Fatigue — Why am I tired?

Fatigue is one of the most common complaints presenting to doctors offices today.

There are many causes and contributors to fatigue and it can be described by different terms by different people.

In my experience over the past 18 years, the overwhelming majority of people that I see have some form of fatigue that can be described as:

          Lethargy, malaise, weakness, tiredness

          decrease in stamina, inability to functiontion

          exhaustion, listlessness, sleepiness


The presentation can be mild or severe, short or long duration, and can come and go.

Mild cases are typically ignored or not evaluated because people think that it will go away, or that it is supposed to occur because of “their age". More persistent cases frequently prompt people to go to their primary care doctor, and after a cursory workup, people end up on antidepressants. Unfortunately this occurs because the average doc doesn't do in-depth testing, or understand nutritional considerations. Mild cases are typically ignored or not evaluated because people think that it will go away, or that it is supposed to occur because of “their age". More persistent cases frequently prompt people to go to their primary care doctor, and after a cursory workup, people end up on antidepressants. Unfortunately this occurs because the average doc doesn't do in-depth testing, or understand nutritional considerations.

The difficulty in diagnosing the problem lies in the fact that there are so many causes. It is difficult to tease these out, unless a physician understands the importance of a comprehensive evaluation. 

The list of causes of fatigue is longer than most, and includes:

                                          – hypoglycemia  (low blood sugar)

                                          – vitamin deficiency

                                          – mineral deficiency

                                          – anemia

                                          – hypothyriodism

                                          – adrenal disorder

                                          – pituitary disorder

                                          – growth hormone deficiency

                                          – female hormone deficiency

                                          – testosterone deficiency

                                          – infection ( viral, bacterial, fungal, parasitic)

                                          – diabetes 1 and 2

                                          – heart disease 

                                          – heart failure

                                          – cancer

                                          – blood loss 

                                          – depression

                                          – myasthenia gravis

                                          – autoimmune disorders

                                          – connective tissue diseases

                                          – low blood pressure

                                          – reaction to medication

                                          – disorders of metabolism

                                          – fibromyalgia

                                          – lyme disease 

                                          – and many more !! 

Each of these categories can be broken down to subclasses and further confound the situation as can individual characteristics of each patient. 

The only way to proceed in cases such as these ( and for all patients as far as I am concerned) is to be able to understand the entire patient and look for all possible clues as to the causes of disease. 

The diet must be evaluated for content of carbohydrate, protein ( amino acids), and fats. Testing must be done for vitamins and minerals, hormones, as well as for digestion and absorption. Infection needs to be evaluated and must go beyond the usual suspects. In many cases an organism may cause fatigue and not be evident on cursory testing. Common creatures implicated frequently are Epstein Barr Virus, Cytomegalovirus, and the Herpes Family. Common bacteria can include Micoplasma, Staph, Strep, Chlamydia, Hemophilus, and even dental organisms. Organ – system evaluation needs to be done to assess functionality of tissues, as well as potential existence of malignancy. 

As this is done there may be combined causes and there may need to be a variety of things done to treat them.

Some of the most beneficial include: 

                                                      – low carb diet.

This can begin to cut back on insulin production and eliminate low blood sugar episodes. This also is crucially important for diabetics.

                                                       – Oral and intravenous vitamin and mineral therapy.

This can correct deficiency as well as strenghten immune response to help fight infection. People always feel significant improvement with these .                                              

                                                        – Hormone replacement and correction.

This can obviously enhance organ , tissue and cellular function and improve metabolic response.

                                                         – Gradual incorporation of exercise into the protocol.

This will deliver oxygen, nutrients, and hormones to all tissues with increased activity.  Remember, the more we understand about the body,  the more able we are to fix it.

Dr. Chris Calapai  


Physical and mental fatigue:

Metabolic mechanisms and importance of plasma amino acids.There are at least 5 metabolic causes of fatigue, a decrease in the phosphocreatine level in muscle, proton accumulation in muscle, depletion of the glycogen store in muscle, hypoglycaemia and an increase in the plasma concentration ratio of free tryptophan/branched-chain amino acids.

Proton accumulation may be a common cause of fatigue in most forms of exercise and may be an important factor in fatigue in those persons who are chronically physically inactive and also in the elderly: thus, the aerobic capacity markedly decreases under these conditions, so that ATP must be synthesized by the much less efficient anaerobic system. A marked increase in the plasma fatty acid level, which may occur when liver glycogen store is depleted and when hypoglycaemia results, or during intermittent exercise when the rate of fatty acid oxidation may not match the mobilisation of fatty acids, could be involved indirectly in fatigue.

