One of the most common complaints for doctor visits is fatigue which can affect almost half of the population! Fatigue is a characteristic of many medical conditions. However, the treatment for fatigue is still inadequate because it can be general and non-specific. Thus, providers often overlook it, stressing the importance of identifying the underlying causes of fatigue. Labs such as functional medical labs can help diagnose fatigue-related conditions and provide practitioners with valuable information on improving the symptom of fatigue for their patients. Fatigue can occur at different points in our lives for various reasons impacting our daily activities such as work. Running lab tests bi-annually can be beneficial to identify the possible causes, address this common symptom, reduce fatigue levels, optimize patients' health, and improve daily function.

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What is Fatigue?

The definition of fatigue is "'an unpleasant physical, cognitive and emotional symptom described as a tiredness not relieved by common strategies that restore energy." This non-specific symptom also has three classifications. These classifications include secondary, physiologic, or chronic. An underlying medical condition under six months is considered secondary, whereas imbalances in lifestyle and daily activities can contribute to physiological fatigue and can be generally resolved with rest. In comparison, chronic fatigue doesn't improve with rest and will last longer than six months. Due to the vagueness of this symptom and the varying underlying factors, it is essential to utilize comprehensive lab testing to identify the root cause(s) of fatigue for patients in order to treat and improve this symptom effectively.

What Causes Fatigue? 

Fatigue can stem from various causes. Physiologic fatigue arises from factors that commonly induce fatigue in most individuals. These include extended periods of mental focus, stress, over- or under-stimulation, lack of sleep due to shift work or jet lag, poor diet, a sedentary lifestyle, excessive exercise without adequate calorie intake, excessive alcohol consumption, and certain medical conditions. 

Speaking of medical conditions, fatigue is a prevalent symptom in numerous diseases, but associated symptoms can offer clues for diagnosis. Conditions primarily characterized by fatigue are anemia, mental stress, depression, medication reactions, thyroid issues, sleep disruptions, chronic fatigue syndrome (CFS), and other conditions. Fatigue with these conditions can last from weeks to months, depending on the severity of the condition. 

Sleep issues, such as sleep apnea, insomnia, and narcolepsy, as well as certain medications, including antihistamines and antidepressants, can disrupt sleep patterns and contribute to fatigue. Other conditions where fatigue is a common symptom include nutritional deficiencies, as deficiencies in vitamins such as B vitamins can lead to fatigue and hormonal disorders like hypothyroidism. Environmental factors like lead, mercury, and carbon monoxide exposure from sources like leaded gasoline, paint, industrial facilities, fish consumption, and home appliances also play a role in fatigue.

Fatigue Symptoms

Fatigue in itself is a symptom of many health conditions and physiological factors. Many feelings of fatigue include mood changes, difficulty concentrating, decreased motivation, weakness, exhaustion, and low energy. Describing these feelings can help practitioners further specify the symptom of fatigue for their patients. Some red-flag signs of fatigue that should prompt immediate attention may include unexplained weight loss, chronic fever, difficulty breathing, confusion, and coughing up blood.

What Are The Benefits of Regular Lab Testing for Patients with Fatigue?

Practitioners often encounter fatigue as a symptom from their patients. Due to the vagueness of this symptom, the regular occurrence, and the various underlying causes that include medical reasons, it is crucial for practitioners to asses what may be causing fatigue in their patients. Regular testing can help providers detect conditions early on to prevent chronic diseases. Lab testing can also tailor treatment plans based on individual lab results, monitor progress, and adjust treatment strategies accordingly for improved patient care and outcome.

Top Labs To Run Bi-Annually on Patients Experiencing Fatigue

Here are some top functional labs to run bi-annually on patients who experience fatigue:

Basic Blood Panel

A basic blood panel includes a Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP). These tests should be run regularly for patients with fatigue. A CBC will measure cell counts; abnormalities can indicate an underlying medical condition or show signs of infections often attributed to fatigue. For example, it will assess red blood cells; decreased values can indicate conditions such as anemia, a condition that can cause fatigue. A CMP will evaluate metabolic processes on how the body uses food and energy, all critical factors in fatigue. These tests are regularly used by practitioners to get a baseline on the overall health of their patients and to help manage underlying conditions that may be contributing to fatigue.

