On this week's Ask Me Anything Monday on the Healthy Steps Show on WMNF 88.5 FM, I opened with something I've treated for forty years and that people are searching for right now: chronic fatigue syndrome. Then the phones lit up, with questions on histamine, cancer treatment, heat, fish oil and kidney disease.
Chronic fatigue syndrome is not the same as being tired
Chronic fatigue syndrome, also called myalgic encephalomyelitis (ME/CFS), is a specific condition. It has no single diagnostic test. It's a diagnosis of exclusion: you rule out the obvious causes of exhaustion, like a thyroid gland that has stopped working, before you use the label.
What sets it apart is a cluster of severe symptoms:
- Post-exertional malaise. Muscle pain and exhaustion that last for days after even mild activity
- A severe drop in your ability to carry out normal daily activities
- Unrefreshing sleep and brain fog
- Dizziness on standing (orthostatic intolerance, sometimes POTS)
- Headaches, digestive symptoms, palpitations, recurrent sore throat and swollen lymph nodes
The CDC estimates that up to 3.3 million Americans have ME/CFS, and up to one in four are home- or bed-bound at some point in their illness. Many can't work.
Everyday fatigue is far more common. A new National Center for Health Statistics report found that about seven in ten adults felt very tired or exhausted on at least some days in the past three months, and about one in six felt that way most days or every day. It was highest in young adults, lowest in people 65 and older, and higher in less urbanized areas.
What's really behind most fatigue
Before anyone calls it chronic fatigue syndrome, look for the causes:
- Chronic conditions: diabetes, lung disease, and heart, liver, kidney or thyroid disease
- Anemia, infections and sleep apnea
- Medications, including antidepressants, antihistamines, and drugs for nausea and pain
- Toxicity and inflammation
- Lifestyle: too little sleep, too much alcohol or caffeine, too little exercise (or too much), and the wrong foods
Start with the basics: move regularly, stop smoking, manage stress (breathwork is a great tool), and stop saying yes to everything. When you're tired, put your own oxygen mask on first.
Low-histamine diets are a test, not a life sentence
A caller had felt better on a low-histamine diet but kept sliding back as foods returned, and was now keeping a food journal indefinitely.
An elimination diet is a test. It relieves symptoms while we figure out why you're reacting to histamine. The possible reasons include an inflamed gut microbiome, a mast cell disorder, or low levels of diamine oxidase (DAO), the gut enzyme that breaks down histamine. DAO can be measured.
Alcohol is one of the biggest histamine triggers, causing congestion and itchy skin. Unless you have something like celiac disease, avoidance shouldn't last a lifetime. A functional medicine practitioner can help you find and fix the root cause.
Four questions to ask before adjuvant chemotherapy
A caller's bladder cancer had been removed surgically, and his oncologist was recommending chemotherapy. Listen to your oncologist; surgery can leave residual cells behind. But get these four answers before you consent:
- How will this treatment improve my life?
- Will it extend my life?
- By how long?
- What are the chances it will?
Ask for rounded numbers. Does it add 3%, 8%, 28% or 98% to my survival? And what will it do to my quality of life? Without those answers, you haven't given fully informed consent.
L-lysine for cold sores: what the evidence says
In the lab, lysine slows the replication of the herpes simplex virus. But that hasn't held up in people: a Cochrane review found no significant difference between lysine and placebo for preventing cold sores. If you're short on protein, amino acids help. Otherwise, eat good food.
The same caller made a point I agree with: we need trees. I grew up in the forests of Pennsylvania, and nature matters to health.
Heat exhaustion is not the same as dehydration
A caller spent an hour and a half weeding before sunrise during the August heat, drinking water the whole time. Afterward she felt woozy, her heart raced, and she ended up in the ER.
She was drinking water, so this probably wasn't plain dehydration. It was early heat exhaustion: the body simply can't shed the heat. In Florida humidity, you sweat, but the sweat doesn't cool you. Watch for:
- Dizziness and weakness
- Thirst and heavy sweating
- Nausea
- A fast heart rate
Heat exhaustion takes longer to recover from than dehydration.
How much water? I use half an ounce per pound of body weight a day. If you exercise outside in this heat, add another liter (about 32 ounces).
Your fish oil label is probably misleading you
A 71-year-old caller asked what tests to request beyond routine blood work and what to use for inflammation besides naproxen.
One test I use is an omega-3 blood test, such as Quest's OmegaCheck, which shows your omega-3 balance and ties directly to inflammation.
Then read the back of your fish oil bottle. "1,000 mg" is the capsule, not the dose. The active ingredient is the omega-3 content, and some warehouse-club brands are good quality but contain only about 300 mg per capsule. For a real anti-inflammatory effect, aim for 2,000 to 4,000 mg of actual omega-3 a day.
Other options:
- Curcumin
- Physical approaches: physical therapy, muscle activation technique, massage, and rehab-certified chiropractic
Her new knee pain, worse at night, likely came from changing how she walked while her hip and back hurt. Find out why the knee hurts, not just how to quiet it.
Stage 3 kidney disease and a plant-based diet
An 80-year-old caller, newly diagnosed with stage 3 kidney disease, asked about protein and going plant-based.
Avoid high protein intake, but around 0.8 to 1 gram per kilogram of body weight a day is reasonable. Don't go below 0.8 without supervision.
A vegetarian diet isn't required for kidney disease, but it's fine to try. To keep calories and protein up, eat a lot of plants, and add tofu, mushroom protein, seeds and nuts. Ask your nephrology group for their renal dietitian, or work with a registered dietitian or functional nutritionist.
Olive oil? Extra virgin, organic, cold-pressed and unfiltered. That green sediment is where much of the heart-protective antioxidant content lives.
Listener email: PFAS after a house fire
A listener worried their home was contaminated with PFAS after a fire put out with water from tanker trucks. PFAS "forever chemicals" are found in some firefighting foams, not in plain water, so a water-only fire is unlikely to be the source. That said, if you suspect toxicity, testing is the way to find out what you're dealing with and where it came from.
Listen and learn more
Listen to the full Sept. 14 episode on WMNF.
The Healthy Steps Show airs Mondays at 10 a.m. on WMNF 88.5 FM in Tampa and streams everywhere at wmnf.org. Call in with your questions on Ask Me Anything Monday.
Wondering whether toxicity and inflammation are behind your fatigue? Take the Toxiflammation™ Assessment.
This post is for education only and is not medical advice. Talk with your own clinician before starting a supplement, diet or treatment.
