By Dr. Victor S. Sierpina
I took a look at the common medical complaint of fatigue in last week’s column.

Frequent causes of chronic fatigue are poor sleep hygiene, lack of exercise, depression, boredom and lack of motivation.

To those, I would add poor nutrition. Without the essential energy provided by a healthful diet, the body’s cells can’t get the fuel they need to function optimally, resulting in just feeling tired a lot.

Eating sugary, highly refined carbohydrates and saturated fats might give you an energy burst, but it is like a rocket going up, then quickly falling down like a stick.

Without sustained energy provided by whole grains, lean proteins, fruits, vegetables and healthy fats, the body is quickly starved of reliable, steady sources of energy.

It is like a fuel pump in your car that is partially blocked or works on and off. It is hard to get much distance without the right amount or kind of fuel.

If you suffer from chronic fatigue and it doesn’t seem to be from any clear cause, you definitely need to have your physician do a comprehensive history and physical examination including blood work plus other tests as needed.

Fatigue can come from multiple causes and as a result of problems with any organ system.

Though usually benign, fatigue can sometimes be a presentation of some serious diseases. Some examples that need to be excluded are:
• Blood/immune: anemia, leukemia, lymphoma, connective tissue disease, chronic infections, cancer;
• Lung: chronic lung disease, low oxygen levels, uncontrolled asthma;
• Heart: cardiac insufficiency, heart failure, valvular heart disease;
• Gastrointestinal: malabsorption, GI bleeding, liver or pancreatic failure;
• Neurological: stroke, multiple sclerosis, myasthenia gravis, dementia;
• Musculoskeletal: fibromyalgia, arthritis;
• Genitourinary: kidney failure;
• Endocrine: diabetes, diminished function or failure of major glands such as the pituitary, thyroid, adrenals, ovaries, testes; and
• Psychological: mood disorders, chronic stress, lack of social or family support, financial worries.

Even this long list is not really complete, and it takes the skill of a well-trained clinician to guide testing and evaluation based on age, family history, risk factors and pre-existing conditions.

For example, many medications used for common conditions have side effects that can include fatigue. Balancing these often is tricky.

Many years ago, a patient with fibromyalgia/chronic fatigue syndrome gave me a book called “From Fatigued to Fantastic,” by Dr. Jacob Teitelbaum.

The book was directed to people with chronic fatigue that defied conventional diagnosis, often including fibromyalgia. This is a painful condition of the muscles with unknown cause, often accompanied by crippling fatigue.

Those with fibromyalgia have what is called allodynia, exaggerated pain from stimuli that don’t cause pain in most people.

This can be chronic and disabling. There is no proven cure. Likely there is something awry with their muscle metabolism and nervous system.

At the time, I thought the book was off the curve medically and scientifically — as it offered unusual cures I had rarely, if ever, heard of.

One such cure was proposing antifungal therapy for suspected Candida overgrowth in the gut, particularly for those who had been on antibiotics, anti-inflammatories or high-sugar diets.

Adrenal fatigue and a variety of subclinical hormonal imbalances are suggested as possible causes of fatigue. Nutritional imbalances were another potential problem in fatigue sufferers.

During the years, many of my patients have used therapies suggested by Teitelbaum. His approach is slowly working its way into major textbooks and clinical practice for a condition for which we often have little to offer.

While some of his prescriptions remain controversial among practicing physicians, both patients and integrative physicians increasingly recognize some as safe, inexpensive and worthy of a therapeutic trial.

So what do you do if you suffer from chronic fatigue, have been thoroughly evaluated by your physician and no clear cause has been identified?

First, discuss with your physician the possibility of some of the options listed. If you also have fibromyalgia, additional recommendations might be considered as well such as acupuncture, gentle massage and medication. Dosages and selection of therapies depend on your exact condition and conditioning, age, lifestyle and metabolism.

Work closely with your nutritionist, integrative physician, health coach or holistic practitioner for exact formulations and dosing.

This will help you to develop a rational and personalized treatment plan that works for you.

Remember, rest well.

• Sleep Issues: valerian, passionflower, melatonin, 5-hydroxytrytophan, trazodone, zolpidem, clonazepam, gabapentin, pregabalin;
• Hormonal Treatments: thyroid, hydrocortisone, DHEA, Biest (females), testosterone;
• Infections/Anti-Yeast Treatments: avoidance of sweets in diet; use probiotics, nystatin, fluconazole if needed;
• Nutritional Treatments: high protein, low-carbohydrate diet rich in fruits and vegetables; high quality multivitamin containing B complex (B50 or B100), magnesium, vitamin D, vitamin C, zinc, selenium;
• Energy Boosters: D-ribose, Coenzyme Q10, Acetyl-L-Carnitine, ginseng; and
• Exercise: goal of 10,000 steps a day; progressive, slow increase of moderate aerobic exercise from baseline.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.