Getting to the Bottom of Constant Fatigue

Constant fatigue affects a large part of the population.  It’s normal to get tired from time to time, but when it becomes the norm, you may begin to suspect something is not right and start to look for answers.

There are various reasons why a person may be feeling tired all the time. Unfortunately, the real reason may take some time to discover and how to deal with it is not always well understood.

Usually, your doctor will start by ordering some blood tests. Perhaps your iron or B12 is low? More often than not everything looks fine and further investigation is needed.

It often takes some time to get a proper diagnosis and during that time the patient may be left to take care of themselves.

With billions of years of evolution crafting the human form, we should be well geared to make it through the day.

As the descendants of hunter-gatherers, who were always on the move, it’s our evolutionary advantage to have abundant energy. It’s our birthright, so to speak.

Every ancestor you have had has survived famine, injury and disease at least long enough to produce another generation. Our genes have evolved to adapt to and overcome many types of stresses.

The problem is that our world is changing very rapidly. The types of stressors we have to deal with today are quite different from the ones our ancestors had to face.  Processed diets, chemical and toxic metal exposure, constant work stress, a lack of sunlight, poor sleep quality, the list goes on.

It can be difficult for our bodies to adapt to the ongoing and novel stressors that we face in today’s modern world.

When a person becomes severely fatigued on consistent bases, it’s the result of their body’s failure to adapt to ongoing stress from their environment.

For some people, it’s years of physical, emotional and chemical stress that add up to ongoing malaise.

For others, it can be quite acute. Fatigue can come on quite sudden following an infection such as Lyme disease or from the shock of a motor accident.

For some people, it means dragging their heels through work and collapsing when they get home. For others, it means only being able to work part-time or not being able to work at all.

Knowing why you are tired all the time is half the battle. A diagnosis really isn’t enough. You have to understand what the root cause of the diagnosis is. This can be different for each individual.

Let’s explore the main fatigue diagnoses and take a look at the factors which lead to these conditions. This will help you to pinpoint the root cause of your condition or at least give you avenues to explore.

Understanding the root cause will allow you to tailor therapeutic action that will help you to recover your energy levels.

HPA-Axis Dysregulation

Chronic Fatigue Syndrome/ Myalgic Encephalitis

Fibromyalgia

Hypothyroidism 

Hypothalamic Pituitary Adrenal Axis Dysregulation (AKA Burnout).

This state of malaise is characterised by chronically low levels of cortisol. Cortisol is the body’s anti-stress hormone. It reduces pain and inflammation while raising blood sugar, all important factors in being active during the day.

In a healthy person, cortisol should be highest in the morning and lowest at night.  We need cortisol to wake up and get going at the start of the day and we need to lower it as the day goes on so we can wind down and rest in the evening time.

Cortisol also spikes in times of stress. When the body is under pressure it revs up levels of cortisol to temporarily increase energy and reduce pain so that the issue can be dealt with.  High cortisol feeds back to the hypothalamus in the brain, damping the signal to release more.

This feedback loop is known as the Hypothalamic Pituitary Adrenal Axis (HPA Axis).  When the body needs cortisol, a signal is sent to the hypothalamus which signals to the pituitary gland to release a hormone called Adrenocorticotropic hormone (ACTH) which in turn signals the adrenal glands to raise cortisol levels.

Stress comes in many forms. It could come as an immediate threat (real or imagined), a high workload, an infection, ongoing inflammation, toxic substances, poor nutritional choices, over-exercise, a lack of sleep or an emotional reaction.

You can also add toxic emotional baggage to the list. Resentments, anxieties and depression all create inflammation and stress in the body which require increased cortisol levels to manage.

Trauma and childhood wounds can cause a person to go into a state of stress.  Some situations trigger stress as a coping mechanism to deal with perceived dangers, even though these may be psychological and not always appropriate.

Trauma can also make a person hyper-vigilant. Their nervous system is permanently on high guard, as it has leant that danger is everywhere.

Stress, It’s More Than You Think!

It’s important that you start to think of stress as a lot more than just your boss giving out to you at work. It’s the sleep you don’t get, the bad food you put in your mouth and your over-concern with issues.

