Healthy digestion is central to overall health. Two functions are particularly important:
- The stomach must produce enough gastric acid and digestive secretions to break down food.
- The intestines must be able to absorb the nutrients the body needs.
More than half of the patients with chronic fatigue described here have digestive problems. The possible causes considered include:
- An imbalance in the gut microbiome : an excess of potentially harmful bacteria and a shortage of beneficial bacteria. Stool testing is used to assess this balance. The approach includes a fibre-rich Mediterranean diet with vegetables, fruit, avocado and wholegrain foods, alongside probiotics and prebiotics (which provide nourishment for gut bacteria).
- An intolerance to certain foods. Food intolerances are considered a possible contributor to fatigue. The foods discussed here include gluten-containing grains (particularly wheat, rye and barley), dairy products, sugar, alcohol and coffee. If an intolerance is suspected, the approach described is to exclude the food for two months and assess whether symptoms improve. Improvements may include less wind, cramping and bloating, and more regular bowel movements. After four to six months, foods may be reintroduced in small amounts. If symptoms recur, I recommend continued avoidance of the foods concerned.
- Increased intestinal permeability (leaky gut) is considered here as a possible contributor to fatigue. Increased permeability allows substances to pass from the intestine into the bloodstream. In this approach, it is associated with strain on the liver, muscle pain, fatigue and impaired nutrient absorption. Potential contributing factors discussed include food intolerances (particularly to gluten), a diet high in sugar, and antibiotics taken in combination with anti-inflammatory medicines. Management described here includes avoiding poorly tolerated foods, taking probiotics, and using glutamine and digestive enzymes to support the intestinal lining and digestion.
- Intestinal organisms such as Candida albicans (a yeast) are also considered in the assessment of fatigue. Blood and stool tests are used in the investigations described here, with nystatin used for yeast infections. Stool testing can also help assess digestive problems. Digestive enzymes and glutamine are used in this approach to support digestion and the intestinal lining.
- Many patients with fatigue are assessed for impaired liver function. The medication taken for symptoms of fatigue and fibromyalgia is considered as a possible contributing factor. Foods such as broccoli and artichoke, and supplements such as lipoic acid and silymarin, are used in this approach to support liver function and detoxification.