Getting to know chronic fatigue – Part 1

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I know so many people who are exhausted. Completely and utterly exhausted. My friends, my patients, my work colleagues, often myself. Fatigue, exhaustion, burnout – it seems to be the chronic disease of our time and I find it quite depressing thinking about it and its impact on our ability to not only work, produce and succeed in life but also to enjoy life, enjoy our families and enjoy ourselves.  So my next few articles are going to be written especially for those of you who have clients struggling with fatigue.  I’m hoping to give you some tools you can use to help them explore what is going on with their health and what they can do about it.  

The first step in ‘fighting fatigue’ begins with finding the underlying cause of the fatigue.  

The most obvious causes are often easy to identify through case-taking or blood tests and in this article I’ll guide you through these common causes.  Please note that for the sake of clarity, I am not going to discuss possible causes of Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME) as this condition is far more complex than the generalised fatigue many of your clients will struggle with.  I will write a more in depth article on CFS/ME at a later date.

When working with a patient with chronic fatigue spend a long time taking their case and looking at their lifestyle.  You will be surprised at how often people come to you complaining of exhaustion and when you start taking their case you notice that they don’t eat properly and don’t have a proper sleep routine.  So often I have working parents coming to me for burnout.  They work a full day in the office, come home and cook and clean and then once their children are in bed they sit down at their computers to do a few more hours work…often until after midnight. Then they are up around 7am to get their children ready for school before they go to work.  My rather rude response to them is: “what do you expect…how on earth can you live like this and not be tired?” Similarly, I find so many of my chronically fatigued patients have a coffee for breakfast, skip lunch, have a chocolate or some chips late afternoon and then usually pasta for dinner.  Of course they are going to be exhausted!  

If you can’t find the cause of fatigue in your client’s lifestyle, then you need to start looking at common health conditions that cause fatigue. Ask them to visit their doctor who will be able to run a few tests to investigate the following common conditions that are all associated with fatigue:

• Anaemia – low iron levels are common in growing children, menstruating or pregnant women and vegetarians and they cause fatigue, decreased immunity, headaches and dizziness.  
• Hypothyroidism – this is a major cause of fatigue, especially if that fatigue is accompanied by weight gain, dry skin and hair, constipation and depression.
• Infection – I feel I am opening a can of worms when I mention this topic. There are so many pathogens that can cause chronic fatigue as a consequence but the most common are Covid-19, Borrelia burgdorferi and Borrelia mayonii (Lyme Disease), Epstein Barr Virus, Cytomegalovirus and chronic gut infections.  
• Low vitamin B levels – the B-vitamins are responsible for maintaining the nervous system, mental health and energy metabolism in addition to other bodily functions.  I like to call them the ‘stress vitamins’ because they are quickly used up by the body in times of stress.  Clients undergoing stress, school children ‘over-studying’ and vegans are all at risk of vitamin-B deficiencies.  If you find clients struggling with low energy levels during or after a lot of stress then suggest they check their vitamin B levels.
• Low vitamin D levels – although not really an ‘energy’ related nutrient, low levels of vitamin D negatively affect the absorption of many minerals, including iron, and result in muscular weakness and bone pain as well as depression.  If you have a client struggling with ongoing fatigue accompanied by a lot of aches and pains or muscular weakness, then suggest they have their vitamin D levels tested.  This is especially important if your client does not get enough sunshine for example night-shift workers or people living in highly polluted cities.

If your client has none of the above health conditions yet still struggles with fatigue, then you need to ‘throw the net wider’ and start looking at other causes of chronic fatigue.  For example:

• Medications – unfortunately lethargy and fatigue are a common side effect of many medications.  Medications for high blood pressure, high cholesterol, reflux/heartburn, antibiotics, antihistamines, antidepressants and those used to treat anxiety and insomnia are all known to have fatigue as a side effect.  Although a client should never stop their medication, they can always talk to their doctor who may be able to adjust their dosage or prescribe an alternative.
• Chronic inflammation, leaky gut and food intolerances are all associated with chronic fatigue.  If you want to develop a good understanding of these conditions, how to identify them and work confidently with clients who have them, then take a look at my online courses at The Health Lounge: https://thehealthlounge.com.au/whats-on/
• Menstrual problems – many women struggle with painful, heavy or too frequent periods and long term these problems can be utterly exhausting and even debilitating.  Unfortunately, the more exhausted a woman becomes, the more irregular and difficult her cycle will be so it is very important that she focuses on good nutrition and a health routine in order to keep her menstrual cycle as balanced and healthy as possible.

All of the above conditions should be investigated if you have an exhausted or burnt out client.  If you eliminate all of the above as possible causes and your client is still exhausted, then you need to start exploring the deeper reasons for their fatigue.  Often these are more than simply pathophysiological causes and in next month’s article we’ll take a look at what lies behind the fatigue.