Your Roadmap to Boundless Energy- Pt 1
…Get to the Root Cause of Your Fatigue
*Feel free to skip to the summary at the bottom if short on time!*
If you are tired more often than not, and it’s affecting your life, you’re not alone! A 2015 poll found that 38% of Americans are tired at least 4 days a week, and the CDC found that 15% were exhausted most days (1). 1-2 million Americans suffer from the worst form, chronic fatigue syndrome, according to the Institute of Medicine.
Why are we struggling? In July 2017, the National Safety Council found that a staggering 97% of Americans have at least one risk factor, such as working too much or not sleeping enough. But in addition to our lifestyle, there can be other not so obvious factors. First I’ll discuss what factors a thorough, conventional doctor should be looking at. If you rule those out and you’re still tired, then I’ll show you how a deep-dive with a functional medicine approach can help you put your slippers and Netflix aside and go out there to seize the day- Carpe diem!
The Conventional Approach
A 2012 study in family medicine found that of patients complaining of fatigue, only 78% of them were referred for blood work, and of those, only 5% had abnormal markers return (2). 1 out of 4 patients was given a diagnosis, mostly anemia or infection. Their overall conclusion?
It seems likely that the most efficient strategy would be watchful follow-up with a minimum of testing.
Why such a uncaring response? Look at how the strategy is defined: as efficient, not as helpful. Another explanation comes from a study showing that while 61% of patients with fatigue felt the main problem was physical, 57% of their doctors thought it was all psychological (3). The study concludes:
Having established that there is no physical problem, doctors may need to focus more on sharing ideas and explanations when patients complain of being “tired all the time”.
And how did they establish no physical problems? By either doing a physical exam or running basic blood-work on immune and organ function. You do not have to be in an end-stage disease (which is what those labs detect) to be having physical problems! And you can’t see poor digestion or a low-grade viral infection by looking at someone. The point is, the patient is coming in saying something is wrong, and the conventional doctor too often responds by saying if you’re not at risk of dying then things are ok, carry on.
And then there is the problem we have where large nationwide and global companies are making the decisions for how doctor-patient interactions should go. This is one of the reasons why so many good doctors no longer accept insurance. Unfortunately at the moment, our medical system is designed using a short-term cost-analysis model. Doctors must fit in as many patients as they can because they are reimbursed per patient. Insurance doesn’t want to pay for a test unless it’s very likely to come back positive, and there’s a treatment for it that utilizes pharmaceutical companies. So you go to the doctor with a complex complaint like fatigue, and the doctor can’t really help because they don’t have time, can’t run the labs, and don’t have a drug to fix it!
However, there are great conventional doctors whose passion for their career fuels them to push past “best practices”. If you are able to consult with a doctor willing to engage, deficiencies and diseases should be ruled out. The typical medical causes for fatigue are anemia (iron, B12, or folate), hypothyroidism, low Vitamin D, sleep apnea, diabetes, or cardiovascular disease. Based on your symptoms and presentation, you should run comprehensive panels for these to rule them out.
Whether blood work shows a problem or not though, there’s a lot we can be doing with lifestyle to give us the energy we desire.
The Functional Medicine Approach
In functional medicine, we look at how everything in the body is working (or not working) together. We look at which systems and pathways are off, what to remove for the body to stop getting damaged, and what to add for it to start healing. Rather than focusing on disease, we focus on the patient and how we can bring their body back into balance.
Specifically, my programs all start with the 4 Foundations of Wellness: sleep, stress/emotional health, nutrition, and movement. I’ll break each one down in their relation to us feeling fatigued.
There are 3 important aspects to consider with sleep, without which we will feel tired.
- Quantity- we need 8 hours people! Research shows that you have fooled yourself and stopped listening to your body if you think you do well with 6. In order to ensure we get the bare minimum of 7 hours of good sleep, we need to be in bed for 8 hours. For those with a lot of inflammation, add an hour, and for those with infections, add two!
- Quality- we want to be going through the appropriate stages of deep and REM during those 8 hours. Whatever keeps you sleeping light, you have to find a way to overcome it, whether it be a pet, sore shoulder, or trouble getting enough air. If you snore, pursue things like nose and mouth tape or getting evaluated for apnea. Also, if you drink alcohol within a couple hours of going to sleep, it will prevent you from getting as much deep as you need.
- Timing- our whole body runs on a circadian rhythm all day long, not just melatonin at night. Our digestion, hormones, brain, immune system, and blood sugar all have a rhythm that is determined by the sun. Therefore, a good night’s sleep starts with a good day: getting sunlight in the morning, eating dinner several hours before bed, avoiding bright lights and stressful activities in the evening. Also, we need to go to sleep around 10pm. This allows us to take advantage of the cascade of hormones being made that help us recover and feel energized the next day. Going to bed late is stressful to your body, and you’ll be more tired the next day for it.
Have you ever been super tired, and then someone you love calls or comes over, and all of a sudden you’re excited and energized? That’s because our emotional state greatly influences our energy levels. Stress, of course, depletes us by keeping us in stages of adrenaline rush and then crash. If we stay in the stress too long, we get used to living in a crash state so long as there’s no emergency.
In addition, suppressing emotions from a lifetime of hurts takes A LOT of energy. This can leave us with little to spend on the here and now. If you’re someone who avoids conflict, doesn’t speak their mind, or doesn’t regularly confide in loved ones about your hurts and struggles, you’re storing your emotions in your body rather than processing them out. It’ll then take immense energy to keep the lid on so that the emotions don’t come bubbling out.
