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Fatigue and exhaustion: symptoms that can have many causes

In this article we would like to provide you with important information on the subject of fatigue and exhaustion.

Definition of fatigue / exhaustion

Fatigue and exhaustion are becoming increasingly common in today’s world. The causes are manifold and many health disorders can manifest themselves through these symptoms, usually alongside other symptoms. These symptoms can occur irregularly and infrequently in mild cases and do not restrict the quality of life too much. In the course of time, however, they can also turn into a permanent condition and lead to a very severe reduction in quality of life, up to a state in which one can no longer pursue the normal activities of daily life or normal professional and social interaction.

In an extreme form, it can also lead to chronic fatigue syndrome (CFS).

Chronic fatigue syndrome (CFS)

CFS is also known as myalgic encephalomyelitis (ME). It is a multifunctional disease. In 30% of those cases, autoantibodies are also found, which are antibodies that are directed against the body’s own antigens, in the sense of an autoimmune disease.

We are also seeing a significant increase in patients with CFS in the context of POST-VAC syndrome or LONG– or POST-COVID. The main problem here is that patients can collapse completely after physical and mental exertion (post-exertional malaise/PEM). This can lead to a complete “crash”. Any further exposure to stress should be avoided as a matter of urgency.

You can also find further information here:

General diagnostics for fatigue

The exact diagnosis of tiredness and fatigue requires a thorough medical history and examination. Detailed laboratory diagnostics are also useful. A step-by-step concept should be followed here. Various aspects are taken into account, including medical history, lifestyle factors, diet, sleeping habits and psychosocial influences. The diagnosis forms the basis for targeted therapy.

General tests:

There are specific tests that can help to identify the causes of fatigue and exhaustion. In a first step, general problems should be ruled out, which should be known to every physician with a medical degree.

These include:

  • Iron deficiency: please note that the ferritin value should be above 75-125 nanograms/milliliter. Below 75 nanograms/milliliter, symptoms of iron deficiency begin, which can manifest themselves in the form of fatigue, among others. At the same time, the CRP value should also be determined to rule out an acute phase reaction, as the ferritin value in the laboratory is falsely tested too high in the context of an inflammation. In 15% of cases, a severe iron deficiency also leads to anemia.
  • Exclusion of anemia: anemia can also lead to fatigue. This must be further categorized and the differential diagnosis may include iron deficiency, vitamin B12 deficiency, folic acid deficiency and rarer causes, which must be clarified by a specialist. A chronic iron deficiency, for example, indicates a loss of blood.
  • Checking thyroid function: the thyroid gland is our central organ for various essential metabolic processes and produces thyroid hormones from the amino acid tyrosine together with iodine, selenium and iron (essential coenzymes for thyroid hormone production). An underactive thyroid leads to fatigue. The TSH value should ideally be below 2.5 µlU/ml. The thyroid gland is also a central organ for heat production and weight regulation in the body. Hypothyroidism and hyperthyroidism can also lead to psychological problems.
  • General review of the current life situation and current exposure to stress. More mindfulness and a healthy lifestyle as well as the elimination of known stress factors and the defusing of interpersonal problems always have positive effects.

However, there are many other causes that can manifest themselves as fatigue and for which the above-mentioned causes are not present. Patients are then often pushed into a psychosomatic corner.

Some other more specific diagnostic options for fatigue:

Histamine balance:
I always shed light on the histamine balance here. An increase in histamine in the body, measured by determining histamine in heparin blood, can lead to sleep disorders and exhaustion during the day. An increase in histamine can occur as part of a histamine degradation disorder or as part of a mast cell activation disease. You can find more information about this on my homepage(Histamine breakdown disorder).

Examination of adrenal cortical function:
Here we look in particular at the daily production of cortisol, which, if sufficiently intact, is very important in order to cope with daily stress situations and also to cover the body’s energy requirements. We measure the daily cortisol profile using a saliva test and always determine the important hormone DHEA-S in the blood. Chronic stress on the body often results in a very flat cortisol diurnal profile and reduced DHEA-S levels. Optimization of the adrenal cortex with adaptogens and the administration of DHEA-S can bring about an improvement. In principle, other hormone deficiencies can also lead to fatigue

Testing of autoantibodies in cases of suspected POST-VAC syndrome or LONG- or POST-Covid.

