Fatigue is a common reason for a visit to a complementary medical practitioner. The type of fatigue I am talking about can be felt not only physically, but also emotionally. The most common cause has to be lack of sleep. Humans should sleep for at least 8 hours a night. Imagine that. We spend 1/3 of our lives in bed! Best make sure to invest in a good mattress and pillow to promote a good nights sleep.
For those insomniacs out there, there is non-pharmacological help at hand. Remember diazepam is a drug of addiction and is another thing for the liver to detoxify. Herbalists will use a mix of valerian, passionflower and hops to induce sleep. Bach flower remedies can address those persistent worrying thoughts that keep us awake.
In Chinese medicine, the spirit is called the Shen. At night, the spirit resides in the heart and sleep occurs. Insomnia is seen as a disorder of the heart. Chinese medicine practitioners will use herbs and acupuncture to calm the Shen and nourish the heart. Insomnia however, is an article in it's own right. If insomnia is not the problem and indeed too much sleep is, then what might be going on?
Mitochondria- Our Living Powerhouse
Inside every cell in our bodies are organelles, organs of the cells, called mitochondria. The mitochondria are referred to as the powerhouse of the cell. It is inside these mitochondria that energy is stored and produced. Energy is stored as something called ATP adenosine triphosphate. Sorry to get technical, but this is happening inside us and the reason for not feeling well, may well be because these mitochondria are not functioning properly. ATP is broken down to fuel metabolic reactions, transport molecules between cells so they may communicate and produce movement. In Chinese medicine this is called Qi or energy. Fatigue can result from mitochondrial dysfunction i.e. problems with ATP.
Mitochondrial dysfunction can occur because a lack of nutrients. This can be because of poor diet or inadequate absorption. Indeed certain drugs can inhibit certain nutrients required for mitochondrial function, the most common drugs being statins. Statins are drugs used to lower cholesterol. They do this by stopping the absorption of fats. An unfortunate side effect is that this interferes with the absorption of fat-soluble nutrients, most importantly ubiquinone, also called Coenzyme Q10 (CoQ10) or vitamin Q. CoQ10 is involved in the production of ATP. Deficiency of CoQ10 will result in not only fatigue, but can be associated with heart disease, Chronic Fatigue Syndrome (CFS), mouth disease, infertility, aids and cancer. Quite simply, you can recharge your battery with CoQ10. Dietary sources are sardines, mackerel, beef, (remember the palm rule) walnuts and pistachios, spinach and brocolli.
Iron is the first mineral to think of when you feel tired, especially if you are a woman. Anaemia is not exclusively a woman's problem as the elderly, men and children may also get it. In Chinese medicine anaemia is called blood deficiency and can lead to fatigue, palpitations and insomnia. Iron is involved in haemoglobin or red blood cell production. The red blood cells carry oxygen around our bodies where it is used in all cellular reactions and the production of ATP in the mitochondria. Ask your doctor for an iron test. It is important to ask for both your haemoglobin and ferritin levels checked. Haemoglobin is circulating iron and ferritin is stored iron in the liver. Other essential nutrients for mitochondrial energy production are vitamins B2, B3, K, folic acid (B9), and magnesium. Good vegetarian iron sources are parsley and other green leafy vegetables, free-range eggs, tofu, beetroot, tomatoes, strawberries, apricots and figs, grape and prune juice.
Chronic Fatigue Syndrome CSF
CSF is what I call one of those strange, fan dangled diseases that is diagnosed at the conclusion of multiple tests to rule out all other causes. Doctors call these syndromes. There can be a history of other viral infections, including Epstein Bar, cytomegalus, Ross river and rubella. Symptoms are chronic fatigue, worse after exercise and not better after a good night's sleep, sore throat, swollen glands, headache, muscle pain, joint pain, irritable bowel, poor concentration and depression. Muscle tests have revealed lack of oxygen in the cells, damage to the mitochondria and not enough ATP for energy.
Naturopathic Causes of Chronic Fatigue Syndrome
- Bowel toxaemia
- Immune toxicants
- Vaccination overload
- Sluggish liver
- Magnesium deficiency
The lack of oxygen in the cells is caused by overloaded liver detoxification pathways. There is a traffic jam in the liver and backlog causing chaos. The liver can be overloaded because of environmental pollutants including shampoo and perfume, chronic infection and inflammation and stress. Our body also produces toxins that need to be processed by our liver. These toxins that can't be processed, recirculate, stimulating immune responses, resulting in inflammation that damages the cells. This reduces the amount of oxygen in the cell, damages the mitochondria, therefore lowering ATP.
