Chronic fatigue is often dismissed and not taken seriously in the conventional medical model. That’s why I’m excited to introduce you to Dr. Jenny Tufenkian. She is a naturopathic physician from the Pacific Northwest but she’s helping people around the world with chronic fatigue and particularly with long COVID type fatigue symptoms. 

It’s always so wonderful to get to connect with another naturopathic doctor and to share more about naturopathic medicine and how we think about health issues and I find that fatigue is one of the most common symptoms that people call with. The thing about it is there’s a lot of possible underlying causes.

Conventional Medicine vs. Naturopathic Medicine

In naturopathic medicine, we have a unique perspective on health and healing. We focus on identifying and treating the root causes of illness, rather than just managing symptoms. When it comes to chronic fatigue, this approach is particularly valuable because fatigue can be caused by so many different factors – from hormonal imbalances to chronic infections to nutrient deficiencies. By taking a comprehensive look at a person’s health history, lifestyle, and current symptoms, we can start to piece together the puzzle and develop a targeted treatment plan.

A lot of people who struggle with exhaustion and fatigue do get dismissed and don’t get the attention they deserve in the conventional medical model. If you go into your conventional physician and say I’m tired, they’re going to run a few labs looking for anemia, acute mono, cancer, or other scary things that can lead to fatigue.

Once they get a “no” check on those, it’s like “you know, it’s probably because you’re just a mom” or “you know, you’re working” or “you’re getting older now that you’re 45, you’re so old.” It’s somehow seen as normal to feel tired all the time. So many people walk out going “wait a minute, how come my labs are all normal but I feel awful?” 

Part of the problem is the way that we are in this culture. There’s this real “you get bonus points if you push yourself really hard, you get bonus points if you’re super exhausted.” This is such a pervasive issue in our society. We’ve normalized burnout and equated exhaustion with productivity and success. But it’s not healthy and it’s not sustainable. As naturopathic doctors, we want to help people understand that chronic fatigue is not normal and it’s not something you just have to live with. There are ways to get your energy and vitality back.

Defining Different Types of Chronic Fatigue

If you are struggling with chronic fatigue, myalgic encephalomyelitis, long COVID or just have been exhausted for a long time, you’re on that burnout train. But we have to consider that there are many kinds of tired. We have to analyze what kind of tired is it. There’s the heavy weighted down in your limbs tired that can be from a chronic viral infection that’s been reactivated or not kicked out completely.

There’s the kind of tired and wired feeling which can be more of an imbalance of your hormones, your adrenal glands, having either high or low cortisol levels from pushing through your energy level all the time. There are different things that we have to consider because there are many many root causes.

It’s so important to really understand the kind of fatigue you have. Is it more physical or mental fatigue? Is it worse at certain times of day? Does it come on suddenly or is it more of a constant background noise? These nuances can give us clues into what might be going on beneath the surface.

Another important distinction is between fatigue and sleepiness. A lot of people use these terms interchangeably but they’re actually quite different. Sleepiness is the drowsy feeling you get when you’re ready for bed. Fatigue is more of a deep exhaustion that doesn’t necessarily resolve with rest. You can sleep 10 hours and still wake up feeling fatigued if the underlying causes aren’t addressed.

Underlying Causes of Chronic Fatigue

The conditions of chronic fatigue and long COVID are so complex. The NIH brings up the latest research every four years on what’s causing these conditions. They still don’t know the cause. But until then we can consider there are five root causes that can lead to somebody having chronic fatigue and/or long COVID:

1. The Hormone Triangle: This is the combination of the thyroid, adrenals, and ovaries (or testes if you’re male). People who are on that stress express, pushing themselves, may wake up in the morning feeling okay but by afternoon are done. That can be a sign of the adrenal gland not being balanced. Hypothyroid can be part of it too – we need to test the full thyroid panel.
2. Mitochondrial Issues: The mitochondria are the powerhouses of our cells and are vulnerable to the environment. A lot of people have mitochondrial problems. If it’s a mitochondrial issue, they have what’s called post-exertional malaise – they do more than usual and then are crashed out for hours or days afterwards.
3. Toxic Overload: This relates to the mitochondria. People who have mold or mycotoxins in their environment, too many heavy metals like lead from gasoline or mercury from fillings, pesticides, herbicides, glyphosate, etc. These toxins can really impact the mitochondria.
4. Infections: These can be viral, bacterial or fungal infections. They are sneaky and take over blood sugar production, zapping your energy. Unfortunately we don’t have great testing for these. As naturopaths, we treat the patient not just the lab. We listen for clues in their story, like if they had mono in college, healed, but then a stressful event like a car accident and they haven’t felt well since. The Epstein-Barr virus can also flourish under stress.
5. Limbic/Emotional Brain: This brain is attached to the vagus nerve which picks up info from your whole body, like if you have gut dysbiosis. It sends the message to the brain that things are not safe. If this latches onto past trauma, the brain starts reorganizing nervous system and immune signals. The mitochondria can go into a protective hibernation mode, producing less energy. 

