Do you wake up feeling tired? Drag through the day and hit the couch in the evening? I hear this complaint from many patients. Then their question is “What can I do to get better? I’ve seen many physicians and they have run blood tests and tell me that the results are normal. I am not anemic and do not have an infection or organ abnormalities as my blood count, liver, thyroid, adrenal and kidney function are all within an acceptable range. I’m frustrated, still feel bad and am tired!”
Evaluating the underlying causes. This is a complicated situation for the physician and the patient and requires time and patience for both the patient and the physician to work through the process of evaluating for underlying causes or triggers. Triggers can be allergies to mold, food, dust mites or animal dander. It also may be due to viruses such at Epstein Barr (Mononucleosis), West Nile Virus or Lyme Disease. Exposure to toxic chemicals in the workplace or at home such as solvents or pesticides affects cell function, thus fatigue. Excessive dampness in a home or building can produce mold growth that in many cases produce mycotoxins, a neurotoxic substance, that affects the nervous system including adverse effects on brain function.
Be mindful of when and where you experience your symptoms. A chronological history is important in understanding the time and place of onset of symptoms including work and living conditions. Frequently, I hear that the illness began shortly after the patient moved from out of state, moved to a new residence or started a new job.
When this is the situation indoor air quality issues are a strong consideration such as mold or chemical exposure. Dampness in a dwelling creates an environment for mold growth that causes allergic conditions such as asthma, cough, eye irritation, nasal congestion and yes – fatigue. If that mold is one that produces mycotoxins such as aspergillus, penicillium or stackyboytris, which are neurotoxins, that affect not only the brain but also the cell mitochondria ATP production (the energy producers) resulting in fatigue.
Food sensitivity and fatigue. If fatigue starts after a meal, then food sensitivity needs to be considered. Foods include what you drink, seasonings and all types of ingredients that one ingests. Recently, I saw a lady that was falling asleep when driving home from work. In taking a history of her problem I asked what was different in what she was eating for lunch. She thought for a moment and then said she had added tea. Skin testing showed a sensitivity to tea. She stopped and the problem resolved.
Many food problems can be defined by doing a Four Day Rotation Diet. This involves eating two to three individual foods per meal and not repeating any of those foods until four days have elapsed. Keep a diary on how you feel after eating. Reactions may occur quickly or be delayed hours, some to the next morning. Pay attention to how you feel on awakening and the quality of sleep you had. Repeat for at least three times for 12 days in total. If you find a reactive food omit the next time around.
Viral infections that can cause fatigue. Some viral infections just make you feel bad and not diagnosed unless the correct tests are run. IgG antibody tests show past exposure or infection. IgM antibodies present in high amounts generally means acute infection. PCR (DNA detection) means the virus is present. Possible offenders could be EBV, West Nile, or Lyme if one has been bitten by a tick. Appropriate testing can be run by a physician.
COVID is the current virus concern. If you have symptoms get tested. Nasal swabs pick up the DNA of the virus. Blood antibody tests evaluate for acute infection, IgM positive, and past exposure is expressed by IgG positive test results. Early treatment as in any infection should lessen the adverse effects of the infection. The recent Henry Ford study is proof of that response.
Stay healthy, pay attention to safeguards and hopefully this will help you understand some of the underlying triggers of fatigue.
Dr. Alfred Johnson, D.O. is a physician practicing in Richardson, specializing in internal medicine, environmental medicine and chronic disease. For more information, visit johnsonmedicalassociates.com.