Chronic fatigue syndrome (CFS) is a complex condition characterised by extreme fatigue that lasts for at least six months and is not improved by rest. Individuals with CFS often experience a range of symptoms, including cognitive difficulties, sleep disturbances, and muscle pain. Mainstream medicine may struggle to provide effective solutions for CFS, which is where functional medicine comes into play as it can lift the lid on what exactly is going on under the bonnet for each individual.
Interestingly, Beverley's own journey into functional medicine followed her then teenage daughter's experience with CFS, fibromyalgia and severe migraine which followed an episode of glandular fever. With no relevant answers in mainstream the race was on to find out what could be going on and the answers were found in exploring nutrition, gut health and multiple nutrient deficiencies. This led to recovery for her daughter and a new career for Beverley! So what causes chronic fatigue? Like many conditions this can be multifactorial. We know that various factors can contribute to chronic fatigue, such as gut health, mould exposure, viral infections, thyroid function, adrenal function, multiple nutrient deficiencies and even small intestinal bacterial overgrowth (SIBO) have implications in the progression of chronic fatigue. But the key is to find out your ‘why?’ So how does the gut play a role? The gut microbiome plays a crucial role in overall health, influencing everything from digestion to immune function. Imbalances in the gut microbiome can lead to dysbiosis, which has been linked to chronic fatigue. We know that a healthy gut is essential for a well-functioning immune system. But when imbalances occur, it has the ability to trigger inflammation and immune responses that can then contribute to fatigue. The gut is also responsible for absorbing nutrients from the foods we eat which are necessary for energy production, but if gut health is compromised, nutrient deficiencies can arise, which again can lead to fatigue. Did you know that the gut communicates with the brain through connection called the gut-brain axis? When the gut microbiome is imbalanced it can affect and alter mood and cognitive function, contributing to feelings of fatigue and brain fog. Looking at comprehensive stool analysis can give us a clearer picture of imbalances within the gut, from low levels of beneficial bacteria to bacterial overgrowth of pathogenic organisms as well as looking at digestive function and inflammatory markers that may indicate leaky gut. SIBO Small intestinal bacterial overgrowth (SIBO) occurs when there is an abnormal increase in the number of bacteria in the small intestine. This condition can be a significant contributor to chronic fatigue. SIBO has the ability to interfere with nutrient absorption, leading to deficiencies that contribute to fatigue. The overgrowth of bacteria can lead to inflammation and an immune response, further exacerbating fatigue and similar to other gut-related issues, SIBO can affect the gut-brain connection, potentially leading to mood disturbances and cognitive issues. Fibromyalgia Chronic fatigue and fibromyalgia are two complex conditions that often overlap, leading to confusion and frustration for those affected. While they are distinct diagnoses, they share many symptoms and can significantly impact quality of life. It's important to understand the connections between these conditions. We know that Chronic fatigue syndrome (CFS) is characterised by persistent fatigue that doesn't improve with rest and is often exacerbated by physical or mental activity. Fibromyalgia, on the other hand, is a disorder marked by widespread musculoskeletal pain, fatigue, sleep disturbances, and heightened sensitivity to pain. It is thought to be related to how the brain processes pain signals, leading to an increased perception of pain in response to stimuli that typically wouldn’t provoke discomfort. One of the most striking features of both chronic fatigue and fibromyalgia is their symptom overlap. Many individuals with fibromyalgia report fatigue as a prominent symptom, often describing it as overwhelming and debilitating. Similarly, those with CFS may experience widespread pain, particularly in muscles and joints. The shared symptoms can make it challenging to differentiate between the two conditions, and it’s not uncommon for individuals to receive diagnoses for both. Emerging research suggests that inflammation may play a role in both chronic fatigue and fibromyalgia. Chronic low-grade inflammation can lead to symptoms characteristic of both conditions, such as fatigue, pain, and cognitive difficulties. Certain dietary patterns that promote inflammation—such as those high in processed foods, sugars, and unhealthy fats—may exacerbate these symptoms. Conversely, adopting an anti-inflammatory diet rich in whole foods, fruits, vegetables, lean proteins, and healthy fats can help mitigate inflammation and improve overall well-being. Gut health is another critical factor that links chronic fatigue and fibromyalgia. Research indicates that individuals with fibromyalgia often experience gastrointestinal issues, such as irritable bowel syndrome (IBS), which can further contribute to fatigue and discomfort. An imbalance in gut bacteria can influence inflammation, immune function, and even mood, all of which can exacerbate symptoms of both