After medication, what steps should you take to reclaim your energy for good?
Note: this is the second article in a series. If you haven’t already, please read the first article – The best ways to treat chronic fatigue through a conventional medical framework.
After reading the first article of this series, you know how to best manage your fatigue symptoms. Even though I write from a holistic or natural point of view, I am by no means opposed to medication. And in the context of chronic fatigue syndrome, I think medication can be an incredibly helpful adjunct treatment. But let me be very clear – the conventional treatment of chronic fatigue syndrome does not address the underlying or root cause.
If you want to overcome your fatigue for good, you need to identify and treat the root of the problem. I believe functional medicine is ideally positioned to uncover the cause of your fatigue. Below, I’ll show you how we use functional medicine to treat chronic fatigue syndrome from the roots up!
The ideal treatment plan for chronic fatigue syndrome
If you’re like many of my patients, the way conventional medicine has treated your fatigue doesn’t inspire confidence. At best, it’s a cluster of trial-and-error therapies that never end up working synergistically. The conventional medical treatment of CFS puts your symptoms first. If your symptoms improve, treatment is thought to be successful. There’s no thought put into identifying why you’re fatigued in the first place!
Following this model will not bring about a resolution to your fatigue. It may make your symptoms more manageable (which is still important!). But it will not solve the underlying problem. In this post, I describe the treatment plan for chronic fatigue syndrome we use here at Flourish Clinic.
If a treatment plan is going to bring about complete improvement in your energy levels, it needs to address the root cause of your fatigue. And let me be absolutely clear that pinpointing the root cause is no easy task. Chronic fatigue is a complicated illness. Often, there are many roots occurring simultaneously. From hormone imbalances to childhood trauma, to protein and even carbohydrate intake.
In this post, I’m going to walk you through the treatment hierarchy we use at the clinic. I’d encourage you to approach healing your fatigue in a similar fashion. I’ve developed this step-by-step program after years of struggling to help CFS patients. This protocol has been used to successfully improve fatigue levels in hundreds of our patients here at Flourish Clinic. Suffice it to say, it works. And while I am certainly biased, I know no other strategy out there that is as thorough in uncovering all the root causes of chronic fatigue syndrome. I call it the foundation to flourish.
Step 1: putting a number on fatigue
One of – if not the – greatest challenges in treating chronic fatigue syndrome is gauging progress. The human brain is a fickle thing. Your brain preferentially remembers the peak or the end of an experience. This is why so many people think they’re having a relapse of fatigue. When really it’s just their brain playing tricks on them.
In the context of fatigue, the peak is the time you felt so tired you couldn’t move – it’s when you felt your worst. The end would be how you’re feeling right now. If I asked you how fatigued you are (0-10), your brain would either remember how you felt when at your worst (peak) or how fatigued you’re feeling right now (end).
If I ask you your fatigue levels at your most energized time of day, you’ll rate them lower than if I asked you just before bed when you’re exhausted. This inherent bias leads you to consistently misrepresent your fatigue. It also blocks you from seeing improvement.
To combat this, you need to perform a variety of fatigue scales at the same time and day of each month or on a weekly/bi-weekly basis. This will be your best weapon against your brain. By regularly tracking your energy, you can begin to spot patterns. As you implement a change in your diet or a change in your supplements, you’ll be able to compare your fatigue levels to where they were prior.
Conventional medicine views chronic fatigue syndrome in terms of complete resolution – either you’re fatigued or you’re not. Obviously, you don’t go from fatigued to energized overnight. Instead, recovering from chronic fatigue is a slow journey from zero energy to low energy to modest energy and so on.
Recovering from CFS happens gradually. If you’re not consistently tracking your fatigue levels, you’ll miss seeing and appreciating your progress. Without tracking, you’ll get discouraged because you’re not yet full of vibrant energy. You’ll never see nor celebrate the 10% improvement your diet change made. Which will lead you to abandon the diet saying that it didn’t do anything.
I tell all my patients that tracking their fatigue levels is likely the most important step in their treatment. This is the only way you’ll notice progress. And progress breeds positive mental states. And positive mental states keep you engaged and motivated to overcome your fatigue.
Step 2: nutrition change
Next to tracking your fatigue levels, nutrition change is the most important step in overcoming chronic fatigue syndrome. If you don’t change the food you eat, you’re not going to get better. It’s as simple as that.
Nutrition change is the foundation that every other step in treatment rests upon. Notice how I said nutrition change and not a diet. A diet implies something you do for a period of time before reverting back to your previous ways of eating.
Diets don’t solve fatigue. Nutrition change solves fatigue. Nutrition change implies forming new habits behind what and how you eat. Nutrition change is a lifestyle change. Diets take willpower; and lots of it. Nutrition change is about creating habits that leave you no choice but to eat clean. No willpower involved here.