Chronic infections:
Chronic infectious diseases are definitely neglected in conventional medical diagnostics today. However, these are one of the most common causes of chronic fatigue. Fatigue is also a symptom of the central nervous system. And if this is affected by chronic infections, fatigue occurs. First and foremost, you should look for chronic and reactivated infections with the following pathogens:

  • Epstein Barr Virus
  • Cytomegalovirus
  • Varicella zoster virus
  • Human herpesvirus 6
  • Borrelia
  • Bartonella
  • Babesia
  • Clamydia pneumoniae
  • Mycoplasma pneumoniae
  • Fungal diseases
  • Chronic parasitosis e.g. lambliasis

Environmental medicine:
Furthermore, environmental pollution, for example with heavy metals or pesticides, should be clarified.

Minerals / vitamins:
It generally makes sense to check your mineral and vitamin intake.

Genetic tests:
Investigation of important genes that have an effect on coping with chronic stress situations and influence the neurotransmitter balance. Here I mainly look at the genes COMT, MAO-A, MTHFR and others, depending on the individual medical history and requirements. A sufficient presence of neurotransmitters (messenger substances) such as dopamine, adrenaline, noradrenaline and serotonin are of course important to get through the day without feeling tired, to be able to concentrate and also to experience feelings of happiness and drive. There are so-called SNPs in the genes. These then lead to an altered function, e.g. to its substrates being broken down too quickly or too slowly. This can sometimes have a major impact on the body.

Mitochondrial function:
An examination of the mitochondria, which are known as the power plants of our cells. They are found in every cell and without them, normal cell function cannot be guaranteed. They produce ATP, which is the energy source we need. Every day, a healthy person produces as much ATP in kilograms as he or she weighs. If the mitochondria are restricted, fatigue occurs. The mitochondria could be damaged by various causes. These include nutrient deficiencies, environmental toxin exposure, chronic infections and other causes.

Intestinal flora:
It is also very important to check the intestinal flora. The overgrowth of putrefactive bacteria and especially the LPS-bearing flora (LPS = lipopolysaccharide) can lead to the production of metabolites or toxins, which enter the bloodstream and have a negative effect on the intestines and can also contribute to fatigue, especially after eating. Sometimes, the term autointoxication is also used.

Therapy concepts

As you can see, fatigue can have many causes and the causes must be investigated as part of detective work. Only if you know the cause can you treat it effectively. Often there are several causes at the same time and you have to work through them in the right order.

In my practice, I have an established therapy concept for the diagnosis and treatment of various causes that lead to fatigue. Very exciting substances and therapies that can be used alongside others are methylene blue, lithium, infusion therapies with important micronutrients and high-dose ozone therapy according to Lahodny.

The alternative practitioner Florian Schilling has also posted two very nice lectures about methylene blue on his homepage. Take a look at them, they are very instructive.

The presentations on methylene blue can be found here:

You can find an interesting presentation on lithium here:

You can find information on high-dose therapy according to Lahodny on my homepage:

Of course, therapy and monitoring should always be carried out by a specialist. We strongly advise against attempting this yourself. If you ignore important points, this can also have a negative impact on your health.

Other ways to help with chronic fatigue are a healthy diet, good sleep hygiene, relaxation exercises, mindfulness training, meditation and yoga, which restore the balance of body and mind.

Talk therapy and psychosomatic co-treatment are also always useful for any underlying chronic illness. If there are severe traumas, conscious or unconscious, trauma therapy is often necessary and helpful.

Every patient is unique, and customized treatment is important and essential. This is the reason why I treat each patient individually and why generalized therapy schemes usually do not lead to success.

For further information, please do not hesitate to contact us. Feel free to contact us anytime and arrange an appointment if you have any questions.

Stay healthy and informed!

Dr. Stefan Rohrer