conditions. Stress Among the various factors that contribute to CFS, the adrenal glands and their production of cortisol play a significant role. The adrenal glands are small, triangular-shaped glands located on top of each kidney. They are responsible for producing a variety of hormones that regulate numerous bodily functions, including: During times of stress—whether physical, emotional, or environmental—the hypothalamus in the brain signals the adrenal glands to release cortisol. This process is part of the hypothalamic-pituitary-adrenal (HPA) axis, which plays a vital role in the body’s stress response. Cortisol prepares the body to respond to stress by: - Increasing blood sugar levels for quick energy. - Suppressing non-essential functions (like digestion and immune responses) to prioritise energy for immediate survival. - Regulating sleep-wake cycles and other bodily functions. While "adrenal fatigue" is not a formally recognised medical diagnosis, it is a term often used to describe a collection of symptoms that arise when the adrenal glands become overworked, typically due to chronic stress. Signs of potential adrenal fatigue may include: - Persistent fatigue and low energy. - Difficulty concentrating or brain fog. - Sleep disturbances. - Cravings for salty or sweet foods. - Mood swings and irritability. In the context of chronic fatigue, dysregulation of the HPA axis can lead to imbalances in cortisol levels. This can manifest in two ways: Chronic stress can lead to consistently high levels of cortisol, which may eventually contribute to fatigue, anxiety, and insomnia. Over time, high cortisol can lead to inflammation and other health issues, further exacerbating feelings of fatigue. Prolonged stress may eventually deplete cortisol production, leading to insufficient energy levels, low blood pressure, and symptoms associated with fatigue. This condition is often referred to as "adrenal insufficiency" and can severely impact daily functioning. Cortisol has anti-inflammatory properties, and chronic stress can lead to an imbalance in immune function. Inflammation is often associated with fatigue, and chronic inflammation can contribute to a cycle of worsening symptoms. Thyroid Did you know that the thyroid can potentially be a driver for chronic fatigue symptoms? The thyroid plays a critical role in regulating metabolism and energy levels. Conditions such as hypothyroidism and Hashimoto’s are common conditions that can lead to fatigue. With Hypothyroidism, the thyroid gland does not produce enough hormones, this can slow down metabolism, leading to decreased energy production and increased fatigue. Conditions like Hashimoto’s thyroiditis, which is an autoimmune disorder, can cause chronic fatigue due to the body’s immune system attacking the thyroid. We always recommend comprehensive thyroid testing that goes beyond standard NHS measurements, which looks at various thyroid hormones and antibodies to get a full picture of thyroid health. In clinical practice we see that many people believe themselves to have CFS but there is an underlying thyroid problem which has not been identified. Other common symptoms of hypothyroidism can be hair loss, dry skin, constipation, bloating, inability to lose weight, feeling cold, depression and anxiety. Mould Mould exposure is another factor that can significantly impact health and contribute to chronic fatigue symptoms, particularly for those with sensitivities or allergies. Mould can produce mycotoxins, which are harmful substances that can enter the bloodstream and affect various bodily systems. Mycotoxins can lead to systemic toxicity, causing fatigue, cognitive impairment, and various other symptoms due to their ability to target organs such as the brain and even cause toxicity within cells Chronic exposure to mould can provoke an ongoing immune response, leading to inflammation and fatigue. Homes or workplaces with water damage or poor ventilation can harbor mould, making it essential to assess and remediate any mould issues in the environment. LONG COVID Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), refers to a range of symptoms that persist for weeks or months following the initial COVID-19 infection. While the acute phase of COVID-19 is often characterized by respiratory symptoms, fever, and body aches, long COVID can manifest in various ways, including fatigue, cognitive difficulties (often referred to as "brain fog"), muscle and joint pain, sleep disturbances, and gastrointestinal issues. Chronic fatigue is one of the most reported symptoms of long COVID and can severely impact daily functioning and quality of life. This fatigue is not merely tiredness; it is often described as an overwhelming sense of exhaustion that is not relieved by rest. It can result from several factors, including inflammation, immune dysregulation, hormonal imbalances, and disruptions in sleep patterns—all of which may be exacerbated by the effects of the virus on the body. One of the key mechanisms behind long COVID and chronic fatigue is the body's inflammatory response to the virus. COVID-19 can trigger a heightened immune response, leading to chronic inflammation that can persist long after the infection has resolved. This ongoing inflammation can contribute to feelings of fatigue and malaise. Emerging research has highlighted the connection between gut health and overall well-being, including fatigue