This post is part of a series I call “My Approach Mondays” where I discuss the framework for how I approach various conditions.

You’re fatigued. Tired. Pooped. Tuckered out. Beat. Drained. Wiped out. Spent. Worn out. Run down. You think “I had a hard day/week/month/year. Surely I won’t be tired once I’ve had a chance to recover.” But you don’t recover. The fatigue carries on for months, even years, until you forget how you even got so tired in the first place. It’s almost like your fatigue is fatiguing. How did this happen, and more importantly, what can you do about it?

In the broadest sense, there are two main types of fatigue I see in my office: metabolic fatigue and brain-based fatigue. Most people who suffer from chronic fatigue have some degree of both, so I find that a well-rounded approach is needed to tackle such cases. The problem is that most physicians only address one of the two, and that’s if they even really address it at all! Many people with chronic fatigue are told that they are depressed and are given an SSRI, which may help but generally does not address the underlying dysfunction at hand. This is why I love functional medicine and functional neurology- it allows me to work with fatigue (and so much more) from two angles.

Metabolic fatigue can be caused by a number of things, and those things can be caused by a number of things. For example, perhaps anemia is causing somebody’s fatigue. But what is causing the anemia? Anemia can be caused by a number of different things like autoimmune disease (pernicious anemia), B vitamin deficiency, bacterial infection in the stomach (H Pylori), inflammation, Iron deficiency, proton pump inhibitors and other acid lowering drugs, and malabsorption, which can be caused by numerous other things. Other things that commonly cause metabolic fatigue are thyroid problemsautoimmune diseasediabetes and adrenal fatigue.

Metabolic fatigue is often times fairly consistent. It may come and go, but there is often a pattern that becomes apparent. Hormonal patterns come and go throughout the month, versus adrenal and blood sugar related problems tend to come and go at the same time every day.

Brain-based fatigue is a whole other beast- partially because it can be caused (in large part) by metabolic conditions. Once the underlying metabolic condition is addressed, however, it is often necessary to stimulate the neurological pathways that have become compromised. This is where functional neurology comes in. I use chiropractic adjustments and specific brain exercises to stimulate the brain and evoke changes in neurological pathways.

Brain-based fatigue often comes and goes in relation to your level of exertion. A classic example is a headache or “crash” that sets in after a challenging event or day. As your brain tires, so does your body and mental clarity.

The real no-brainer here is to take care of yourself and see if that makes a difference. A plant-intensive paleo diet, good sleep hygiene and meditation alone goes a long way in resolving much of the above problems. Although sometimes there are underlying problems that might need a little bit of help from a doctor- like anemia and hypothyroidism.

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham “triangle” area.

In health,


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