Episode 3: Causes of Fatigue Generally and Chronic Fatigue Specifically

Show notes

Fatigue can be complex and multifaceted, with many possible combinations of contributing factors, and every case is different! In this episode, Anna talks through the framework she uses in clinical practice to narrow down the causes of fatigue for each client. 

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Causes of Fatigue Generally and Chronic Fatigue Specifically

Causes of Fatigue Generally and Chronic Fatigue Specifically

Hello, and welcome back to the chronic fatigue and burnout recovery podcast. I am your host Anna Marsh. And today, we’re going to talk about the causes of fatigue generally and chronic fatigue specifically. 

I wanted to talk about general causes of fatigue because very often, even if someone has a chronic fatigue syndrome diagnosis or has burnout, it’s very common for them to have underlying imbalances, which are general causes of fatigue as well. So, for example, someone with chronic fatigue syndrome or burnout may have nutrient deficiencies, they may have blood sugar imbalances, they may have what I would call oxygenation issues or poor red blood cell health. When we’re working towards helping someone increase their energy and become more well, irrespective of the complexity of their case, we always want to ensure that all areas are covered. 

So these are the areas I will discuss in this podcast today. I will move through them in sequential order, starting from the most basic and obvious and then moving into the most complex. So this podcast is for you. If you have chronic fatigue syndrome or burnout, or you don’t know why you feel so tired, or maybe you’re actually quite a high functioning, but you’re just struggling with a little bit of fatigue, there will be information in this podcast that will be really, really useful to help you get to the bottom of things. 

Then further down the line, there’ll be another episode on testing so that you can begin to explore these things for yourself or know where to begin to explore these things for yourself if you want to dig a little bit deeper. So let’s just go straight in. This is the sequence or the, I guess, the sequence of my thinking when I’m working with a client. 

The very first thing we want to consider when we consider fatigue is the overall energy balance, which is that very simple scientific equation of energy in versus energy out. And essentially, is this person with fatigue? Or are you fatigued, doing too much, and not eating enough calories? 

Very, very typical for women, very typical for busy women, especially, who are just running like a million miles an hour, maybe there are kids, maybe there’s a career, maybe they’re very involved in work, or they have other life pressures, and they’re just not eating enough. There are a lot of demands, whether that is mental demands, physical demands, or emotional demands. All of these things take energy to cope with. And if we’re not eating enough and not resting enough, we’ll feel tired. 

Having previously run a successful weight loss program, sometimes this is something I asked my clients to check, do you feel that you’re eating enough? And we can use something like an app like My Fitness Pal, not forever not to become dependent on external apps. But just to say, let’s just check in and put your food into an app and see how much you’re eating daily. 

Sometimes people just need to eat a little bit more and feel better. So even if someone is really unwell with a diagnosed condition, often the symptoms associated with the condition if there’s nausea or a lot of lack of appetite due to something else going on in the body. People are naturally going to begin to restrict how much they’re eating. And just eating more won’t solve the whole condition. 

But it will help them feel better, it will increase their baseline within the condition. Therefore, even if you’ve been unwell for a while, it’s important to remind yourself about some of the basics because sometimes the basics are so basic that we look past them, and they become our blind spots. So the first thing we want to look at is whether we are eating enough, and knowing how much exactly someone needs to eat depends on their height and weight, muscle mass, and how much they move each day. 

I can’t give you specifics about how much you, as the individual listening to this podcast, should be eating. But I would say kind of on average anything around sort of 1500 to 2000 maybe even 2500 calories for a bigger or more active person is sort of ballpark, but if people are only eating sort of 800 calories consistently, then we really want to be mindful of how that’s contributing to how they’re feeling. So then the next thing we want to look for is blood sugar imbalances. 

Within that kind of energy balance, eating enough food, the quality of that food will also be really important. And I will do a specific episode on blood sugar imbalances where we can dive deeper into all the reasons why someone may have a blood sugar imbalance. But for the essence of this podcast, just to keep things surface level today, we really just want to make sure that the proportions of macronutrients, proteins, fats, and carbohydrates are appropriate for the individual. 