Your nutrition has to empower your mitochondria. Remember, happy and healthy mitochondria are absolutely essential in overcoming chronic fatigue. And the first step to power-up your mitochondria has to be nutrition change.
Don’t worry if your energy hasn’t improved after changing your nutrition. That’s entirely normal. Remember, there are many root causes of chronic fatigue. The food you eat is only one of them. Once you’ve got yourself on the ideal diet for chronic fatigue, it’s time to look at your gut health.
Step 3: gut health
Study after study after study shows that those with chronic fatigue syndrome have irregularities in the health of their gut. Some studies show that those with CFS are more prone to gut infections like SIBO and dysbiosis. Others show that a leaky gut is strongly connected to fatigue levels.
By changing your nutrition (step #2) you should experience an improvement in gut health. But if after changing your nutrition you’re still having gut-related symptoms, it’s time for further investigation. I recommend the following tests for CFS patients with gut issues:
- SIBO breath test
- Stool analysis and parasitology
- Intestinal permeability
The SIBO breath test will identify whether or not you have a bacterial infection in your small intestine. The stool test will identify if there are invading bacteria, parasites, protozoa, and even yeasts. A screen for intestinal permeability will identify whether or not you’ve got a leaky gut.
Together, these three tests will give a thorough look at the health of your gut. If any of the above come back positive, diet alone will not be enough to overcome the illness. You’ll need to follow a healthy diet AND work with a knowledgeable functional medicine practitioner to help you overcome SIBO, dysbiosis, and/or a leaking gut.
Step 4: balance the HPA Axis
The HPA axis stands for the hypothalamic-pituitary-adrenal axis. The HPA axis is the connection between your brain and the adrenal glands. It’s the control center for how your body responds to stress.
You’re probably more familiar with the term adrenal fatigue. A condition characterized by low levels of cortisol. While cortisol levels will most certainly affect your energy, adrenal fatigue is really more of a brain problem than it is an adrenal problem.
Adrenal fatigue or an imbalanced HPA axis (whichever you prefer to call it) will have a profound effect on fatigue. I have seen patients diagnosed with chronic fatigue syndrome who really just had an imbalance in their HPA axis.
Please keep in mind, chronic fatigue and adrenal fatigue are two separate – though overlapping – conditions. To overcome chronic fatigue, you need to have a healthy, well-balanced HPA axis. There’s simply no way around this.
Before moving to step 4, it’s imperative your HPA axis has at least some semblance of healthy functioning. Otherwise, the proposed treatments are not going to go over well. You see, healing is in itself a mild stress. If you HPA axis is stretched to its limit, it won’t be able to tolerate any more stress.
If you’ve tried many different treatments for your fatigue but they all seem to make you feel worse, your HPA axis is likely to blame. Proper testing is essential in identifying how your HPA axis is functioning. In the clinic, we recommend and use the DUTCH test to analyze HPA axis function.
Remember, you need to have a well-functioning HPA axis before moving on to step 5.
Step 5: identify and treat chronic infections
This is the crux of the treatment plan for chronic fatigue syndrome. For many patients, their fatigue was brought on following a cold/flu/infection. Researchers have looked at many different infectious agents and their connection to CFS. The Epstein-Barr virus, the Enterovirus, Human Herpesvirus, and even Candida/yeast infections have all been explored as potential causes of chronic fatigue syndrome.
While there certainly does seem to be some correlation between the above infections and CFS, there has never been a causal link established. In the clinic, I see mold as the most common infection causing chronic fatigue syndrome.
Genetically mold-susceptible individuals (which is approximately 23% of the population), are unable to expel mold toxins out of their body after exposure. This is characterized by a chronic state of inflammation and fatigue. Dr. Ritchie Shoemaker has written extensively about mold illness (which he calls chronic inflammatory response syndrome or CIRS) and its effect on fatigue.
Mold is one of the most common root causes of chronic fatigue syndrome. Treating it is no easy task. In future blog posts, I’ll outline the diagnostic and treatment rubric for overcoming CFS caused by mold.
Treating chronic fatigue from the inside out
In this post, I’ve outlined the methodical approach needed to treat chronic fatigue syndrome effectively. Remember, there are often many different root causes of CFS. In all likelihood, you probably have a number of factors contributing to your fatigue. Including:
- Improper diet
- Unidentified gut infections
- A dysfunctional HPA axis
- A hidden infection
If you tackle just one of these issues, your improvement in energy will be minimal. If you tackle these issues outside of the order I recommended, you’ll struggle to succeed. This occurs because these steps are meant to build on one another. The prior step supports the subsequent step.
The treatment of chronic fatigue is analogous to a marathon. It is nothing like a sprint. Treatment needs to be methodically paced. If treatment is rushed, you’ll likely experience a large setback in your energy. Slow and steady overcomes fatigue!
Now, I want to hear from you!
What helped you treat your fatigue? Leave your answers in the comments section below!