Chronic Fatigue, a gut feeling? What are the causes and treatments? by Dr. Raymond Tolmos

August 6, 2015


Chronic fatigue effects over 1 million Americans according to the CDC, and there is not one specific treatment available for chronic fatigue. While the medical field is quick to diagnose chronic fatigue, discovering the root cause of ongoing fatigue is still a mystery to most medical doctors. Nowadays terms like chronic fatigue get thrown around a lot. But what does it really mean? Is it a real disease? Are we born with chronic fatigue syndrome (or CFS)? How do we get it and is it contagious? These are all questions I have heard from my patients. So first let’s talk about what CFS is and how many people it effects. Then we can get into how we can treat chronic fatigue; you may be surprised at how this is done.

Diagnosing Chronic Fatigue Syndrome

Chronic Fatigue Diagnostic Criteria
As you can see above, diagnosing chronic fatigue syndrome requires at least 6 months of fatigue as well as a minimum of 4 of the listed criteria. There is not a specific blood test or biomarker that your doctor may use to diagnose you with chronic fatigue syndrome. This means that your diagnosis is solely up to your subjective complaints and your doctor’s intuition. If you are seeing a medical doctor and get this diagnosis, you may be left wondering “why is this happening to me?”. While most doctor’s will be satisfied by simply diagnosing chronic fatigue, the follow through of treatment is lacking. The same way there is no specific test to diagnose this condition, there is also not a medication for the treatment of CFS, as it’s cause usually differs from patient to patient. This may be one of the reasons that a medicine has not been developed for chronic fatigue: Although over one million Americans are suffering from CFS, many of them suffer for different reasons! Let’s talk about why.

What are the causes of Chronic Fatigue?

As mentioned, chronic fatigue syndrome can have many causes. In fact, there are usually multiple factors that manifest to become chronic fatigue syndrome.

In the world of holistic primary care, we try to identify each one of these factors and return the body to homeostasis or balance in the three realms of stresses. As a chiropractor in Miami, most of the patient’s I see for chronic pain, also tend to have issues with chronic fatigue. The same goes for many of the patient’s with autoimmune disorders and hormonal issues. So why are these patients all so different, but have chronic fatigue in common? Get ready, because this part can get tough to put together- but once you understand it, it makes perfect sense.

Patients with chronic fatigue have physical, chemical, and emotional stresses that contribute to an overall imbalance. This imbalance ends up draining their bodies of vital nutrients and minerals that maintain their state of health and wellness. There are multiple predisposing, as well as environmental, factors that play a role in chronic fatigue, making it so difficult to treat. Let’s start with the predispositions.

Our DNA is coded to perform certain processes on a regular basis that run all of the systems in our body. These processes are then carried out by enzymes that use vitamins and minerals as essential parts of the process. Some people have what are known as genetic mutations, polymorphisms, or SNP’s. SNP’s create a variation in our body’s natural process and can speed up and slow down different processes making each individual completely different. There is one SNP, in general, that plays a large role in chronic fatigue syndrome. As a holistic chiropractor in Miami, I have found that the majority of my patients have the MTHFR gene variant. So what does MTHFR do for us?

The MTHFR gene is vital for making B vitamins readily usable by the body. This is huge for patients with chronic fatigue because B vitamins play an essential role in energy production and also in new cell proliferation. The MTHFR SNP makes the water soluble B vitamin viable to enter a cell, where it’s action occurs, by undergoing the methylation process. It is a simple chemical reaction that happens over 80 billion times a second in the body, however it can occur up to 60% less efficiently for those with the MTHFR mutation.

Understanding the role of how the body uses these vitamins is of the utmost importance because people with the MTHFR mutation are already behind when it comes to energy production. Now let’s look at how else chronic fatigue can become a reality for this population of people.

As previously mentioned the MTHFR SNP decreases the body’s ability to make new cells. This includes both white blood cells and red blood cells. White blood cells make up our immune system meaning people with the MTHFR variant are more susceptible to having immune deficiencies. In addition, our tissues are nourished by our red blood cells. Most people with the MTHFR variant (and a lack of usable B vitamins) have a sort of functional anemia that does not deliver adequate oxygen and nutrients to the body. This means that in the event of a stressful environment, someone with the MTHFR variant has more of a chance of catching a cold from a virus or bacteria as opposed to someone who may be more genetically efficient and more importantly, less deficient in vitamins and minerals.

Sometimes these immune system offenders like viruses, bacteria, fungus, and mold, stick around longer than intended and start to drain the body of its nutrients even more! Some of the biggest culprits here are viruses. Almost all my patients with chronic fatigue have elevated antibodies to Epstein Barr Virus, Cytomegalovirus, Hepatitis, Herpes 1 or 2, and even Varicella. Once we contract a virus we always have it. Our immune system is designed to suppress these viruses but in times of stress or nutrient deficiency, they can run rampant throughout the body and severely drain the body of its B vitamins and anti-oxidants.

