Fatigue

Why am I so tired?

Fatigue is the second most frequent reason people consult their health advisor after pain (with low back pain being the commonest type of pain). The good news is there is a lot that can be done even in cases of severe fatigue, the bad news is that the true chronic fatigue/ ME type patient can take several years of appropriate treatment to resolve the problem – most are happily much quicker. Fatigue is a good example of where the cause is almost always multi-factorial and may include structural chemical and stress related/ mental aspects. Excellent treatment needs to take into account multiple causes where relevant and may involve a team approach to treatment. In my clinic we have a counselling psychologist who runs relaxation classes, an aromatherapist and masseur, nutritionist, naturopath, chi-gung, cranial practitioners as well as two chiropractors who use multiple techniques; all of which may be needed in the toughest cases. Please read also my BLOGS on nutrition and stress which give  an overview of key points in nutrition and stress which I will not repeat here. The true case history below relates to a lady with ‘normal fatigue’ as opposed to chronic fatigue/M.E. which I mention at the end; the principles though, would apply to both.

So where to begin:

“Why am I so tired” says the new patient. Mrs Smith (name changed but details are real) has been to her GP recently due to fatigue; she had some blood tests done indicating she is neither anaemic nor suffering with obvious poor thyroid function. While she felt better knowing this she is still fatigued and came to see us. She has a history of everyday infections, no serious medical disorders or operations. She has back pain most days and normal, perhaps high, stress levels with two delightful but demanding teenagers plus a workaholic husband who is largely absent from the home doing shift work, this has lead to a loss of sleep for Mrs Smith. She has little time for anything other than making it from breakfast to bedtime, she has no exercise plan; perhaps a weekend walk with her husband, but this has been inhibited by a nasty sprained ankle 12 months previously and the routine has been broken. She also reports a recurrent mild irritable bowel syndrome. She craves sugar and coffee (3 cups a day) to keep her going and has put on 1 stone in weight (6 kilos) over the last 3 years despite being ‘forever on a diet’. Sound familiar to anyone? She eats a typical English supermarket omnivorous diet. She has a part time receptionist job which she loves as it gets her out of the house and meeting people but even this she is finding hard work recently.

Triad of Health

I use a healthcare model called the triad of health which places structural or physical causes on one side of the triangle, biochemical or dietary on another and mental or  stress induced on the third. As I chat to Mrs Smith I am formulating where her priorities are.

Structural/physical causes of fatigue:

On physical examination she has postural distortion with associated muscle spasm putting strain on her back. I show her in the mirror her uneven shoulder and hip heights. Such problems waste energy as muscles are unnecessarily tense. Muscle testing reveals not only a pattern of weak muscles but also poor co-ordination between muscle groups. The sprained ankle she had last year caused a bit of a limp throwing her weight to the opposite side. This has slowly effected all the other muscles in the body such that each step is using much more energy than it should and has exacerbated her low back making it much more irritable. Later on foot mobilisation and the provision of some simple shoe inserts/ orthotics correct these factors making walking a joy once again and improving spinal stability. I ask Mrs Smith to take a few deep breaths and note she is a shallow breather. I explain that breathing deeper using the diaphragm could help get more oxygen around her system. I mention swimming, yoga, singing and chi-gung as gentle exercises she might like to try. She recalls that she used to go to yoga but stopped due to commitments with the children’s clubs, and at that time she had felt reasonably fit. I suggest she finds a beginners class appropriate for her age group (over 50’s) and has a go, at her own pace of course. She agrees but it takes several months before she feels able to go to her first lesson. I explain the necessity for good sleep and she agrees to get to bed at regular times despite her husbands work.

Biochemical causes of fatigue

Mrs Smith like many people does not drink as much as is recommended, in fact she prefers any drink other than water. As dehydration is a major cause of fatigue I explain to her that we need around a litre per 25 kilos body weight; she agrees to drink more. Nutritional analysis is complex so `I suggest that in order to get a handle on it Mrs Smith sends a hair sample to the lab. The lab we use had performed over 500,000 hair-mineral-tissue analyses tests by 1997; there is a wealth of information to be had, which I find useful from this non invasive low cost test. Two weeks later we shall see what her mineral levels are and offer advice on raising the low levels and removing toxic build-ups. This testing has been used in forensic medicine for many decades. Napoleon was diagnosed this century as having been poisoned by arsenic using this form of testing. For information on heavy metal poisoning see www.detoxmetals.com. For nutritional testing information see www.mineralcheck.co.uk, see also under services on this web site.

Mrs Smith completes a diet diary: she has all bran cereal for breakfast, or toast, some salad or a sandwich at lunchtime and perhaps chicken or fish in the evening with a selection of vegetables. The rest of the family do the same. Adding up the protein we find she is eating about half what is needed for her weight. The amounts needed can be calculated using a formula that takes into account weight, height, age, waist and hip measurements and computes body fat and lean body mass giving a figure from which the correct daily protein input is found. In my experience about 90% of people I have treated eat too much carbohydrate and not enough protein.

Protein provides long term energy and boosting it contributes to Mrs Smith’s return to energetic living over the next few months. Although the GP wisely tested for frank thyroid deficiency and anaemia I ask Mrs Smith to fill in a temperature chart for a month. Dr Broda Barnes a consultant endocrinologist devised and recommends this simple test as superior to a blood test. I came across the test in a book called “Common Glandular dis-functions in general practice” back in 1984; I am proud to say it is by a Doctor of Chiropractic Wally Schmitt DC. After a month Mrs Smith’s average temperature is 1.5 degrees lower than normal indication mild hypothyroidism, a condition said to effect as many as 1 in 6 people in the UK not diagnosed with a thyroid condition. I know this is often due to adrenal insufficiency which in turn is due to stress. These findings also show up on the hair mineral test received back after two weeks from the USA. The results show Mrs Smith to have results typical of a slow metabolism and makes specific recommendations for her.