So really, what I see with a lot of clients is, especially if they’re more unwell and therefore less active, carbohydrate tolerance tends to be lower, which means if they’re eating large amounts of carbohydrates, or too many processed carbohydrates, or sometimes not even large amounts of carbohydrates, but just too many carbohydrates for their unique situation at the time, we’re going to start to see maybe highs and lows in blood sugar. And when blood sugar goes too high. This affects energy penetration in the brain. 

Obviously, we need to get energy into the brain. So we can think and operate really well, in terms of focus, concentration, mood, and all those lovely things. The other thing is that if our blood sugar drops too low, we will also feel tired. 

Blood sugar stability is the name of the game. We want to have stable blood sugar throughout the day. And to achieve that, we really want to be able to know what that breakdown of proteins, fats, and carbohydrates that we need in the diet needs to be, and to be eating consistently throughout the day, not too much, not too little. As I said, we can go into this in more detail further down the line in another episode. 

But blood sugar imbalances are also associated with our mitochondria health. Our mitochondria are the little organelles in the cells where we create energy. So if blood sugar is imbalanced, that’s impacting the cellular machinery, which is important for energy production. 

Therefore, we really want to get blood sugar balanced as we work towards more energy and better health. So we’ve got the energy balance dialed in, we’re stabilizing blood sugar throughout the day. What comes next? The next big thing that I start to think of when working with my clients is oxygen delivery. In the presence of oxygen, we make energy in the mitochondria, which means that we need to get oxygen from the air that we breathe into the body via the lungs, the bloodstream, and our cells. 

That is a multi-step production line where multiple things can go wrong that would affect oxygen delivery in the cell and, therefore, the ability to produce energy. So here, the main thing we’re looking at is how we’re breathing. If someone’s mouth breathes, has sleep apnea, or has any breathing issues, then we’re not necessarily going to be getting oxygen into the body.

Once oxygen is in the body, we need to transport it. And the red blood cells are our oxygen transporters. If there are any issues with our red blood cell health, that’s going to affect oxygen delivery. Here we rely on specific nutrients like B12, folate, iron, B6, to make healthy red blood cells. Nutrient deficiencies, which then have a knock-on impact on blood cell health, will impact our energy levels and fatigue. 

This is part of what I would call the low-hanging fruit. These are the things that are really important to test and address. First and foremost, they’re almost like the initial screening that I do with all clients how are your red blood cells? Do you have an oxygenation issue? What do we need to address here?

Because this can be a quick win for people if we have low red blood cell health or poor red blood cell health, and we can just take a few supplements and address that quite quickly and feel a little bit better, then we know that we can that’s done and dusted, and we can move on to other things with more energy to tackle those things. So talking about oxygenation segues kind of nicely into nutrient deficiencies. I’ve already mentioned B12, folate, iron, and B6. 

But there are multiple different nutrient deficiencies that can be associated with fatigue. So for the purposes of today, I’m not going to talk about every single one. But I would like to think about this idea of nutrient deficiencies happening because something has gone wrong in that production line. We’re either not eating adequate amounts of certain nutrients, which can be common in restrictive diets. 

Sometimes people will restrict their diets because they feel unwell when they eat certain foods. If there’s poor digestive health, and the nutrients aren’t necessarily getting digested, and then absorbed and transported appropriately to wherever they need to go in the body, then that’s going to be an issue for the functioning of the body, and the end result is fatigue. So there are many reasons why someone would potentially have nutrient deficiencies. 

We could also have nutrient deficiencies if there’s a high need for specific nutrients, and therefore the body is burning through a lot of that nutrient and using it up, and so we have a high demand for more. For example, iron, which we know is really important for mitochondrial function and energy production, which we know it’s really important for oxygen, oxygenation, and the transport of oxygen around the body can also be used in our antioxidant enzymes, for example, catalase. So we need iron to make catalase. 

But then if we’re, if we have a lot of damage, we have a lot of oxidation in the body, we’re going to need to make lots of catalase, and therefore our demands for iron can be higher. Then obviously, another classic one for iron is women with hormonal imbalances and heavy bleeding. So talking about nutrient deficiencies is also then a nice segue into gut dysfunction. 

There are many reasons why gut dysfunction can cause low energy. One of those reasons is that if the gut is dysfunctional, we can have poor nutrient digestion and absorption. Then we have nutrient deficiencies, which can contribute to fatigue. 

