How To Get Rid Of Fatigue And Weakness - 12 Ways
by Dr. Talia Marcheggiani
Dr. Talia Marcheggiani is a naturopathic doctor practicing in Toronto. She has a special focus in mental health and hormones and uses an individualized mind-body approach to uncover and treat the root cause of disease. She is registered with the College of Naturopaths of Ontario and is a member of the Ontario and Canadian Associations of Naturopathic Medicine.
Like many people I see, Sandra was experiencing debilitating fatigue and weakness.
Completing her PhD, she was working all day and collapsing on the couch at 8 pm.
She stopped going out in the evening. She stopped spending time with friends, engaging in activities outside of her studies, exercising, and having sex.
Her motivation and zest for life were at all-time lows.
Her marriage - and her life - were being sidelined in the service of her fatigue.
Her family doctor met her complaints with a defeated shrug. “You’re just getting older,” he offered by way of explanation.
Sandra was 27.
My patient is not alone. At least 20% of patients approach their family doctors complaining of fatigue and weakness.
24% of North American adults report feeling fatigued for more than two weeks, unable to find a cause.
Additionally, one third of adolescents report feeling tired most days.
Surely these teens are not just “getting older”.
Lack of energy is a problem that can arise from any body system. Fatigue can be an early warning sign that something has been thrown off balance.
I frequently see fatigue in patients suffering from hormone imbalances, including suboptimal thyroid function, insulin resistance, and low estrogen, progesterone, or testosterone. But also those suffering from chronic stress, depression, and anxiety.
Fatigue is often connected to mental health conditions, digestive issues, lifestyle imbalances, chronic inflammation, chronic stress, and lack of restful sleep. It’s no wonder, then, that most of the people I work with experience some level of low energy.
Conversely, I see improvement in energy as one of the first signs that someone is moving towards more robust health. Some of the first signs of healing are a clear mind, bright mood, and vibrant, buoyant energy.
So, if you want to know how to get rid of fatigue and weakness, there are a few steps you can take to identify and remove the cause of fatigue while optimizing your health and energy levels.
First, differentiate between sleepiness and fatigue.
It's important to determine if low energy is fatigue or sleepiness.
Sleepiness is characterized by the tendency to fall asleep when engaging in non-stimulating activities like reading, watching TV, sitting in a meeting, commuting, or lying down.
- Is often improved by exercise, at least in the short-term
- Is improved with rest
Fatigue, on the other hand, is characterized by a lack of energy, both physical and mental. Fatigue is often worsened by exertion.
Those who are fatigued:
- Suffer from mental exhaustion
- Experience muscle weakness
- Have poor endurance
- Typically feel worse after physical exercise and take longer to recover
- Don’t feel restored after sleeping or napping
- Might experience ease in initiating activities but progressively experience more weakness as they continue them (e.g.: engaging in social activities, movement, working, etc.)
If Sleepiness Is Your Issue...
1. Assess sleep.
Assessing and optimizing sleep is essential for beginning to treat all low energy and, in particular, sleepiness.
Assessing sleep involves looking at a variety of factors such as:
- Bedtime and waking time
- Sleep onset: how long it takes
- Sleep routine and sleep hygiene habits
- Sleep duration: how many times you wake up, how quickly you can fall back asleep after waking
- Causes of interrupted sleep such as sleep apnea, chronic pain, frequent urination, children/pets/partners, etc.
- Nap frequency and length
- Ability to wake up in the morning
- Perceived sleep quality: do you wake feeling rested?
- The use of sleep aids
- Exercise routines, how close to bedtime you eat or exercise.
And so on.
There are a number of sleep diaries you can use to self-assess your sleep. Perhaps the best is the Consensus Sleep Diary. It was created by bringing together a number of existing diaries from a panel of experts with an objective to "present an expert consensus, standardized, patient-informed sleep diary".
On top of that, using a sleep app like those from Apple or FitBit and undergoing a sleep study are additional tools for assessing the quality and duration of your sleep cycles that may be useful.
2. Address sleep issues.
Whether the cause of fatigue is sleepiness or not, restful sleep is essential to restoring our energy levels. Optimizing sleep is an important foundational treatment for all health conditions.
Restorative sleep regulates hormones and balances the stress response, called the hypothalamic-pituitary-adrenal axis (HPA axis). It improves cell repair, digestion, memory, and detoxification.
