contribute to the fatigue you are experiencing. Some prescription medicines can affect nutrients that are necessary for mitochondria function and energy production. Here are a few common medications that can be associated with physical or mental fatigue: antidepressants, anxiety medication, antihistamines, beta-blockers, muscle relaxors, pain medications, and seizure medication.
Functional Medicine Labs to Test for Root Cause of Fatigue
Depending on your clinical presentation, your practitioner may choose to run one or a variety of these labs.
Complete Blood Count (CBC)
A CBC test will help assess for anemias and infections that can contribute to fatigue. By evaluating the biomarkers in a CBC, your practitioner can provide an appropriate plan to address any dysfunction that may be present.
Cortisol Testing
Obtaining multiple cortisol readings can provide context into your stress response and whether or not that is playing a role in your fatigue. Cortisol is best evaluated through Diurnal Salivary Cortisol testing, like the option ZRT Laboratory offers. This test requires four salivary collections throughout the day, which evaluates fluctuations in your cortisol levels throughout the day.
Comprehensive Thyroid Panel
Completing a full Thyroid Panel from Genova Diagnostics will help determine if your symptoms are connected to thyroid hormones or Hashimoto’s disease. Ruling this out as a cause of persistent fatigue will aid in addressing the underlying factors.
Micronutrient Evaluation
Vitamin and nutrient deficiencies due to infections, medical conditions, a poor diet, or medications can play a role in your energy status. Ruling out any deficiencies in B vitamins, iron, vitamin C, and folate is helpful in understanding the factors contributing to fatigue. SpectraCell's Micronutrient Test is a comprehensive test that will look at these markers, plus more. This is an effective method for implementing nutritional support while addressing the factors contributing to your fatigue.
Pathogen Panels
Some infectious agents produce antibodies and biomarkers that can be detected through blood work. Obtaining an Epstein-Barr Evaluation can provide context as to whether you have an active new infection or a reactivation of a chronic infection. A comprehensive Lyme disease panel can look at not only the bacteria, Borrelia burgdorferi, that is commonly known to cause Lyme but also co-infections that are often concomitant with this condition.
Autoimmunity Screening
Being that various autoimmune conditions can contribute to fatigue, investigating this avenue may be necessary in ruling out an autoimmunity condition such as Lupus or Rheumatoid Arthritis. Access Medical Laboratories has an AutoImmune Analyzer test that measures the marker for autoimmunity, antinuclear antibody, plus numerous condition-specific antibody biomarkers.
Cardiac Health Panel
If you have suspected cardiac health issues or are symptomatic with a family history of cardiac disease, obtaining a full cardiac blood workup may be warranted. Access Med Labs offers a Cadiac Health Panel that evaluates the most common biomarkers associated with heart health.
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Conventional Approaches for Managing Fatigue
Depending on the factors contributing to fatigue, conventional medicine may offer some solutions. In terms of secondary fatigue due to infections and other causes, prescription medications may be recommended. If a factor such as anemia is identified, addressing iron levels and the underlying cause of anemia will be considered.
When it comes to physiological fatigue, lifestyle recommendations are often given to improve sleep and manage stress. Conditions such as autoimmunity will typically be managed with medications to support the affected organ system. In many primary care practices, the goal is symptom management and addressing underlying processes.
Integrative Approaches for Supporting Fatigue
Receiving integrative care for fatigue can help address contributing factors while also providing support for symptoms. Integrating a balanced diet and evidence-based supplements are helpful tools in this process.
Dietary Considerations For Fatigue
Implementing an anti-inflammatory diet can help support energy levels. Chronic low-grade inflammation is a contributing factor to many of the above-mentioned conditions that can lead to low energy, tiredness, and persistent fatigue. Rather than focusing on a single nutrient to counteract fatigue, creating a nutrition regimen of nutrient-dense whole foods has shown promising results. An anti-inflammatory diet consists of amino acids, omega-3 fatty acids, antioxidants, polyphenols, and probiotic-rich foods.
In one review on the topic, it found that diets such as the “fatigue reduction diet”, the leaky gut diet, the Mediterranean diet, and the Nordic diet all had beneficial results in supporting energy levels. Patients experiencing fatigue could benefit from these types of diets in addition to other lifestyle and supportive interventions. Rarely is it dietary changes alone that will improve fatigue, but it does play an important role in the whole picture.
Supplements That May Support Fatigue Management
Along with diet and exercise, supplementation has the potential to support energy levels.
Micronutrient Support
Providing the body with nutrients that you are deficient in can support energy levels. Vitamin B12, Vitamin D, CoQ10, and Glutathione supplementation are all nutrients that may help manage various forms of fatigue. Iron, magnesium, and zinc are micronutrients that, when depleted, can contribute to exhaustion, but restoration may help support energy. It’s advised to test your levels through a comprehensive micronutrient panel, so you know what you are deficient in and what the appropriate nutrient and dosing should be.
Herbal Supplements
Adaptogenic herbs may be beneficial when utilizing plant-based approaches for fatigue. Ashwagandha is one of the most widely used herbs for stress-related fatigue. This botanical is an excellent choice for those experiencing physical exhaustion, elevated cortisol, hypothyroidism, anxiety, and many other situations that may contribute to fatigue. The suggested dosage is 500mg twice a day.
Ginseng family herbal medicines have been used for centuries to enhance energy, stamina, and mental stress. Panax Ginseng was shown to be beneficial as an antifatigue intervention in patients experiencing idiopathic chronic fatigue. American Ginseng, also known as Panax quinquefolius, has shown similar results in supporting energy levels in people experiencing chronic conditions. Dosing for Panax Ginseng starts at 200mg and goes up to 3 grams daily for three months. A general dosing for American Ginseng is 200-400mg twice daily for three to six months. As always, it’s best to consult with a healthcare provider to determine your appropriate dosage.
When To Retest Labs
The patient's clinical presentation and initial laboratory results play a key role when appropriate retesting is necessary. In acute fatigue caused by anemia, you’ll want to do follow-up blood work in a month to see if supportive interventions normalize the CBC and affected nutrients. In more chronic conditions such as Hashimoto’s or Lupus, monitoring the patient’s lab twice a year is the most clinically appropriate route. Many antibody markers will not shift quickly, and symptom presentation can provide more insight into the sometimes slowly shifting autoimmunity biomarkers. In cases of infections such as EBV and Lyme disease, you’ll want to do laboratory testing when flare-ups or worsening of symptoms are present.
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Summary
An integrative approach to managing fatigue can provide insights into contributing factors and offer a comprehensive support strategy. Through clinical expertise and specialized laboratory testing options, this healthcare paradigm can be a valuable tool in your journey to improved well-being. Taking the next steps to explore this holistic avenue could be key in your transformation from feeling exhausted to feeling vibrant.
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