Unfortunately, over time, constant stress interferes with the HPA axis. Prolonged high levels scramble the cortisol feedback loop leading to HPA axis dysregulation. Sometimes this is experienced as low cortisol in the morning and high cortisol at night. The inverse of what it should be.

This is a miserable state. There is no energy during the day, but then plenty of energy in the evening when you should be winding down.

It’s possible for such a person to prop themselves up during the day with caffeine and other stimulants but without addressing the actual problem, energy levels just get worse over time.

Eventually, total burnout sets in and cortisol levels become flat all the time. The person feels miserable and becomes bedridden.

As all systems in the body are interrelated, low cortisol produces other effects in the body besides fatigue. It’s vital that the brain always functions, so to keep it going it increases levels of the stimulatory neurotransmitter noradrenaline (aka norepinephrine). This produces a wired and tired feeling.

High noradrenaline throws other neurotransmitters out of balance, as one neurotransmitter tries to compensate for the lack of another. Insomnia, hypothyroidism, fibromyalgia, imbalances of sex hormones, blood sugar imbalances, anxiety and depression are all associated with HPA axis dysregulation.

In fact, these conditions are frequently experienced by the individual with burnout, so much so that we could consider this disorder a syndrome. Different people will experience different sets of conditions which are all interrelated.

The term “Adrenal Fatigue Syndrome” has been coined which is quite apt. It’s fatigue, relating to adrenal output, with a variety of add on conditions a person may be unlucky enough to develop. That’s as good a definition as any.

Sleeplessness and/or anxiety may be a big aspect of HPA axis dysregulation, due to noradrenaline levels being too high in the brain. As mentioned, the brain fires up noradrenaline to compensate for low cortisol levels.

If insomnia is running your life you must learn to calm your brain down by avoiding stimulants (hard when you’re tired), managing your emotions and engaging in plenty of relaxing activities such as yoga, saunas, meditation, walking, etc.

Nutrients and herbs such as Pharma Gaba, Valerian, phosphatidylserine, Chamomile and L-theanine can be a great help in winding down the brain.

Female Hormones Are Affected by Stress

For a woman, PMS may be a big problem due to high levels of oestrogen relative to progesterone levels.  Stress blocks ovulation which lowers progesterone levels. When survival is at stake reproduction is not a high priority.

Oestrogen, without progesterone to keep it in check, can lead to many unwanted conditions such as PMS, irregular or heavy periods, fibroids, endometriosis, polycystic ovary syndrome and even breast cancer.

So no programme to fix a hormonal problem is complete without also addressing stress levels.

Adrenal Fatigue is a Syndrome

So, as you can see, many conditions are related to cortisol imbalance and chronic stress. Although stress is the root cause of these conditions it is usually not considered. Instead, each condition is usually treated as if it’s its own separate independent problem.

With this approach, the best that can be hoped for is symptom management, and these symptoms may progressively get worse as the actual cause has not been dealt with.

When a person is burnt out, they have used up their metabolic reserves. It takes a lot of focused nutrition and key lifestyle changes to support the body and rebalance metabolic pathways.

Rebuilding metabolic reserve is key to healing adrenal burnout.  For example, the nutrient pantetheine, which is the active form of Vitamin B5, is critical for producing cortisol. This needs to be supplemented so that cortisol levels do not tire so easily.

For reasons not yet understood people with burnout may experience a stimulatory effect from taking supplements, especially with adaptogenic herbs such as Ginseng and Rhodiola, which are often touted as saviours for fatigue conditions.

We are not looking for a short-term stimulatory effect. It can give a temporary sense of recovery but ultimately, it’s putting the HPA axis under more strain. Instead, we want to rebuild and rebalance the HPA axis slowly, avoiding stimulation and hyperactivity.

As a person heals and experiences more energy the tendency is to want to get back to the old routine. That can be dangerous at this point and lead to a crash in energy levels. Avoid energy crashes like the plague.

Only do what can be done while maintaining what energy you have. If something is exhausting, it’s too much. Maintaining consistent energy levels is key to resorting balance to the HPA axis.