Mental and emotional stress, artificial light, blood sugar dysregulation, inflammation, and hormone imbalances can interfere with sleep.
To address issues with sleep, it's important to:
- Maintain a strict sleep schedule. This means keeping bedtime and waking time consistent, even on weekends.
- Practice good sleep hygiene by avoiding electronics at least an hour before bedtime, using blue-light-blocking glasses and/or software (such as f.lux) if necessary, and keeping the bedroom as dark as possible.
- Avoid stimulating activities like exercise in the hours before bed.
- Keep the bedroom cool and dark.
- Reserve the bed and bedroom for sleep and sex only.
- Balance circadian rhythms by exposing your eyes to sunlight immediately upon waking and eating protein in the morning.
In addition to sleep hygiene and balancing circadian rhythms, sleep aids can be helpful. I start my patients with melatonin, a non-addictive antioxidant, to reset the sleep cycle and help with obtaining deeper, more restorative sleep.
It is important to take melatonin in a prolonged-release form a few hours before bedtime and to use it in addition to a dedicated sleep routine.
How To Get Rid Of Fatigue And Weakness...
1. Determine whether the fatigue is secondary to an underlying medical condition.
Secondary fatigue is defined as low energy, lasting from 1 to 6 months, that is caused by an underlying health condition or medication.
With your medical or naturopathic doctor, be sure to rule out any issues with your immune system, kidneys, nervous system, liver, and heart, and to assess the side effects of any medications you’re taking.
Ruling out chronic infections, pregnancy, anemia, and cancer may be necessary, depending on other signs and symptoms that are present, your individual risk factors, and family history.
While the vast majority of fatigue is not caused by a serious health condition, ruling out more serious causes is an essential part of the diagnostic process.
Remember that this is not a job for Dr. Google! Because fatigue is a sign that something in the body is not functioning optimally, it can be implicated in virtually every health condition, alarmingly serious ones, but also more benign conditions as well.
Taking into account your entire health history, risk factors and particular symptoms, as well as assessing blood work is a complex job that a regulated health professional can assist you with.
2. Identify physiologic fatigue, or burnout.
Once sleepiness and any underlying health conditions have been ruled out, your naturopathic doctor may determine whether you have physiologic fatigue.
Physiologic fatigue, also commonly called “burnout” or “adrenal fatigue”, is the result of an imbalance in sleep, exercise, nutrition intake, and rest.
It is by far the most common category of prolonged fatigue that I see in my practice. Two-thirds of those experiencing fatigue for two weeks or longer are experiencing this type of fatigue.
Feeling a lack of motivation, low mood, and increased feelings of boredom and lethargy are characteristics of this kind of fatigue.
Physiologic fatigue can be confused with depression, leading to a diagnosis and subsequent antidepressant prescription, which may fail to uncover and address contributing lifestyle factors.
Fortunately, there are many solutions to improving low energy and mood caused by burnout.
For example, studies show that Cognitive Behavioral Therpay can be more effective than medication for the depression and anxiety related to physiologic fatigue.
3. Rule out food sensitivities.
Research may suggest that fatigue, including CFS, may be caused by food sensitivities.
IBS and food intolerance are also linked to fatigue of various types.
Our gut is the seat of the immune system, sampling foreign substances from the external environment and activating an immune response if it finds any of those substances pose a threat to the health of the body.
If our immune system comes into contact with something doesn’t like, even if that something is a benign food substance, an inflammatory reaction can be triggered. Chronic inflammation can exacerbate fatigue.
You can learn a lot about food sensitivities by doing an elimination diet, where suspicious food is removed from the diet, the gut is healed, and foods are later reintroduced.
Common foods to eliminate are gluten, dairy, sugar, eggs, and soy. Stricter Autoimmune Paleo diets involve the removal of all dairy, eggs, grains, legumes, and nuts.
You can do it on your own, but if you want help with ensuring it's done properly, a naturopathic doctor can help.
They may also order a blood test for you, if they think it's called for and if you're up for it.
4. Rule out Chronic Fatigue Syndrome.
Chronic fatigue syndrome (CFS) is characterized by fatigue that lasts 6 months or longer, is not improved by exercise and rest, is not related to an imbalance in lifestyle, and is not caused by a primary health condition.