The strategy is to detoxify the liver, as discussed previously. Bitter herbs that promote bile flow are recommended. Supervised fasting is also recommended if the person is strong enough and supplementation is necessary. Supplements to aid detoxification pathways in the liver need to be prescribed. A strong disease needs a strong army.
Overgrowth of Candida
In the bowel we know there is good and bad intestinal flora. Candida albicans is one bad bacteria that can get out of hand and become difficult to eradicate. Symptoms of Candida overgrowth are fatigue, feeling foggy, nausea, bloating, thrush, jock itch, tinea, and any fungal infection. These symptoms are aggravated by white wine, beer and other foods containing yeast, in particular bread. Sugar also aggravates Candida symptoms The organism itself produces toxins that overload the liver. Zinc deficiency can lead to chronic yeast infections. Zinc promotes hydrochloric acid production in the stomach that in itself, is anti-bacterial. Traditional Chinese Medicine (TCM) practitioners will tonify the Spleen Qi to move the Damp/Candida. To treat chronic Candida, treatment involves killing the bad bacteria, and creating a healthy internal environment where bad bacteria don't thrive. A naturopath will prescribe gut-antimicrobials to kill the bad bacteria in conjunction with increasing the good bacteria by prescribing a bifidus supplement. Bitter herbs are also indicated to dry Damp. Chronic Candida infection in associated with CFS.
Chronic fatigue sufferers often have a history of viral infection as mentioned above. Supporting the immune system with practical approach including drinking 6-8 glasses of water (room temperature) a day. Include a diet rich in whole, unprocessed food. Certain food like garlic and onions are anti-viral. A zone diet would be appropriate to lower blood sugar levels as high blood sugar feed Candida. Importantly, an elimination diet is necessary to identify allergic foods. A low reactive diet should be followed for two weeks the suspect foods sugar, wheat, dairy, yeast, dried fruits, alcohol. It may be necessary to eliminate one or more of these foods from your diet for some time until your body adapts. Nutrients that are anti-viral and stimulate the immune system are necessary such as, Vitamin C, Zinc and Beta-carotene and there are more specific herbs and supplements.
Seasonal Affective Disorder SAD
Are you feeling blue this winter? Lack of sunlight may well be the reason. Seasonal affective Disorder SAD is described as a winter depression. It can affect up to 20% of people and here is a higher incidence in colder climates. The reason why I am touching on it here is that it can cause fatigue. Other symptoms include mental emotional symptoms such as depression, anxiety, low sex drive, irritability and weight gain. Everyone can be affected, even children.
SAD is associated with an increase of a hormone called melatonin. Sunlight works on the pineal gland in the brain to inhibit melatonin production. Darkness stimulates melatonin and lack of sunlight can result in excess melatonin. Melatonin is a very important hormone in that it controls our circadian rhythm therefore determinates the time of secretion of all hormones throughout the day. Melatonin also makes us sleep.
Melatonin is converted in the body from seratonin, our feel good hormone. The more melatonin, the less serotonin. UV light suppresses this conversion and darkness stimulates. Solar radiation can help stimulate the immune and digestive systems. The sun also increases vitamin D production which increases calcium absorption into bones. What all this means is to prove what we already know, sunlight is good for us. It is more important in winter to get out there and take a walk. Expose the backs of your hand and faces to the UV and this can help you feel uplifted and suppress the appetite.
Coenzyme Q10 has also been used successfully to improve energy levels in Chronic Fatigue patients, as CoQ10 is often found to be deficient in these patients. Three months following supplementation of CFS patients with 100 mg CoQ10 daily, exercise tolerance more than doubled and all patients' symptoms had improved. Ninety percent had reduction and/or disappearance of clinical symptoms, and 85 percent had decreased post-exercise fatigue. 3
Vitamin B3 (nicotinamide) is the precursor to NAD (nicotinamide adenine dinucleotide), the activated form of vitamin B3. NAD is an essential electron carrier in the electron transport chain and thus essential for energy production.
