Three hidden culprits and how you can conquer each
One of the most common complaints I hear as a doctor is having a lack of energy. But the reasons behind it are always tricky to pin down—especially among older patients.
The fact is, a lot of things could make you feel tired—from spotty sleep, to poor nutrition, to lack of exercise. Not to mention, it’s easy to wave off low energy as a simple consequence of aging.
But let me be very clear: Chronic fatigue is a huge red flag when it comes to your health. And not taking it seriously is a huge mistake… at any age.
New research shows that a high susceptibility to fatigue, or fatiguability, can be a crystal ball for the fate of your health. In fact, it could DOUBLE your death risk.
I’ll tell you all about it, along with three hidden culprits behind chronic fatigue—and how you can conquer each.
Fatigability predicts death
According to a recent study from researchers at the University of Pittsburgh, an older person’s fatigability can predict death within a matter of just three years.
This team assessed energy levels among nearly 3,000 subjects aged 60 years or older. (All data was collected by the end of 2019, so the pandemic was not a factor.)
Participants reported, on a scale of zero to five, how activities like a 30-minute walk, light housework, or heavy gardening would make them feel, in terms of tiredness.
And get this: Over an average of just under 3 years—and after accounting for factors like depression, pre-existing illness, age, and gender—the researchers found that subjects who scored the highest on the fatigability scale were 2.3 times more likely to die than their higher energy counterparts.1
In other words, steady energy is a signpost of vitality—literally. And as you can see, losing it really is a matter of life and death. Unfortunately, the secret to fighting fatigue isn’t always so simple…
Yes, I could tell you to exercise more. (A consistent commitment to daily physical activity is the single best way for you to increase your endurance and energy levels.)
I could also tell you to stress less and sleep better. (Relentlessly high stress levels without adequate rest and relaxation will leave you feeling exhausted, no matter what you do.)
But let’s say you’re already doing those things—and your energy levels are still in the toilet. Does that mean your fatigue is all in your head?
The fact is, there are some very real and identifiable hidden causes behind chronic fatigue. And as this latest research shows, failing to address them could prove lethal.
So, let’s review three of the biggest culprits that your doctor might be missing…
Culprit No. 1: Your thyroid
Okay, I can hear you now—your doctor already checked for that. But here’s the thing: They probably didn’t check your thyroid levels properly. That’s why hypothyroidism—an underactive thyroid—often goes undiagnosed. Let me explain…
Your thyroid is a tiny butterfly-shaped gland located in your neck. It generates two main hormones—thyroxine (T4) and triiodothyronine (T3). These hormones influence metabolism, body temperature, heart rate, protein production, and more.
Maintaining optimal levels of T4 and T3 requires thyroid-stimulating hormone (TSH). When levels of either T4 or T3 are too low, your body produces more TSH to stimulate your thyroid. That’s why high TSH levels will often be one of your very first signs of hypothyroidism.
Unfortunately, most conventional doctors tend to treat this as the only sign—so when TSH test results come back normal, they consider it case closed.
As a result, tons of patients with thyroid dysfunction are slipping through the cracks. And research suggests that chronic fatigue syndrome (CFS) is one of many devastating consequences of this oversight.
In fact, one recent study showed that CFS patients have normal levels of TSH… but low levels of T3 and T4.2 At the same time, levels of reverse T3—an inactive form of the hormone—were notably elevated.
So, what’s behind this anomaly? The short explanation is that your body needs to convert inactive T4 into T3 in order to use it. But this conversion rate isn’t always successful in those with hypothyroidism.
This suggests that an issue converting T4 into T3—or “low-T3 syndrome”—could also be responsible for CFS.
How to detect a thyroid imbalance
It should be clear by now that, when testing proper thyroid function, you can’t go on one number alone. Because even when TSH levels are perfectly normal, there could still be trouble brewing behind the scenes.
Of course, another part of the problem is what mainstream doctors consider to be “normal.”