Those with CFS often have signs of an activated immune system such as enlarged lymph nodes, a low-grade fever, or a sore, inflamed throat. Sufferers may experience generalized weakness and pain.
CFS can be an extremely debilitating condition that results in a 50% reduction of daily functioning.
The cause of CFS is not known, but the following are all useful treatment strategies.
- Balancing HPA axis function
- Improving nutrient status
- Reducing inflammation
- Healing the gut
- Reducing toxic burden
- Boosting mitochondrial functioning
- Promoting self-care
And again with Cognitive Behaviour Therapy - it can be used to create healthy coping habits for people with chronic fatigue syndrome while balancing sleep and stress.
5. Get blood work done.
Assessing blood work is necessary for ruling out common causes of fatigue.
Blood tests are used to rule out anemia, infections, suboptimal iron, B12, and folate levels, under-functioning thyroid, inflammation, insulin resistance, and hormonal imbalances.
To evaluate the cause of fatigue, your naturopathic doctor will look at:
- A complete blood count (CBC) that looks at your red and white blood cells.
inflammatory markers like ESR and hs-CRP
- TSH, to assess thyroid function, and occasionally free thyroid hormones and thyroid antibodies, if further investigation is indicated
- B12, iron, and folate
- Other tests such as fasting insulin, fasting blood glucose, liver enzymes, and hormones like estradiol, testosterone, estrone, LH, FSH, and progesterone, depending on the health history and the constellation of symptoms.
Your doctor may take further measures to assess your heart and lungs or to rule out chronic infections.
6. Balance the HPA Axis
Balancing the stress response, otherwise known as the Hypothalamus-Pituitary-Adrenal (or HPA) axis, is an important component of treating physiologic fatigue.
Our HPA axis becomes activated in the morning when the hormone cortisol is released from the adrenal glands. Cortisol suppresses inflammation and gives us the motivated, focused energy to go about our day.
Towards the end of the day, cortisol levels naturally fall. In the evening, cortisol is at its lowest, and melatonin, our sleep hormone, rises.
Those with HPA dysfunction have an imbalance in this healthy cortisol curve.
They commonly experience sluggishness in the mornings, a crash in the afternoon (around 2 to 4 pm), and restless sleep, often waking up at 2 to 4 am as a result of nighttime cortisol spikes and an impairment in melatonin release.
These individuals often experience cravings for salt and sugar. They may have low blood pressure and feelings of weakness.
It is common for those experiencing burnout to get sick when they finally take a break or experience prolonged healing time from common infections likes colds and flu.
They may suffer from inflammatory conditions like chronic migraines, muscular tension, and report feeling depressed or anxious.
But HPA dysfunction is not something you can diagnose on your own - a naturopathic doctor might do a salivary cortisol test or DUTCH to help figure it out.
When a dysfunction is discovered, balancing the HPA axis is a treatment priority.
- HPA axis balancing through adaptogenic herbs
- Optimizing adrenal nutrient levels
- Regulating blood sugar
- Improving circadian rhythms
- Reducing workload and perceived stress through addressing perfectionism, practicing setting boundaries, and developing mindfulness, among other skills.
- Improving sleep
- Engaging in regular, scheduled exercise
- Reducing inflammation, improving digestion, or regulating hormones
- Being proactive about mental health and emotional wellness
- Improving self-care and stress resilience
Of course, from a holistic perspective, the above strategies are the foundations for improving general health and wellness for all fatigue-related conditions, regardless of whether the fatigue is due to sleepiness, secondary fatigue, physiologic fatigue, or chronic fatigue syndrome.
7. Consider adaptogenic herbs.
Adaptogenic herbs are an important natural tool for improving mood and energy.
Adaptogens help the body “adapt” to stress. They up-regulate genes involved in boosting the body’s natural stress resilience.
They also balance the cortisol curve and protect the brain from the effects of stress.
Because of this, adaptogens not only improve energy and mental and physical endurance, they also improve attention and concentration, immune system function, and mental work capacity.
They can treat depression and anxiety, and regulate circadian rhythms.
Common adaptogens are withania (or ashwagandha), rhodiola, holy basil, the ginsengs, like Siberian ginseng (or eleuthrococcus), schizandra, licorice, and maca, among others.