This becomes a vicious cycle in which the body is trying to defend itself but is running low on gas. Our body though, amazing as it is, will pull gas from other areas of the body and as a result we start to see fatigue and other symptoms develop. The B vitamins that we need to make new cells, make energy, make anti-oxidants, and detoxify our blood are being used up way to fast by the immune system and therefor lacking in other areas. This is why a comprehensive blood panel from a holistic chiropractor will tell you more about how to heal from chronic fatigue than anything else.

Many times the MTHFR SNP plays a role, but it is also possible that the stomach can be involved in malabsorption of the same B vitamins. This is why sometimes chronic fatigue syndrome can also come from your gut. As a holistic chiropractor in Miami, I send many of my patients home with a stool testing kit. This test is an essential part of discovering the patient’s nutrient absorption and also their immune activity (70% of the immune system is in the stomach). Most people with the MTHFR variant have lowered immunity, meaning they have probably visited their MD and taken a round of antibiotics. These antibiotics wipe out the “good” flora or bacteria in our stomach and create even more of an immune system problem. (This is why it is so important for you to see a holistic chiropractor when you’re sick, as we can use a multi-factorial approach to aiding your immune system rather than wiping out a large part of it with antibiotics.)

So now we have a person with:
• Lowered immune function due to the MTHFR variant,
• Opportunistic infections due to unbalanced stomach bacteria (dysbiosis) which up regulate the immune system and drain it’s nutrients,
• And a genetic inefficiency to make energy.

This is one of the reasons that swollen palpable lymph nodes are part of the diagnostic criteria for chronic fatigue. A chronic low grade infection is usually present along with dysbiosis and nutrient deficiency. This is one of the ways that many chronic fatigue syndrome patients are similar but also so different. While they may have similar case presentations, they may also have different infections which makes finding the cause of the fatigue an individualized diagnosis and therefore requiring individualized treatment.


Treatment of Chronic Fatigue and Chronic Fatigue Syndrome

Treatment of chronic fatigue consists of specific treatments to help balance the patient physically, chemically, and emotionally. As a holistic chiropractor in Miami I have found that starting with the stomach is extremely important. Chemical treatment includes removing harmful substances and any unwanted guests like bad bacteria, fungus, yeast, or parasites is essential. Resolving inflammatory conditions of the lining of the stomach are also important as this inflammation plays a role in proper nutrient absorption. Reinoculating the stomach with the proper flora or bacteria aids in proper digestion, removal of toxins, immune modulation, and also nutrient absorption.

Balancing blood chemistry, which can reveal other nutrient deficiencies, also plays a pivotal role in healing from chronic fatigue. This may include adrenal support, liver detoxification, hormonal rejuvenation, and even neurotransmitter balancing. Additionally, looking for gene variants such as the MTHFR can aid in specifying treatment even more for each individual. For example one type of B vitamin may be useless for a certain genetic make up and it may be too potent for someone with a different genetic make up. Again, this is one of the reasons there is not one specific treatment for chronic fatigue.

Physically, chiropractic treatment has been vital in helping to remove pain from the muscles and joints which prohibit the patient from exercising and moving properly. Depending on the presentation of the patient, relief care may first be necessary which consists of intensive physical therapy and chiropractic adjustments. Moving into wellness care aids to maintain balance of the nervous system which controls everything involuntary in our body. Chiropractic ensures that the patient is adapting to treatment, and also daily stress, as best as possible.

Exercise is also a must. This is case dependent and must be done to tolerance. Exercise however is essential in stimulating the body at the proper time to restore adrenal and hormonal function that has been unbalanced for so long once someone has fatigue for that length of time.

Emotionally, the patient must find time to de-stress. Picking up a new hobby, working with their hands, stimulating creativity are all ways that I recommend we “distract” the body from it’s ongoing stress response and allow the body to “catch up”.  Taking a break from technology and focusing on breathing properly is where most patients start. Progressing to mediation and yoga is recommended and adapting these to their lifestyle will only improve quality of life for each patient in the future.

In closing, I would like you to remember that chronic fatigue and chronic fatigue syndrome are multi-factorial manifestations of lifestyle choices, sometimes genetic make-up, immune status, gastrointestinal function, and history of antibiotic use. If you or a loved one are suffering from chronic fatigue and your doctors are running out of answers or ideas, you may consider seeing a functional medicine doctor or holistic primary care chiropractor such as myself. I am dedicated to helping people realize that there is an alternative to “living with disease and symptoms” and that is to truly heal from our ailments. The process can be a long and difficult one, however if diagnosed and treated properly, the results can be outstanding and the change in quality of life of patients that heal from chronic fatigue is monumental.

Dr. Raymond Tolmos is a graduate of the Florida State University with a B.S. in Exercise Physiology from the college of Human Sciences. He then attained his Doctorate of Chiropractic from Palmer College of Chiropractic in Florida.
Along the way to his education Dr. Tolmos was a personal trainer at the Florida State gym, L.A. Fitness, and Gold’s Gym as well. Besides one on one training and nutritional advice Dr. Tolmos also taught group exercise classes. He feels that all of these experiences to this point have helped him become a better Doctor of Chiropractic.

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