Chronic fatigue

Understanding chronic fatigue

Chronic fatigue is one of the most common and frustrating problems people bring to integrative medicine. It isn't ordinary tiredness. It's a deep, persistent exhaustion that doesn't go away with rest, often gets worse with exertion, and gradually limits a person's ability to work, exercise, socialise and live fully.

Chronic fatigue can be hard to live with and hard to explain. Reece offers a long first consultation, a detailed history and a plan you work through together, alongside your GP.

Common symptoms

• Deep tiredness that doesn't lift with rest and lasts for months or years
• Feeling worse after physical or mental effort
• Brain fog, poor concentration, and word-finding difficulties
• Disordered sleep, either too much or unrefreshing
• Muscle weakness and body aches. If you also have fibromyalgia, photobiomodulation may help with the aches.
• Feeling worse when standing (worth checking with your GP)
• Sensitivity to light, sound, or chemical exposures
• Recurring infections or swollen glands, which need a GP check first
• Gut problems, such as bloating and changing bowel habits
• Low mood that comes with being unwell for a long time

Common causes Reece looks into

Post-viral and immune dysregulation

Many cases of chronic fatigue start after a viral illness, such as Epstein-Barr (glandular fever), cytomegalovirus or COVID-19. Ongoing immune activation, viral reactivation and the mitochondrial damage that follows are increasingly well documented. [1] Reece can go through any results you already have, and if more tests could help, he explains why and what they cost.

HPA axis dysregulation

Chronic stress disrupts the hypothalamic-pituitary-adrenal (HPA) axis and leads to abnormal cortisol patterns: usually a period of high cortisol, followed by a flattened or blunted response. This directly affects energy production, immune function and sleep. If a cortisol test could help, Reece explains why and what it costs, and you decide.

Mitochondrial dysfunction

Mitochondria are the parts of every cell that produce energy. They're sensitive to nutritional deficiencies, toxic exposures and long-term oxidative stress. If supplements might help you, Reece explains why and what they cost, and you decide.

Thyroid and hormonal factors

Thyroid problems, including poor conversion of T4 to T3, and the hormonal changes of perimenopause can also play a part in fatigue. Reece goes through your thyroid and hormone results with you as part of the work-up.

The gut in ME/CFS

Studies have found differences in gut bacteria in people with ME/CFS compared with healthy people, [2] and a small study found signs of increased intestinal permeability.[3] It isn't yet known whether these changes cause symptoms or come from the illness.[4] If you have gut symptoms such as bloating or changing bowel habits, Reece can support you with these alongside your GP.

Nutritional deficiencies

Deficiencies in iron (even without anaemia), B12, folate, vitamin D, magnesium and zinc are all common in people with chronic fatigue, and they directly affect how the body makes energy.

The Chinese medicine view

In Chinese medicine, chronic fatigue most often reflects patterns of Spleen Qi deficiency, Kidney Yang deficiency or Heart-Spleen deficiency, depending on the person. Classical Jingfang herbal formulas are chosen for your full constitutional pattern. Acupuncture and moxibustion are used to support Qi and Yang, settle the nervous system and treat specific symptoms such as poor sleep and pain.

A realistic approach to treatment

Progress with chronic fatigue is rarely a straight line. Reece works through it step by step: he finds the main drivers and decides which come first, brings in treatments gradually so they're manageable, and keeps a close eye on how you're going. The aim is real improvement in how you function where that's possible, as well as managing symptoms.