My two favorite adaptogens are ashwagandha and rhodiola, but it's better to talk to a naturopathic doctor to help you pick the best herbal combination for your individualized needs, as my experience has been that the vast majority of people who choose for themselves end up choosing the wrong herbs for their body.
8. Mind your mitochondria.
Our mitochondria are the “powerhouses” of the cell, responsible for making ATP, our body’s energy currency, out of the carbs, protein, and fats from our food.
Research has shown a link between mitochondrial dysfunction and chronic fatigue.
The mitochondria need a variety of different nutrients to function optimally. These nutrients include B vitamins, magnesium, Coenzyme Q10, and certain amino acids.
When the mitochondria are unable to produce sufficient ATP, fatigue may result.
Similarly, a problem with antioxidant production can result in the buildup of reactive oxygen and nitrogen species, otherwise termed “free radicals”, in the mitochondria.
Free radicals can trigger inflammation and immune system activation in the entire body, causing us to feel ill and fatigued.
B vitamins are also important for a process called “methylation” which is essential for energy and hormone production, immune function, detoxification, mitochondrial function, and DNA repair.
9. Balance your blood sugar.
Insulin resistance, hypoglycemia, type II diabetes, and metabolic syndrome are all common conditions that reflect the body’s inability to regulate blood sugar.
All of these conditions can cause frequent energy crashes, fatigue after eating, brain fog, and lethargy.
Even those free of the above conditions may still struggle with blood sugar imbalances.
Signs of blood sugar dysregulation are craving sweets, feeling hungry less than 3 hours after a meal, getting “hangry”, feeling weak and dizzy if missing meals, waking at night, and snacking at night.
Balancing blood sugar by eating enough fiber, fat and protein at every meal is essential to maintaining the endurance to get through the day.
A naturopathic doctor can help you come up with a diet plan that keeps your blood sugar balanced and your energy levels stable throughout the day.
10. Support your immune function and eradicate chronic infections.
Chronic infections can result in prolonged activation of the immune system, resulting in chronic fatigue.
Viral infections, like mononucleosis and Epstein Barr, and gut bacteria imbalances, such as SIBO, C. Difficile, and candida overgrowth can be implicated in chronic fatigue.
Supporting the immune system with herbs, balancing the HPA axis, and using natural remedies to eradicate the infection are all courses of action you may take with your naturopathic doctor to eradicate infectious causes of fatigue.
11. Uncover and treat hormone imbalances.
Our hormones, the messengers of the body, regulate how our cells talk to each other.
Hormones are responsible for blood sugar control, the stress response, ovulation and fertility, sex drive, metabolism, and, of course, energy production and utilization.
It is possible that those who suffer from low energy have an imbalance in the hormones cortisol, insulin, estrogen, progesterone, DHEA, testosterone, or thyroid hormones.
Directly addressing hormones is then the main treatment goal for improving energy.
Uncovering other signs of hormonal imbalance, such as the presence of PCOS, endometriosis, or symptoms of hypothyroidism, as well as ordering blood tests, can help reveal if an imbalance in hormones is the main cause of your fatigue.
12. Encourage detoxification.
Our body has the powerful ability to process and eliminate the 500 chemicals and toxic substances we come into contact with daily, as well as the hormone metabolites and immune complexes produced as a result of normal metabolic functioning.
Our livers, kidneys, colon, and skin regularly filter hundreds of harmful substances from our bodies. This process happens naturally without the aid of outside support.
However, it is possible that an increased toxic burden on the body paired with a sluggish liver and digestive system can increase the body’s overall toxic load.
Toxic overload can contribute to fatigue by increasing inflammation and immune system activation, as well as impairing energy production pathways and disrupting hormonal function.
Reducing contact with harmful toxins, while supporting kidney, liver and colon function can help restore optimal energy and health.
Treating fatigue first involves developing a relationship with your healthcare provider: finding someone who takes your concerns seriously.
Conducting a thorough assessment of blood, lifestyle factors, sleep, hormones, digestion, and as many other factors as possible is essential to uncovering the cause of fatigue.
Treatment involves removing obstacles to healing, supporting energy production, balancing lifestyle, and using herbs to boost energy and stress resilience.
When we consider fatigue as an important sign that something in our body is functioning suboptimally, we can use our energy levels are important indicators of health.
It IS possible to fight fatigue and beat fatigue if you follow the steps above.
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