A lot of people are surprised to learn how much these different systems in the body are interconnected. For example, you might not think your thyroid has anything to do with your gut health, but in fact, an imbalanced thyroid can lead to constipation and digestive issues. Or you might not realize that unresolved emotional trauma can actually manifest as physical symptoms like fatigue and pain.

This is where the naturopathic approach is so powerful, because we’re always looking at that big picture perspective. We understand that you can’t just treat one part of the body in isolation. Everything is connected and everything matters when it comes to your health.

Naturopathic Medical Testing

As naturopathic doctors, we can do tests that are considered specialty tests, outside the standard blood work, that can help us know what’s underlying. We can get more specific information about what’s going on in your body so you’re not having to stay in a state of guessing.

There are conventional tests we run that are standard tests from LabCorp or Quest that insurance covers and give us good info. But you can have a normal lab that’s high normal or low normal and that can indicate a functional level of dysfunction in your body. You may not be at an extreme disease state but we can begin to see issues – like if liver enzymes are in the 30s (still “normal”) but along with headaches, PMS and skin issues, maybe we want to pay attention to your liver.

A few tests to run when looking for the underlying cause of fatigue are:

• Salivary cortisol test: An easy, inexpensive test that gives so much information. Understanding what’s happening with our main stress hormone cortisol is so important. We all have some degree of stress so it’s very likely affected. But that info you won’t get in standard blood work. Simply doing a salivary cortisol at different times of day is so eye opening – then we can go “oh wow, this is what my body’s been trying to tell me.”
• Mold and mycotoxin testing: This is a tricky subject but mold exposure can wreak havoc on your immune system, hormones, cause brain inflammation. In recent years, mold toxin testing has gotten so clear and helpful. It’s so worth it to know, otherwise we’re in constant guessing. When you can invest in a test that clearly shows mold toxins, you get to be proactive.

It can be hard to prioritize testing when you feel like “how am I going to get through the day because I feel so yucky.” But sometimes, once you have the test info in front of you, it actually doesn’t take that much energy. Then it gives us as practitioners such valuable information to guide you better, so you can be more efficient in your healing. Once you have validation in black and white you can say “OK, so now what is going to work with my body?”

Expanding the Toolkit

A lot of people have been sick for many years, sometimes decades, and have tried many things that may or may not have worked. If you’ve tried things and felt discouraged, do not give up hope. Everybody’s body is different. Just because your friend took this one thing and it made her feel amazing, it doesn’t mean it will also work for you. Everybody responds differently to different treatments. It’s really about understanding how your body works, what remedies work for you. 

In naturopathic medicine we have such a wide toolkit. We have energetic medicines, pharmaceuticals, mind-body work, and this whole huge range of things. We have to figure out what works for you. Finding that thing so the patient can be empowered and know forever what remedies they respond to is key.

Testing is such an important part of the naturopathic approach because it allows to gather objective data about what’s going on inside your body. We do not just rely on symptoms, which can be subjective and changeable. We’re looking at measurable markers that give us insight into your hormones, your immune system, your detoxification pathways, and more.

And the beautiful thing is, once we have that information, we can develop a personalized treatment plan that is tailored specifically to your needs. We’re not just giving you a one-size-fits-all protocol or a pill for every ill. We’re really looking at what YOUR body needs to heal and thrive.

The 5 Pillars of Healing

There are five pillars that are the foundation for all good health. No matter what treatment you’re doing, these will help. Often this is all you need to do is to work on these foundations. 

Think about which ones you have under control and which ones you know are a challenge. It’s good to look at both. Then the ones where you feel challenged – that’s the place to pay attention and address.

The pillars are:

1. Digestion and Detoxification 
2. Rhythm and Sleep
3. Movement and Breath
4. Mindset and Spirit
5. Connection (connection with others, ourself, and our higher self/spirit)

Every day we want to have all of these pieces in place. Some days will be better than others, some more in or out of balance. But having them in mind or on your fridge of what you’re focusing on can be really helpful. For those struggling with chronic fatigue or any illness, discovering which one is most disrupted for you is going to be massive. I would just focus on that one.

If your sleep is trash, focus on sleep. If you know you’ve probably got leaky gut and dysbiosis, get that digestion working. Treat the gut first, we all know that. A lot of times when patients are hitting that point of fatigue, it often comes with anxiety, depression, overwhelm, and digestive issues — all combined. And then patients feel like “where do I go from here?” We know if we just go to the ER, they’re not going to be able to help with this situation. It’s not a broken bone or need for surgery. 

