As you might expect, fatigue is a fairly common reason people visit doctors. Feeling tired is vague symptom and can be linked to dozens of possible diagnoses, plus there’s a need to differentiate between physical fatigue and mental fatigue (brain fog) or consider both.
When your doctor or nurse practitioner starts to ask questions, she’s looking for associated symptoms that will narrow down the diagnostic possibilities:
- “Sleeping well?” (poor sleep is a common cause of fatigue).
- “Eating a reasonably healthful diet?” (junk food is like watering down your car’s gasoline).
- “Any chest pain or palpitations?” (heart disease in general, atrial fibrillation in particular).
- “Excessive thirst?” (dehydration or diabetes are both common).
- “Muscle aching?” (fibromyalgia).
- “Cold hands and feet?” (hypothyroidism).
- “Mood?” (depression).
In seeking an answer for fatigue, you’ll likely receive a battery of medicine’s most common blood tests. Just a single blood draw will screen you for an impressive number of possibilities.
A CBC (complete blood count) checks mainly for anemia, common in menstruating women, and early cancers and leukemia.
The CMP (comprehensive metabolic profile) checks for diabetes, kidney disease, liver disease, and electrolyte imbalances.
The TSH (thyroid-stimulating hormone) check may pick up thyroid problems.
At WholeHealth Chicago, we tack on vitamin levels (B-12, folate, and D), adrenal fatigue (see below), and, if there’s a hint of possible exposure, a screen for Lyme disease even if you don’t remember a tick bite.
I think it’s reassuring to know that most causes of fatigue are not disease-based, but rather inadvertently unhealthful lifestyle choices. Keep in mind that with “lifestyle fatigue” your tests will return negative results. Disease-based fatigue returns positive test results.
Lifestyle fatigue and functional medicine
I prefer to call lifestyle fatigue benign personal neglect and having it places the ball squarely in your court. Sleep longer, eat healthier, move around every day, and so forth, and you should start feeling better.
“But,” you protest, “I do live a healthful lifestyle. I’d exercise more if I weren’t so tired. Don’t I deserve some credit for shopping at Whole Foods? I’m still tired all the time.”
Here’s where the relatively new field called Functional Medicine can be useful.
The routine blood tests your doctor orders are basically snapshots of you at the moment of the blood draw. For example, a blood sugar drawn at 8:00 am will be completely different an hour later after you eat. It’s also important to note that all screening tests tell your doctor nothing about how your body is actually functioning.
There are several dozen functional tests ordered by physicians (MDs, DOs), chiropractors, and nutritionists who have taken some training in functional medicine. These functional tests group together a number of individual tests (blood, urine, stool, saliva) and the specimens are taken at the same time.
The results convey an idea of how a particular system in your body is functioning. For example, a comprehensive digestive analysis will, by testing your bowel material, determine if you are digesting and absorbing what you eat (yes, you mail vials of poop to the lab, which is easier than it sounds, plus we give you instructions). A detoxification profile can check to see if your liver is clearing toxins absorbed from the environment. Measuring cortisol levels in your saliva over a single day will establish whether or not you have an issue with adrenal fatigue.
Patients are always pleasantly surprised to learn that when ordered through a doctor’s office, their health insurance does contribute something toward these tests, sometimes up to 70 to 80% of the charge.
Normal tests, other options
Even with normal functional tests you might still be feeling fatigued. You’ve cleaned up your lifestyle transgressions. You’re no longer a Twinkie and diet cola vegetarian. You’re no longer rehydrating with chardonnay and jumpstarting yourself with Starbucks. You’re actually saying no to those weeknight dance club outings that get you in bed just before sunrise.
In addition to lifestyle improvements, you could try traditional Chinese medicine (acupuncture, herbs) or homeopathy. Each treats fatigue as an imbalance of your subtle energy. Balance this and your old energetic self is restored.
You could also add one or both of these supplements. Both were designed by MDs recognized as pioneers in the treatment of chronic fatigue.
Corvalen (D-Ribose) was first introduced by Jacob Teitelbaum, MD, author of From Fatigued to Fantastic, as part of his program for chronic fatigue syndrome (CFS)/fibromyalgia. Although his research was directed specifically at the fatigue accompanying these related conditions, D-ribose helps all fatigue. It works by stimulating production of ATP (adenosine triphosphate), a molecule found in every cell and the source of what we know as energy. With Corvalen, your cells function more efficiently and most chronically tired people report improvement.
Dose: Corvalen comes as a powder. Take one scoop in water twice daily.
K-PAX MitoNutrients, created by CFS researcher Jon D. Kaiser, MD, is a combination of several molecules that enhance the efficiency of your mitochondria, the microscopic cellular energy factories that produce ATP.
Dose: two tablets twice daily.
The D-Ribose boosts cellular ATP by increasing the raw materials. K-PAX MitoNutrients increases ATP by enhancing its manufacturing processes.
A word to the fatigued
If you’re tired all the time and your doctor hasn’t suggested lifestyle changes, functional testing, or nutritional supplements, but instead says “You’re probably depressed” (though you know you’re not) and refers you to a therapist or tries to push some antidepressants, politely but firmly disagree.
You’re witnessing blame-the-patient physician slothfulness. As she hands you a therapist’s card or a prescription for Prozac, she’s thinking “I can’t figure out what’s wrong with her. Her tests are normal, so she must be depressed.”
You deserve better.
David Edelberg, MD