Is Fatigue Emotional or Medical?

Dr. Aimie

Dr. Aimie

Fatigue is one of the most frustrating physical symptoms and medical diagnoses; however, it’s also one of the least understood! After all, we can’t figure out whether it’s emotional or medical.

It isn’t uncommon for people with diagnoses of Chronic Fatigue Syndrome to be told that fatigue is all in their head.

Looking for a cure, people are sent to psychologists and counseling. This has caused a stigma on how people see Chronic Fatigue Syndrome; people who are diagnosed with it are seen as being crazy. Some people, who have these symptoms, tend to avoid going to the doctor out of fear of receiving this diagnosis and being labeled emotional, difficult, or crazy.

I remember when I started having fatigue episodes, and I was a medical professional who had made jokes about these types of patients in the past. It was a really harsh awakening for me and I didn’t have any answers for it.  

Perhaps it was necessary for me to experience these fatigue symptoms to know that it isn’t all in one’s head. It has not only dramatically changed my perspective on fatigue, but also on the other physical symptoms people experience that don’t have good scientific explanations for…yet.

Fatigue is a Problem! Address it!

The fatigue can come in many different forms, but at the end of the day, any lack of energy that is debilitating is a problem.  

Any other physical symptoms affecting your life are a problem and should be addressed! Chronic pain and fibromyalgia are other symptoms similar to fatigue that don’t have clear answers, and yet, can be greatly impairing and be perceived by others as being all in your head.

No matter what your specific limiting physical symptoms are, there are ways to improve your symptoms and the quality of your life.

Without answers though, what do you do?  

Let’s look at some things in this blog that can help you manage fatigue better. Many of the things we will discuss today will be tools that you can apply to other symptoms for a better quality of health and therefore, life.

Triggers For Fatigue

Fatigue can be persistent or it can come in episodes. Either way, there are times that it’s worse, which means there are times that it’s better.

What makes the difference?  

Fatigue can be triggered by both emotional and physical stressors.

Fatigue is a biological process, and thus is intimately connected to all other biological processes in the body, including the nervous system.

Any deficiencies or imbalances in the body’s nutrition will make it more susceptible to fatigue.

Total stress on the body from disease on the body will be another biological factor that will move a body towards fatigue. This includes things like recovering from an injury or surgery. The body requires energy to heal and repair injuries and attempt to maintain a balance from chronic inflammation or other diseases.

Triggers for fatigue can also be emotional. Emotions are processed by the nervous system, which is purely biological. Therefore, emotional states will affect the other biological systems of the body including energy production and fatigue.  

So, fatigue is a biological process affected by (not necessarily caused by) emotions, but more precisely the nervous system.

You’ll want to address both emotional and physical factors in your life for optimal health and quality of life with fatigue.

Physical (Medical Factors) of Fatigue

However, first of all, you want to rule out the more well-understood causes of fatigue.  

You need to see your primary care doctor and get your labs checked for thyroid hormone levels, vitamin levels, especially B vitamin levels, and hormone levels.

Thyroid: If your thyroid isn’t working well, you’ll be sluggish. This is often presented as fatigue.

Hormones: If you have low testosterone, you’ll also be tired, have low motivation, and be depressed.  
Hormone levels are especially important if you’ve had a head injury in the past or are on pain pills or other opiates. Naturally, hormones will be something you want to consider if you’re perimenopausal.

Vitamins: All the vitamins are important for our nutrition, overall health, and energy production that happens in our mitochondria.

Vitamin B12 deficiency is the one most commonly associated with fatigue. This can happen more in people with restricted diets, especially a vegan diet.  

Vitamin D is another vitamin that has been important for me with fatigue.

More Medical Factors

Diabetes, Autoimmune disease, obesity, allergies, and any other medical conditions all put a stress on the body.  

This is especially true, because conditions with inflammation absorb the energy stores of the body very fast.

You may even want to consider lesser well-known diagnoses like chronic Lyme disease. It’s been other people’s experience that diagnosis and treatment of this was helpful for resolving fatigue.

My recommendation is that you to go to your primary care doctor and get a regular check-up with labs.

Ask them to check everything even if they don’t think that anything is wrong.

If that all turns out well, then you’re left with fatigue without answers.  

Chronic Fatigue Syndrome

Depending on how long you’ve had symptoms and how bad those symptoms have been, you may get a diagnosis of Chronic Fatigue Syndrome.

In this journal published by the American Family Physician, they state the following about Chronic Fatigue Syndrome according to the Center for Disease Control: 

“Chronic fatigue syndrome include severe fatigue lasting longer than six months, as well as presence of at least four of the following physical symptoms: postexertional malaise; unrefreshing sleep; impaired memory or concentration; muscle pain; polyarthralgia; sore throat; tender lymph nodes; or new headaches. It is a clinical diagnosis that can be made only when other disease processes are excluded. The etiology of chronic fatigue syndrome is unclear, is likely complex, and may involve dysfunction of the immune or adrenal systems, an association with certain genetic markers, or a history of childhood trauma. Persons with chronic fatigue syndrome should be evaluated for concurrent depression, pain, and sleep disturbances. Treatment options include cognitive behavior therapy and graded exercise therapy, both of which have been shown to moderately improve fatigue levels, work and social adjustment, anxiety, and postexertional malaise. No pharmacologic or alternative medicine therapies have been proven effective.”