Diet is also key to recovery from burnout. Fluctuations in blood sugar put pressure on the HPA Axis. When blood glucose is low, cortisol is released which causes the release of glycogen from the liver.

A diet high in refined carbohydrates causes the blood sugar to swing up and down widely, which is highly stressful for the nervous system.

There are many considerations a person must make when in recovery.  Rest is essential and calming herbs, such as valerian and chamomile, may be needed if a person has insomnia or trouble getting enough sleep.

Taking time for active relaxation each day is essential and exercise should not exceed what is considered moderate for that individual.

Over-exercise puts the body into stress and will cause a crash. The person knows this because they exhausted after the exercise session, even the next day.

Stress – the Mind-Body Connection

A lot of stress is created in the mind. Whether something happens to us, or we just imagine it, the body reacts the same way as if it’s really happening right now. It’s therefore important to detoxify the mind of resentments and anxieties.

Learning to breathe through these feelings and acknowledging them can help to release them, while suppressing them causes them to sink into the unconscious mind, only to resurface at the worst of times.

On the other hand, expressing emotions like anger or anxiety only increases these feelings and will serve to alienate us from those around us.

Since stress occurs on so many levels, energy and adrenal exhaustion can be a web of interactions and connections that need to be unravelled. Biochemical pathways need to be supported while sources of stress need to be neutralised.

Improvements can take time as the internal constitution of the body improves.  The physical and emotional health of the individual increases as new healthy habits are practised over a period of time. The result is a return to excellent and robust energy levels, though this may take months.

To facilitate this, it is recommended that a person works with an experienced practitioner who can identify all the areas that need correction while tailoring a dietary, supplemental and lifestyle programme that suits their needs.

Chronic Fatigue Syndrome/ Myalgic Encephalitis

Chronic Fatigue Syndrome (CFS) is also known as Myalgic Encephalitis (M.E).  It’s a debilitating condition that leaves the sufferer with little or no energy.  A person with CFS is often bedridden and struggles to keep up with the most basic of tasks.

All of the associated symptoms of HPA axis dysregulation are present in CFS.  Insomnia is a huge one. It’s often experienced by the CFS patient who has no energy during the day but can’t get enough sleep at night. Although the causes of CFS are different, the patient often has HPA axis dysregulation, which further confounds the problems.

Digestive issues are another big problem, as is detoxification. These systems need energy to function properly. When energy is low in the digestive tract, it moves slowly. This allows time for food to ferment. Fermenting food produces toxins which overwhelm the liver and further lower energy levels. It also creates digestive problems.

Other symptoms of CFS include headaches, brain fog, poor memory, anxiety and depression.

At the root cause of CFS is mitochondrial dysfunction. The mitochondria are the little powerhouses that exist in every cell of the body. These produce adenosine triphosphate (ATP) which is the currency of energy in the body.  In the CFS patient, the mitochondria are not functioning effectively, and the result is debilitating fatigue.

As the main energy delivery system fails there is a switch from aerobic to anaerobic metabolism, with the production of lactic acid. Despite a low level of activity, the CFS patient may have to deal with intense muscle pain and cramping.

Mitochondria stop functioning properly because the chemical pathway by which ATP is produced (known as the Krebs cycle) shuts down.

The mitochondria are extremely sensitive to threats such as toxins or pathogens. They are like the canary in the coal mine and will quickly signal danger at the slightest disturbance.

If the cell “feels”  it has been overwhelmed by a threat, it goes into a sort of hibernation to conserve resources and essentially protect itself.  This is known as Cell Danger Response (R).

By becoming less metabolically active the cell is able to keep out toxins and pathogens. The idea is to wait out the danger. It comes with a heavy price though. During this time, the cell does not function well or carry out it’s intended role.

In a similar way, some pathogenic bacteria can become immune to antibiotics by lowering their metabolism (R). Once they start metabolising again, they lose that defence.

Reasons for Mitochondrial Dysfunction.

Since we know that Cell Danger Response is responsible for CFS (R) we can target therapies towards removing the danger so that the cell can return to normal functioning.