But because the gut is so closely linked with the immune system, infections in the gut or imbalances in the gut, like dysbiosis, and imbalance of the bacteria in the microbiome, can all have an impact on the immune system. This is essentially one of the things that can keep the body in a sense of threat or a sense of danger.

We know that the mitochondria, which are really important for producing energy, are not only energy-producing machinery, they are also defense machinery. The mitochondria are sensing the body and sensing what’s going on. Then make decisions about whether I should make lots of energy because it feels safe and well to do so. 

Or are we under threat? Do we need to maybe shut down energy production or prioritize energy production in the immune system but shut down energy production in the brain and the muscles until this threat has been resolved? So if there are imbalances going on in the gut, or if there’s a gut infection, then that can potentially be a sort of signal to the mitochondria to say, there’s a threat here, we don’t want to prioritize energy production to the brain or to the muscles, we need to prioritize energy production to the immune system. 

If you’ve ever had a cold or flu, which I’m sure that you’ve had what it feels like when energy is prioritized to your immune system, you feel tired, you feel foggy, you maybe have a headache, you feel socially withdrawn, you have flu-like symptoms. So those sickness symptoms that we get when our immune system is active are a consequence of this change in energy distribution, energy prioritize to the immune system, energy prioritize away from the brain and the muscle tissue. So this is just one of the mechanisms by which gut dysfunction can affect our energy. 

There are many others, and in the future, I will do another podcast where I talk about all of these in more detail. But for now, just know if you have any GI symptoms, those symptoms could be a clue that you have imbalances in your gut, and you may want to look at the gut function and how it relates to your fatigue. Here that could be bloating, constipation, diarrhea, acid reflux, or cramping. 

There are lots of different GI experiences people can have. And really, you want to be able to eat your foods, digest your food, no bloating, no smelly gas, or no excessive gas, a little tiny bit is okay, and have regular bowel movements without any issues. And so if that’s not happening, then it could be a sign that you need to look at your gut. 

But sometimes I have clients who say, “Oh, my gut is fine, it works absolutely perfectly.” But they still have gut issues that are manifesting systemically. That means it’s manifesting in challenges with this skin, or maybe they have challenges with their joints, or maybe they have hormonal imbalances. 

Other things are going on outside the gut, but the root cause is gut dysfunction. So I’ve introduced you a little bit as I’ve been talking about gut dysfunction as the cell danger response. So the cell danger response is a universal response to threat. 

It’s really a change that happens in the body when the cells perceive that there’s a danger or threat. So as I’ve already explained, the mitochondria are not only energy-producing machinery, they’re also defense machinery. They’re sensing the body’s environment for infections, toxins, or stress in general, and then making decisions about energy production, should we make more energy, or should we prioritize energy towards the immune system at this time, we’ll shut down energy production altogether. 

The cell danger response is a really helpful model for understanding fatigue. Because once the cell danger response has been activated, a series of biochemical changes happen in the body. These changes can be associated with dysfunction and imbalance, leading to chronic disease and, in this case, chronic fatigue. 

So I won’t talk again in extreme detail about the cell danger response; that’s for another day. But it’s important then to understand that toxins can trigger the cell danger response, infections can trigger the cell danger response, and trauma, micro-traumas, multiple micro-traumas, like chronic stress, can trigger the cell danger response, but so can b traumas, and just general nervous system dysregulation. So these are the other factors that can possibly cause fatigue. 

Usually, when someone has a chronic fatigue condition, and they’re addressing the nutrient deficiencies and balancing their blood sugar, they’re working on oxygenation, and their energy balances well. But they’re still kind of stuck in this very low-energy place. The stuckness is usually a clue that the body is almost stuck in the cell danger response because the body feels like it is still under threat. There is still something that is causing the body to feel threatened, hence the sustained low energy. 

This is where we want to start to dig deeper. This is where I’ll talk a little bit about the root cause. What is keeping the system under threat? And how do we address that? So in some cases, as I’ve mentioned, it could be toxins. If someone has had mold exposure, they have mold spores in their body, and those mold spores are producing mycotoxins, that’s going to be something that keeps the cell under threat. 

But there will probably also be multiple changes in the body’s biochemistry due to the damage created by those toxins. And again, I won’t talk about it in great detail today because I can talk about that in its own episode. But mold is a common cause of chronic fatigue syndrome. 

