Chronic Fatigue: Are You Just Tired or Is it Something More?

Have you dealt with unrelenting fatigue that is unaffected by a good night’s sleep? Do you need to lie down after taking a shower or find it exhausting to make dinner? While everyone gets run down from time to time, unshakeable, severe fatigue that lasts for months may indicate something more is going on. According to the Centers for Disease Control and Prevention (CDC), “Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious, long-term illness that affects many body systems.” [1]

What is Chronic Fatigue Syndrome (CFS)?

Chronic Fatigue Syndrome is a chronic medical condition based on three diagnostic criteria outlined by the CDC on a printable PDF. This list comes from a report published by the Institute of Medicine in 2015: Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Here are the three criteria doctors will look for: [2]

Not being able to participate in routine activities that were possible before becoming ill, such as work, school, social life, and/or personal life, lasting for more than six months and is accompanied by fatigue.
Post-exertional malaise (PEM). Refers to worsening symptoms after physical, mental, or emotional effort that would not have caused a problem before the illness.
Unrefreshing sleep. People with ME/CFS may not feel better even after a full night of sleep.

If you have these three symptoms plus at least one of the following, a medical professional will likely give you a diagnosis of ME/CFS:

Impaired memory or ability to concentrate.
Orthostatic intolerance (symptoms that occur when standing upright)

These symptoms are used to diagnose CFS, but there are many other symptoms that may or may not accompany those listed above.

Additional Symptoms of Chronic Fatigue

Some additional CFS symptoms that may cause a person to seek out medical care include: [3]

Daily tiredness or extreme fatigue not improved by bed rest.
Tender lymph nodes
Neurological issues
Joint pain
Muscle pain
Frequent sore throats
Frequent headaches
Dizziness
Autonomic dysfunction (Damaged nervous system affecting the function of the heart, bladder, sweat glands, pupils, blood vessels, and more) [4]
Visual problems (blurry eyes, light sensitivity, eye pain)
Mood swings
Irritable bowel syndrome (IBS)
Chills or night sweats
Allergies, multiple chemical sensitivities, and other sensitivities
Other sleep problems (difficulty falling asleep, staying asleep, or waking too early)

You may also experience symptoms beyond these listed. In Europe, chronic fatigue syndrome is called myalgic encephalomyelitis (ME), which refers to the symptoms of muscle pain combined with brain inflammation. Together, these syndromes are referred to as ME/CFS. Often CFS goes along with a fibromyalgia diagnosis as well.

Another recently proposed name for this condition is systemic exertion intolerance disease (SEID) due to the worsening of symptoms that occur with physical activity. However, it’s not just a response to physical exertion; mental activity may also aggravate symptoms. [5]

The severity of fatigue and cognitive impairment can impact quality of life and mental health. Many turn to their healthcare providers for answers but are simply given medications for depression or anxiety or encouraged to try behavioral therapy, deep breathing, or yoga.

While those practices can help, symptoms of CFS may continue for weeks, months, or even years –until the underlying causes are addressed.

Who Gets Chronic Fatigue Syndrome?

While CFS affects people of all ages and all walks of life, it’s more often reported by middle-aged women. However, it’s beginning to become much more common in adolescents. In fact, The Mayo Clinic has stated that fatigue in teens is at “near-epidemic proportions.” Mayo Clinic Pediatrician and professor Philip R. Fischer, M.D. wrote a Tired Teens to explore autonomic dysfunction and chronic fatigue syndrome in teenagers. [6][7]

There may be a genetic component to chronic fatigue syndrome, as twin studies indicate, but genetics are only a “loaded gun.” Environmental factors (both inside and outside the body) pull the trigger. [8]

How is Chronic Fatigue Diagnosed?

To really know what’s going on, healthcare professionals need to get a thorough medical history to know some of the risk factors or possible causes. They will likely rule out other underlying conditions and take your symptoms into account. While they may test for viruses like Epstein Barr Virus, there’s no one test for diagnosing Chronic Fatigue Syndrome.

The Fireman vs. The Carpenter in Healthcare

At The Wellness Way, we talk about the mainstream perspective on healthcare versus our perspective and methods as the “fireman approach” or the “carpenter approach.”

Mainstream “fireman” doctors have two tools (treatment options) for caring for people: an axe and a hose. The axe represents cutting things out in a surgical procedure. The hose represents using medications to extinguish inflammation, pain, and other symptoms.

