Marty Ross, MD's Solutions for Post-exertion Fatigue & Malaise

Unlocking Energy: Empowering Solutions for Post Exertional Fatigue Malaise

Living with chronic conditions such as Lyme disease, tick-borne infections, mold toxicity, long-covid, chronic fatigue, syndrome, and fibromyalgia often feels like a relentless battle against fatigue and exhaustion. For many, post-exertional fatigue and malaise exacerbates this struggle, making even the simplest tasks feel daunting.

But what if there was a way to reclaim your energy and take control of your wellness journey? In this article, Marty Ross, MD explores empowering solutions that offer hope and practical strategies for managing post-exertional malaise and fatigue. By understanding the root causes and embracing holistic healing approaches, you can unlock a path to improved vitality and a better quality of life. Join us as we delve into actionable insights designed to support your proactive pursuit of health and wellbeing.

Understanding Post Exertional Malaise and Fatigue: Causes and Treatments

Post Exertional Malaise (PEM) and Post Exertional Fatigue are debilitating symptoms commonly associated with conditions such as tick-borne illnesses, mold toxicity, Lyme disease, chronic fatigue syndrome (CFS), long-covid, and fibromyalgia. These conditions often leave individuals feeling overwhelmed with fatigue after minimal exertion, impacting daily life and overall well-being. Understanding the causes and exploring both natural and prescription treatments can help manage these symptoms effectively.

Causes of Post Exertional Malaise and Fatigue

1. Neuro-mediated Fatigue:

Neuro-mediated fatigue is a central feature of many chronic conditions, where the nervous system struggles to regulate energy, blood flow, and stress responses. This dysregulation leads to overwhelming fatigue and can be exacerbated by physical or mental exertion.

Inflammation and tryptophan. The central causes of neuro-mediated fatigue are inflammation and shortages of essential neurotransmitter building blocks like tryptophan.

2. Dysautonomia:

Conditions like Postural Orthostatic Tachycardia Syndrome (POTS) are forms of dysautonomia often linked to neuro-mediated fatigue. Dysautonomia affects the autonomic nervous system, leading to poor blood circulation and energy regulation.

Infections, toxicity, mitochondria dysfunction, and inflammation. A leading cause of autonomic nervous system dysfunction is impairment of the vagal nerve from infections, toxicity, mitochondrial dysfunction, and inflammation.

3. Mitochondrial Dysfunction:

Mitochondria are responsible for energy production in cells. Dysfunction in these organelles can significantly contribute to fatigue. When mitochondria are dysfunctional, they do not create enough cell fuel called ATP to handle extra exertion.

Inflammation and damaged mitochondrial membranes. Inflammation from infections and toxins leads the immune system to make oxidizing agents that damage the mitochondrial membranes leading to poor ATP energy production.

4. HPA Axis Dysregulation:

The hypothalamic-pituitary-adrenal (HPA) axis is crucial for managing stress responses and energy metabolism. Dysregulation can lead to abnormal cortisol levels, resulting in fatigue.

Excess cytokine inflammation. Cytokine excess impairs the ability of the brain hypothalamus and pituitary areas to correctly regulate cortisol production in the adrenal glands.

5. Inflammation:

Chronic inflammation is a common underlying issue in chronic Lyme disease, tick-borne infections, mold toxicity, Long-Covid, chronic fatigue syndrome, and fibromyalgia contributing to persistent fatigue and malaise.

Infections and toxicity. Chronic inflammation occurs with infections and mold toxicity trigger the immune system to overproduce inflammation cytokines.

Treatments for Post Exertional Malaise and Fatigue

A multi-faceted approach is essential for managing PEM and fatigue, addressing both the underlying causes and symptoms. Here are some effective strategies:

1. Control Infections and Mold Toxicity:

• Ultimately, getting your chronic tick-borne infections, long-covid, or mold toxicity under control is the solution for post-exertion fatigue and malaise.
• As a starting point look at The Ross Lyme & Tick-borne Disease Protocol and the Ross Long-Covid Support Protocol. 

