Chronic fatigue can be the result of much more than just a lack of sleep

Chronic fatigue problems

One of the most common complaints encountered in general practice is fatigue.

Evaluating the origin and cause of fatigue is important in treating it correctly. A thorough medical examination including a detailed history and appropriate diagnostic lab tests are vitally important in diagnosing and treating chronic fatigue.

Fatigue is a common term that describes a general lack of energy, lethargy or inability to do perform a physical or mental task. It is a generalized feeling of tiredness or exhaustion and involves loss of power or capacity to respond to stimulation.

Fatigue is a normal reaction to physical exertion, emotional strain or lack of sleep and is experienced by all of us at one time or another. It is usually short-lived and responds to rest, relaxation, food and a good night’s sleep.

However, if fatigue becomes persistent and does not respond to nutrition and rest, then a more serious underlying disorder may be indicated. Many diseases can cause chronic fatigue and include cancer, cardiovascular disease and infections. Fatigue, sore throat, lymph node enlargement and muscle aches are common symptoms of chronic fatigue. A proper medical workup, including labratory tests, is required to help rule out the cause(s) of unusual, persistent fatigue.

Chronic fatigue is a low level of energy that interferes with normal daily activities. The duration of the fatigue is about six months or longer. It is believed to affect twice as many females as males and is common in young to middle-aged adults. It is also common in the elderly but is more commonly associated with advanced age and other underlying comorbid medical conditions.

The symptoms can occur after a period of stress or following a bacterial or viral infection. Post-viral fatigue can occur following a viral infection like Covid-19. An estimated 10% of people experience unusual, persistent fatigue following Covid-19 infection.

A detailed patient history is important in understanding the origin and cause of fatigue. Listening to the patient is paramount. They will often supply important information and vital clues about the origin and the cause(s). Questions about diet, nutrition and lifestyle including exercise and sleep habits are crucial.

Poor nutrition and a bad diet can cause fatigue. What nutrients you put in your body helps determine energy output. If you put in bad and poor-quality foods, then decreased energy output can occur. Eating high-quality protein, good fats and oils, unprocessed and whole carbohydrates, including ample amounts of vegetables and fruits is best. Eating a lot of processed foods high in added sugar, processed and refined carbohydrates, like chips, donuts and ice cream is not beneficial.

Lack of exercise and movement contributes to feelings of fatigue and lethargy. Studies consistently show regular exercise and movement can help improve overall energy. Many individuals argue they don’t have the energy to exercise, but research is resolute that pushing yourself to exercise at least a little is very beneficial. Also, the quality of exercise is important. Being outside in fresh air and green space is better than being indoors.

Sleep is vitally important for energy and recovery from physical and mental exertive activities. Studies also consistently show getting an average of at least seven hours of sleep is necessary for proper rest and recovery.

Also, the quality of sleep is important. Frequent sleep interruptions caused by nighttime awakenings diminish the overall quality of sleep. Sleep apnea and nocturnal trips to the bathroom contribute to frequent awakenings. That interferes with the normal health sleep cycle and causes a lack of deep stage 4 rapid eye movement or rem sleep. Both these conditions contribute to daytime fatigue and if persistent, can contribute to chronic fatigue.

A proper and thorough diagnostic workup should be a part of investigating the cause of unusual and persistent fatigue. Initial lab tests may be indicated at the discretion of the evaluating licensed medical professional. Basic blood tests should include a complete blood count that measures red blood cells, white blood cells and platelets, ferritin or iron stores, vitamin B12, blood sugar or glucose levels, proteins, electrolytes and thyroid hormone levels.

Additional testing may include kidney and liver function tests, inflammatory markers like ESR or CRP, lipids and cholesterol, urinalysis. More detailed tests may include autoimmune markers, vitamin D, adrenal cortisol levels and other hormones.

If those tests are negative, other non-conventional tests for allergies, toxicities and other infectious disease markers may be needed. They can help rule out a cause of unusual and persistent fatigue. For instance, if ferritin is low indicating low iron stores, then appropriate treatment involving iron supplementation may be started and observed to see if the fatigue improves or resolves.

However, in many cases basic lab tests may be negative and no clear-cut cause or source of chronic fatigue is identified. In those cases, psychological and stress-related causes may contribute to its occurrence.

Exciting new research into mitochondrial dysfunction as a cause of chronic and persistent fatigue is occurring.

Chronic fatigue may be difficult to evaluate, however, a proper investigation of diet, nutritional, lifestyle, exercise and sleep habits is important and a proper and thorough diagnostic workup is also required to rule things out. Then, appropriate treatment guidelines can be suggested.

The information provided in this article does not, and is not intended to, constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

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About the Author

Doug Lobay is a practicing naturopathic physician in Kelowna, British Columbia.

He graduated with a bachelor of science degree from the University of British Columbia in 1987 and then attended Bastyr College of Natural Health Sciences in Seattle, Washington, where graduated with a doctorate in naturopathic medicine degree in 1991. While attending Bastyr College, he began to research the scientific basis of naturopathic medicine. 

He was surprised to find many of the current major medical journals abounded with scientific information on the use of diet, vitamins, nutritional supplements and herbal medicines.

Doug is a member of the College of Naturopathic Physicians of British Columbia and has practiced as naturopathic family physician for more than 30 years.  He maintains a busy practice in Kelowna where he sees a wide age range of patients with various ailments.

He focuses on dietary modification, allergy testing, nutritional assessments, supplement recommendation for optimal health, various physical therapy modalities, various intravenous therapies including chelation therapy.

An avid writer, he has written seven books on various aspects of naturopathic medicine that are available on Amazon and was also a long-time medical contributor to the Townsend Letter journal for doctors and patients, where many of his articles are available to view on-line. He has also given numerous lectures, talks and has taught various courses on natural medicine.

Doug enjoys research, writing and teaching others about the virtues of natural health and good nutrition. When not working, he enjoys cycling, hiking, hockey, skiing, swimming, tennis and playing guitar.

If you have any further questions or comments, you can contact Dr. Lobay at 250-860-7622 or [email protected].

The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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