If you are tired all the time, you’re not alone. Far from it, in fact. It’s one of the commonest reasons people go to see their doctor.
Over half the people presenting to their doctor as ‘tired all the time’ can’t be diagnosed with any specific condition. [[i]] Doctors refer to it as TATT for short. In such cases, there are no signs of underlying diseases, yet the patient feels most of the time like someone’s pulled the plug out.
Your doctor may not have the answer
One of the problems is that doctors’ training invariably doesn’t cater much for non-specific conditions like TATT. Doctors can often successfully diagnose certain underlying conditions that might give rise to fatigue or malaise, such as iron deficiency anaemia, heart disease, various thyroid diseases, type 2 diabetes, kidney or liver disease, upper respiratory tract infections, gastric or duodenal ulcers, Lyme disease or pneumonia. But it’s the more common, non-specific type of fatigue that plagues so many that they have more trouble with, and about which they aren’t necessarily trained to provide answers. For example, testing for mitochondrial function (e.g. ATP profile)[[ii]] or offering a protocol that might kickstart improved mitochondria reserve, is rarely on their possible things-to-do list.
When someone suffers from persistent fatigue, many aspects of their life suffer. The quality of their work, the nature of their relationships or family life, their ability to go out, have fun, holiday, exercise –or even party –are often affected dramatically.Depression and anxiety may be triggers for fatigue, or they may be causes. The bottom line is that all kinds of events in life – ones that any healthy person would find manageable or even enjoyable – become a matter of trepidation. A doctor confronted with someone who exhibits these non-specific fatigue symptoms, along with symptoms of depression or anxiety, will often prescribe SSRI drugs (antidepressants). In the US, up to 10% of the population is taking an antidepressant at any one time. [[iii]] Things aren’t much different in most other industrialised countries.
It’s different for different people
TATT sufferers may also experience fatigue at certain times, and not others. Okay, if you haven’t managed to get enough sleep, you’ve got good reason, but if you’re sleeping solidly, or at least trying to sleep, and you just can’t seem to recover and feel energised even after eight hours’ solid, undisturbed sleep, you know something’s not right.
You may also find you lose all your energy at particular times of day, such as after you’ve eaten, or when you’ve taken a limited amount of exercise. Here, specific food intolerances can represent ‘straws that break the camel’s back’, or the exercise may over-drain a body that simply could not produce enough energy for its myriad of functions. It may also be that your immune system is stealing so much energy from the system that it can’t quite mount a successful full-blown attack against a pathogen, while also not leaving enough spare energy for bounding health and vitality – which is the natural state of anyone who is not genetically or physically impaired.
There can also be ongoing mediators or perpetuators that prevent the body restoring normal energy functions, such as exposure to specific allergens or environmental toxins, through to stressful life events (e.g. relationship or work-related challenges, financial difficulties, loss of a loved one), a poor diet, a particular nutrient deficiency, insufficient physical activity or relaxation, poor sleep quality, smoking, too much drink or other unhealthy habits.
All of these elements can work together and conspire to create a vicious circle that is, sadly, all too familiar to long-term sufferers of TATT syndrome.
However, as many previous sufferers of TATT, chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) have found, there are things that can be done both nutritionally, and in terms of lifestyle, that can help provide an environment that allows the body to be re-orientated back to a path of vital health and well-being. [[iv]]
Three processes to head you in the right direction
The starting point often involves supporting the energy-producing ‘factories’ in our cells, the mitochondria. By eating and exercising in specific ways, you can transform both the density and volume of mitochondria in your skeletal muscles especially. More and bigger energy factories in your cells means there’s more energy in your system.
The second process needing attention is finding ways to manage the amount of oxidative stress within the body. This is about ensuring that you have the right balance of nutrients that help to scavenge free radicals that can damage cells, cell membranes and DNA.
The third process, linked closely to the above two, is about providing the best possible environment for your body, one that nurtures it and allows it to function optimally. This means learning to be good to yourself, including eating as well as you can, taking particular supplementary nutrients, resting right and sleeping well. It also involves finding appropriate ways of being physically active and finding the best ways of transforming stress.
Six steps to help fire up your mitochondria
- Don’t sit for more than five hours a day, and don’t sit for longer periods than one hour, without standing, walking or moving from a non-seated position for at least five minutes. Regularly counteracting gravity –be it through going to make a cuppa for your colleagues or friends, bouncing on a rebounder, running up some stairs, or doing some press-ups, sit-ups or other bodyweight exercises–should be built into your daily routine. This is particularly important if your job is sedentary. Set a timer to remind you it’s time to stand, walk and move! Or, if you can manage it, get yourself a standing desk or workstation.
