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The Naturopathic Approach to Fatigue

by Ronald Steriti, NMD, PhD

 Naturopathic medicine is an ecclectic combination of ancient wisdom and modern medicine. As such, it combines the best of both worlds. In this article, the naturopathic approach to fatigue is outlined. We begin with quotes from ancient healers to set the stage for healing, and then list the most common diseases associated with fatigue. The main vitamins and herbs are listed for each of the categories in the differential diagnosis.

Naturopathic Medicine

Naturopathic medicine is a system of medicine that emphasizes natural therapies: botanical medicine, clinical nutrition, classical homeopathy, hydrotherapy (therapeutic use of water), acupuncture and physical medicine (chiropractic adjustments). Naturopathic medical schools are four-year, full-time, accredited medical schools. There are four accredited naturopathic medical schools in the United States.

Vis medicatrix naturae: The Healing Power of Nature

Inherent in every living being is a healing power that works toward: Self-repair, Self-organization, and Self-actualization. Naturopathic medicine attempts to optimize this innate healing response using diet, exercise, lifestyle, and specific nutritional intervention.

Tolle Causum: Find the Cause

To truly diagnose a patient is to identify not just the constellation of symptoms, but to ascertain the cause of the patient’s symptoms. Once the cause is identified, the treatment regimen is likely to become clear.

Effective Diagnosis and Treatment

The only purpose of diagnosis is to find an effective treatment. Effective treatment leads to a permanent resolution of symptoms and a healthier way of living.
The man of the present day would far rather believe that disease is connected only with immediate causes, for the fundamental tendency in the modern view of life is always to seek what is most convenient. - Rudolf Steiner, The Manifestations of Karma


Health is homeostasis (balance). Health is having homeodynamic mechanisms that are capable of keeping the body’s physiology in balance despite ever-present harmful environmental influences.
Symptoms are not the disease. Symptoms are the body’s homeodynamic response to underlying functional imbalances. Symptoms are the body’s attempt to: re-establish balance, restore function, and restore health.
When health is absent, wisdom cannot reveal itself, art cannot become manifest, strength cannot be exerted, wealth becomes useless, and reason is powerless. - Herophilus

Differential Diagnosis of Fatigue


Anemia results in fatigue of gradual onset. The clinical expression of anemia results from tissue hypoxia (oxygen deprivation). Symptoms include: fatigue, weakness, drowsiness, headache, irritability, amenorrhea, and loss of libido.
Iron deficiency is the most common nutritional deficiency worldwide. In adults, iron deficiency anemia is most likely secondary to blood loss. Symptoms include: fatigue, loss of stamina, pica (cravings non-foods), pagophagia (craving ice), glossitis (sore tongue), cheilosis (dry lips).
Megaloblastic anemia is macrocytic anemia with increased MCV, anisocytosis, hypersegmented PMNs, mild leukopenia, thrombocytopenia, and elevated indirect bilirubin. It is predominately due to a prolonged deficiency of either B12 or Folic Acid. Anemia is evidence of very late stage deficiency. Homocysteine is a far more sensitive indicator of B12 or Folic Acid deficiency.

Infections and Epstein-Barr virus

The presence of fever, malaise, myalgia, and lymphadenopathy increases the likelihood of an infectious agent etiology
Epstein-Barr Virus (EBV) is a herpes virus that is a cause of mononucleosis. Symptoms include: fatigue, fever, pharyngitis, and lymphadenopathy. While acute infection (mononucleosis) is well characterized, chronic or recurrent infections are less well understood, especially in Chronic Fatigue Syndrome.


All hepatitis viruses can cause significant acute fatigue. All hepatitis viruses (except hepatitis A) can induce a chronic, low-level infection. Liver enzymes are helpful in identifying viral activity.

Free Radicals

Reactive Oxygen Species react with and damage structural or functional components of the body, including Membranes, Enzymes, Cellular DNA, and Mitochondrial DNA.
Increased Oxidative Stress occurs anytime there is increased energy production (overeating, empty calories); an increased need for detoxification; a prolonged immune response; or  increased steroid production (which can occur from stress, menstrual irregularities, puberty, etc.). A major source of fatigue and free radical generation comes from local tissue hypoxia.

Adrenal Fatigue

Continued stress can cause adrenal fatigue. The first stage involves increased cortisol and DHEA secretion. During the second stage DHEA resulting in mood swings and feeling “stressed”. In the third stage both DHEA and cortisol are decreased causing feelings of exhaustion and depression.

Cortisol Deficiency

Symptoms of cortisol deficiency include: Fatigue (worse in evenings and with stress), Restless, irritable, absent-minded, dizzy, Anorexia, N/V, diarrhea, abdominal pain, Hypoglycemia, Craves salt, sugar, spice; Tachycardia, palpitations; Orthostatic hypotension; Pale, cold, clammy skin. These patients tend to collapse under the slightest additional stress and become paralyzed, unable to take action.