A third way our emotions can drain us is if we don’t have a purpose. Women who have stayed at home to raise kids experience this when they become empty nesters, or when people retire. Without purpose, we lack energy and motivation. The Blue Zones Project studied the healthiest populations around the world, and found one of the strongest common denominators was a clear sense of purpose and contribution to the world.
Finally, one of the most common reasons for fatigue is over-extending ourselves. There should be balance between human doing and human being. There has to be time in most of our days for stillness, reflection, re-charging, play, laughter, love, etc. Time for things that we can’t schedule and plan. Time for being present in the moment, and soaking up the awe and wonder of this life. These moments are nourishing to your brain and nervous system, filling your bucket back up so you can keep on giving.
I intentionally put this third because I believe the points above are primary, and nutrition and movement are secondary, to having energy. Sound like blasphemy coming from a nutritionist? Years of clinical experience have taught me that the intangibles have the greatest effect, as much as my data-driven brain hates to admit it.
I’ve seen many more people maintain good health with less than stellar diet and exercise because they sleep well and do not stress. But I haven’t seen too many people be in great health who eat well and exercise but don’t sleep and are super stressed. The former have natural energy but come to see me because of their labs or weight. The latter have energy based on willpower and determination, and come to see me because they’re trying hard and not feeling much better. How many of us feel more energy when on vacation? We’re usually not eating well or exercising, but we’re sleeping in and not stressing.
That being said, the goal is boundless energy, so we want to optimize all aspects of health. From a nutritional perspective, the most important points to consider for increased energy are:
- Blood sugar- when you eat carbs that get absorbed too quickly, insulin is pushed out too fast, and overcompensates. The result is a big drop in blood sugar an hour or two later, making you feel tired. Therefore, eating slow-digesting carbs such as from berries, vegetables, beans, and roots will make your energy more stable. Eating them with healthy fats and protein will help further. Another good way to set the tone of your blood sugar for the day is to get 20-25g of protein at breakfast.
- Food intolerances- when we consume something we’re allergic or sensitive to, or intolerant of, we create an inflammatory reaction in the body. To preserve you while it’s fighting something, the body slows down metabolism and diverts resources to the immune system. Therefore, you’ll feel tired and have less stamina.
- Quality- if there are ingredients in a food that are not nourishing you, then they’re taking energy from you to detoxify and eliminate. Do your best to avoid things like artificial colors and sweeteners, preservatives, pesticides, GMOs, and any other ingredients you wouldn’t have in your kitchen at home. Focus on whole foods rather than packaged or processed foods, and cook at home as often as you can.
This one is last because, hey, if you’re already super tired, telling you to exert energy is not what you want to hear! We know that being sedentary is extremely inflammatory to the body, and remember, inflammation makes you feel drained. So when incorporating movement, you just have to match it with your current state of health. For those with severe fatigue, this can look like 5 minute walks and sitting in a chair doing stretches or yoga poses. Eventually the goal is 5 days per week for at least 30 minutes.
Most people will notice they have more energy- mental, physical, and emotional- once they are in a routine with exercise. Just note, if you are more tired an hour after your workout than you were before, it was probably too intense for you. Just like eating should give us energy (not make us want to take a nap), exercising the right way for our bodies should feel a bit exhilarating, not exhausting.
Having a balanced, healthy lifestyle will go a long way in preventing fatigue. In addition to making sure there’s nothing off biochemically with your body, focus on the 4 Foundations of Wellness. Your checklist:
- Sleep: 8 hours, asleep around 10pm, sun in the morning, and no light, stress, or food 2 hours before bed
- Emotional: reduce stressors, be vulnerable and process out emotions, know your purpose, balance your schedule
- Nutrition: balance slow-carbs with fats & protein, minimize food triggers, eat whole and clean
- Movement: gently work your way up to 5x/wk for 30min, do what feels good
I always spend the first couple visits working on this checklist with my patients. I give them handouts, a meal plan, homework for emotional health, and help them troubleshoot as they try to implement the program. I’d say for 2/3 of my patients, this is enough to give them all the energy they desire. But for the other 1/3, we do some functional testing and advanced protocols. This might take 6-12 months of clearing out whatever is dragging their bodies down and then restoring normal function. The good news is that even the most fatigued, unwell patients can get enough energy back to go on living the life they desire.
Next Post- Part 2
Part 2 of this post will focus on the more advanced strategies. If you’ve optimized your lifestyle as much as possible but your symptoms are holding you back from gaining any more ground, we’ll talk about underlying root causes such as the gut, toxins, mold, and infections. These advanced strategies help those with more severe levels of fatigue, such as those with chronic fatigue syndrome, fibromyalgia, depression, and autoimmunity.
I’m curious- what has made the biggest difference for you in overcoming fatigue? What makes you feel the most energized? Comment below!
- National Public Radio, Apr 24, 2017. https://www.npr.org/sections/health-shots/2017/04/24/525385610/we-re-all-tired-but-when-could-fatigue-mean-a-medical-problem
- Fatigue as a First-Time Presenting Symptom: Management by Family Doctors and One Year Follow-Up. https://pdfs.semanticscholar.org/7173/ced0ddec96724025219f3e86061a69b250d2.pdf
- Patients who consult with tiredness. https://www.ncbi.nlm.nih.gov/pubmed/8790655