The Wellness Way doctors are more like carpenters. They assess the current state of the body with testing and then create a personalized plan to rebuild using nutrients from foods and supplements. Sunshine, rest, and positive relationships are additional natural therapies that help with healing.

While these things are considered “complementary medicine” or even “alternative medicine,” scientific research backs up their effectiveness in healing.

Mainstream Medicine’s Approach to Chronic Fatigue

Mainstream medicine’s way of treating chronic fatigue syndrome is generally with a slew of medications and a few complementary therapies. They seek to improve chronic fatigue syndrome patients’ symptoms rather than get to the root of the problem. [9]

Common Medications for Chronic Fatigue

Here are some common meds used for CFS patients:

Stimulant drugs: These drugs may be used to give CFS patients a feeling of energy. Examples include methylphenidate (Ritalin, Concerta), amphetamine/dextroamphetamine (Adderall), and lisdexamfetamine dimesylate (Vyvanse).
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake Inhibitors (SNRIs) are thought to delay the uptake of neurotransmitters, keeping them active longer in the brain. Monoamine oxidase inhibitors (MAOIs) are also used, but only when other medications don’t work, as they can also have severe side effects. An example used for CFS is citalopram (Celexa).
Antiviral drugs: Valganciclovir (Valcyte) and Rintatolimod (Ampligen) are antivirals used for viruses associated with chronic fatigue syndrome.
Immune modular drugs: Rituximab (Rituxan) is an antibody drug that triggers cell death in B cells and may help CFS.

Medications are thought to treat chronic fatigue by improving or prolonging the effects of neurotransmitters like serotonin in the brain. They may temporarily help with symptoms. However, they all have negative side effects and can lead to other health problems. Those side effects are often why many people seek out natural ways to overcome fatigue.

Complementary Therapies for Chronic Fatigue

Other therapies that may be recommended in the treatment of chronic fatigue may include: [9]

Biofeedback – Biofeedback is a therapy that teaches people how to control some autonomic functions like heart rate and body temperature and get immediate feedback. A study of 28 women with CFS using biofeedback had significant improvements in their symptoms. [10]
Cognitive Behavioral Therapy (CBT) – CBT uses counseling or talk therapy to discover and work to change detrimental thoughts and behaviors. A review study of 511 CFS patients found that CBT improved long-term outcomes in those with chronic fatigue. [11]
Graded exercise therapy (GET) – Graded exercise therapy is a structured approach to physical activity, which is often guided by a therapist. The goal is to enhance endurance by gradually increasing the intensity and duration of the exercise. While the jury is out, it may be helpful for those with CFS. [12]

We know long-term medication is probably not the answer for improving energy levels. While some of these therapies may be helpful, they still don’t address the underlying factors contributing to chronic fatigue.

What Really Causes Chronic Fatigue? Trauma, Toxins, and Thoughts

At The Wellness Way, we always go back to the Swiss watch principle of health, which states that every cell, tissue, organ, and system of the body affects all the others. An initial trauma, exposure to toxins, or mental stress ultimately may lead to low energy production and a diagnosis of CFS. The “three Ts” cause distress to the nervous system, which then translates throughout the body. The CDC acknowledges that scientists have not identified one clear cause of chronic fatigue syndrome. Rather, they admit that ME/CFS could result from several different causes, which correspond with The Wellness Way concept of trauma, toxins, and thoughts contributing to chronic illness.

Traumas (Physical Stressors)

Chronic fatigue is a result of physical and mental stressors that take away from our energy production. It often begins after a major traumatic event or an infection. Traumatic events can set the nervous system off in a way that can be difficult to turn back off:

Physical traumas to the spine
Traumatic loss of a loved one (loss in general)
Sexual assault/rape
Major surgery
Being a victim of violence

Wellness Way doctors have seen a correlation between a loss of curvature in the neck and chronic fatigue with a fibromyalgia diagnosis. Some of these traumas may be coupled with toxins, such as a viral infection from a vaccine combined with adjuvants in the shot.

Toxins (Biochemical Stressors)

Chronic fatigue may also be triggered by toxic exposures or biochemical stressors like nutrient deficiencies. Toxins may include mold toxins, synthetic chemicals, non-native electromagnetic frequency (EMF) exposure, heavy metals, man-made blue light sources, or even toxins released by parasitic or other infections.