There are countless people who have symptoms of a thyroid imbalance, but their TSH results don’t indicate a problem. (Proof that the numbering system is all wrong.) That’s why I always treat every patient whose TSH is greater than 2.0 mIU/L.
But—a comprehensive thyroid panel should also look for levels free T4, free T3, reverse T3, thyroid autoantibodies, and TBG (thyroxine binding globulin—a protein that moves thyroid hormones through the body).
Free T3 and T4 tests will tell you how much available thyroid hormone is circulating in your body. A reverse T3 test will tell you if your body is storing T3 or if it’s using it properly. And any results that show out-of-range levels are big red flags.
As for treatment, I’ve been prescribing desiccated thyroid replacement my entire career. (You’ll find it under the names Nature Thyroid, Thyroid USP, and Armour Thyroid.)
Meanwhile, Synthroid® (levothyroxine)—a synthetic form of T4—is the drug many mainstream doctors prescribe for an underactive thyroid. But I’ve found that many of my patients don’t like the way they feel when they take it. This is likely due to the conversion problems we talked about above… because our bodies need to convert T4 into T3.
That’s why I always prescribe a natural thyroid preparation that includes both T3 and T4, like the three I mentioned above.
Now, let’s move on to the second culprit that the average doctor could be missing…
Culprit No. 2: A leaky gut
Once again, this is an all-too-common issue that gets serious short shrift among conventional doctors. If they can’t cure a problem with their prescription pad, it might as well not exist.
But believe me, the effects that leaky gut have on your health are very real—spiraling energy levels could simply be the first telltale sign.
In fact, Cornell researchers found evidence that people with CFS have very different gut bacteria than those who don’t. (Those with CFS had greatly reduced bacteria diversity.)
Research also revealed differences in the types of bacteria. (In people with CFS, the species of bacteria known to fight inflammation were noticeably lacking.)3
But here’s where it gets really interesting… The researchers also looked at blood samples and discovered increased inflammation markers in CFS sufferers. And, well—those inflammation markers likely got into the blood from the intestines.
It all boils down to an intestinal problem I’ve warned you about before: leaky gut.
The technical name for leaky gut is “intestinal permeability,” and it occurs when the junctions that control what can pass through the small intestine’s lining don’t work properly. The result? Substances that are meant to be excreted (like waste and toxins) instead pass into the bloodstream.
This malfunction can lead to a constellation of symptoms, including some of those seen in CFS—aches, pains, abdominal cramps, and more.
But it also triggers an inflammatory immune response, as the body reacts to bacteria in the bloodstream. Of course, there’s a simple way to combat leaky gut—and, in turn, chronic fatigue…
How to repair your gut
As with most health concerns, taking control of leaky gut starts with a healthy diet that will reduce inflammation.
And yes, the dietary principles I continue to advocate for apply: Cut out sugar and grains. Focus instead on whole, organic vegetables, healthy fats, and lean protein (like grass-fed and -finished meat and wild-caught fish and seafood).
In addition, smart supplementation can help you heal the damaged junctions in your intestines that are allowing waste to leak into your bloodstream.
Probiotics are among the most important here. Because the simplest way to make sure your microbial population is thriving is by taking a high-quality probiotic daily.
Look for one with multiple live strains of good bacteria. And remember, when it comes to probiotics, more isn’t necessarily better. The key is diversity of strains rather than quantity. A good probiotic should also have its own food supply (known as prebiotics) and postbiotics (such as bacteriocins) to help to kill off the bad bugs in your gut.
Vitamin A is another important player, which reinforces the junctions of your intestinal walls and ensures proper function of the cells lining your gut. I recommend 12,000 mcg (40,000 IU) of vitamin A (as retinol) per day.
Finally, there are a handful of key botanicals that can help reinforce the mucosal lining of your intestines, too:
- Deglycyrrhized licorice (DGL)—500 mg per day
- Aloe vera leaf extract—250 mg per day
- N-acetyl glucosamine—250 mg per day
- Slippery elm bark—200 mg per day
- Marshmallow root—100 mg per day
Last but not least, when taken on an empty stomach, digestive enzymes can make their way into your bloodstream and go after any undigested food particles that may have slipped through your intestine’s lining. (See the box below.)
