One of the most common complaints expressed in an Integrative practice, is fatigue, or lack of energy. Accurately framing a problem is a prerequisite to understanding it. For clinical purposes, this means creating an appropriate lifestyle and therapeutic interventions.
Fatigue is generally divided into two main categories: peripheral and central.
Peripheral fatigue is driven by functional aberrations in metabolism that is required to drive muscle activation: oxidative, phosphorylation and glycolysis. It is equally driven by reductions in the contractile functions of muscle: impaired reuptake/release of calcium in the sarcoplasmic reticulum (also known as excitation-contraction uncoupling), or loss of conduction plasticity in the muscle membrane.
Central fatigue refers to the central nervous system. Like peripheral fatigue, it’s also affected by functional aberrations in metabolism. Loss of brain coherence interferences in the brain’s rhythms, commonly resulting from lack of sleep, therapeutic caffeine intake, sleep medication or combinations of all three. Reduced movement causes reductions in peripheral afferent sensory and motor feedback from the body, resulting in loss of central motor plasticity.
From a holistic, clinical perspective, fatigue can be grouped into two functional categories, which include peripheral and central fatigue characteristics within each.
Inefficiency fatigue is the sensation of fatigue driven primarily by the inefficiencies of excess. Inefficiencies in nutritional status from excess processed-food-like substances lead to nutrient and cofactor deficiencies. Inefficiencies in the systems that drive movement result in reduced muscle, joint, nerve, mitochondrial, heart and lung capacities. This is an over-consumption and underutilization fatigue, or an imposed adaption to malnutrition and reduced physical demands on the body.
Fatigue of chronic illness is the systemic mental and physical fatigue underlying the processes of imbalance and dysfunction that accompany chronic illness. Consider both peripheral and central mechanisms when addressing hypothalamus-pituitary-adrenal-thyroid (HPAT) dysfunctions, immune dysregulation, pain, neurotransmitter imbalances or even noncompliance.
When addressing any complex problem, it is vital to take care of the basics first.
• An adequate amount of sleep coupled with good sleep hygiene will reduce peripheral and central fatigue.
• A whole-food, Paleo-Mediterranean diet (vegetables, fruit, nuts, healthy fats and lean protein) will shore up a deficient diet and reduce peripheral and central fatigue.
• Lifestyle interventions incorporating appropriate increases in the frequency, intensity and duration of physical activity will gradually increase the body’s adaptive capacities and reduce peripheral and central fatigue.
• Since exercise promotes the oxidation of branched-chain amino acids (BCAA), supplemented BCAA pre- and post-exercise can reduce delayed onset muscle soreness (DOMS). Common dosing of BCAA is 3–5 grams both pre- and post-exercise session. For endurance events, 7–12 grams during the event mixed into a carbohydrate solution.
Think of exercise as a hormetic intervention that positively impacts the mitochondrial respiratory capacity; enhances substrate delivery by increasing cardiac output and blood flow; and increases the contractile and elastic plasticity of muscles, connective tissue and the brain.