2. Periodic Fasting:

• Consider a fasting mimicking diet FMD for 5 days every few months. FMD uses minimal calories of carefully selected foods that trick the body into a fasting state. The benefits of this type of prolonged fasting include
  • cellular and mitochondrial rejuvenation through increased autophagy and mitophagy and 
  • decreased inflammation by clearing senescent inflammatory zombie cells.
• For more information see Revitalize Your Health with a Fasting Mimicking Diet in Chronic Tick-borne Infections & Mold Toxicity

3. Managing Dysautonomia:

• Increased Salt and Fluid Intake: Increasing salt and fluid intake can improve blood volume and circulation, reducing symptoms like dizziness and fatigue.
• Medications: Beta-blockers and Midodrine may help regulate heart rate and improve blood flow.
• Supplements: Ashwagandha 400 to 500 mg 2 pills in the morning and 2 pills between 1 and 2 PM promotes better adrenal function leading to improved water retention in the vascular space.
• Compression Garments: Wearing compression stockings can aid in maintaining blood circulation, alleviating fatigue.

4. Pacing and Energy Conservation:

• Activity Management: Structuring activities to include regular rest periods can prevent overexertion and post-exertional malaise. Finding a level of activity you can tolerate without causing a next day crash is useful.

5. Mitochondrial Support:

• Support Mitochondria Membranes and Provide Nutrients: ATP 360 by Researched Nutritionals 3 pills 1 time a day
• Limit Oxidation Damage: Tri-Fortify Liposomal Glutathione by Researched Nutritionals 5 ml 1 time a day.
• For more information see Power Up Your Mighty Mitochondria & Get Energy.

6. Regulating the HPA Axis:

• Adaptogens: Herbs like Ashwagandha and Rhodiola modulate the stress response, improving energy levels and reducing fatigue. I prefer Ashwagandha 400 to 500 mg 2 pills in the morning and 2 pills between 1 and 2 PM.
• Low-Dose Hydrocortisone: Prescribed to support adrenal function under careful medical supervision. Hydrocortisone 5 mg 1 to 2 pills in the morning and 1 to 2 pills between 1 to 2 PM.
• Lifestyle Changes: Techniques such as yoga and meditation can enhance HPA axis regulation and reduce stress.

7. Sleep Optimization:

• Sleep Hygiene: Maintaining a consistent sleep schedule and creating a calm sleep environment can improve restfulness.
• Supplements: Melatonin and magnesium and other sleep herbs can aid in regulating sleep cycles, enhancing recovery. I recommend Sleep Formula by Karuna 2 to 3 pills before bed.
• Addressing Sleep Disorders: Treating conditions like sleep apnea can significantly improve energy levels.

8. Targeting Inflammation:

• Anti-Inflammatory Diet: Plant-forward or exclusive plant-based diets are best to lower inflammation. For more information about Plant-forward diets see Exploring the Benefits of Plant-Based Nutrition for Chronic Illness Management.
• Curcumin and Anticytokine Combinations: These supplements have potent anti-inflammatory properties that support cellular health. I recommend either Curcumin Phytosome by Thorne 500 mg 3 times a day or Cytoquel by Researched Nutritionals 1 pill 3 times a day.

9. Neurotransmitter Support:

• 5-HTP or Tryptophan: Boost serotonin levels, enhancing mood, reducing mental fatigue, and decreasing POTS. I recommend 5 HTP by Thorne 100 mg 3 times a day.

10. Physical Therapy and Exercise Rehabilitation:

• Graded Exercise Therapy (GET): A supervised exercise program can help improve stamina without overexertion. Be careful to work with a physical therapist who knows how to work within your limits. Pursuing exercise that exhausts you the next day could worsen your condition.
• Gentle Movement: Activities like yoga and tai chi maintain mobility and circulation without depleting energy.

Disclaimer

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