Food allergies: Another common contributor to chronic inflammation and fatigue is unknown food allergies. Eating foods you’re reactive to creates an immune response and the inflammation that goes along with it. This puts the body into an emergency state where it struggles to maintain balance and heal. There’s no energy left to exercise or get work done. [13]
Sick Building Syndrome: Exposure to toxins in the surrounding environment can lead to chronic fatigue syndrome. In Sick Building Syndrome (SBS) and multiple chemical sensitivity, toxic exposure leads to chronic inflammation and illness with accompanying fatigue. [14]
Mold sickness may be misdiagnosed as chronic fatigue or fibromyalgia. According to our experience with patients at The Wellness Way, addressing mold toxicity by identifying the toxic source and supporting the body’s detox pathways often restores energy levels. [15]
Bacterial overgrowth/gut dysbiosis: Scientists proposed the theory of “The Dysbiotic March” in 2020 via the journal Medical Hypotheses. This hypothesis states that gut dysbiosis is often associated with chronic fatigue syndrome. The dysbiotic march starts with excessive antibiotic use during childhood, leading to digestive complaints like IBS. Eventually, it develops into chronic fatigue syndrome (CFS), fibromyalgia (FMS), and/or myalgic encephalitis (ME) years later. “All diseases begin in the gut,” so the gut is a good place to start with testing. [16]
Lyme disease is a classic infection that is linked to chronically low energy levels. Doctors may run a Lyme panel to rule out this debilitating infection before looking for other contributors to chronic fatigue and increased pain levels. [17]
Viral infections: Common viral infections linked to chronic fatigue include Epstein Barr Virus (EBV) and human herpesvirus 6 (HHV-6). [18] Some viruses enter the body through the end of a needle –in a vaccine.
Medications also act as toxins in the body. Just look at the side effects listed on medication labels, and you’d be surprised how many of them have “fatigue” as a side effect. Top medications that may contribute to fatigue include antianxiety meds, antidepressants, high blood pressure medications, allergy medications, pain meds, and cancer treatments. [19]
Non-native EMF exposure: Man-made electromagnetic frequency (EMF) exposure has also been known to contribute to fatigue, among other symptoms, in those who are sensitive. [20]

Thoughts (Emotional Stressors)

Chronic stress is very much associated with chronic fatigue syndrome. It makes sense because stress impacts our thoughts and the subsequent hormones (like cortisol) and neurotransmitters (like histamine and adrenalin) that our body produces. This impacts the immune system and creates inflammation throughout the body.

Here are some things that serve as emotional stressors, creating inflammation and oxidative stress and lowering energy production:

Emotional stress from marriage, financial, family, or other issues
Social isolation
Tuning in to news sources, whether on TV, on the internet, or through alternative news apps (fear/worry)
Overwhelm due to major life changes, whether good or bad: marriage, a new baby, graduation, divorce, or even moving to a new city.
Holding grudges/pent-up anger
Grief/feelings of loss

Cortisol is our major stress hormone. When under mental stress for long periods, we deplete cortisol and deplete our energy levels. This especially affects women as stress hormones are tied to normal cycling hormones. You can measure your cortisol levels throughout the day as they fluctuate with your circadian rhythm.

Hormone imbalances due to poor adrenal function are known to contribute to chronic fatigue syndrome. Low thyroid hormones can also play a major role in low metabolic function and energy production.

At The Wellness Way, when we talk about trauma, toxins, and thoughts, the main point is that everything is connected. We are very much affected by the physical, emotional, and spiritual environments surrounding us. Trauma impacting the central nervous system, toxins burdening our liver, and the thoughts making our hearts race… are all interconnected.

The Wellness Way Approach to Chronic Fatigue

The systems of your body work together like the gears of a finely tuned Swiss Watch, meaning each system affects all the others. If something is out of balance in one area of the body, it will have consequences for others. Everything affects energy levels, so if there are multiple imbalances, it may lead to chronic fatigue.

When the body is inflamed and tired, it’s hard to heal. Sleep suffers, the muscles suffer, the brain suffers, and life seems harder. Caffeine and supplements may help us get through the day, but ultimately, we aren’t addressing the problem.

Important Tests for Assessing Your Gut and Brain Health

Here are some commonly recommended tests at The Wellness Way:

Food Allergy Test: Immuno Food Allergy Test
Gut Health Test: Genova GI Effects with Parasitology
Custom Viral Panel: Access Custom Viral Panel
Thyroid Panel: Thyroid Panel
DUTCH Test: DUTCH Complete Hormone Panel

Testing depends on which ones your Wellness Way practitioner considers most important based on your symptoms and health history.