Low thyroid function (hypothyroidism) results in feeling cold, slow and depressed. A comprehensive thyroid assessment includes TSH,  free T4, free T3, reverse T3, anti-thyroglobulin and anti-thyroidal peroxidase antibodies.

Dysglycemia and Insulin Resistance Syndrome

Carbohydrate craving and fatigue after eating is associated with blood sugar problems (dysglycemia). Measurements of glucose, however, may not reveal insulin resistance syndrome, in which more and more insulin is needed to keep glucose levels stable.
Insulin resistance is a direct consequence of our modern civilization and lifestyle: Overeating and Under Nutrition; Lack of Exercise; and Chronic Stress. Insulin resistance is a form of diabetes where the glucose levels are kept in the normal range, but the insulin levels are sky high. Symptoms of insulin resistance include: Central obesity; Dyslipidemia; Hypertension; and Progressively increasing levels of serum insulin and glucose leading eventually to full-blown type 2 diabetes mellitus.


Estradiol falls by 90% and Estrone falls by 60%. Even though all forms of estrogen are lower, estrone now predominates. Progesterone falls by 60% and Testosterone falls by only 20% (it continues to be produced by the ovaries). Estrogen Deficiency in Menopause is associated with: Atrophic vaginitis, urinary tract infections, skin aging; Elevations of cholesterol (CAD risk); Cognitive impairment (Alzheimer’s risk); and Increased bone resorption (Osteoporosis risk).
Estradiol (E2) is the most potent estrogen (12 Xs more potent than estrone, 80 Xs more potent than estriol) High levels associated with increased risk of breast and endometrial cancer.
Estrone (E1) is the predominant estrogen post-menopausally (despite lesser amount). Estriol (E3) is the least potent estrogen. E3 MAY be cancer protective.

Low Testosterone

Testosterone levels affect: sexual function; emotional well-being; muscle mass and strength; cardiovascular health; bone integrity; and cognitive ability. For both MEN and WOMEN.

Nutritional Support for Fatigue

Anti-Viral Herbs

Botanical medicines with demonstrated anti-viral activity include: Echinacea, Astragalus, Lomatium, Sambucus (Elderberry), Allium sativa (garlic), and Thymus vulgaris (thyme).

Liver Support

Silybum Marianum (Milk Thistle) is a well-documented hepatic protector, that works by preventing oxidative damage and by stimulating protein synthesis and production of new liver cells. Silybum dramatically increases serum glutathione levels.

Insulin support

Nutritional strategies for insulin resistance include omega-3 and omega-6 essential fatty acids (fish oils) and The Zone Diet: low calorie (< 1500 cal/day); low carbohydrate (40%); high protein (30 %); and low fat (30%).

Adrenal support

Nutritional support for the adrenal glands includes vitamin B5, DHEA, licorice, sarsparilla, and adaptogenic herbs: Ashwagandha and Ginseng. Calming herbs: St. John’s Wort, Valerian, Skullcap, Hops, and Oats.

Testosterone support

Supplemental Support for Low Testosterone: DHEA, Adrenal support, Tribulus terrestris, Panax ginseng, and Zinc 15-30 mg per day.

Estrogen support

Phyto-Estrogen Treatment includes: Black Cohosh, Dong Quai, Korean Ginseng and Soy Isoflavones.


Mechanisms that help protect against Reactive Oxygen Species include: Enzymes, including Superoxide dismutase-SOD (Zn, Cu, Mn). Glutathione peroxidase (Se) and glutathione reductase (B2 ); and Catalase (Fe); Dietary Anti-Oxidants, including Vitamin C for aqueous compartments; Vitamin E for lipid compartments; Carotenoids, flavonoids, etc; and Endogenous Molecules with Secondary Anti-Oxidant Properties: Glutathione, coenzyme Q10, lipoic acid, etc.


That is a very long list of herbs and vitamins for fatigue!

Many people go to the health food store and ask which vitamins are recommended for their fatigue. The clerk looks up chronic fatigue in one of the popular natural health books and recommends all of the vitamins listed. The customer leaves with a bag full of vitamins, most of which are not for their particular type of fatigue.

By steady and sure functional differential diagnosis and nutritional intervention strategies, the underlying cause of fatigue can often be isolated and eradicated.

The first visit to a naturopath usually lasts an hour, during which a lot of questions are asked. The astute naturopath seeks to identify the underlying cause of the disease. Confirmation of the naturopathic diagnosis can be made with specialty alternative lab tests (such as salivary hormones, oxidative stress tests, etc). A specific nutritional support program can then be designed for the person.


Fantastic new books!

CAM Therapies has studies on natural therapies for over 100 diseases.

CAM Labs lists lab tests for 100 diseases.

Nutritional Genetics is a fantastic resource.

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