Chronic fatigue or feeling tired all the time is a growing but treatable problem affecting thousands of Australians.
What is chronic fatigue?
Imagine waking up every day and facing your daily activities like a challenge you need to meet, but you can’t even get out of bed to start breakfast. Like a toy running low on battery, suffering from chronic fatigue leads to little action in your life.
People who always feel tired are often left behind in primary care, as their condition is hard to diagnose or treat.
However, chronic fatigue is a real and debilitating condition affecting thousands of Australians’ lives. This condition can be successfully treated in many cases, giving patients a whole new perspective on life.
Feeling tired all the time can be the consequence of multiple factors, like poor sleeping habits, malfunction of different systems in the body, hormonal imbalance, alteration of circadian rhythms, and more.
From a clinical perspective, the standard medical approach recognises that there is no diagnostic test, validated biomarker, clear pathophysiology or curative treatment for this condition, commonly known as chronic fatigue.
Feeling tired all the time affects both the body and the mind and is characterised by a prolonged duration of the condition. Studies so far have not identified a single cause behind chronic fatigue, hinting at the likely multi-factorial origin of this disease.
Always Tired – What is driving your chronic fatigue?
Some conditions associated with feeling tired all the time include alterations to the circadian rhythms, sleep alterations, HPA axis malfunction, nutritional deficiencies, and thyroid or mitochondrial malfunctions.
Disruption of circadian rhythms
All the systems within our body follow the rhythms of our internal circadian clock. How does the circadian clock works? It starts with sunlight, the most powerful external stimulus affecting our circadian system. Daylight stimulates melanopsin receptors found in retinal ganglion cells, and these cells transform these stimuli into electrical signals, which in turn stimulate neurons in the suprachiasmatic nuclei (SCN). The electrical signal activates circadian proteins found in the SCN and across all organs through these neurons.
In practice, this means that during the day, when we are awake, our body functions differently than when it is night-time and we are asleep. Some of the functions regulated by circadian rhythms include Sleep/wake cycles, hormonal activity, body temperature rhythm, and eating/digesting. Likewise, several factors can affect our circadian rhythms.
Broadly speaking, disruption to the body’s circadian rhythms can be grouped into short and long-term disruptions, each carrying different effects on health.
Short-term disruptions to our circadian clock can include occasional late-night activities that disrupt your normal sleep, facing occasional stressful situations or taking certain medications. Some symptoms associated with short-term disruption of the circadian clock include:
- extreme daytime sleepiness
- insomnia, tiredness
- decreased alertness, and
- problems with memory or decision-making
Long-term disruptions involve lifestyles that involve, for example, regularly changing between day and night work shifts, working or living in a stressful environment. Long-term circadian alterations can also be due to age, specific genetic signatures, or a chronic or permanent medical condition. In addition to symptoms that also occur with short-term disruption of the circadian clock, people facing long-term alterations to their circadian system can also face more serious conditions, such as cardiovascular disease.
- It has been shown, for example, that there is a three-fold higher incidence of myocardial infarction during the morning compared to late evening hours. Other studies have identified circadian patterns linked to a broad range of cardiovascular events, such as unstable angina and stent thrombosis, stroke, ventricular arrhythmia, and aortic dissection. While the mechanisms involved are not fully understood, research supports the involvement of circadian-regulated proteins and hormones.
- Circadian rhythms have also been linked to the pathogenesis of people in critical conditions. Patients treated in the intensive care unit tend to experience regular sleep disturbances and other factors. Continuous lighting, noise, overnight patient-care interactions, mechanical ventilation, pain, surgery, fatigue, stress, and sedation can potentially disrupt the patient’s normal circadian rhythm.
Some of the most common causes of disruptions to the body’s circadian rhythms involve the following:
- Poor sleeping habits
- Night-time work shifts
- Travelling to a location with a different time zone
- Having a baby
- Certain medications
- Stress
- Certain mental health conditions
- Health problems like brain damage, dementia, head injuries or blindness
- Eating a large meal before bedtime
Sleep Apnoea
This is a condition where a person experiences constant sleep disturbances due to a physiological problem. Each night, a person suffering from sleep apnoea typically follows this cycle:
- The walls of the throat come together during sleep, blocking the airway.
- The person stops breathing briefly, enough for the brain to send a wake-up signal.
- The person awakes briefly, the airway is open again, and the person goes back to sleep almost immediately.
- Then, the process starts again. Each night this process can occur hundreds of times, leading to a highly disrupted sleep.
Some established causes or contributing factors for sleep apnoea include:
- Obesity – this is the most common cause of sleep apnoea.
- Alcohol consumption at night relaxes the throat muscles and hampers the brain’s reaction to poor breathing.
- Certain diseases, such as poor thyroid function.
- Large tonsils, especially in children.
- Certain medications, such as sleeping tablets and sedatives.
- Nasal congestion and obstruction
Sleep apnoea can lead to significant health issues, such as:
- daytime sleepiness, fatigue and tiredness
- poor concentration
- irritability and mood changes
- impotence and reduced sex drive
- need to get up to the toilet frequently at night.
Some common treatments for sleep apnoea include strategies to reduce weight in affected people and reduce alcohol consumption. Other therapeutic approaches include a nasal CPAP, a mouthguard or surgical correction of the upper airway obstruction.
In Australia, about 5% of the population suffers from this condition, with about one in four men suffering from sleep apnoea.
