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The surprising reality of chronic fatigue for millions of people around the world is that it is the only symptom of metabolic syndrome, the combination of risk factors known to lead to type 2 diabetes and heart disease, that is noticeable without a blood

Millions of people suffer from chronic fatigue

The surprising reality of chronic fatigue for millions of people around the world is that it is the only symptom of metabolic syndrome, the combination of risk factors known to lead to type 2 diabetes and heart disease, that is noticeable without a blood test. Treating metabolic syndrome the right way, fortunately, can also help people regain energy and stop feeling tired all the time.

Metabolic syndrome is diagnosed when a person presents three out of the following bad results from routine blood workups:

  1. Fasting glucose greater than or equal 100 mg/dL (or receiving medication for diabetes)
  2. Blood pressure greater than or equal to 130/85 mm Hg (or receiving medication for high blood pressure)
  3. Triglycerides greater than or equal to 150 mg/dL (or receiving medication, such as Lovaza, for high triglycerides)
  4. HDL-C less than or equal to 40 mg/dL in men or less than or equal to 50 mg/dL in women (or receiving drug therapy for reduced HDL-C)
  5. Waist circumference greater than or equal to 102 cm (40 in) in men or greater than or equal to 88 cm (35 in) in women; if Asian American, greater than or equal to 90 cm in men (35 in) or greater than or equal to 80 cm in women (32 in).

Of course, anyone can have high blood sugar, high blood pressure, high triglycerides, low HDL, or a sagging waist line and feel perfectly fine. Most people with these symptoms, however, feel just a little run down all the time. And the common cause of these symptoms is a phenomenon known as insulin resistance.

Is the insulin resistance the key to the problem?

Insulin resistance is a method fat cells, muscle cells, and the liver use to protect themselves from high blood sugar levels. Long before any blood test would confirm diabetes, blood sugar levels can rise just a little too high after heavy meals. Ordinarily, insulin would transport sugar out of the bloodstream into the cell and bring blood sugar levels very quickly right back to normal, within less than an hour in most healthy adults. When blood sugar levels pass about 170 mg/dl, however, cells protect themselves from receiving so much sugar that burning it would release free radicals that would damage their DNA.

These cells shut down the "loading docks" insulin uses to offload sugar from the bloodstream. The pancreas responds by producing even more insulin to bring blood sugar levels back to normal, and after a few hours, it works. If this happens too often, however, cells become permanently insulin-resistant, at least as far as sugar is concerned. Insulin also transports fatty acids, and cells continue to take in fat. More and more insulin in the bloodstream only results in more and more insulin resistance, leaving blood sugar levels high but storing fat even more efficiently than normal. This is why eating too much sugar too often is the biggest contributor to mid-life weight gain.

Chronic fatigue begins to set in with insulin resistance. This is not the life-changing kind of chronic fatigue associated with classical chronic fatigue syndrome, but the kind of vague run-down feeling so many people experience with aging. And it's not just insulin that gets out of balance.

Chronic fatigue in connection with hormones and sex 

  • In women, insulin resistance can result in excessive testosterone production. Unlike other tissues, the ovaries do not have the ability to "turn off" their insulin receptors. When blood sugar levels run high, the ovaries make greater quantities of both estrogen and testosterone, the excess testosterone interfering with ovulation in women of reproductive age and causing acne, hair loss, and aggression.
  • In men, insulin resistance can lead to excessive estrogen production. Estrogen is produced in fat cells, and as insulin resistance forces fat inside, estrogen production rises, too, enough to interfere with muscle tone and cause erectile dysfunction.
  • In both sexes, some of the medications used to treat metabolic syndrome can cause problems with thyroid hormone. ACE-inhibitors, beta-blockers, calcium channel blockers, and hydrochlorothiazide (HCTZ) for high blood pressure, and many of the drugs for high cholesterol interfere with the body's ability to respond to thyroid hormone. The result is even more weight gain and, more importantly, feeling tired all the time.

Thyroid function is usually assessed by measuring thyroid stimulating hormone, the substance the pituitary gland in the brain sends to the thyroid to stimulate its functions.

The more thyroid stimulating hormone the brain has to send to the thyroid to do its work, the "sicker" the thyroid gland. Higher levels of thyroid stimulating hormone are therefore considered more problematic than lower levels (within limits).

Often the thyroid stimulating hormone test comes back not high enough to treat with thyroid hormone replacement medication, and doctors don't advise their patients of the many other positive steps they can take.

Sluggish thyroid can be helped with certain simple steps

  • Avoid goitrogens, sulfur-rich foods that contain compounds that interfere with the binding of thyroid hormone to the cells that need it. These foods include cabbage, broccoli, cauliflower, kale, kohlrabi, mustard greens, and turnips, as well as walnuts, peaches, and strawberries. These foods are more of a problem when they are served raw than when they are served cooked. Don't eat more than one or two servings of these foods in a single day, or more than three servings a week.
  • Avoid exposure to chlorine in swimming pools and from household cleansers. Avoid exposure to bromine from brominated (bleached) white flour. Chlorine and bromine interfere with the thyroid's ability to receive the iodine it needs to make thyroid hormone.
  • Make sure you get vitamin C, selenium, and zinc. You're just trying to avoid deficiency, so for this purpose it's enough to take only the recommended daily intake in a good quality supplement.
  • Get enough iodine, but not too much. Sea vegetables, sea food, and spinach are good sources of iodine, but if you eat them at every meal, you can cause hyperthyroidism--a condition that ironically often leads to a kind of thyroid burnout and hypothyroidism.

Once you take care of thyroid function, then you can reduce insulin resistance:

  • Avoid overeating. If you must indulge in a rich dessert, have just one piece. This is the most important thing you can do control insulin resistance. Most adults can only tolerate about 600 to 700 calories at one meal.
  • Avoid eating carbohydrates and fats at the same meal. As mentioned earlier in this article, both carbohydrates and fats are transported by insulin. If insulin is busy storing fat, it is not available for storing sugars, and insulin resistance is the long-term result.
  • Consider taking chromium nicotinate (the only form of chromium that will help, chromium picolinate sometimes making insulin resistance actually worse) and R-lipoic acid, an antioxidant that acts likes insulin in helping store sugar but that is different from insulin in that it does not store fat. The alpha-lipoic acid you buy in the less expensive supplements is about 45 per cent R-lipoic acid--just take twice as much.

  • Roberts CG, Ladenson PW. Hypothyroidism. Lancet. Mar 6 2004
  • 363(9411): 793-803. Sawin CT, Castelli WP, Hershman JM, McNamara P, Bacharach P. The aging thyroid. Thyroid deficiency in the Framingham Study. Arch Intern Med. Aug 1985, 145(8): 1386-8
  • Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. Jan 14 2004, 291(2): 228-38