By DR. VICTOR S. SIERPINA
Remember our case from last week of the lady who came in one late Friday afternoon with a chief complaint of 10 years of fatigue? After extensive normal workups, such patients often feel frustrated, mislabeled as psychiatric cases and suspicious of the medical care system.
Over the years, integrative healers have found that chronic fatigue comes in many varieties, as different as people’s genomic and immune profiles. Consider the following options:
1. Sleep: As simple as it sounds, assessing quality of sleep in the chronically fatigued person is step one, though often overlooked. Many things can affect the quality of sleep and result in persistent daytime fatigue. Among these are insomnia, anxiety about insomnia, poor sleep hygiene such as bright lights and screen time at night, substances like caffeine and alcohol, chronic pain, especially musculoskeletal pain, sleep apnea and other medical conditions. Addressing these is critical to helping the sufferer return to a normal sleep life. Sleep medications may not really help as they largely prevent development of slow brain wave sleep that brings deep rest. Melatonin, 5-HTP or valerian may be useful.
2. Exercise: It may seem paradoxical, but exercise and movement is often critical to treating fatigue. Deconditioning, poor circulation, lack of enthusiasm for life and a couch-potato lifestyle all are perpetuated by fatigue. Getting up to move, doing almost any kind of exercise on a regular basis breaks this vicious cycle. Additionally, body work can help remove physical and energetic problems that have caused or developed because of chronic fatigue. Among these are acupuncture, massage, chiropractic, Rolfing, Feldenkrais, osteopathic manipulation and other types of energy work.
3. Emotions: Many people with chronic fatigue are often stressed, depressed or have just given up on life. Treating these emotional states can be a complex mix of medication, meditation, psychotherapy and spiritual support. One approach is simply to help people remember what is most important in their lives, what brings them joy, fulfillment or what their real goals are. Sometimes, it is as simple as getting them to volunteer to help others. By changing their focus to others, a new perspective is possible. For those who are fatigued from being caretakers constantly, providing encouragement and opportunities for some time alone, some personal space, relaxation and maybe a vacation can be a life changer.
4. Chemistry: Hormones are often blamed for chronic fatigue. Low T is a big one just now that is highly promoted, though many men with borderline or low T fail to improve fatigue after replacement. Thyroid replacement is likewise helpful in some cases but not all. A good B complex multivitamin, su CoEnzyme Q 10, acetyl-L carnitine, ashwaganda, ginseng, magnesium, probiotics, DHEA and others may be helpful and should be guided by a healthcare practitioner skilled in their use.
5. Diet: An anti-inflammatory diet with increased fruits, vegetables and less fried, fatty foods can help one’s digestion, elimination, attitude and circulation while providing a foundation for healthy mind, body and spirit.
So if you are chronically tired, don’t give up. Try a new approach.
Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.