“Don’t ask yourself what the world needs. Ask yourself what makes you come alive, and then go do that. Because what the world needs are people who have come alive.” — Howard Thurman

Treatment of fatigue begins with identifying the cause. If it’s identifiable, reversible or treatable with changes in medication, lifestyle, diet or a procedure, this should be done.

The simplest examples are a previously unidentified low thyroid state or depression that can usually be remedied by an appropriately dosed medication. Others are use of a CPAP machine for sleep apnea or supplemental iron for anemia.

However, what about the kind of fatigue that won’t go away and for which no clear cause can be found? Let me offer a pragmatic approach based on my clinical experience and that of many other doctors facing this dilemma together with their patients.

First, there’s no one way for everyone. For post-COVID syndrome fatigue, managing the organ system affected, be it heart, lungs, or muscular and physical deconditioning with rehabilitation exercises, appropriate medications, even oxygen may help.

Integrative medicine practitioners offer an array of supplements that ought be given a therapeutic trial and discontinued if not effective. I nearly always offer a high potency B-vitamin for those suffering from persistent fatigue. The B vitamin group performs many functions in the body having to do with energy.

Low B12 is a classic example and low levels, say from poor dietary intake, malabsorption because of low stomach acid, gastric bypass surgery or certain medications like metformin can lead to fatigue and anemia. A good high potency B-50 or B-100 is preferable to the usual multivitamin. For some, higher levels such as with self-administered B12 injections is helpful.

Co-Enzyme Q10 is an important factor in mitochondrial energy transfer and also is a safe consideration. It has been found to be low in those on statin medications for cholesterol and can reduce muscle cramps in this group.

A variety of plant-based or herbal compounds are known traditionally to be used for fatigue. Caffeine is, of course, the most well-known and widely utilized. Others that might be considered are ginseng and ashwaganda.

Depending on the cause of the fatigue, I often offer magnesium, which is helpful in over 300 enzyme functions and may be low in our dietary intake or washed out by diuretics or excess alcohol use. It also often helps with muscle cramps.

If you find yourself in a hole, stop digging. Certain maladaptive lifestyle patterns such overwork, stress, poor sleep, inactivity, obesity, an unhealthy and pro-inflammatory high-fat, high-sugar diet, substance abuse or plain boredom can all lead to chronic fatigue. Change what and when you can, perhaps with the help of your health professional, coach, counselor or nutrition consultant.

Above all, don’t give up on chronic fatigue because you don’t think you have the energy to deal with it, or that it can ever improve. Persist and know that with the appropriate evaluation and management, you can be better, coming alive to the life you have dreamed.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.

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