Whether or not your symptoms fall under the category of Chronic Fatigue Syndrome, any lack of energy that’s impairing your life and lifestyle is a problem.

If conventional medicine isn’t giving you any answers, I encourage you to look into other practitioners, like those of Functional Medicine and Alternative Medicine.  

If you have no answers with those additional resources or don’t have money for those visits, all is not lost.

You can start experimenting with your health and learn about your body. You will most likely find out a lot about what seems to trigger the fatigue and things that prolong or worsen it.  

Self-Experimenting and Energy Tracking

Food diaries can be a very helpful tool for you to do on your own that will help you get to the bottom of your fatigue.  

Write down everything you eat and track your energy levels throughout the day; this can reveal a lot of information. This method has been able to help a lot of people with discover what is contributing to their fatigue. People can have food sensitivities, where, for whatever reason, their bodies are reacting to different foods, which can be easy to know about.  

Often they haven’t correlated their mood or energy levels to the food that they’re eating.

Sometimes they’re unaware because their food isn’t immediately causing problems. Since it’s a delayed response, they haven’t been able to connect the fatigue with certain foods.

You also may consider going off of certain foods entirely. It’s been some people’s experience that certain foods are much more prone to trigger fatigue than other foods. This list includes high sugar foods, wheat, corn, and dairy.  

High Sugar Foods – this is recommended anyway for health. Chronic fatigue problems is even more of a reason to go off of sugar! High sugar foods do cause fatigue over time

However, you should expect that you’ll get sugar withdrawals if you do this. Part of those sugar withdrawals can be severe fatigue. This is just an initial response; it’ll get better.  

If you get fatigue when you stop high sugar foods, this doesn’t mean that high sugar foods are actually good for you and you should keep them in your diet!

Feelings Journal – There’s an emotional component to fatigue. That isn’t to say it’s all in your head!
We do know from studies that Chronic Fatigue Syndrome is associated with adverse childhood experiences.

In adverse childhood experiences and other forms of stressful childhoods including relationship and attachment trauma, the nervous system gets imbalanced from the beginning.

Because of how the nervous system is wired, our emotions and biology are intimately connected. While we think about them as separated components, in reality, they’re closely connected in the body. One affects the other.  

This means that stress in general will cause fatigue.  

High anxiety states will also cause fatigue.

Then there are also triggers that will cause a fatigue episode. Things that cause that immediate blow to the gut feeling, the punch to the stomach, and usually what follows is fatigue in the next few days.  

This is because the body has gone into a shut-down mode in response to that trigger.

As we improve our physical health, we’ll build more resiliency for those emotional triggers.

As we improve our physical health, we’ll also be able to do more of that emotional work so that it’ll have less impact.

Those triggers won’t hit us as hard.  

It may scare us, but not overwhelm us to the point of putting our bodies into panic, freeze, and shut-down mode.

This is also where tracking our energy can be a really helpful thing. We talked about journaling our food and tracking our energy to look at any connections there, but we can also track our emotions and any triggers.

Any time we feel that kick in the stomach, we can track our mood and energy over the next several days.  
What I have found to be very common is for the fatigue to hit 1-2 days later.  

Once the fatigue hits, there are things you can do to get out of it a little quicker. For the most part though, you just have to ride it out.  

It’s very normal to get stuck in the fear that you may never feel better. This is exactly what it feels like when your body has shut-down! You don’t feel your life energy anymore! Your energy and mood has flatlined and it feels like it’ll never end.  

While it’s very hard to overcome, this fear will actually keep your body shut-down for longer. As you start to track your energy levels, you’ll notice your specific pattern.  

How quickly do you come out of it?

How deep into collapse does your body go?  

What things make it worse?

What things are useful to your body and mind during this time?

This information is very valuable in addressing the fear that can accompany the collapse, because you’ll start to see a pattern. You’ll start to know your body’s specific patterns, which makes this experience a little more predictable. By understanding it better, it doesn’t feel as scary or unmanageable.

You know what to expect, you understand your better body, and you know it’s only a matter of days before your body comes out of it.  

Some days there are things you can do to pull yourself out of it quicker.

Vitamin D helped me come out of the fatigue a day later. It’s interesting that this is no longer the case since I have started to take daily Vitamin D.

Now I find eating smaller amounts of food and very simple foods will help my body.  

There is almost an unlimited amount of information that you can start to learn about your body and any fatigue or other problematic physical symptoms you get! This deeper knowledge of your body is a real game changer!  

There might be other things that you find in your experimenting that help.  

Summary

If you have fatigue, I really want to encourage you that it can get better.  

You’ll need to invest time and money to figure out what things can help, but it can get better!

On this journey, you can expect there to be ups and downs. With a history of trauma and an imbalanced nervous system, it isn’t a straight path to good health.

You’ll make grounds with one change, and then lose some ground another day.  

What worked before may stop working at a point and you’ll need to go back to the drawing board.  

Overall though, it’s a progressive journey to better health and quality of life.  

With calm persistence, you’ll look back at a point and be able to see your progress.  

With a history of trauma, it’s easier for our nervous systems to go to a place of being overwhelmed and what feels like hopelessness and helplessness. It can be helpful to recognize that this is just your nervous system and not who you truly are as a person.  

With that, I hope that the stories of others can give you encouragement!  

To Health and Healing,
Dr. Aimie

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