- Focus on getting high quality sleep at night in a completely darkened room. Any light (e.g.,street light, moonlight) in your bedroom will interfere with your ability to produce melatonin. Maintain good ‘sleep hygiene’ practices, including making sure that you have no electronic devices within five metres of your bed that are switched on while you sleep, and ensure you have at least one hour before bedtime that you are entirely screen free (also minimise screen time generally as far as you can).
- Incorporate some high intensity interval training (HIIT) into your week’s activity, ideally around three times a week. How hard you push yourself during your intense phase, which might last between 30 seconds and two minutes, is going to depend on your level of fitness and underlying health. If you’re unsure what’s right for you, consult a personal trainer. Try your HIIT sessions in a fasted state, ideally after an overnight fast that’s run for over 12 hours (yes, that might means doing your HIIT before breakfast, or even skipping breakfast). It’s a great way of upping your natural production of growth hormone and improving your insulin sensitivity. Inside a 30 minute window of completing your session, consume around 20g of protein to replenish your exhausted muscles that will be ready to recover and grow after their ‘super compensation’ trigger and anabolic response.[[v]] It’s often easiest to take this as a shake, such as a high quality, dairy-free, vegetarian protein based on pea protein isolate.
- Have you tried intermittent fasting? If you haven’t, now’s maybe the time – knowing it’s what your mitochondria love! That could mean not eating more frequently than every five hours,[[vi]] giving up snacks between meals, eating just two meals rather than three meals a day – or doing Dr Michael Mosley’s 5:2 fast diet,[[vii]] where two days a week you drastically restrict your food intake to around 500-600 kcal a day.
- Include some longer bouts of endurance training into your weekly activity. That can be anything from longer walks, cycle rides, swimming, kayaking– take your pick. These activities should ideally be two hours or more as, during the first 90 minutes or so, you’ll just be burning stored carbohydrate in the form of glycogen in your muscles and liver.[[viii]] After this you start burning fat – your mitochondria’s favourite and cleanest endurance fuel. Your fat fuel can come both from your own body fat, and fats you consume in your diet. These should all be healthy fats like hydroxytyrosol-rich, cold-pressed, extra virgin olive oil, MCTs from coconut oil and omega-3 fatty acids from fish oils or algal sources. Take it easy on omega-6 rich polyunsaturated acids that are the predominant fats in most cheaper vegetable oils, over-consumption of which prevent our anti-inflammatory responses from working properly. Most people will need to supplement with a high quality omega-3 product.If you can get a blood spot test done (e.g. HQT fatty acid analysis), your omega 6:3 ratio should ideally be less than 3:1, which represents our evolutionary norm.
- It’s also important to ensure that all the cofactors your mitochondria need for making energy via the citric acid (Krebs) cycle and the respiratory chain (electron transport), are included in your diet and/or supplements. This includes B-vitamins (especially niacin, B6, panthothenic acid, folate and B12), vitamin C, magnesium, zinc, calcium, iodine and selenium, as well as L-carnitine, coenzyme Q10 and alpha lipoic acid. Supplements should include at least the Nutrient Reference Value (recommended daily allowance) of all vitamins and minerals in their most bioavailable forms.[[ix]] Recent evidence suggests that PQQ (pyrroloquinoline quinone) can actually trigger mitochondrial biogenesis.[[x]] Fermented soybeans (natto) and parsleyare two of the richest food sources of PQQ, which is now also available in some supplements.
Robert Verkerk PhD is the founder, executive and scientific director of the non-profit, Alliance for Natural Health International (www.anhinternational.org). Through his work over the last 30 years in academia, commerce and the non-profit sector, he has been an outspoken advocate of working with, rather than against, nature. His work has spanned the fields of agriculture, healthcare, energy and the environment.
[[i]] Patient website, entry on ‘Fatigue and TATT’: http://patient.info/doctor/Fatigue-and-TATT.
[[iii]] Calderone, J. The Rise of All-Purpose Antidepressants. 1 Nov 2014, Scientific American: www.scientificamerican.com/article/the-rise-of-all-purpose-antidepressants
[[vi]]Verkerk, R. ANH Food4Health Plate: the starting point for metabolic flexibility. 4 Feb 2015: http://anhinternational.org/2015/02/04/anh-food4health-plate-the-starting-point-for-metabolic-flexibility/
[[vii]] The Fast Diet website: https://thefastdiet.co.uk
[[ix]] Myhill S, Booth NE, McLaren-Howard J. Targeting mitochondrial dysfunction in the treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) – a clinical audit. Int J Clin Exp Med. 2013; 6(1): 1-15.
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