Chronic Fatigue : Long Term Solutions


Fatigue is a personal experience of exhaustion and a general sense of weakness, rather than a medical condition in itself. It manifests as a diminished energy reserve for physical exertion, known as easy fatigability. In the realm of cognitive functions, mental fatigue encompasses difficulties in focusing, retaining memories, and maintaining emotional equilibrium.

Chronic fatigue is not an isolated phenomenon; it is a complex and layered issue influenced by various factors.

Typical manifestations include tiredness, fluctuating weight, and lack of appetite; psychological issues such as depression, anxiety, mood variations, diminished drive, concentration challenges, and disrupted sleep.

Causes of Chronic Fatigue

According to some expert writings, there are four main types of causes for feeling extremely tired all the time: physical, mental, chemical, and unknown reasons.

Physical reasons might be related to issues with the heart and lungs, hormones, gut, immune system, or the musculoskeletal system. These are often the easiest to figure out and fix.

Mental reasons are usually feeling down or worried, having a hard time dealing with emotions, or experiencing sudden fear and panic.

Chemical reasons could be due to problems with using too much alcohol or drugs, long-term use of medicines for relaxing muscles, sleeping, mood disorders, allergies, and some blood pressure medicines.

When doctors can’t find a specific reason for the tiredness, we call it “unknown.” OR idiopathic. This happens in about 30% of people who are tired all the time.

Idiopathic chronic fatigue is when someone feels extremely tired for more than 6 months, but it’s not because of chronic fatigue syndrome or fibromyalgia, which are specific medical conditions. Health-care providers often find these cases tough to deal with because there isn’t a clear illness causing the tiredness, making it hard to know the best way to help. Sometimes, the tiredness might be wrongly thought to be due to a mental health issue like depression, leading doctors to suggest seeing a mental health professional. However, from what I’ve seen in my practice, most people with this kind of ongoing, unexplained tiredness have some parts of their daily routine out of balance, such as their sleep, diet, exercise, and mental or emotional well-being.

Treatment of Chronic Fatigue

So why is it important to look at daily habits? Because making good choices in our everyday lives can prevent or manage 70% of long-lasting illnesses. These choices include getting enough sleep, eating well, staying active, and taking care of our mental and emotional well-being.

Sleep: Getting at least 7 straight hours of sleep is crucial for maintaining good physical and mental health, a strong immune system, and clear thinking. Developing a sleep routine is a process, and it typically takes around 3 weeks to establish a new habit. I usually encourage my patients to track their sleep for two weeks, although it’s worth noting that fitness trackers might not always be accurate and could overestimate how much sleep they’re getting.

So how many hours of sleep is enough. Sleep duration recommendations differ by age. This graph shows the current recommendations from the national sleep foundation.

I usually advise my patients to establish a calming bedtime ritual, which can be remembered with the acronym CALM:

  • Consistency in bedtime, whether it’s a weekday or weekend.
  • A relaxing routine that starts at least 30 minutes before turning off the lights.
  • A bedroom environment that’s cool, around 60–67 degrees Fahrenheit.
  • A comfortable bed with supportive pillows.
  • Avoid caffeine, nicotine, and heavy eating in the evening, or at least 4 hours before going to bed.
  • Engage in daily physical activity.
  • Lighting : Ensure exposure to bright light upon waking up to help regulate the sleep-wake cycle, whether it’s natural or from a lamp.
  • Medications : Consider the use of sleep aids like melatonin, taken about an hour before going to sleep if needed.

Nutrition: We all need the right balance of macronutrients—proteins, carbohydrates, and fats, and knowing where to find them in foods is really important. It’s better to concentrate on the balance of these nutrients in what we eat rather than just counting calories, and to focus on forming healthy eating habits. For instance, if your are wondering whether to try a paleo or keto diet, I will say it’s more important to  understanding macronutrients and their effects on your health. For instance, I prefer to use the term “nutrition” or “healthy eating” instead of “diet” as often as I can.

I usually encourage patients to keep a record of what they eat for two weeks, sticking to their regular diet. Then, review the average daily balance of macronutrients they consume. Using electronic food diaries like the MyFitnessPal app often leads to better tracking. For someone with normal kidney and liver function, the goal can be to have about 40% of their daily intake from carbohydrates, 30% from protein, and 30% from fats. Suggested calorie intake ranges from 1200–1500 calories per day for a typical woman over 40 years old (whether inactive or active) and 1500–1800 calories per day for a typical man in the same age bracket (inactive to active).

By keeping a food diary, you will start learning about the macronutrients and where they come from, as well as how to interpret food labels. While dietitians offer great help in this area, unfortunately, their services aren’t always covered by insurance.