There are usually two main reasons why mitochondria go into hibernation.

1). Toxins, which can come from a variety of sources

2). Exposure to pathogens, such as Lyme disease or Epson Barr Virus.

Toxins can arise from a variety of sources. Internally they can arise from gut issues. If there is an imbalance in the guts microflora then unfriendly microbes will produce toxins that signal danger to the mitochondria.

In this case, the person will normally (but not always) have gut disturbances that will indicate that that’s where the problem lies.  Clean up the gut with a clean diet and restore colonies of friendly bacteria by feeding them soluble fibre. This will eliminate a major source of toxins, providing relief to the mitochondria.

There’s a range of environmental toxins that can affect mitochondrial health, but probably the most notorious are heavy metals such as mercury, lead, aluminium and cadmium.

Toxins like this bind to receptor sites in the mitochondria which interfere with normal cell signalling. Detoxification with minerals and possibly chelating agents is necessary to reduce levels and allow the mitochondria to function properly.

Cell danger response can also be triggered by infections. Some people notice the symptoms of CFS straight after infection, but in truth, it could manifest years later.

This may be because the original virus was not destroyed completely but still lurks in the body causing low-grade systemic inflammation. This threat can be enough to signal Cell Danger Response in some individuals.

It’s important therefore to remove lurking viruses or at least make them go dormant enough that they no longer trigger inflammation. Natural compounds such as humic acid have been shown to have strong anti-viral properties (R). 

Another important stage of recovery from cell danger response is feeding the mitochondria with nutrients that promote healing and the production of ATP.

Supplementation with high doses of specific nutrients is necessary.  Magnesium, CoQ10, Vitamin B3 & B12, L-carnitine, D-Ribose, Zinc, Selenium and Glutathione should be considered. These are all used in the Krebs Cycle and can kickstart ATP production.

All of this is best done with the help of an experienced practitioner.

Fibromyalgia

Fibromyalgia (FM) is often confused with CFS because the symptoms are the same. But as where CFS is a fatigue condition that leads to pain, Fibromyalgia is primarily a body-wide pain condition that usually has fatigue as a symptom.

Fibromyalgia Syndrome (FMS) is the term used to describe the symptoms experienced by the FM patient. Chiefly they are body-wide pain, fatigue, insomnia, anxiety, depression, digestive issues, headaches, memory problems and morning stiffness.

A person with fibromyalgia may have any combination of these symptoms but will always have global pain that is not specific to one area of the body. Fatigue is very common among sufferers but it’s not always present.

Fibromyalgia is a stress-related condition (R). We have seen earlier the effects of stress on the HPA axis. Indeed, HPA-axis dysfunction is highly likely to be the cause of the low energy experienced by the FMS patient.

Besides the HPA-axis, stress also affects other parts of the nervous system such as the balance maintained by the autonomic branch of the nervous system.

There are two branches of the autonomic nervous system, the sympathetic and the parasympathetic.

The sympathetic deals with sudden stresses, such as seeing your boss’s name in your inbox late at night.

Noradrenaline (aka norepinephrine) is released in the brain which increases alertness. Adrenaline is released in the bloodstream which frees up glucose. This gives the person energy to deal with the perceived threat. Energy is taken away from healing, digestion and sexual function.  The body is in fight or flight mode.

The parasympathetic nervous system puts the breaks on this. It’s the rest, digest and healing part of the automatic nervous system. There needs to be a balance between these two systems. When we are in high-level activity the sympathetic branch should be more dominant. When resting and relaxing the parasympathetic needs to be more engaged.

Prolonged periods of high stress can put a person into a state of sympathetic dominance. This could be due to a traumatic incidence, such a childhood trauma or car crash, or it could be due to an infectious disease.

In any case, the nervous system is on full alert and it’s difficult to get it to switch off. Sympathetic dominance is associated with FMS and offers an explanation for the many varied symptoms.

