Chronic Fatigue & Low Energy

About This Condition

Chronic fatigue is one of the most common chief complaints in primary care and one of the most poorly addressed. It encompasses a spectrum from persistent tiredness that impacts daily function to the debilitating post-exertional malaise of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Conventional medicine frequently dismisses these symptoms once basic labs return normal, leaving patients with lifestyle advice and no answers. The actual differential is broad: thyroid dysfunction, iron deficiency (with or without anemia), sleep disorders, adrenal insufficiency, mitochondrial dysfunction, viral reactivation (EBV, HHV-6), mood disorders, and nutritional deficiencies (B12, folate, vitamin D, iron, ferritin).

Our Approach

We investigate fatigue systematically. Our extended fatigue panel includes complete blood count with differential, comprehensive metabolic panel, thyroid full panel (TSH/Free T3/Free T4/reverse T3), ferritin (not just serum iron), vitamin B12 and methylmalonic acid, folate (RBC), vitamin D (25-OH), magnesium (RBC), cortisol (AM with optional 4-point salivary), and inflammatory markers. We also assess sleep quality with validated screening tools and refer for formal sleep study when warranted. When adrenal dysfunction is identified, we implement structured cortisol support protocols prior to any stimulant-based approach. Mitochondrial support protocols including CoQ10, ribose, acetyl-L-carnitine, and B-complex are deployed when indicated. We track response with validated fatigue scales and body composition data over time, not just symptom surveys.