This is because such an increase in the plasma level of fatty acids raises the free plasma concentration of tryptophan, which can increase the entry of tryptophan into the brain, which will increase the brain level of 5-hydroxytryptamine: there is evidence that the latter may be involved in central fatigue. In this case, provision of branched-chain amino acids in order to maintain the resting plasma concentration ratio of free tryptophan/branched-chain amino acids should delay fatigue–there is prima facie evidence in support of this hypothesis.

This hypothesis may have considerable clinical importance.

Click on the link below to read more:




Chronic Fatigue: Symptom and Syndrome.

Chronic fatigue is common, is difficult to measure, can be associated with considerable morbidity, and is rarely a subject of controversy. The chronic fatigue syndrome also presents problems in definition and measurement, is associated with even more morbidity than chronic fatigue itself, and is often controversial. Particularly unclear is the way in which chronic fatigue and the chronic fatigue syndrome relate to each other: Is one the severe form of the other, or are they qualitatively and quantitatively different?

We know that many things can cause chronic fatigue, and this is probably true for the chronic fatigue syndrome, too. We can anticipate that discrete causes of the chronic fatigue syndrome will be found in the future, even if these causes are unlikely to fall neatly along the physical–psychological divide that some expect. The causes of chronic fatigue are undoubtedly many, both in a population and in any individual person, even when a discrete cause, such as depression or cancer, is identified.

Social, behavioral, and psychological variables are important in both chronic fatigue and the chronic fatigue syndrome. Interventions that address these general variables can be successful, and currently they are often more successful than interventions directed at specific causes. 

Click on the link below to read more:





Hypoglycemia, also called low blood sugar, occurs when your blood glucose (blood sugar) level drops too low to provide enough energy for your body's activities. In adults or children older than 10 years, hypoglycemia is uncommon except as a side effect of diabetes treatment, but it can result from other medications or diseases, hormone or enzyme deficiencies, or tumors.Glucose, a form of sugar, is an important fuel for your body. Carbohydrates are the main dietary sources of glucose. Rice, potatoes, bread, tortillas, cereal, milk, fruit, and sweets are all carbohydrate-rich foods.

After a meal, glucose molecules are absorbed into your bloodstream and carried to the cells, where they are used for energy. Insulin, a hormone produced by your pancreas, helps glucose enter cells. If you take in more glucose than your body needs at the time, your body stores the extra glucose in your liver and muscles in a form called glycogen. Your body can use the stored glucose whenever it is needed for energy between meals.

Extra glucose can also be converted to fat and stored in fat cells.When blood glucose begins to fall, glucagon, another hormone produced by the pancreas, signals the liver to break down glycogen and release glucose, causing blood glucose levels to rise toward a normal level. If you have diabetes, this glucagon response to hypoglycemia may be impaired, making it harder for your glucose levels to return to the normal range.  



Symptom: Fatigue. 

Fatigue means lacking energy or strength and is a very common symptom.

However, the term in common usage may mean many things, including drowsiness (sleepiness), lethargy, tiredness, malaise, lislessness, or weakness (including muscular weakness). Sometimes it is hard to know exactly whether you are tired, weak, fatigued, or have other symptoms. Nevertheless, any type of fatigue can indicate a serious medical condition and needs prompt medical investigation.




Chronic Fatigue Syndrome – CFS Introduction.

All of us are familiar with being tired after a period of over exertion, or perhaps a bout of the flu.  But for some, the tiredness is not alleviated and becomes a condition that begins to affect activities of daily living.  Many don't understand that their lack of energy is not optimal, and many times, consider their energy-output normal.  The majority of individuals often disregard the symptoms of chronic fatigue, attributing indicators to over working and lack of sleep. While these are many times valid explanations, fatigue that persists must be investigated.  

Fatigue can affect all people.  Regardless of age, gender, or socioeconomic class, there are a multitude of reasons why someone may experience low energy over prolonged periods of time.  It may be caused by endocrine disturbances, such as hypothyroidism, premenstrual syndrome, or Addison's disease; Attributed to sleep disturbances, such as sleep apnea or insomnia; Emotional imbalances, like depression; Conditions with immune involvement, such as a viral illness; Blood loss or inadequate blood cell production stemming from anemia: Or perhaps, the fatigue may be caused by something more obvious, like periods of high stress or inadequate nutritional intake.

Whatever the reasoning, chronic fatigue is paralleled with many chronic diseases, including certain forms of cancer.  While most fatigue is due to an unhealthy lifestyle choice, the fact remains that this condition may be associated with a more serious underlying condition. If a clear reason cannot be determined and treated, a more thorough evaluation must be completed by specialized tests and procedures.