In animal studies it has been shown that prolonged stress can induce abnormal connections between the sympathetic nervous system the nociceptive system, that is, the part of the nervous system that deals with pain (R)

The sympathetic nervous system is activated by the neurotransmitter noradrenaline and it’s been shown that administration of noradrenaline can activate and increase fibromyalgia pain (R).

Sympathetic dominance has effects on other neurotransmitters too. It suppresses serotonin, a key neurotransmitter which inhibits pain and improves mood.  Pain signals travel from the peripheral tissues to the dorsal horn of the spinal cord and from there to the brain.

The brain decides how important this signal is and if it’s not important a descending inhibitory signal is sent down the spine to block the pain signal at the dorsal horn. Serotonin is a key neurotransmitter in this inhibitory signalling.

Low serotonin and high stress also lead to an increase in Substance P which stimulates pain signalling. Sympathetic dominance, therefore, increases both the ascending signal of pain and the descending inhibitory signal.

For the FMS patient, wearing a tight shirt can be painful. Normally when someone puts on a shirt the brain picks up the signal then says, “that’s fine, no need to keep experiencing that”. You don’t need to be aware that you are wearing a shirt the entire day.  With FMS, pain is accentuated, triggered inappropriately and doesn’t switch off.  So, the sensation of wearing that tight shirt may actually cause pain.

Other neurotransmitters go awry as well. GABA a stress inhibitor tends to be low. Glutamate, which stimulates the brain’s perception of the stimulus, tends to be high. This causes all sensations such as noise or touch to be more pronounced.

Research describes noradrenaline as being low (R).  Noradrenaline like serotonin is responsible for the inhibition of the nociceptive pain signal. It’s likey that this is downregulated in response to prolonged stress, leaving a person more susceptible to pain.

Immune Activation

Traditionally there has been no inflammation found in the muscles, ligaments or joi9nts of FMS patients.  However, recent research has revealed high levels of microglia in their brains and spinal cords (R). Microglia are immune cells that work in the central nervous system. They are its first and main defence and where they are active, you are sure to find inflammation.

Although it’s early days with this research, it’s a plausible hypothesis that inflammation of the central nervous system is leading to the dysfunctional neurotransmitter levels found there. It’s another form of cell danger response, this time affecting the central nervous system and pain signalling nociceptive neurons in particular.

So we have to ask, what is causing this cell danger response? Long-term stress definitely increases inflammation, so trauma, anxiety or a generally stressed mind-set is going to significantly impact the neural inflammatory response.

Other things also need to be looked at and ruled out.  Post-viral infections such as Lyme Disease (R), heavy metal toxicity (R), mitochondrial dysfunction (R), environmental toxins, gut dysbiosis (R), food intolerances and allergens all need to be investigated as possible triggers or causes of central nervous system inflammation.

Fibromyalgia – Finding Natural Pain Relief 

Naltrexone, a drug with lowers immune activity in the central nervous system, has been shown to improve symptoms of fibromyalgia (R). Drugs that affect levels of serotonin and nor-adrenaline are also effective for some patients, although side effects can be strong.

Strategies like these deal with symptoms of the problem but fail to get to the root cause, which may be different for each individual.

Getting to the heart of the matter, the best course of action would be to balance sympathetic dominance while supporting the correct balance of neurotransmitters and reducing levels of inflammation in the central nervous system.

The actual protocol will vary from person to person.  For example, the cause of each individual’s sympathetic stress will be different.  Improving sleep and energy levels is a must. Herbs and nutrients that promote this should be encouraged until the patient is sleeping soundly and the HPA-axis has become balanced.

Cutting out caffeine is a great step towards reducing sympathetic dominance and helps to HPA-axis to restore balance. There are a lot of positive performance studies going around touting the benefits of caffeine, but they are short-term and fail to look at long term depletion to the system.

Resolving emotional stress is hugely important for improving the parasympathetic nervous system which is weak in FMS patients. It’s very important to resolve emotional issues and let go of emotional baggage. This produces a more relaxed state of being.

Neurotransmitter levels can be supported with nutrition. Various supplements and herbs will gently and naturally raise (or lower) various neurotransmitter levels without nasty side effects.