But there can be other toxins that can also cause fatigue. We live in a toxic world we have multiple toxin exposures every day. Sometimes if we have one big exposure, for example, to mold and more and mold producing mycotoxins. 

It weakens the body system. So the body struggles to cope with other toxins. Then there’s a load that builds up. And I have had a client who had breast implant illness, she had breast implants removed. But then she had multiple toxins in her body, heavy metals, plastics, and mold, because the system was overwhelmed and couldn’t cope with the toxicity. 

In this case, we really want to sort of remove and avoid toxins where possible and support the body to detoxify so that that cell danger response can move through its full cycle, and the body and the cells no longer feel under threat. The next thing would be possibly infections. So we talked about gut infections, which could be parasites and just be a general imbalance of the gut microbiome or no other infections. 

Sometimes people will get a virus, and then they end up with post-viral fatigue, or someone may be infected with Lyme disease and its co-infections. It’s a lot of people who have glandular fever, EBV, mononucleosis, whatever terminology you’d like to use, and then that can be a cause of their ongoing fatigue. So, again, that’s something I can talk about more in another episode. 

But here, I like to think of this analogy of the window pane and the hammer. If the window pane is your body, and the hammer is the virus or the infection, if I throw the hammer at it, it shatters that window. If I go over to the shattered window and the hammer, and I pick up the hammer, and I take it out of the room, I’ve removed the infection, I’ve removed the virus, but there’s all this broken glass that still needs to be cleaned up. That’s usually the approach that we would take is that sometimes what happens is there’s been a big threat, and that big threat has created a lot of damage. 

But even once we remove the threat, the damage itself that was created can also be a perceived threat. So even though the virus is long gone, there’s still much cleanup work. As we clean up those body systems that have become damaged and disrupted from the massive immune response needed to deal with that threat, the body becomes better again. 

That’s essentially the approach I take when working with my clients who’ve had a major infection that’s been a trigger for their chronic fatigue. So the next thing on this list is trauma and nervous system dysregulation. Again, you’ve probably heard me say this so many times today, but I’ll go into this specifically in its own episode. 

This is just a broad overview today. But chronic stress just regulates the nervous system. And we know that nervous system dysregulation keeps the body in a threat state. When the nervous system is stuck in what we would call sympathetic activation, so fight or flight, or even not necessarily stuck in fight or flight. But if there’s too much activation, it goes into a nervous system freeze and gets stuck there. 

That can typically be associated with many symptoms that we see in chronic fatigue and burnout. But also takes a huge amount of energy to maintain a system that is constantly trying to survive. That’s what Steven Porges calls the cost of doing business. 

The cost of keeping the body in this very heightened nervous system state is very draining on the body’s resources, nothing is being prioritized for the general sort of day-to-day housekeeping that we all need for rest, recovery, and repair that keeps the body systems healthy, isn’t happening. And nutrients are getting depleted, and we’re burning through our energy stores. 

There are a lot of changes that happen biochemically in the body to sustain our survival responses. We need tools to help the body get out of that stuck survival response. Especially if someone has had big traumas. 

Or especially if someone has a lot of adverse childhood experiences referred to as ACEs. This can make their body more sensitive. So sometimes, the actual event which triggers the fatigue or the burnout is a small event. 

But it’s actually a big event relative to the body’s ability to tolerate because there has been so much that has happened before, even from childhood, that has worn the system down over time. Then something small needs to happen. That tips the scales over into imbalance. 

These imbalances in the nervous system that are created across a lifetime can make someone’s immune system more susceptible to infections and more susceptible to toxins, and therefore, the immune system is weaker and then eventually loses its ability to cope. So there are just a couple more things that I wanted to touch on here. And the next thing is mitochondrial dysfunction. 

Mitochondrial dysfunction is, as I’ve already explained, your mitochondria are your little energy-producing factories in the cell. And healthier and stronger mitochondria are associated with body resilience and our ability to make energy. What a lot of people might think that you need to do is just give nutrients that support the mitochondria. 

But hopefully, now from listening to all of this, you can maybe understand that the mitochondria function has possibly become dysfunctional because of active cell danger response. So part of restoring mitochondria health is helping the body to feel safe again. Then yes, we want to do other things that support the mitochondria, like give them the nutrients they need, support cell membrane health, and support blood sugar. 