Vitamin B2 (Riboflavin) is the precursor to FAD, an essential electron carrier for the electron transport chain. It has been postulated that mitochondrial dysfunction may play a role in migraine pathogenesis. Because riboflavin increases energy production in the mitochondria, it was theorized that administration of riboflavin might have an impact in migraine prophylaxis in patients with reduced energy production within the mitochondria of cerebral blood vessels. The results of three trials of high-dose riboflavin in subjects with a history of migraine demonstrate the safety and efficacy of this agent in migraine prophylaxis. 4
Vitamin K is presumed to mediate electron transport from NADH to electron acceptors such as coenzyme Q or cytochrome C. Vitamin K3 in combination with vitamin C has been shown to improve cellular phosphate metabolism and oxidative phosphorylation.
Creatine is synthesized in the body from arginine, glycine and methionine. It is used in the muscles to help maintain a constant supply of ATP during bursts of exercise. Creatine supplementation may help prevent the depletion of ATP in muscle cells.
Carnitine is used to transfer long chain fatty acids across the inner mitochondrial membrane and animal studies indicate that it can enhance mitochondrial function and energy production. 5
In an open, randomised fashion three groups of CFS patients were compared. Supplementation of the three groups included 2 g/d acetyl-L-carnitine, 2 g/d propionyl-L-carnitine, and its combination. Clinical global impression of change after treatment showed considerable improvement in 59% of the patients in the acetylcarnitine group and 63% in the propionylcarnitine group. Acetylcarnitine significantly improved mental fatigue and propionylcarnitine improved general fatigue. In the acetylcarnitine group, the changes in plasma carnitine levels correlated with clinical improvement. Acetylcarnitine had a main effect on mental fatigue and propionylcarnitine on general fatigue. 6
Mitochondrial dysfunction may contribute to a variety of conditions
Mitochondrial dysfunction in the brain has been suspected as a contributing factor in a range of neurodegenerative conditions such as Alzheimer's disease, 7 Parkinson's disease 8 and dementia. Supporting mitochondrial function with essential nutrients may therefore support patients suffering from or who are at risk of development of such conditions.
Mitochondrial dysfunction may also play a role in cardiovascular diseases, contributing to decreased heart function. Support for mitochondria may therefore also be beneficial for cases of cardiovascular diseases. Coenzyme Q10, 9 magnesium orotate and acetyl-l-carnitine, specifically may improve mitochondrial function in heart tissue.
Supplementation for support of mitochondrial energy function may also be beneficial for athletes and the elderly.
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1 Marriage, B., et al., Cofactor treatment improves ATP synthetic capacity in patients with oxidative phosphorylation disorders. Molecular Genetics and Metabolism, 2003. 81(4): p. 263-272.
2 Rauchova, H., Drahota, Z., Lenaz, G., Function of coenzyme Q10 in the cell:some biochemical and physiological properties. Physiol Res., 1995. 44: p. 209-216.
3 Werbach, M., Nutritional strategies for treating chronic fatigue syndrome. Alternative Medicine Review., 2000. 5(2): p. 93-108.
4 Balbisi, E., Ambizas, EM., Riboflavin in Prophylactic Treatment of Migraine. US Pharm, 2005. 5: p. 32-38.
5 Hagen, T., Acetyl-L-carnitine fed to old rats partially restores mitochondrial function and ambulatory activity. Proceedings of the National Academy of Sciences, USA, 1998. 95: p. 9562-9566.
6 Vermeulen, R., Scholte, HR., Exploratory open label, randomized study of acetyl- and propionylcarnitine in chronic fatigue syndrome. Psychosom Med., 2004. 66(2): p. 276-82.
7 Redjems, B., et al., Abnormal substrate levels that depend upon mitochondrial function in cerebrospinal fluid from Alzheimer patients. Gerontology., 1998. 44(5): p. 300-304.
8 Mizuno, Y., et al., Role of mitochondria in the etiology and pathogenesis of Parkinson's disease. Biochima et Biophysica Acta., 1995. 1271: p. 165-274.
9 Rosenfeldt, F., et al., Coenzyme Q10 therapy before cardiac surgery improves mitochondrial function and in vitro contractility of myocardial tissue. J Thorac Cardiovasc Surg., 2005. 129(1): p. 25-32.