I recommend she follows these recommendations for 6 months and then has a re-test. (See book ‘Why am I so tired” by Martin Budd ND DO & Adrenal stress disorder, the 21st century disease by XYZ) We recall Mrs Smith also has mild digestive problems. In addition to supplementing her diet I advise her to follow the blood type diet which means as she is an O blood group eating some red meat and stopping wheat products. The blood type diet has been around for about 40 years and in my experience is a useful starting point on a patients road to healthy recovery. Blood types have evolved out of dietary changes in the last 100,000 years. Mrs Smith has the original and commonest blood type-o which means her diet should resemble a hunter gatherer or stone age diet.

We confirm that she has food sensitivities with a simple muscle test (see Applied Kinesiology section under services on this web site) and the  Food Detective antibody blood test, (fooddetective.com) sure enough wheat and cow’s dairy show up as the worst offenders and both are common sensitivities in fatigued and IBS patients. She is willing to try rye bread and goats cheese instead and is soon used to the change. A low blood sugar quiz result suggests this is another factor; as Mrs Smith increases protein in her diet her sugar cravings all but go. While eating high sugar foods provides short term relief it probably makes things worse and can lead to type 2 diabetes in middle years- as happened to Mrs Smith’s mum, who was very similar to look at and did suffer with fatigue which no one could sort out. Sadly she died of coronary artery disease 2 years previously.

Another clue Mrs Smith presented with is low blood pressure. While this may be the envy of those with very high blood pressure Mrs Smith would occasionally feel faint on getting up in the morning and had to get up very slowly adjusting to the change of position or she could faint. In he 1920’s there was an epidemic of this problem and a prize was offered to doctors who could solve why millions of people were suffering with a post world war 1 problem. Dr Ragland collected the 10,000 dollar prize. He found that as people arose from lying down normally blood pressure would rise by 10 points, but in cases of faintness it would fall by the same. This test continues to bear his name. Mrs Smith did indeed have this ‘dumping blood pressure’ indicating adrenal insufficiency which causes hypoglycaemia and a myriad of symptoms. (See my Article on Stress). The adrenals are the closest thing we have to re-chargeable batteries in the body. If you keep charging them with good food, fun, and a healthy lifestyle they will keep going for ever. But if you drain them with unending stress and make an inadequate effort to ‘make time for yourself’ then in the end they breakdown. Mrs Smith’s regular bowel motions changed from weekly to daily with her change in diet and from hard to well formed bulky soft stools! Wonderful.

Structural

A study in 1985 showed that if you wobble laterally as you run by 2 degrees this is equivalent to running an extra 2 miles over the length of a marathon. Lateral or sideways wobble is the commonest finding in people with low back pain. Mrs Smith had suffered with a recurrent pelvic back ache since her first child was born 15 years ago; in time it had responded to a previous chiropractors care. (The sprained ankle had re-triggered the problem and was now perpetuating it). I explained to her that soft tissue healing takes two months for rough repair, by which time it usually feels great, but about 12 months for full tissue reconstruction during which time she should take care and not overdo it. I agreed to her doing any exercise which made her feel better, but of course initially this was not very much. Two and a half years later Mrs Smith attends my clinic every three months for maintenance treatment. She is now back to normal in terms of her energy expectations. Her temperature chart rose by 1 degree over 12 months, her blood pressure improved over the same period. Meanwhile her diet changed to suit her metabolism giving her more protein and more energy. Her weight meanwhile reduced about 7lbs but more importantly her body mass index changed by 10 % meaning a massive change from a mildly obese body to a near ideal body mass index for her age and sex. She goes to yoga twice a week, and has started at the gym, she still works and runs the kids around, still has a workaholic husband but she feels fully able to cope with the demands life puts on her.

Health

Health is a state of complete physical well-being, not just the absence of disease or infirmity (World Health Organisation). It involves people taking responsibility for their health and consciously choosing a healthy lifestyle. Mrs Smith was willing to have a go, to trust me and change her diet from a very normal one to one containing more nutritious substances. For a year she took specific supplements and continues to take the basics- a good multivitamin and mineral and some fish oil. She understood the importance of physical therapy in relaxing her muscles and making her movement effortless and joyful. She found a way of sleeping and she re-joined classes that she had previously enjoyed, thus making time for herself, valuing herself as well as her family commitments. Of course she is now an even more positive person than she was 3 years ago and is an inspiration to many around her.

Chronic Fatigue

Fatigue has many levels from mild post exertion to burnt out to such that you are unable  to get out of bed. In my 25 years experience of working with patients who have had chronic fatigue the basic principles in the case history above would still apply. Time expectations would be slower. Exercise classes might read more like a 2 minute walk once a day to start with. Dietary and allergy tests and recommendations can be got on with and acted upon. It takes time for these changes to work but after 3-6 months there is often an improvement.

Resources

Tired of Being Tired, Dr Jesse Lynn Hanley & Nancy DeVille; Hypoglycaemia and Why am I so Tired? by Martin Budd; The encyclopaedia of Natural Medicine by Murray and Pizzorno; Ageless Ageing  by Chopra. For doctors: Common Glandular Disfunctions in general practice by Wally Schmitt DC.