These supplements are easy to find. And they’re affordable.
Culprit No. 3: Amino acid deficiency
Speaking of nutrition, this brings me to our third hidden culprit behind fatigue: amino acid deficiency.
Back in 2017, researchers identified that the hallmark symptoms of CFS—most notably, a profound lack of energy—result from the blockage of a key metabolic enzyme.
In fact, the study revealed that most CFS patients have low levels of specific amino acids that fuel oxidative metabolism. As a result, the key enzyme necessary for turning carbohydrates into energy fails.4
When this enzyme is impaired, the body may be forced to consume different fuels—causing energy levels to plummet. This can also spur a buildup of lactate in the muscles.
(This explains why CFS sufferers complain of burning pain after even the slightest bit of exertion. So, be careful when it comes to exercise. Any amount can cause an energy drop and lactic acid build-up, depending on your fitness levels and the severity of your condition. Taking it too far could lead to major symptom flare-ups that can persist for weeks, even months. In other words, keep moving, but at tolerated levels—pay attention and listen to your body.)
Of course, functional medicine has always focused on amino acids and the roles they play in the body’s processes. So I’m hardly surprised that it’s not yet “accepted and standard” practice for CFS sufferers. Or that your doctor may also overlook this simple contributor of fatigue.
So, here’s how you can take advantage of these findings.
How to put amino acids to work for you
Twenty percent of the human body is made up of protein, and amino acids are the buildings blocks of all proteins. So it’s not hard to see why sufficient intake—through diet and supplementation—is important. (After all, amino acids play a critical role in just about every single biological process.)
If you have chronic fatigue—or even just persistent low energy—you need to pay close attention to your amino acid intake. Then, work to fill the gaps.
There are three groups of amino acids: essential, non-essential, and conditional.
Our bodies cannot make essential amino acids, which is why they must come from our diet. Those include histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.
Meanwhile, our bodies can produce non-essential amino acids, even if we don’t get them through diet. Those include alanine, asparagine, aspartic acid, and glutamic acid.
And finally, conditional amino acids can typically be made in our bodies, except during times of illness or stress. Those include arginine, cysteine, glutamine, glycine, ornithine, proline, taurine, serine, and tyrosine.
Of course, everyone’s amino acid needs are different, depending on age, weight, and health status.
I address all of this in detail in my book, The A-List Diet. (Can you guess where the “A” in “A-List” comes from?) If you haven’t ordered a copy, I urge you to do so today, so that you can start putting amino acids to work for you: www.AListDietBook.com.
You have nothing to lose. And a whole new reserve of energy—not to mention, a longer lifespan—to gain.
SIDEBAR: Six key digestive enzymes
- Cellulase—10 mg daily
- Papain, bromelain, and lactase—50 mg
of each, daily
- Lipase—16 mg daily
- Amylase—200 mg daily
- Glynn NW, et al. “Perceived Physical Fatigability Predicts All-Cause Mortality in Older Adults.” The Journals of Gerontology: Series A, 2021; DOI: 10.1093/gerona/glab374
- “Higher Prevalence of “Low T3 Syndrome” in Patients with Chronic Fatigue Syndrome: A Case-Control Study.” Front Endocrinol (Lausanne). 2018 Mar 20;9:97. doi: 10.3389/fendo.2018.00097.
- Giloteaux L, et al. “Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome.” Microbiome, 2016; 4 (1) DOI: 10.1186/s40168-016-0171-4
- Fluge O, et al. “Metabolic profiling indicates impaired pyruvate dehydrogenase function in myalgic encephalopathy/chronic fatigue syndrome.” JCI Insight. 2016 Dec 22;1(21):e89376. doi: 10.1172/jci.insight.89376.