Why am I always tired?
Countless patients have asked us this question, and as the pace of life and stress increase, we expect many more to ask it as well. For these people with chronic fatigue, sleeping little is enough to feel energized and refreshed.
According to a CDC survey, approximately 15% of women and 10% of men reported feeling tired or exhausted in the past three months. Furthermore, women between the ages of 18 and 44 are more than twice as likely as men to report low energy levels. 1
In addition to feeling exhausted, many people with chronic fatigue face frustration. They go from doctor to doctor trying to determine the cause of their fatigue, but receive few answers and even fewer coping strategies.
Fortunately, there is a better way to overcome chronic fatigue: one that treats the whole person, not just their symptoms.
What is chronic fatigue?
Fatigue is the common feeling of tiredness. But chronic fatigue is different. Generally, an illness or condition is considered chronic if it persists for at least three months. Chronic conditions can also worsen over time. Furthermore, a chronic illness or condition limits quality of life and impairs health. .
Chronic fatigue is not the same as chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME). 3 The CDC estimates that between 836,000 and 2.5 million Americans suffer from CFS. 4 In addition to feeling tired, CFS includes worsening symptoms after exertion, non-restorative sleep, and some cardiovascular symptoms, among others. 5
While no one wants to suffer from an illness or syndrome, people with CFS find some comfort in knowing what they have and how to manage it. Unfortunately, for those with chronic fatigue without CFS, answers and relief are often hard to come by.
This is because the causes of chronic fatigue can be multiple. And managing it often involves implementing various lifestyle interventions.
But first, we cannot treat what we do not fully understand, which underlines the need for a comprehensive and thorough clinical evaluation for anyone experiencing chronic fatigue.
Assessment of chronic fatigue: the big picture
At Anzara Health, when a patient comes to us with chronic fatigue, we begin our evaluation by analyzing the person's overall health. This is because fatigue can result from lifestyle factors such as stress, diet, exercise, or sleep, as well as from illnesses or metabolic or hormonal dysfunctions. Addressing any (or all) of these elements requires a thorough analysis. and a comprehensive therapeutic approach.
First, we analyzed BMI, age range, and sex. Regarding age range and sex, the data indicate that women are more likely to report fatigue than men. There also appears to be a correlation between certain age groups. Women between 18 and 44 years old, and between 45 and 64 years old, tend to report greater fatigue. 6
Body mass index (BMI) is also crucial in any diagnostic evaluation for chronic fatigue, as a high BMI is associated with feelings of tiredness. A high BMI can cause fatigue for various reasons, such as sleep apnea and conditions stemming from insulin resistance. However, even in the absence of sleep apnea, patients with obesity tend to experience more fatigue than those without obesity. 7
Finally, sex is crucial for assessing fatigue due to its hormonal implications. In women, perimenopause and menopause, and their associated hormonal changes, can affect energy levels. 8 For example, in perimenopause, fatigue may be related to progesterone deficiency. 9 And during menopause, fatigue may be associated with estrogen deficiency. 10 In this case, we have two different hormonal deficiencies causing the same symptom, which underlines the need for careful evaluation.
There are also critical hormonal implications for men. Male hypogonadism (low testosterone levels) can also be associated with fatigue and affect metabolism, brain function, and the composition of bone and muscle tissue. 11
From here, we can begin to evaluate more granular aspects of health and how they might contribute to chronic fatigue.
Assessment of chronic fatigue: the granular approach
Many factors can contribute to chronic fatigue. Based on what we learn about each patient by assessing their overall health, we delve into the hormonal and metabolic details.
In the hormonal sphere, we check the function of essential glands, systems, and hormones, such as the thyroid, adrenal glands, pituitary gland, ovaries, testosterone, vitamin D, vitamin B12, and folate levels. For example, some people with chronic fatigue also have low T3 levels. a important hormone thyroid. Low T3 levels are indicative of hypothyroidism. a common symptom of fatigue.
Fatigue is also often associated with metabolic diseases, such as diabetes. 15 and fatty liver disease. 16 To rule out any of these diseases and assess overall metabolic health, we evaluate liver function, liver enzymes, and triglyceride levels, as well as detect leptin resistance.
Leptin is an essential hormone for metabolism and weight regulation. <sup>17</sup> Some people can develop leptin resistance. Fat cells, known as adipocytes, produce leptin. And the more fat cells a person has, the more their leptin levels can increase. 18</sup> Over time, high or rising levels of leptin can disrupt leptin signaling, which the body misinterprets as starvation. These starvation signals drive the body to conserve energy by gaining weight or to slow down in response to fatigue. 19</sup>
While many physicians can perform these tests, many simply verify that the results fall within normal ranges. However, many of these ranges are broad and distorted by the prevalence of metabolic dysregulation and disease in the U.S. Laboratory results should be considered within the broader context of a person's health in order to address CFS.
Finally, a sleep study is often warranted in patients with chronic fatigue, especially if they are obese. Certain lifestyle factors, such as alcohol and tobacco use, can also contribute to sleep apnea and, consequently, to chronic fatigue. 20
Once we have identified and/or ruled out any underlying hormonal or metabolic problems that contribute to chronic fatigue, as well as determined whether sleep-disordered breathing is a contributing factor, we can begin to take steps against chronic fatigue.
Overcoming chronic fatigue
Based on our clinical experience, in addition to treating the underlying hormonal dysregulation and dysfunction that accompanies chronic fatigue, certain habits and behaviors can alleviate some of the symptoms. These include:
Eliminate toxic habits: Drugs and alcohol disrupt sleep and cause fatigue. Paradoxically, some people may use these substances to fall asleep, but their normal sleep cycles will be disrupted. 21
Improve gut health: For many people, improving gut health starts with consuming enough fiber. Fiber nourishes the gut microbiota, and the gut microbiome is responsible for creating neurotransmitters like dopamine and serotonin. 22 which may be associated with feelings of tiredness or energy, as well as a general feeling of well-being and vitality. 23 , 24
Improve your diet: A diet based on whole, unprocessed foods can also help relieve chronic fatigue, especially a diet rich in vitamin B12 and folic acid. 25 In addition, a diet rich in fiber promotes intestinal microflora, essential for the production of neurotransmitters, while also improving satiety. 26 Finally, try to consume less sugar. For more information on how to improve your diet, read on. This article , which describes the 30-30, 3-3 rule.
Improve lifestyle: Healthy habits can also help improve the symptoms of chronic fatigue. Listening to music, 27 to expose yourself to the sun safely, 28 have sex, 29 or cultivate a mindfulness practice, 30 They can affect neurotransmitters and endorphins that modulate energy levels and the feeling of well-being.
Dealing with chronic fatigue can be physically and emotionally exhausting. At Anzara Health, we follow a simple mantra: We know, we listen, we care. While most doctors know this, they may not have the time to listen or delve into emotional care as much as they would like.
As a concierge medical practice, we have the time, skills, and emotional capacity to determine the cause of your chronic fatigue, work to address it, and support you throughout the process. In addition, our in-house nutritionist and health advisor complete the holistic approach to treatment that chronic fatigue requires.
The answers to your questions about chronic fatigue and a plan to combat it are within your reach. You just need to work with healthcare professionals who know where to look, have the time to listen to your concerns, and care enough to guide you.
Do you suffer from symptoms of chronic fatigue? Schedule your consultation today. with the chronic fatigue experts at Anzara Health.