Moderate exercise can be very helpful for the fibro patient. It reduces glutamate levels which are usually too high while raising noradrenaline and serotonin levels which generally too low.

There are various ways to reduce inflammation of the nervous system but I suggest finding and eliminating what’s causing it in the first place. Heavy metals could be one source (R) and should be tested for.

It is also worth testing for viruses that might be lurking in the nervous system. Retroviruses insert their DNA into a person’s cells and it stays with the person forever. Other viruses can also hang around for years causing low-grade inflammation that flares up when the person is under stress.

The gut is another possible cause of inflammation. An unbalanced microbiome can contain high levels of certain bacteria that produce pro-inflammatory toxins. Any gut disturbances should be addressed. In particular, it’s common for people with FMS to have Candida Albicans overgrowth (R).

Some foods increase the chances of a fibromyalgia flare-up. These include sugar, alcohol, processed foods, unhealthy fats and refined carbohydrates. These foods increase inflammation in the body including the nervous system, so they make the condition worse.

As gluten increases gut inflammation, it can also cause FMS to flare up.  Many people have found relief by taking it out of their diet.

Fibromyalgia is a condition that can be greatly improved with some investigation and the right changes to diet and lifestyle. These will be different for each individual.

Getting to the root cause of nervous system inflammation while relieving stress and supporting the body with appropriate nutrition and exercise can have a profound effect on the symptoms of FMS.

Hypothyroidism

If the mitochondria are the engines of cellular energy, the adrenals are the accelerator and the thyroid is the gearbox.  The thyroid gland produces thyroid hormone which revs up cellular energy production.

If you take a cold shower, the hypothalamus will signal to the thyroid (via the pineal gland) to produce more thyroid hormone, with the effect of increasing metabolism and raising body temperature.

Hypothyroidism is a major cause of fatigue. Since metabolism is slow, the patient is often cold and puts on weight easily. Other symptoms include constipation, muscle weakness, dry skin, depression and thinning hair, especially around the eyebrows.

There are two main causes of hypothyroidism. The first is stress and the second is Hashimoto’s Thyroiditis.

Stress and Hypothyroidism

Thyroid Stimulating Hormone is produced in the pituitary gland in response to a signal sent from the hypothalamus. Since stress depresses the hypothalamus and pituitary gland, thyroid hormone is affected too. In this way, stress reduces thyroid function.

The thyroid gland produces thyroxine (T4) which is the inactive form of thyroid hormone. To active it, it must be converted to triiodothyronine (T3) in the liver.  High cortisol levels, caused by stress, block the conversion of T4 to T3. Instead, the T4 converts to what is known as Reverse T3 (rT3). This form of thyroid hormone is inactive and incapable of raising metabolism.

Stress also has an effect on oestrogen levels for women. Stress, as talked about above, decreases levels of progesterone, causing oestrogen dominance. Unchecked by progesterone, this oestrogen can bind with thyroid hormone which prevents it from signalling to cells to increase metabolism.

With thyroid dysfunction, dealing with stress and rebalancing the HPA axis is a critical step in restoring proper thyroid hormone levels. Drugs provide symptomatic relief but also mask the underlying problem. When the root cause is not dealt with, the problem may over time get worse, requiring increasingly higher levels of medication.

Hashimoto’s Thyroiditis

The second cause of low thyroid output is Hashimoto’s, which is an autoimmune disease.  The immune system attacks the thyroid gland, diminishing thyroid hormone output.

L-thyroxine is prescribed to replace the diminishing levels of thyroid hormone (T4) which should be produced by the thyroid gland.

While it’s absolutely necessary to have sufficient levels of thyroid hormone in circulation, this approach does nothing to address the underlying autoimmune condition. Functional medicine seeks to get to the root of the matter and not just deal with the symptoms.

Thanks to the work of Alesso Fansno, autoimmune disease is seen as a combination of genetic disposition, a trigger and intestinal permeability. It’s a three-legged stool. All three factors have to be present for an autoimmune disease to arise (R).

When the gut is inflamed it allows undigested proteins to cross the gut barrier. This triggers the immune system which destroys these, as they may belong to invading pathogens. Sometimes, however, these protein molecules are similar to protein structures in various organs of the body.