Dietary Changes for Those with Chronic Fatigue

First, it’s essential to lower inflammation so the gut can heal. That means avoiding your food allergies and following a personalized nutrition program, as recommended by your Wellness Way practitioner. These are some additional guidelines for inflammatory conditions like chronic fatigue syndrome:

No sugar or processed foods – Both increase inflammation, and balancing blood sugar is also important for avoiding crashes and depleted energy.
Avoid high omega-6 vegetable oils, like corn, canola, soybean, cottonseed oil, sunflower, grapeseed, and others, which can alter the omega-6 to omega-3 balance to be more inflammatory. [21] Instead, use fruit oils like olive, coconut, avocado, and palm oil; or animal fats like beef tallow, bacon grease, and duck fat.
Gluten-free, mostly grain-free – Gluten is known to aggravate the gut lining, contributing to chronic inflammation throughout the body [22]
No cow’s milk dairy products – Goat and sheep’s milk products may be better tolerated –and even beneficial. [23]
Follow an overall low carbohydrate, non-inflammatory diet of organic whole foods.
Avoid alcohol – Alcohol compromises the gut lining and increases inflammation. [24]
Follow a Personalized Nutrition Program, based on your food allergy test results.
Include these nutrient-dense foods: Liver/organ meats, sauerkraut, and microgreens for added nutrition.
Focus on antioxidants – Including things like turmeric, green tea, berries, dark chocolate, and foods high in polyphenols can help keep inflammation under control. [25]
Omega-3-rich foods – Wild-caught salmon, herring, sardines, walnuts, and ground flaxseeds provide omega-3s and help lower inflammation. [26]

Committing to a healthy diet is essential, but supplements can help the body lower inflammation and heal the gut and brain.

Supplements For Those with Chronic Fatigue

Nutritional deficiencies have been linked to chronic fatigue syndrome, including low levels of vitamins (B complex, folate, and C), minerals (sodium, magnesium, zinc), amino acids (l-carnitine, l-tryptophan), essential fatty acids, and coenzyme Q10. Herbal medicine may also be helpful by serving as adaptogens, helping the body overcome infections, and reducing inflammation. [27]

Potassium – Electrolyte minerals like potassium are a huge element to consider when it comes to fatigue. You need 7-10 cups of vegetables daily to get enough potassium for good energy levels. Many people need to supplement. [28]
Iron – Anemia due to iron deficiency may also contribute to symptoms of chronic fatigue syndrome. Wellness way glandulars like Liver Glandular can help provide added iron. [29]
B12-Folate – Vitamin B12 and the other B-complex vitamins play a huge role in energy production. [30]
CoQ10 + NADH – Nicotinamide adenine dinucleotide (NADH) is a naturally occurring molecule derived from vitamin B3 (niacin). When combined with vitamin CoQ10, it significantly reduced feelings of fatigue in a study of 207 patients with CFS. [31]
Ginseng – While it may not help everyone, ginseng is the most researched herb for fatigue or CFS. In a randomized controlled trial of this herb for CFS, symptoms significantly improved in 2 months for 45 patients with fatigue. [32]

Nutritional deficiencies may occur because of a poor diet, nutrient-depletion due to modern farming practices, but also may be due to gut dysbiosis or inflammation leading to poor absorption.

Lifestyle Changes & Complementary Therapies for Chronic Fatigue

Other natural treatments for low energy are lifestyle changes and other therapies that lower inflammation and bring balance to the brain, including the following:

Regular chiropractic care – Subluxations are misalignments in the spine that interfere with the nervous system. Misalignments of the vertebrae can irritate the surrounding nerves causing a sympathetic (“fight-or-flight”) response. The body then responds by releasing inflammatory chemicals, which may disrupt the natural electrical current in the body and affect blood flow. The disruption of energy current and decreased nutrient delivery can lead to chronically low energy levels. [33][34]
Acupuncture – Acupuncture is another therapy that may be worth pursuing for chronic fatigue. In an overview of systematic review studies, acupuncture was helpful for some people in reducing symptoms in CFS, but follow-up studies are needed. [35]

Chronic fatigue syndrome has many potential causes. The only way to know those causes for each patient is by testing. That’s why we always say, “We don’t guess –we test!” Between food allergy, gut, hormone, viral infection, neurotransmitter, nutrient-deficiency testing, and more, Wellness Way doctors are prepared to help you get to the bottom of your chronic fatigue.

Educational Resources for Chronic Fatigue

Videos & Webinars Related to Chronic Fatigue

Articles to Support Those With Chronic Fatigue

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