Getting to the cause of chronic fatigue

by Dr. Joseph Debé

Many people ask me, "What can I take for more energy?" Unfortunately, there is no simple answer to this question. For one individual, vitamin B12 supplementation may reduce fatigue. In another person, increasing dietary protein may improve energy levels. For others, NADH may be very important. In most cases, the achievement of marked improvement in energy levels requires more than simply taking a "magic bullet." Randomly trying different supplements that are purported to be "for energy" is unlikely to make much of a difference. What is necessary to predictably boost energy levels is, first of all, a respect for the complexity of the human body and an appreciation of the multitude of possible causes of fatigue. Thorough medical history, physical examination and routine blood work sometimes uncover causes of chronic fatigue such as anemia, infection, or hypothyroidism. What's more, a holistic doctor, utilizing a nutritionally oriented interpretation, can glean additional information from these standard procedures, thus increasing the likelihood of getting to the cause of fatigue. 

However, in most cases, routine testing fails to shed any light on the origins of chronic fatigue. Routine evaluation simply is not sensitive enough, and does not measure many of the potentially causative factors. Although each individual should have a unique work-up based on their routine evaluation, the following are the laboratory tests most likely to identify the causes of chronic fatigue: 


Nutritional minerals and toxic elements retained by the body are deposited in the hair. A sample of hair, analyzed by a good laboratory, gives an accurate picture of the quantities of different elements the body has been exposed to in the past two months. This is often a wealth of information. Mineral deficiencies and elevations of toxic elements both can impair metabolism and result in fatigue. What's more, different patterns of mineral deficiency and excess indicate malfunction of various bodily processes that can produce fatigue. Allergies, select vitamin deficiencies, weakened detoxification and antioxidant defense systems, hypothyroidism, maldigestion and malabsorption, disorders of carbohydrate metabolism, and stress are a few of the causes of fatigue that are alluded to by various results of hair analysis. Reduction in toxin exposure and use of specific natural supplements are indicated for correcting abnormalities found on hair analysis. 


The Adrenal Stress Index is a test that shows how the body's stress response system is functioning. The adrenal glands produce the body's two long-acting stress hormones, cortisol and DHEA. When these hormones become imbalanced by prolonged stress, fatigue, even exhaustion, results. It's important to realize that stress includes not only mental-emotional strain, but also excessive levels of sound, light, certain chemicals, fatigue, starvation, acute illness, pain, tissue injury, trauma, surgery, long airplane flights, heat, cold, and swings in blood sugar levels. The Adrenal Stress Index involves laboratory testing of saliva samples for levels of cortisol and DHEA. The precise nature of the results leads to various natural strategies to restore the body's stress response system to normal and improve energy levels. 


One of the most common types of stress is rapid swings in blood sugar concentrations. This is often the cause of the type of fatigue that comes and goes, especially in relation to eating. The Carbohydrate Challenge Test is performed in the following way: A high carbohydrate meal, consisting of white bread, a banana, and orange juice, is eaten in the morning, after taking a blood and saliva sample. Over the next three hours, additional blood and saliva samples are taken. Glucose, insulin and cortisol are measured from these samples. Heart rate is monitored during the test, as well. Abnormalities in any of these parameters, especially when accompanied by fatigue at the same time during the test, points to the underlying cause of the dysfunction in carbohydrate metabolism. Because the test uses whole food, it can point to delayed emptying of food from the stomach, impaired carbohydrate digestion, and malabsorption as root causes of low blood sugar levels that result in fatigue. Natural treatments are customized, based on the exact nature of the results. 


The gastrointestinal tract is the source of many health problems, including fatigue. It may come as a surprise to learn that the gastrointestinal tract is the site of greatest interaction between the individual and the environment. This is because with all the folds upon folds within the intestinal tract, the actual surface area is equivalent to the size of a tennis court! What's more, the intestines and colon are home to hundreds of trillions of tiny bacteria and yeast. Although they only amount to three or four pounds of weight, their numbers are greater than the number of cells comprising the human body, or the number of stars in the universe! This being the case, it makes sense that more than half of the body's immune system is clustered around the gastrointestinal tract. Poor digestion, malabsorption, food decay, weakened immunity, inflammation, blood loss, as well as overgrowth of yeasts, toxic bacteria, and parasites, are all possible causes of fatigue that can be identified by analysis of a stool specimen. 


Toxicity is a common source of fatigue. Toxins include not only chemical exposure from air, food, and water, but also metabolic waste products of organisms within the gastrointestinal tract or other tissues. Chemical compounds naturally produced by the body as part of metabolism can also become toxic when they accumulate beyond a certain concentration. The Comprehensive Liver Detoxification Profile gives detailed information about the body's ability to process toxins, its current load of toxins and free radicals, and the status of its antioxidant defense system. This test involves analysis of saliva, urine, and blood specimens after "challenging" the body to detoxify caffeine, Tylenol, and aspirin. The body's detoxification of these compounds is representative of the most important detoxification pathways. Results from this test allow for recommendation of specific nutrients and foods to improve detoxification. Fatigue often quickly disappears upon enhanced detoxication and reduced oxidative (free radical) stress. 


This test, like hair mineral analysis, is a good screening tool for chronic fatigue because of the diversity of the information it gives. From a urine sample, the laboratory measures several dozen different biochemicals which, when present at abnormal levels, are associated with various causes of fatigue. These causes include: disturbance of acid-base balance, suboptimal carbohydrate metabolism, toxin exposure, imbalances of neurotransmitters, and deficiencies of B vitamins, minerals, lipoic acid, carnitine, amino acids, glutathione, and coenzyme Q10. Most of the organic acids are compounds produced from normal metabolism. However, some are produced by bacteria, yeast, and parasites residing in the small intestine. Stool analysis is good for picking up toxic organisms in the colon, but usually does not give much information about the inhabitants of the small intestine. Several chemicals produced by toxic bacteria, yeast, and parasites are measured with the Urine Organic Acid Analysis. When these chemicals are found in high concentration in the urine, it means that there is an overgrowth of these organisms in the intestines, their metabolic waste products are being absorbed into the bloodstream, stressing the liver, activating the immune system, circulating throughout the body, poisoning it, and then being eliminated in the urine. Some of these microbial organic acids are structurally similar to the organic acids used by the body in cellular energy production. It is theorized that the close resemblance of these microbial compounds results in a "jamming" of the body's cellular energy machinery, resulting in fatigue. In fact, patients with Chronic Fatigue Syndrome have a unique organic acid elevation in their urine. This organic acid has been found to be of bacterial origin.