levels. The gut microbiome plays a crucial role in immune function, inflammation regulation, and nutrient absorption. Disruptions to gut health during COVID-19, such as changes in gut bacteria or gastrointestinal symptoms, can further contribute to fatigue. Nutrition and CFS Although an exact cause can be challenging to uncover, we know that nutrition plays a crucial role in influencing energy levels and overall health in respect to chronic fatigue.. One of the most common nutritional causes of chronic fatigue is the presence of nutrient deficiencies. Essential vitamins and minerals are vital for energy production and overall bodily functions. Vitamin B12 is crucial for red blood cell formation and energy metabolism. A deficiency can lead to anemia, fatigue, and neurological issues. Vegetarians and vegans are particularly at risk due to limited dietary sources. Iron deficiency can result in anemia, leading to reduced oxygen transport in the body and increased fatigue. Individuals with low iron levels may feel weak and lethargic. Low vitamin D levels have been linked to fatigue and mood disorders. This vitamin is essential for immune function and overall health, and deficiencies can occur, especially in individuals with limited sun exposure. Magnesium is a mineral involved in over 300 biochemical reactions in the body, including energy production. Low magnesium levels can lead to fatigue, muscle weakness, and irritability. The quality of the diet significantly impacts energy levels. Diets high in processed foods, refined sugars, and unhealthy fats can lead to energy crashes and increased fatigue. Consuming excessive amounts of sugary foods can lead to rapid spikes in blood sugar followed by crashes, resulting in feelings of fatigue and lethargy. Inadequate calorie intake can deprive the body of the energy it needs to function optimally. Restrictive diets may not provide enough macro and micronutrients, leading to fatigue. Protein is essential for muscle repair and overall health. A diet lacking sufficient protein can lead to weakness and fatigue. Chronic inflammation can drain energy levels and contribute to fatigue. Certain foods can promote inflammation in the body, impacting overall health. Some individuals may experience fatigue due to food sensitivities or allergies. Common culprits include gluten, dairy, and certain additives. Identifying and eliminating trigger foods can lead to improved energy levels. Even dehydration can significantly impact energy levels and lead to fatigue. Water is essential for various bodily functions, including nutrient transport, digestion, and temperature regulation, but aside from water, our bodies need electrolytes which are regulated by the adrenals, these include potassium, sodium, magnesium and calcium. Not drinking enough water or getting sufficient electrolytes in the diet can lead to dehydration, causing fatigue, headaches, and decreased cognitive function. Ensuring adequate hydration throughout the day is vital for maintaining energy levels. Chronic fatigue can be influenced by various nutritional factors, including nutrient deficiencies, poor dietary choices, gut health, inflammation, and hydration. Identifying and addressing these nutritional causes can be an essential step toward improving energy levels and overall well-being. The importance of testing in finding your why…. At Nourishing Insights we offer functional testing to get to the route cause of your symptoms. Complete Blood and Metabolic Panel which can assess metabolic function, kidney function, and liver function, as well as thyroid function. Abnormalities in these areas can lead to fatigue and may indicate underlying health issues. We offer a comprehensive thyroid Function Test, which tests thyroid hormones (TSH, Free T3, Free T4) and thyroid antibodies. We offer nutrient testing which evaluates levels of essential vitamins and minerals in the body, such as B vitamins, vitamin D, iron, magnesium. Identifying deficiencies can guide dietary changes and supplementation.. Hormonal imbalances can significantly impact energy levels. Functional tests such as the DUTCH test can help assess hormone levels and their potential contribution to chronic fatigue. Salivary Adrenal Function Testing can assess cortisol levels throughout the day, helping to identify adrenal fatigue or dysregulation. The gut microbiome plays a critical role in overall health, and imbalances can lead to fatigue. Functional tests can help assess gut health. Comprehensive stool analysis can evaluate gut bacteria, inflammation markers, and digestive function. Identifying dysbiosis, infections, or malabsorption issues can guide treatment strategies to improve gut health and energy levels. We also offer Small Intestinal Bacterial Overgrowth (SIBO) Testing as well as Mycotoxin testing to identify triggers for chronic fatigue. The functional medicine approach involves taking a full medical history to explore all possible risk factors, triggers and drivers as well as utilising detailed functional testing where appropriate to get to root cause. If you would like to organize a free discovery call to talk through your case and ask any questions about how we can work with you to identify your ‘why?’ you can book that here. Neleta Winter Nutritional Therapist
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December 2023
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