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James McNabb, M.D., C.N.S.

Flagging energy levels and the causes of fatigue

Lack of sleep

My first question to patients is always; how well do you sleep?  I am frequently amazed at how many people get 4, 5 or 6 hours of sleep at night and feel that is enough. It also seems that most people wake up with an alarm clock, knowing that they cannot trust their bodies to awake when they are rested. The best advice is to go to bed early enough to get all the sleep that you need, and wake up without an alarm clock. That way you will know that your body has gotten all the sleep it needs.

Secondly, as we age, we do not produce the melatonin that we produce when we are teenagers. Our production at 60 is virtually nil. Melatonin is produced by our pineal gland in our brain, and is released when nighttime approaches and ceases production when daylight starts. Melatonin is what allows restful sleep. If you are over 40 and find yourself awakening at 3, 4 or 5 in the morning and not being able to get back to sleep, a timed-release melatonin just may work for you.

Lack of exercise

This topic often is tied in with the question of sleeping. If you have
not exercised enough, your body will have trouble falling asleep. Secondly, people who exercise daily will tell you that on the days that they exercise, they feel peppier and more energetic. On their off days, they feel more lethargic. Vigorous exercise has been shown to increase our basal metabolic rate for a number of hours afterwards, thus directly affecting our energy levels. I believe the best time for exercise is in the morning. Besides jump-starting the day, it seems to raise your energy levels so that your day goes better. Evening exercise could possibly interfere with you sleep patterns.

Antibiotics

The mitochondrion is the organelle within the cell that is responsible for making energy. They are present in every cell in our body with the exception of red blood cells. It is the mitochondrion that converts fats and glucose into ATP, which is the unit of energy for the body. Mitochondria are interesting in that they reproduce themselves and do not rely on the genetic material of the nucleus. Thus, the genetic material for the mitochondria of a child is strictly that of the mother, since the cytoplasm of the egg is maternal,  not a combination of the mother and father. One could almost consider mitochondria intracellular parasites that have a perfect symbiotic relationship with their host. A fact little considered is that the genetic material of a mitochondrion is much more similar to bacteria than human DNA.

One of the ways antibiotics work is by interfering with the reproduction of bacteria. This is successful because bacteria replicate differently than mammalian cells. Doesn't it make sense that since mitochondria are very similar to bacteria, we may be hurting the ability of mitochondria to reproduce themselves by using antibiotics? We may well be creating chronic fatigue by multiple courses of antibiotics.

Overweight

Being overweight hurts us on a variety of fronts. Lugging around extra pounds requires more energy just to do the normal activities. It also requires extra effort to exercise. The layer of fat insulation prevents heat dissipation, which in turn causes us to enjoy exercise less. If the weight is excessive enough, the weight on the chest and abdomen can cause sleep apnea and sleep deprivation. This alone is a profound cause of fatigue.

Helpful nutrients

A good multivitamin

After I have recommended a good quality multivitamin, the next time I talk to to a patient, I will ask them how they are doing. Many times the response will be that they feel more energetic. Since they are now taking 66 more things than they were taking previously, we can only speculate what has caused the improvement. In fact, it may be different in each person. I want to emphasize that if you only take 1 supplement, make it the best quality multivitamin you can find and afford. I recommend the Purity Products The Perfect Multi, The Perfect Multi Focus or the Perfect Multi Super Greens as the most up-to-date formulas for the best price

Omega 3 fatty acids

L-carnitine

L-carnitine is a substance produced by our muscles (hence the name carni), especially under the stimulation of exercise. Carnitine acts like a fork-lift in a factory, shuttling material from loading dock to assembly line. In this case, carnitine takes a molecule of fat from outside the cell and transports it to the mitochondria to be used as fuel. L-carnitine has been shown to improve fat utilization dramatically in weight loss studies.

CoQ-10

The other name for CoQ-10 is ubiquinone, meaning it is found in every cell in every organism, both plant and animal. It is critical for the functioning of mitochondria. It is responsible for the handling of glucose and lipids along the mitochondrial membranes, almost like a conveyor belt passing a product from worker to worker. It is normally made for us by our liver by the action of HMG Co-A reductase. The pharmaceutical class of drugs known as statins (Mevacor, Lipitor, Crestor) are blockers of this enzyme, as this enzyme is the rate-limiting step in the manufacture of cholesterol. So, when you take one of these drugs, (and who isn’t these days?) your cholesterol goes down, but so does your CoQ-10. This can have major consequences. Slight decreases in CoQ-10 can result in an overall malaise or tiredness. Further drops in CoQ-10 can result in congestive heart failure. In Germany, the most common  drug to treat CHF is CoQ-10 (in Germany it is classified as a drug.) Heart muscle has one of the highest concentrations of CoQ-10 in the body. Skeletal muscle also shows the effects by first becoming weak. If the lack of CoQ-10 becomes critical, muscle tissue will begin to break down, releasing myoglobin into the blood stream, potentially causing blocking of the kidneys, renal failure, and possibly death. The bottom line is if you are taking a statin drug, you should be taking CoQ-10 with it. I would recommend 100 mg daily.

Vitamin D

Lack of vitamin D for years has been thought of as only being important for bone health. Now we are beginning to learn that this important vitamin has much to do with cancer prevention, as well as modulating auto-immune diseases, such as MS and Rheumatoid arthritis. We are learning that lack of vitamin D can have many other symptoms, such as muscle weakness. If your muscles are weak, you will definitely feel tired. The solution? Get full body sunshine for 20 minutes several times a week. Each exposure will generate 10000 IU of vitamin D for you. In the winter, I recommend 2000 to 4000 iu daily to compensate for lack of sun exposure. Vital Nutrients makes an excellent supplement: 2000 iu of Vitamin D3.

Melatonin timed release

If you are over 40 and awakening in the early morning hours and not being able to fall back asleep, you could be lacking melatonin. I would therefore recommend Melatonin 3 mg timed release. Most places that sell supplements sell the non timed release melatonin which is absorbed and gone in the first hour. The first hour of sleep is not when most of us need help, unless we have just crossed many time zones. The timed release version will last to the early morning hours when we really need it. I also recommend adjusting the dosage to your particular needs. If 3 mg doesn’t work well for you, try taking 2 pills, or even three. Some people respond best to 1/2 or even 1/4 of a pill. See which of these works best for you. While melatonin is properly classified as a hormone, it is also a good anti-oxidant, as well as a cancer fighter. I see little downsides to taking it nightly. You will appreciate your improved sleep patterns.

Summary

Being fatigued is obviously a problem that can have many causes. It may take you a while to determine for yourself what is your cause of fatigue. I hope that one of these ideas above will help you find a way to feel more lively and energetic.

 

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