Prolonged fatigue is one of the most common complaints among our patients. In standard medicine, when someone complains of fatigue, their doctor usually begins by ordering some basic lab tests to exclude thyroid disease and iron deficiency. They may also ask about sleep but after that many patients experience that investigations come to a halt. Many testify that their doctor or psychologist subsequently looks exclusively for explanations in the psychosocial environment. A common diagnosis is stress-related disorder, and patients are often offered treatment with antidepressant drugs. Chronic fatigue is seen by many as a symptom caused primarily by stress and depression, but the fact is that few symptoms can be caused by such a variety of factors as chronic fatigue.
At Nordic Clinic, we work like detectives to identify the individual causes behind each patient’s symptoms. We ask them to describe in detail their symptoms and their fatigue; when the symptoms occurred, if the course was sudden or slow, how it feels, what makes their fatigue worse or better, what other symptoms the patient has and whether they interact. We’re trying to understand the fatigue – can it be myalgic encephalomyelitis (ME)? Is it a dysfunction of the thyroid gland? Is it burnout? Brain fog? Lack of sleep? Undiagnosed diabetes or narcolepsy? We look at the patient’s entire history, from birth to today. We look at conclusions made by their previous doctors and recommend laboratory tests to confirm or exclude our own hypotheses.
Diet, lifestyle and stress play very important roles in our work, but we also look at many factors that differ from case to case. For example, if there’s reason to suspect an infection, we may choose to investigate whether the patient suffers from tick infections, oral cavity infections and chronic viral infections. In case of suspected abnormalities in the patient’s immune system, we recommend appropriate testing. Furthermore, we also look at many different aspects of intestinal function and the composition of the intestinal flora that have been linked to chronic fatigue in medical research. This also applies to mold exposure, nutritional deficiencies, sleep apnea, celiac disease and physical or mental trauma. We can also choose to proceed with sleep investigations and detailed examinations of sex, stress and sleep hormones. If we suspect that the cells’ detoxification processes or mitochondria (where energy is generated in the cells) are not functioning optimally, we use specific testing to rule that out. If there are indications of heavy metal exposure, we investigate that. The patient might’ve been diagnosed with hypothyroidism but standard medication isn’t working well for them. In those cases we can perform an advanced examination of the thyroid function and possibly look at other pharmaceutical alternatives to standard treatment. If we suspect a severe undiagnosed condition, we refer the patient back to primary care.
In summary, chronic fatigue is well suited for a functional medicine investigation. Most of the time, these patients have already been investigated by their primary care doctor, but haven’t experienced symptom relief. According to our clinical experience, the time it takes to recover differs depending on the complexity of the individual case and how long they’ve lived with his symptoms.