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Episode Transcript
Hello friends!
The underlying principles of functional medicine work on such a basic level of physiology that when we apply them carefully it is quite possible to help patients suffering from a wide variety of conditions and imbalances. In fact, it seems that on a weekly basis, I’m sitting down with a new patient who has been referred to our office by a friend or family member, who is suffering from a very complicated health condition.
I’ve been paying attention to the types of cases that we consistently hit “home runs” with and what I’ve been able to track is that our biggest turnarounds are in patients with 1 or more of the following “top 5” conditions.
In today’s episode, I want to focus attention on some of the underlying causes of fatigue so we can figure out why we’re all so tired all the time.
Fatigue is the primary or secondary complaint in over 20% of all visits to a doctor. Why is that? Well, just about every state of dysfunction or disease in the body impacts the key cellular mechanisms that produce energy in your body.
I think it might be helpful to break down this topic into 4 main levels. We’re going to work from big lifestyle causes down to the cellular level just so we can have a framework to think about this topic. Hopefully, you’ll see that this isn’t just an academic exercise and that this is exactly how we need to investigate and treat clinically as well.
1- Lifestyle Factors – Sleep, Diet, and Movement
Okay. So, first, let’s think about the Lifestyle Level.
Which of the Simple 7 Lifestyle Habits would have a direct impact on your energy? The obvious answer is Sleep!
You might be surprised at how many people complain of running out of energy during the day but report that they stay up way too late and only get 5-6 hours of sleep. I know it sounds so simple, but the reality is that these people realize the incongruity but they are having a hard time actually making changes. That may be a bigger topic than we can take up today but suffice it to say, prioritizing sleep is a crucial part of health and it simply cannot be ignored. If you aren’t getting 7-8 hours of quality sleep per night. This needs to be addressed ASAP. underlying health issues like sleep apnea, snoring, or pain shouldn’t be ignored. We spend a full episode on this topic so if you want to go a bit deeper, check out episode #4 of the podcast.
In addition to sleep, we need to consider the quality of our diet and the adequacy of movement. Many of us are eating foods that are full of empty calories. These foods create relatively little energy and leave us riding the cycle of hunger throughout the day. We discuss the fundamentals of building a nutrient-dense, whole-food-based diet in Episode #6.
Our sedentary lifestyles aren’t helping us create energy. In fact, when we are physically active through exercise we are creating a more efficient metabolic furnace to generate energy.
Beginning a sensible physical fitness program including a baseline movement strategy and supplementing that with high-intensity interval training and weight lifting can actually create more energy. We do a deep dive on this topic in Episodes #8 and #33.
2 – Organ Systems and Glands
As we move from behaviors into the physiology of the body, we need to consider some organ system dysfunctions that are central to energy production. First and foremost, we should discuss the importance of the thyroid gland. Thyroid hormones are the main drivers of our basal metabolic rate. These hormones are produced throughout the day to give us the energy we need to accomplish all that is needed.
Often patients with low thyroid output won’t have enough energy to make it through the day. They can themselves to get things going but when they sit down between projects or errands, they are wiped out. Sometimes these symptoms are exacerbated by brain fog and a “heavy head” and even what some might consider depression. Getting your thyroid hormone levels checked can be a bit tricky. If you don’t look hard for the problems, you might get a “normal” lab report even though there is a definite problem. This is really quite common and this is an area where functional medicine approaches really can be helpful. There are a lot of people with suboptimal thyroid function who aren’t being managed well in the conventional system. By the way, I discuss this at length in my blog post entitled “The Functional Medicine Approach to Thyroid Health” and I’ll put a link in the show notes.
Another major cause of fatigue is anemia. To put it simplistically, anemia is a situation where the red blood cells aren’t able to transport oxygen to our cells. Of course, our cells need oxygen to produce energy so if there is a problem getting the ‘fuel’ to the furnace, we simply can’t make energy efficiently. The main causes of this are low levels of iron and/or B12. Transporting oxygen to the cells is such a foundational physiological process that if it isn’t working well, it will be nearly impossible for the body to heal itself and function properly. Getting to the root of where this anemic state is coming from becomes a primary solution in these cases. It could be from a deficiency in iron, B12 or folate in the diet. It could be a problem with nutrient absorption in the digestive system, possibly from autoimmune disorders like celiac disease. There could be issues with the size, shape and function of the blood cells for a variety of reasons. There could also just be a loss of blood for a variety of reasons, like heavy menstruation, or occult blood loss from the gut. This isn’t meant to be an exhaustive list but it gives you the idea that there are lots of potential drivers of anemia that need to be evaluated.
3. Cellular Energy Production
Okay, that brings us to what is going on inside each of our cells. We just talked about the importance of getting oxygen to the cells. Once inside the cell, oxygen is taken to the tiny power stations called “mitochondria”. These organelles are primarily responsible for making energy for our cells. When these mitochondria aren’t working at 100%, we have less cellular energy available to run the body. Mitochondria are damaged by a variety of things including inflammation, toxicity, and oxidative stress due to insufficient antioxidants in the body. There are key nutrients that are needed for mitochondria to function well and for our bodies to detoxify and fight off “free radicals”. The bulk of these nutrients should be coming from a nutrient-dense, whole-food eating approach that I already mentioned. In addition, there are some supplements that may be called into action for those suffering from mitochondrial dysfunction.