Thyroid Panel

Fatigue is a common symptom in patients with thyroid disorders such as hypothyroidism. A comprehensive thyroid panel should be commonly tested for patients with thyroid issues or people suspected of having thyroid issues, such as the case of patients with chronic fatigue. This thyroid hormone panel is completed through a blood sample and assesses the levels of eight thyroid hormones and their antibodies, such as TSH, T4, T3, and Anti-TPO. Imbalances in these hormones can indicate thyroid dysfunction and cause fatigue. Practitioners can utilize the results of these tests to help monitor thyroid levels and improve any imbalances that are occurring. Regular monitoring can allow for necessary adjustments in thyroid treatments, which can improve fatigue symptoms.

Comprehensive Hormone Panel

There are many symptoms related to sex hormone imbalances, such as anxiety, weight issues, and sleep disturbances. However, a prevalent symptom is fatigue. Assessing for these hormones can help practitioners regularly monitor fluctuating levels that may contribute to underlying conditions with fatigue. This blood panel assesses 13 sex hormones, such as progesterone, estrogen, and testosterone, all of which are associated with energy levels. The results of this panel can Identify any hormonal imbalances to aid in individualized treatments and regular testing and provide insights into the effectiveness of those treatments.

Advanced Adrenal Stress Test

Chronic stress is often associated with many health conditions and symptoms, such as fatigue. Our adrenals are glands that release and regulate stress hormones such as cortisol. Disruptions of these regulations from high-stress levels can cause symptoms of fatigue and other issues. This lab test assesses for the function or disruptions of the adrenal glands by measuring cortisol levels throughout the day. This lab is done by providing a saliva sample at four different times throughout the day, giving practitioners a thorough picture of a patient's stress response. Stress levels are constantly changing, and regular testing can help manage those changes that affect the cortisol response and can lead to fatigue or energy issues. By utilizing this test, practitioners can help patients adjust to those changes through individualized protocols based on the results.

Micronutrient Panel

Vitamins and other micronutrients are essential in the metabolic function of humans, especially when it comes to energy production. Nutrient deficiencies in vitamins B, C, D, iron, magnesium, and zinc have all been linked with mental and physical fatigue. These nutrients are needed for metabolism, DNA function, neuronal signaling, and other physiological processes in the body that can impact energy production and lead to fatigue. Therefore, regularly assessing for levels of these nutrients can help patients who often experience fatigue address any nutritional imbalances occurring. The micronutrient panel is a serum test that provides information on levels of various nutrients such as vitamins, minerals, and antioxidants. These results can give individualized dietary plans and guidance on sufficient intake of nutrients through food and supplementation.

Environmental Toxin Screen

There are more than 80,000 environmental toxins in our food, air, and water that can cause adverse effects such as fatigue. Some of the substances include molds, gases, detergents, pesticides, and phenols that can initiate toxin-related diseases. Regular monitoring of these toxins can help identify any exposure, help patients with toxin-related fatigue avoid these exposures, and provide guidance on treatment protocols to reduce their toxic burden.

Additional Labs to Check 

In addition to the functional labs mentioned above, other lab considerations include iron studies to assess decreased iron levels and the Epstein-Barr Virus (EBV) Antibody Test, as this virus is often associated with chronic fatigue. Other labs to consider include sleep studies to assess for sleep apnea. Sleep apnea causes disruptions in breathing which cause daytime sleepiness and can impact daily life. Although labs are highly beneficial in evaluating the underlying causes of fatigue, a thorough review should also be completed to identify any lifestyle factors that may be affecting the patient's energy levels, such as exercise and alcohol use. Of late, the National Institutes of Health (NIH) has made an effort to measure fatigue in more specific detail through its Patient-Reported Outcomes Measurement Information System (PROMIS), a multi-center project to measure outcomes in fatigue, pain, emotional distress, and physical functioning.

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Summary

Fatigue has multidimensions and is one of the most common complaints in healthcare. Therefore, an integrative approach considering these multiple factors is necessary to manage fatigue effectively. Bi-annual testing utilizing functional labs such as the micronutrient panel or adrenal stress test can provide practitioners with the tools to identify any underlying causes of their patient's fatigue concerns allowing for personalized interventions, monitoring, and treatment adjustments.