So you're tired? It's impacting your day-to-day and you're worried you'll feel this way forever. Let's talk about it.
How does normal fatigue differ from Chronic Fatigue Syndrome?
'Normal' fatigue has explainable roots; changes in sleep, emotional distress, nutrient deficiencies, perhaps a smidge of adrenal depletion. Most people have experienced this at some point in their life. Whereby something is contributing to their energy levels, often one of those things or a disease state (IBS, SIBO, HPA disruptions etc). We will often look at nutrient levels and more obvious triggers like sleep first, in case it's something simple. Nutrients such as vitamin B6 and B12, folate, iron/ferritin, zinc, calcium, magnesium, and vitamin D will contribute to energy levels from various mechanisms. But what if it goes beyond that, it's been months with little to no improvement...
Chronic Fatigue Syndrome or CFS is characterized by numerous symptoms which come from that deep, draining, pile of tired that you live under.
headaches,
myalgia, arthralgia, and post-exertional malaise;
cognitive difficulties, with impaired memory and concentration;
un-refreshing sleep;
and mood changes, such as depression and anxiety.
It's intense, disabiling and often comes after a viral infection. This level of fatigue has to be consistent for 3-6 months. The amount of research out there for post viral fatigue is showing us some clear signs - especially with Glandula Fever (epstein barr virus = EBV), and now COVID too. But, WHY?
With post viral fatigue, usually the EBV or COVID has done some damage to an organ, such as the thyroid or the lungs, that interrupts normal feedback or energy production needs. This is without taking into account the enormous load on the immune system to repair, source nutrients, fight of the EBV ghost, and calm back down. In the gut, and lungs, and skin, we have a mucosal barrier which protects us from the 'outside'. In the gut it's highly affected by stress, accidentally allowing entry of antigens and microorganisms due to the loosening of tight junctions. Which in turn stimulates hyperactive responses in the mucosal immune system. So then you've got inflammation, hyperactive immune activity and a leaky gut. But, why does this immune stress lead to fatigue? Because it drains nutrients, takes the focus away from other areas, creates a lot of collateral damage and is a constant driver of higher cortisol and adrenaline.
Your body interprets all danger as stress - mental, physical, or physiological. This includes mental stress, a workout, inflammatory foods, high immune activity, organ damage, too little water, too little sleep = danger! We're not safe. Again, being on high alert also drains us of nutrients and energy. With EBV you often get this immune attack on the thyroid as it likes to hide out there, a crucial member of the energy support team. With COVID, I've found it can affect oxygen status, lung capacity, and neural connections. Cortisol is ordinarily anti-inflammatory and contains the immune response, but chronic elevations can lead to the immune system becoming “resistant,” an accumulation of stress hormones, and increased production of inflammatory cytokines that further compromise the immune response. They work side by side, so one affects the other.
So this issue of the immune system being hyperactive = inflammation, adding stress - can contribute to fatigue from more than one area, despite you initially only having had a virus. The stress from that load + the stress of the immune system responding can weaken the gut and cause issues there too.
A Fatigued Gut...
The other fun fact about CFS, is that it involves a hell of a lot more than just potential thyroid damage. Patients with CFS are more likely to report a previous diagnosis of irritable bowel syndrome (IBS). They're more likely to have issues with that mucosal barrier, issues with bowel motility and changes to their microbiome. Remember how I said the gut is highly affected by stress? And that high immune activity is a stressor? Well...patients with diagnosed CFS (already hard to get) also have lower levels of Bifidobacteria and Lactobacillus (the good guys) and higher levels of aerobic bacteria (boo). At the same time, they also have raised serum concentrations of IgA and IgM to lipopolysaccharide (LPS) of gram-negative enterobacteria, such as Pseudomonas aeruginosa, Morganella morganii, Proteus mirabilis, Pseduomonas putida, Citrobacter koseri, Klebsiella pneumoniae and high D-lactic acid producers. Not good. This is an unhappy, pro-inflammatory and sad gut.
Image what that's signalling to your body?
Now, not all is lost because probiotics could alter the gut microbiota, improve mucosal barrier function, decrease pro-inflammatory cytokines, and have the potential to positively influence mood in patients where both emotional symptoms and inflammatory immune signals are elevated. There is hope! HOWEVER, not all probiotics are the same. You can eat good foods to help rebalance your gut microbiome, but further than that and it's best to seek assistance from someone who knows their stuff.
This is what naturopaths do all day. Assess what's going on for you and work out what can have the best impact. Probiotic wise, this means finding key strains that will bring balance, while working on reducing the overgrowths (if they exist). For CFS, this is also means looking at your cortisol levels, your adrenal function, your nutrient needs, and your immune system and working out what will actually make a difference for you.
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