Root Causes of Chronic Fatigue
Ever feel like you could sleep for 10 hours straight and still not wake up refreshed? You’re not alone. Although sleep definitely plays a big role in your energy levels, sometimes it could be an underlying condition that needs to be evaluated. Let’s take a look at common conditions associated with chronic fatigue.
Iron Deficiency Anemia
Low iron is a common finding mostly in women of reproductive age and in pregnant individuals. Without enough iron, your body can't produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin). As a result, iron deficiency anemia may leave you tired and short of breath. Women who have heavy menses are more at risk of developing iron deficiency, as are individuals who follow a vegetarian or vegan diet.
Common laboratory findings will show low ferritin & iron on an iron panel and low MCV & MCHC on your CBC.
Treatment includes increasing intake of iron-rich foods, which includes red meat, poultry, legumes, and lentils. Other treatments are iron supplements, which are commonly recommended, especially to pregnant women. Iron IVs can also be prescribed if your physician determines that your iron levels are very low.
B12 and Folate Deficiency
Fatigue is most often one of the early presenting findings when one presents with B12 or folate deficiency. Symptoms typically develop gradually and progress to neurological and psychological symptoms as well such as numbness and tingling in the extremities, brain fog, and depression. Vitamin B12 is an important nutrient that helps your body keep your nerve cells and blood cells healthy. It also helps your body make DNA, the genetic material in all of your cells. Folic acid, or Vitamin B9, helps your body make red blood cells, so without it, again, we don’t have enough blood cells in our body. Both B12 and folate deficiency is most common in those who follow a vegan diet, since plant-based food is not an adequate source of B12. Those who have a compromised digestive system are also at risk of deficiency since this enables them from properly absorbing these key nutrients. Individuals with pernicious anemia, a rare medical condition, aren’t able to produce enough intrinsic factor, which is a key protein in the ability to absorb B12 properly. And those with MTHFR mutation are not able to process folic acid properly, causing elevated homocysteine levels. Many commonly prescribed medications, such as metformin, OCPs, and PPIs, also cause low vitamin B12.
Common laboratory findings include low B12 and folate or high MMA and homocysteine levels, which are markers of B12 and folate deficiency.
Treatment mostly includes supplementing with B12, especially in those who are plant-based, since our body doesn’t produce B12 on it’s own. Other considerations are regular B12 IM injections and ensuring adequate dietary intake of B12 and folate.
Low Cortisol
Cortisol is commonly referred to as our ‘stress hormone’ as it is released by our adrenal glands when our body experiences stress. It helps the body respond to stress by increasing blood sugar, enhancing the brain's use of glucose, and increasing the availability of substances that repair tissues. It serves other important functions like maintaining blood pressure, regulating our metabolism, suppressing inflammation, and regulating our sleep-wake cycle. Low cortisol can be a common finding in individuals who follow a high-stress lifestyle. The idea is that the adrenal glands can't keep up with the demands of the ongoing fight-or-flight state in the body that chronic stress causes, so they stop producing cortisol. Addison’s disease, however, is different, in that the adrenal glands are damaged and don’t produce enough cortisol for that reason. Other findings in Addison’s disease are weakness, weight loss, low blood pressure, poor appetite, and darkening of the skin.
The main lab run to assess for cortisol function is A.M. cortisol, which assess your cortisol status early in the morning, when it should be at its peak. A cortisol x4 can also be ordered at most labs, to assess how your cortisol is changing at 4 different times throughout the day. If your physician suspects Addison’s disease, further testing would include checking ACTH and aldosterone, as well as ordering an MRI to look for changes in the pituitary gland.
Treatments for increasing cortisol typically include lifestyle and dietary changes, stress management, and adaptogenic herbs like Schisandra and Eleuthro. Some supplements also include bovine adrenal extract to help further stimulate the adrenal glands to produce more cortisol.
Hypothyroidism
Low thyroid function is most commonly found in post-menopausal females, although it can affect any gender at any age. Hypothyroidism occurs when the thyroid produces too little thyroid hormone. Hashimoto’s thyroiditis is an autoimmune type of hypothyroidism, in which the immune system attacks the thyroid gland and causes it to produce too little thyroid hormone. While hypothyroidism can be an outcome of lifestyle or hormonal changes, Hashimoto’s is most often caused by genetic factors or environmental triggers, such as infection, radiation, or high amounts of stress. Other symptoms of hypothyroidism include weigh gain, constipation, dry skin, thinning hair and cold intolerance.
The most common lab test to run is a full thyroid panel which should include TSH, free T3, free T4, thyroid peroxidase antibodies (TPO) and thyroglobulin antibodies (TgAb), which evaluate for autoimmunity.
Levothyroxine medication is most commonly prescribed for individuals with hypothyroidism. Making appropriate dietary and lifestyle changes can also significantly affect thyroid function.
Vitamin D Deficiency
Vitamin D is a fat-soluble vitamin that is essential in helping the body absorb phosphorus, calcium, and magnesium. It’s responsible for maintaining proper nerve and muscle function, supporting adequate bone health, protecting the immune system, and lowering inflammation. Vitamin D deficiency can present with a host of different symptoms, the most common ones being fatigue, depression, hair thinning, and mood changes. Individuals who live in colder climates and who don’t have adequate sun exposure generally tend to be more prone to vitamin D deficiency.
A simple vitamin D blood test can assess if you have deficient or insufficient vitamin D stores.
Regularly supplementing with vitamin D is the most common treatment, although those who are severely deficient can also get IM injections, similar to those with B12 deficiency, to quickly boost their levels.
Infections
Of course, there are many types of infections to consider here, as most cause symptoms of fatigue and generalized weakness. The most common viruses that I test for in my practice are Epstein-Barr virus (EBV), Cytomegalovirus (CMV), Herpes virus (HHV6), and Hepatitis C. A common bacterial infection that is important to rule out, especially in New England, is Lyme disease. And finally, a condition I see more and more often in practice is Candida overgrowth, which is a yeast. This can present in many different ways but I have recently seen it present with GI symptoms (bloating & diarrhea) or GU symptoms (recurrent vaginal yeast infections). And finally, a lesser thought of cause of fatigue is mold exposure! Mold can be found in our homes, office buildings, bathrooms, kitchens, so if you’re experiencing new-onset fatigue, joint pain, and moof changes, a MycoTox panel may be a good option for you!
If you are suffering from low energy levels, contacting your physician is crucial so you can get some lab work done to treat the root cause. As shown, there are different treatments depending on what the root cause of your fatigue is, which is why it’s so important to test and know for sure how to proceed with treatment. Working with a licensed healthcare professional is always a great idea so they can take into account all of your symptoms and