The immune system remembers each protein sequence that it mounts a response to. When it sees this sequence in another part of the body, it mistakes that part of the body for an invading organism and attacks it. This is known as molecular mimicry.

The immune system learns about its environment first through mother’s breast milk and later through exposure to pathogens, mostly coming from the gut.

Unfortunately, it can learn the wrong thing and in the case of autoimmune disease, it can’t unlearn it.

However, the immune system only attacks the specific organ when it is triggered and this happens when the gut is permeable. Gut permeability depends a lot on the level of inflammation.  Eating a bad diet will increase inflammation and so will stress, infection and toxicity.

An inflamed gut is hyper-permeable or “leaky”.  This means that it’s easy for undigested proteins to get across the gut wall and thus it’s easy for the immune system to react against them.

It, therefore, makes sense to reduce gut inflammation so the gut barrier can heal and keep out undigested proteins. Since the immune system is systemic, this will have the effect of reducing inflammation in other areas of the body too.

This process would involve resolving dysbiosis, such as candida overgrowth, and cleaning up the diet by removing refined foods, sugar, dairy and gluten. Gluten is a notorious immune trigger for Hashimoto’s (R).

At the same time, it would be wise to restore the balance of healthy bacteria with their favourite food – fibre. The best way to get fibre is by consuming raw vegetables. Salads are an excellent choice, but for those who really need help with their guts, I would recommend blending a cup of raw vegetables with filtered water and consuming it each day.

Not very tasty but guaranteed to restore the guts microflora which will have a tremendously beneficial effect on the gut barrier, while inhibiting the growth of unwanted bacteria and yeasts.

Choose a variety of non-starchy vegetables. Jeff Leech of the Human Food Project recommends that for a healthy gut microbiome you’ll need to consume 25 different types of plants per week, so mix it up!

Raw vegetables work best. Cooking breaks down fibre but also interestingly there is a much lower immune reaction to raw foods than cooked foods. Cooking denatures proteins which are more confusing for the immune system (R). 

The next thing to do would be to remove any foods which the immune system may confuse with the thyroid. In his ground-breaking research, Dr Datis Kharrizan has identified the exact food molecules that the immune system may mix up with thyroid tissues. Avoiding these foods will help someone to recover from a Hashimoto’s flare-up (R).

The next thing to do is to improve the immune function itself, which becomes unbalanced in Hashimoto’s. Nutrients such as vitamin D, Omega 3 and Vitamin E have powerful immune-modulating effects. Certain herbs and nutrients will further help to calm and correct the immune system, but this will depend upon the individual.

An experienced practitioner can help to balance the TH1 and Th2 branches for the adaptive immune system which are always imbalanced in somebody with an autoimmune condition.

While there is no “cure” for an autoimmune condition like Hashimoto’s, with the right protocol in place, flare-ups can be avoided and damage to the thyroid gland can be greatly decreased.

Correct management with the right diet can reduce inflammation of the thyroid gland, which reduces the damage done to it. This reduces the need for medication which can otherwise increase over time. This is an effective strategy to improve this type of fatigue and its associated symptoms.

I would strongly recommend working with a practitioner experienced in the functional medicine or integrative approach, as the steps can be complex and there are often confounding factors.

Conclusion

Constant fatigue is debilitating and frustrating for many people as a solution may be elusive. It’s crucial to understand the underlying factors causing the fatigue which are rarely addressed.

Lab testing may be required to rule out various possibilities such as heavy metal toxicity.

Once we get a clear picture of what the underlying cause of a condition is, we can set about designing a protocol to improve it.

This will look different for everyone as two cases of the same condition could have two very different causes.

This article explores the various types of constant fatigue and what the underlying issues may be.

In the real world, it’s quite common for a person to have a combination of various types of fatigue, each impacting the other.

It takes time, dedication and the direction of a skilled practitioner to unravel the issues and help the patient return to a state of good energy and wellness.

Regaining consistent energy levels is a patient’s top priority.  After all, energy is the currency of life; you can’t do much without it.