Glutathione – Your body’s number 1 antioxidant and powerhouse molecule. Having enough glutathione in the body is crucial for health. This isn’t a nutrient that we generally get from food but nutrients that come from food have the ability to “recharge” our glutathione production. The amino acid called L-cysteine plays a huge role in the maintenance of our glutathione stores.
Acetyl L-carnitine – Another important amino acid that is found in red meat helps with glutathione production.
B Vitamins – B Vitamins act as key enzymes in critical processes inside of our cells. Many can be considered specialized antioxidants as well.
Alpha Lipoic Acid – Our bodies need adequate amounts of healthy fatty acids such as alpha lipoic acid have been shown to be particularly helpful in supporting the mitochondria in the brain and nerve system.
Co-enzyme Q10 – Another important antioxidant, CoQ10 is essential for mitochondrial function. In fact, without it, there is no way to generate energy in our cells.
Other helpful nutrients include Resveratrol, Omega-3 fatty acids, catechins from green tea, and quercetin.
4. How Do We Assess These Issues?
Let’s wrap up this episode with a quick overview of how to work through this problem if you are dealing with it.
Let’s make up an imaginary couple, we’ll call them Larry and Mary. They are both in their late 40s and they both are feeling pretty run-down. They struggle to make it through the day at work and then they come home at night and have to manage the dinner, kids, clean up the house… you get it. By the time the regular routine is done, Mary is completely exhausted so she just wants to go to bed. Larry is tired as well but he likes to watch his favorite sporting events on TV so he just chills out on the couch for a couple of hours before going to bed. Mary spends more time in bed than Larry, but they both wake up feeling unrested. Larry is a heavy snorer and that disrupts Mary’s sleep. Both Mary and Larry are significantly heavier than they were 10 years ago and they are pretty stressed out. They don’t have a very good diet and Mary is often so tired at the end of work that getting fast food takeout is happening several times a week. They are finally getting to the point where they both know that it is time to make some changes so they make an appointment with their friendly functional medicine specialist.
Alright! Where are we going to start with these two? Right off the bat, we can see that we’ve got some low-hanging fruit when it comes to their lifestyle habits. We’ve got to address sleep hygiene. With his weight issues and heavy snoring, Larry is a strong candidate for a sleep study to evaluate for airway obstruction issues like sleep apnea.
They are eating the Standard American Diet with lots of junk and fast foods. This is a big risk factor for nutrient deficiencies that could impact mitochondrial function as well as cause inflammation and drive thyroid hormones out of balance. This diet has caused Larry to develop a pretty significant case of heartburn so he is on an antacid medication which he doesn’t even know increases his risk for problems absorbing nutrients. Mary is in perimenopause and has had even heavier periods over the past several years. Not to mention, Mary’s mother and sister have been diagnosed with Hashimoto’s disease.
So, with that background, we know that we’re going to run a very comprehensive blood panel to look for anemia. We’re going to go beyond the typical thyroid screening test where they just look at the TSH number and we’re going to run a full thyroid panel, including T3, T4, both free and total. We’re going to also look for thyroid antibodies. While we’re at it, it makes sense to look at other hormone levels like estrogen, progesterone, and testosterone with both of them. We’ll evaluate other metabolic markers for blood sugar balance like fasting glucose, fasting insulin, and hemoglobin A1c along with a complete blood count and comprehensive metabolic panel.
It’s likely that we’ll find some of the big drivers of their issues just with this nutrition and lifestyle assessment and their blood work. BUT… in a case like this, I will often also run a functional test called an Organic Acid test that gives me some insight into the function of the mitochondria.
So, in summary here’s the workup.
- 60-minute deep dive consultation with me on the overall case and to order the tests.
- 60-minute health coaching consultation with Tammie to dig into the habits that are currently sabotaging their energy.
- Comprehensive blood panel
- Organic Acid test
- Referral for a sleep study for Larry
After we get these diagnostics done, we can build a customized roadmap to get these issues resolved.
In my experience, even with all of these factors at play, I’d give Larry and Mary a 90% chance of complete resolution. In my mind’s eye, I can see these two 30-40 lbs lighter, sleeping through the night and having plenty of energy to last all day.
Sounds good right?
If you or a loved one are dealing with fatigue, you really owe it to yourself to have a functional medicine workup.
We’ve all got things to do! We’re trying to make a positive impact on this world so we’re going to need all the energy we can get.
Alright, that’s it for today. Until next time, let’s go out and do some good in the world today.
Resources:
If you’re one of the many people struggling with a chronic health problem and feeling stuck, you might consider working with us directly! We work with local patients and folks from all over the US through our online coaching program. Our personalized functional wellness membership programs combine the expertise of a functional medicine-trained doctor, and a health coach trained in holistic nutrition and lifestyle. We can help you along your journey!
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Disclaimer: This podcast is for educational purposes only and is not a substitute for professional medical care by a licensed practitioner. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you’re looking for help on your journey, we recommend that you seek out a qualified functional medicine practitioner.