But all of those interventions can sometimes be wasted, or possibly even make someone feel worse if we haven’t dealt with the root cause or that big threat. Then the other thing we want to think about, which I’ve touched on when we talked about toxins is toxic load. When the body is overwhelmed with toxins, we are overwhelming the cells and entering into a cell danger response. 

We want to consider detoxification, supporting the liver and the kidneys, and the drainage pathways like the gut and the skin and our ability to sweat and how we breathe and supporting all of those pathways to reduce the overall toxic load. Then lastly, kind of all the way there on its own is hormones. So hormones can be, to a certain extent, a root cause of fatigue, which might be as if someone has very low levels of certain hormones. 

For example, women entering perimenopause, who have low levels of progesterone, or perhaps athletes who are overtraining, undereating, and may have low levels of estrogen, specifically. So sex hormones can be a fatigue factor. But I find that sex hormone balance is usually a byproduct of everything else going on. 

When the body is in a cell danger response, it’s not really prioritizing reproduction. It’s just not the most important thing at that point in time. So we want to work on the overall health of the body systems, get the cell out of threat support, just general and healthy adrenal functions so that the body is coping with stress day to day, we’re keeping blood sugar balance, the body has all the nutrients that it needs, the gut health is working well. When we do all of those things, sex hormones usually get better. 

So that would usually be my approach: let’s deal with all those foundations first, and then either test sex hormones are circled back in test sex hormones and then decide if we need to intervene. And in some cases, we do, and in some cases, body identical hormone replacement therapy can be really helpful. So that’s what we might consider when we’re looking at sex hormones. 

But I think that there can be an attitude where people say, “Oh, it’s just my hormones.” And they either just want to take hormone replacement therapy, but they’re not addressing all the other things that are going on or do not understand the connection between hormones and everything else going on in the body. Then the last thing would be thyroid hormones. 

Yes, under active thyroid can be a cause of fatigue. So that’s something that I would usually test for do an initial screen, rule it in, rule it out. If we see that underactive thyroid is an issue, we want to consider how we would deal with that. 

Does this person need medication? Do they need to speak to their doctor about that medication? Is it more borderline? Do we want to support the cell danger response again because that can impact thyroid hormone? Do we want to give important nutrients for manufacturing those thyroid hormones? 

Again, considering where the thyroid is in the picture of everything else going on, and if there’s thyroid autoimmunity, like caching motors, we also need to consider how we support the immune system’s tolerance. So you might be wondering, the one thing I probably haven’t mentioned so far is adrenal dysfunction and what is colloquially called adrenal fatigue or tired adrenal glands. I haven’t given too much attention to this because I often don’t find that it’s that relevant in practice. 

I get asked this question very often on social media. Now, what’s the relationship between chronic fatigue, adrenal fatigue, and burnout? I want just to say if I’m clinical practice is I have clients with chronic fatigue, fatigue or burnout with normal adrenal function, high adrenal function, low adrenal function, and have tried to work on adrenal function specifically, and then not really seeing adrenal profiles change. 

Where I’ve kind of arrived personally, in my practice, is, let’s support the whole body and the nervous system. If we do all of those things, and someone feels well, great, and what this looks like in terms of an adrenal profile test is maybe not as important as how they feel. If they feel like they’re making progress and having success and their fatigue recovery, they’re feeling good. 

I will also probably do another episode in the future where we talk about the adrenal glands specifically. So that is everything for today in terms of the causes of fatigue, general and chronic fatigue syndrome specifically, are there other things that could be causing fatigue? Yes, maybe, but these are the major players in the game, what I would call the big rocks. 

This is where you can look as you start exploring what could be at the root of your chronic fatigue or burnout. I’ll see you in the next episode. And once again, if you have enjoyed today and are experiencing value from the information I’m sharing, please leave a five-star review on iTunes. When you leave a review on iTunes, that helps other people who might need or benefit from this information find the information in the first place. 

It would be really much appreciated by me. And of course, if you’ve loved the episode if you know somebody who may benefit from hearing it, share it with them, and share the love. So again, I’ll see you in the next episode and have a wonderful fatigue recovery day.