Dysregulation of the HPA Axis
Dysregulation of the HPA Axis – the hypothalamic-pituitary-adrenal (HPA) axis refers to an important interaction that normally occurs in our body, involving the hypothalamus, the pituitary gland and the adrenal glands. The main function of the HPA axis is to regulate our body’s response to stress. See our article on this topic for more information on the HPA axis.
Dysregulation of the HPA axis can have serious consequences on a person’s health, potentially contributing to the development of conditions like to type 2 diabetes, obesity, cardiovascular disease, and an increased chance of developing infections.
Alterations to the HPA axis have the potential to affect every organ and system of the body, including the gut, brain, and thyroid gland. Also, our body’s metabolism, catabolism, and male and female reproductive system can be affected. Some common symptoms associated with HPA axis disruption involve altered production of stress hormones, such as cortisol. Some common symptoms of altered cortisol production include:
- Ovulatory issues
- Infertility
- Gut dysbiosis
- Leaky gut
- Irritable bowel syndrome
- Anxiety
- Depression
- Panic attacks
- Hypervigilance
- High blood sugar
- Insulin resistance
- High blood pressure
- Post-traumatic stress disorder
- Seasonal affective disorder
- Burnout
- Feeling less resilient than normal
- Chronic infections
- Brain fog
Functional medicine and chronic fatigue
A central goal of our modern functional medicine approach is to understand the underlying causes behind your health problems. Our approach merges standard medical treatments with natural treatments, guided by advanced diagnostic testing. Once we have identified the cause of your HPA dysregulation, we can correct the problem.
Nutritional deficiencies are an important factor that can occur due to poor dietary patterns and genetic factors that can affect the body’s normal physiology. Nutritional deficiencies occur due to poor dietary habits that do not include sufficient nutrient-dense foods. Consequently, the body lacks optimal levels of key minerals, vitamins and other micro-nutrients. These micro-nutrients have important roles in our body, such as promoting the optimal production and function of hormones. For example, micro-nutrients, like iron, Vitamin B and iodine, are important for the optional function of hormones. At AUSCFM, we consider your current nutritional status using a comprehensive blood panel test, which allows for the identification of key missing micro-nutrients. However, we consider other factors before we design a new diet for you. For example, our genetic makeup and the environment where we live are important factors to consider when designing a new nutritional pathway for a patient. After understanding a patient’s genetic and environmental background, we can establish the ground rules of which foods are good for the patient.
Conditions affecting the function of the thyroid gland are relatively common in Australia. The most common form of thyroid malfunction is hypothyroidism, which has a prevalence ranging from 0.5% to 5% for overt and subclinical cases, respectively. In contrast, hyperthyroidism has a prevalence of around 0.5%–1.0%.
The most common cause of thyroid dysfunction is autoimmune thyroid disease affects 10%–15% of the population in Australia. The two major autoimmune thyroid diseases are Hashimoto’s disease (which causes hypothyroidism) and Graves disease (which causes hyperthyroidism). Both conditions are characterised by the presence of circulating thyroid-specific auto-reactive antibodies.
Some common symptoms of hypothyroidism include fatigue, weight gain, cold intolerance, arthralgia, constipation, menorrhagia, irregular menstrual cycles, and dry skin and hair.
In contrast, typical symptoms of hyperthyroidism include weight loss, heat intolerance, palpitations, breathlessness, anxiety, diarrhoea, menstrual disturbances, tremor, and proximal muscle weakness.
Chronic fatigue at AUSCFM
At AUSCFM, we follow a modern and evidence-based approach to diagnosing and treating pathologies associated with chronic fatigue. For example, we are on top of current research on hormones’ role in chronic fatigue. We employ leading diagnostic testing technologies to hormonal imbalances, as well as other markers of health. Our DUTCH hormone test, for example, provides a comprehensive assessment of key hormones and metabolites. This test informs clinicians about key physiological aspects of your body, such as cortisol and melatonin function, levels of dehydroepiandrosterone, cortisol metabolites, six organic acids and levels of sex hormones. To learn more about the DUTCH hormone test, see our article.
In addition to the DUTCH test, we perform a full thyroid panel test, which measures levels of free T3 and T4 hormones and reverse T3 and antibodies. Based on the results of these tests, we can identify evidence of hormonal imbalances that may be driving your symptoms. In addition to hormone health, we employ advanced testing that targets six additional gut pathologies. Taken together, the results of these seven tests will give us a comprehensive view of the factors influencing a patient’s health and will help us design personalised treatment strategies.
In parallel, getting an in-depth understanding of your current health and lifestyle, including your diet, can help clinicians identify the root of your problems. Working closely with your practitioner and health coach, you can resolve the underlying cause of hormone imbalance with a personalised plan, including changes to your nutrition, lifestyle, and stress management practices.
If you are experiencing chronic fatigue or other health problems that could be explained by hormonal imbalances, start by registering to
References
- Brainard, J., Gobel, M., Scott, B., Koeppen, M., & Eckle, T. (2015). Health implications of disrupted circadian rhythms and the potential for daylight as therapy. Anesthesiology, 122(5), 1170–1175. Read it!
- Takahashi JS, Hong HK, Ko CH, McDearmon EL. The genetics of mammalian circadian order and disorder: implications for physiology and disease. Nature reviews genetics. 2008 Oct;9(10):764-75. Read it!
- Braunwald, E. (2012). On circadian variation of myocardial reperfusion injury. Circulation Research, 110(1), 6-7. Read it!
- Thyroid disease: challenges in primary care. https://www.nps.org.au/news/thyroid-disease-challenges-in-primary-care