We need to get back home and practice implementing these foundational self-care activities that we don’t learn very well in childhood. At whatever point we are, there’s no judgment. This is our time to learn how to take better care of ourselves, so we have what we need to function each day.

Food is such a foundational piece of health that often goes overlooked. We’re so used to thinking of food as just fuel or calories, but the reality is, the foods we eat are literally building blocks for our cells and tissues. If we’re not giving our body the nutrients it needs or if we’re consuming foods that are inflammatory or hard to digest, that’s going to have a massive impact on how we feel.

Sleep is another big one that a lot of people struggle with, especially in our go-go-go modern world. We’re so used to burning the candle at both ends and sacrificing sleep for productivity. But sleep is when our body repairs, regenerates, and recharges. If you’re not getting enough quality sleep, it’s going to be really hard to overcome fatigue no matter what else you’re doing.

It is critical to build a strong foundation for our health. Yes, targeted supplements and treatments are important, but if you don’t have those basic building blocks of good nutrition, restful sleep, stress management, and so on, it’s going to be an uphill battle.

Connection Between Brain and Fatigue

There really is a lot happening in the brain. There are so many connections now where we’re seeing the brain fog people get with fatigue, and some of the mood stuff like anxiety and depression, is a similar mechanism in the brain. It’s inflammation in the brain. That really needs to be taken care of because the progressive state is to lead to one of the dementias. Those are early signs we really want to pay attention to and get under control.

We usually think of inflammation on our skin when it’s red and swollen, but inflammation in our nervous system can look like fatigue and brain fog. That’s the brain saying “ouch.” Brain inflammation has a different pattern than the rest of the body. If you sprain your ankle, there’s a 72-hour peak of inflammation and then it goes down unless you reinjure it. The brain isn’t so good at turning that inflammatory process off. It can stay burning and smoldering and prime those glial cells, so it’s really easy to become a chronic problem.

This is such an important point because I think a lot of people don’t realize how much our brain health impacts our overall health and vice versa. We tend to think of the brain as separate from the body, but in reality, they are intimately connected.

Chronic inflammation in the brain can lead to all sorts of symptoms beyond just fatigue and brain fog. It can affect our mood, our memory, our ability to focus and concentrate. Over time, as you mentioned, it can even increase the risk of more serious neurodegenerative diseases.  

This is why it’s so crucial to address brain health when we’re dealing with any kind of chronic health issue. We need to be supporting the nervous system and reducing the inflammatory burden. There are many ways to do this from a naturopathic perspective – things like optimizing nutrition (especially omega-3 fatty acids and antioxidants), balancing neurotransmitters, supporting detoxification, and using targeted botanicals and nutrients that cross the blood-brain barrier.

We also can’t ignore the impact of stress and emotional health on the brain. Chronic stress, unresolved trauma, anxiety, depression – all of these can keep the brain in a state of hyperarousal and inflammation. This is where practices like meditation, mindfulness, therapy, and other forms of stress reduction can be so transformative.

The important thing to know is that healing is possible. Yes, it can feel like an overwhelming and even impossible journey at times, especially if you’ve been dealing with chronic fatigue or other health issues for a long time. But our bodies have an incredible capacity to heal when given the right support. 

It’s not always a linear process and it does take work and commitment. But small steps over time can lead to profound transformations. Don’t give up on yourself. Keep seeking answers, keep advocating for your health, keep believing that you can feel better.

Naturopathic Next Steps for Addressing Chronic Fatigue

If you would like to learn more about Dr. Jenny and how she can help you, check out her website here. In her website you will find a quiz to learn your “tired type”. You can also find her on Instagram @dr.jennytufenkian or Facebook @Dr. Jenny Tufenkian ND. 

To learn more about my approach to fatigue using my Stress and Trauma Recovery Protocol® which involves optimizing cortisol and adrenaline levels to heal the adrenals using nutrients, herbs and C.A.R.E.™, my proprietary program to support clean eating, adequate sleep, stress recovery and exercise, I encourage you toread all about it in my latest book, Master Your Stress Reset Your Health.

For the most comprehensive support, even with the most difficult health issues (physical or mental), and for access to the tests I mentioned in this episode, it is best to meet with me one-on-one, which is available to you no matter where you are in the world (via phone or zoom). You can set up a one-on-one appointment here.

And remember, you don’t have to do it alone. Surround yourself with a team of practitioners and support people who believe in you and your ability to heal. Whether that’s a naturopathic doctor like myself or Dr. Jenny, a functional medicine practitioner, a therapist, a health coach, a loved one – find your tribe and lean on them.

This is your journey and your story. Trust the wisdom of your body and never stop fighting for the vibrant health and energy you deserve. It’s there waiting for you.

We’re here to help you!

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