So what are carbohydrates? Well, carbohydrates act as the body’s main energy source, and not getting the right amount can make a person feel tired, have trouble thinking, or affect their mood.

 Proteins are essential for muscle building and are found in meats, fish, beans, dairy, nuts, and seeds. However, too much protein can harm the kidneys, and not enough can cause muscle loss.

Fats are important for creating hormones, and it’s better to choose polyunsaturated fats found in nuts and avocados over saturated fats like those in fried foods. Eating too much fat can increase the risk of heart disease, while not enough can lead to problems with vitamin absorption, increased cancer risk, and even depression.

Movement: Movement includes both planned exercises and everyday physical activity. I usually encourage my patients to track their daily steps with a pedometer for at least two weeks.

The goal is to reach an average of at least 10,000 steps per day, which is in line with the American Heart Association’s recommendation.

I usually suggest patients include a variety of workouts in their formal exercise routine, combining cardiovascular exercises with strength training.

 Strength training should include activities that enhance flexibility, core strength, balance, and muscle strength. Studies suggest that 30 minutes of moderate activity each day is beneficial. Ultimately, the recommendations should always be tailored to an individuals physical condition. Speak to your health care provider before embarking on any new exercise routine.

For those who are in good health but new to exercise, starting by committing to a daily 10-minute brisk walk. In truth, it’s not about the duration but the consistency—walking every day is key, even on days when you might not feel up to it. Once they’ve made this a routine, I suggest adding 20 minutes of strength training three times a week.

The NIH Go4Life program is an excellent starting point for beginners. The ultimate aim is for patients to work up to doing cardiovascular exercises three times a week, which includes two longer sessions (about 40 minutes each) and one shorter, high-intensity interval training (HIIT) session (20 minutes), plus three 20-minute strength training sessions weekly.

Proper form is critical to avoid injuries, so for those who aren’t confident, it is reasonable to consider a few sessions with a professional personal trainer to set up a safe and effective strength training routine.

So how about informal activity? When I talk about informal activity, I’m referring to integrating movement throughout the day in natural ways—much like how children are always on the go. As we age, we tend to lead more sedentary lives, so it’s important to counteract this by incorporating activity into our daily routine. This could mean moving around for 5 minutes every hour, balancing on one foot while putting on socks or brushing teeth, doing squats while waiting for lunch to be ready in the microwave, or standing on tiptoes while in line at the grocery store.

Mental health: Working with a trained therapist can be effective for treating diagnosed mental health issues like anxiety and depression. But what about those who experience mild symptoms that aren’t severe enough to be diagnosed as a major disorder?

These mild symptoms are often referred to as subclinical depression or anxiety, which means they’re significant but don’t fully meet the criteria for a clinical diagnosis. Doctors might identify these symptoms through a standard questionnaire like the PHQ9 or simply through their professional judgment and the details a patient provides on their intake forms.

There’s no one-size-fits-all treatment for these cases, but I usually suggest a mix of medication and non-medication approaches.

Vitamin Supplementation : The use of Vitamin D supplements is a topic of some debate. Since Vitamin D receptors are present in the brain, and low levels of Vitamin D (below 20 ng/mL) are often observed in those with depression, it’s generally advised to supplement Vitamin D to maintain levels above 20 ng/mL. In my own experience, maintaining a Vitamin D level around 45 ng/dL can be particularly effective for improving mood.

Non-drug approaches include structured therapy options like Cognitive Behavioral Therapy (CBT), or mindfulness practices. These can be done one-on-one or in group settings and are valuable for managing mental health.

Emotional Health: Emotional health represents a positive state of mental well-being. It embodies resilience – the capacity to adapt and recover from difficulties. It’s about being flexible, not fragile, under stress.

Being resilient means facing challenges head-on instead of feeling defeated by them. It’s about feeling empowered and finding purpose in our actions. The core elements of a resilient mindset include acceptance, joy, and thankfulness. And the key to cultivating these qualities? Mindfulness.

Mindfulness has been shown to reduce chronic pain, lessen depression, and break patterns of negative emotions. It’s not something that typically comes without effort—it requires regular practice, similar to physical exercise for your brain. To start, it’s essential to learn how to concentrate and live in the moment. Mindfulness is one method to improve our concentration. It’s like revisiting the basics we were taught as kids: stay calm, stay focused, and don’t forget to express gratitude.

I hope you found today’s topic informative. 

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About the Author MyEndoConsult

The MyEndoconsult Team. A group of physicians dedicated to endocrinology and internal medicine education.

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