Fatigue is one of the most common complaints presenting to a primary care physician. Beyond simply not having enough sleep, there are a myriad of causes for this state. The American College of Allergy and Immunology has listed food allergy as a prominent initiator of fatigue. Indeed at Francis Holistic Medical Center, we have also seen many people achieve a major relief from fatigue by ceasing to consume their food allergens as determined by both immediate and delayed hypersensitivity skin testing.
Where improving the diet, avoidance of food allergens, and taking adequate supplements do not bring relief from fatigue, we next consider hormonal problems, primarily from the adrenal glands or from the thyroid gland. The adrenal glands are suspected when the patient has abnormally low blood pressure, hypoglycemia, or a family history of emotional instability in the parents. We frequently use fasting morning blood cortisol measurements, four timed salivary specimens for cortisol, or a 24 hour urinary cortisol measurement. Assessments by conventional physician ns are designed to rule out severe adrenal deficiency but are not sensitive enough to identify borderline conditions which cause people to experience troublesome fatigue but are not extremely severe.
When adrenal hormone investigations do not reveal the cause of fatigue, we next look at the thyroid gland output. Conventional physicians often measure only the blood TSH, which is adequate to identify major cases for thyroid failure. However, as with adrenal hormone assessment, the measurement of a single test (the TSH) is often inadequate to identify borderline states of inadequate thyroid hormone production. Consequently, we measure 9 values (Total T3, Free T3, total T4, free T4, reverse T3, iodine, two thyroid antibodies, as well as TSH) to obtain a more sensitive measure of thyroid insufficiency and pick up the borderline states which can lead to troublesome fatigue.
Physicians specializing in Chronic Fatigue Syndrome have often looked for chronic infections as the cause of the syndrome. This usually has involved chronic viral infections, such as Epstein Barr virus. However, a much overlooked cause of chronic fatigue is persistent parasitic or bacterial infections, e.g., tick-borne diseases, such as Borreliosis (a.k.a. Lyme Disease). If diet, supplements and hormones do not improve energy, then you may be asked to consider sensitive testing for tick-borne diseases. Because testing at conventional laboratories is not sensitive, you may want to pay out-of-pocket for a good test from a company which does not bill your insurance.
Most patients who have done all of the above will find the cause and solution for their lack of energy. If these are not found, one should consider mold toxicity, especially if one knows that they have had mold exposure from water intrusion behind roof ice dams, leaking windows, or flooding basements.
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We provide integrative, functional medicine in Central Massachusetts in the Worcester area. Many of our patients come from Boston and the Metrowest Boston area as well as all areas of Massachusetts and the other New England states.
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