Fix Fatigue & Boost Energy: The Basic Steps

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How to fix low energy in a Lyme disease treatment image from Marty Ross MD

How to Fix Chronic Lyme Fatigue

Most people with chronic Lyme disease have fatigue and low energy. There are basic steps that can correct this problem. These range from getting sleep to fixing and getting rid of underlying infections like Lyme, yeast, or viruses. In this article I describe the basic steps that can fix this problem.

"Take These Steps in The Beginning and Throughout a Chronic Lyme Disease Treatment"  Marty Ross MD

1. Sleep

Treatments

Natural medicines:

(You can take these two herbal medicines together or use in combination with the prescription medicines, if needed.)

  • L-Theanine 100 mg 1 to 6 pills a night 1 hour before bed. Do not exceed 1,200 mg a day if using for nerve pain or anxiety during the day, as well. Excessive amounts in the day are very sedating. and/or
  • Herbal Combination 1 to 4 pills 1 hour before bed. (Common herbs in sleep combination pills include valerian root, hops, yams, wild lettuce, L-Theanine, and others. For instance, these herbs are found in a product by Enzymatic Therapy called the Revitalizing Sleep Formula.)

Prescription medicines:

  • Zolpidem (Ambien) 10 mg 1 pill 30 minutes before bed. (Use if your primary problem is getting to sleep. It is short-acting.) and/or
  • Trazodone 50 mg 1/2 to 2 pills 30 minutes before bedtime. (Use this if your primary problem is staying asleep.)

For more information about these items or for additional options about sleep hygiene, see Sleep in Lyme Disease: The Basic Steps. For information about sleep herbs and supplements, see Sleep: The Natural Medicines.  For more information and sleep prescriptions options, see Sleep: The Prescription Medicines.

Why These Treatments May Help

Sleep is often disturbed in chronic Lyme disease. Lack of adequate sleep worsens pain, increases fatigue, and suppresses the immune system. It appears that in response to infection, the excess inflammatory cytokines produced by the immune system decrease the output of sleep inducing hormones to the sleep centers of the brain. And lack of sleep increases cytokines. A restorative amount of sleep is seven to nine hours of sleep per night. Sleep in the few hours before midnight is most restorative.

2. Diet

Treatments

Eat a Paleo-based diet rich in organic foods, healthy fats, proteins, and vitamin rich vegetables. For more detailed information about the diet, see The Best Brain, Inflammation, Pain, Energy & Detox Diet Ever.

An elimination diet is another diet to consider starting. For detailed information, see Elimination Diet to Find Food Problems.

Why These Treatments May Help

A Paleo diet is low in simple sugars, which decreases the chances of developing intestinal yeast. It also promotes brain health and supports the energy factories—called mitochondria—found in every cell. Because it is low in sugar, it may decrease inflammation.

An elimination diet helps a person find which foods that trigger allergies or inflammation reactions. If you are reacting to foods, consider trying an elimination diet first. Removing allergic and inflammatory foods from your diet leads to decreased pain and improved energy.

3. Cytokine Control

Treatments

Natural medicines:

  • Curcumin 500 mg 1 pill 3 times a day. Choose a liposomal product. In such a product, the curcumin is microscopically wrapped in oil like sunflower oil to increase its absorption. or
  • Anti-Cytokine Combination 1-2 pills 3 times a day.  Anti-cytokine combinations include curcumin, resveratrol, black tea extract, and N-Acetyl Cysteine (NAC). One product that contains these items is CytoQuel by Researched Nutritionals.

Prescription medicines:

There are no effective and safe options.

Why These Treatments May Help

Cytokines are inflammatory chemicals made by the immune system in chronic Lyme disease. Nutritional supports like curcumin, resveratrol, black tea extract, NAC, and antioxidants found in a good multivitamin (see Part 6.) may lower cytokines. This can

  • correct many Lyme symptoms,
  • boost the immune system, and
  • limit Herxheimer die-off reactions.

On the one hand, cytokines are good because they turn on the immune system. They perform a number of functions that include:

  • making antibodies work more effectively,
  • increasing active white blood cells to fight infections,
  • recruiting white blood cells to the location of an infection,
  • turning on white blood cells to fight infections, and
  • decreasing viral and bacterial replication.

On the other hand, in chronic Lyme disease the immune system makes too many cytokines, which is bad. Too many cytokines

  • suppress the immune system,
  • cause pain,
  • decrease hormone production from organs like the thyroid and the adrenal glands,
  • disturb sleep,
  • decrease brain function,
  • increase fatigue and tiredness,
  • waste muscles,
  • cause depression, and
  • decrease the function of various organs throughout the body, resulting in many other symptoms and medical problems.

At the beginning of treatment or when antibiotics are changed, the cytokines are made in even greater amounts, which causes a person to feel much worse. This is called a Herxheimer dieoff reaction.

See Control Cytokines: A Guide to Fix Lyme Symptoms & The Immune System for more information and additional herbal medicine options to use in a Lyme disease treatment.

4. Adaptogen

Treatment

Natural medicine:

  • Ashwagandha 400 mg 1 to 2 pills in the morning and 1 to 2 pills between 12 pm. Taking ashwagandha late in the day may disturb sleep.

Why This Treatment May Help

An adaptogen is a substance that helps the body deal with the harmful medical and emotional stress of being ill. Adaptogens have been used for centuries in Ayurvedic and Chinese medicine with greatly observed benefits. Based on animal experiments, ashwagandha may improve energy, immune function, and adrenal and thyroid function. It likely has additional beneficial effects that have not been researched.

5. Hormones

Treatments

Adrenal Insufficiency

Start with the natural medicine or prescription medicine. It is possible to use both together if the symptoms of low adrenals persist.

Natural medicine:

  • Ashwagandha 400 mg 1-2 pills in the morning and 1 to 2 pills between 1-2 pm. Taking late in the day may disturb sleep.

Prescription medicine:

In my practice, I rarely used this because there is a very small risk of immune suppression using prescription hydrocortisone. However, the doses I recommend are the normal amounts the adrenal glands should make. I prefer ashwagandha because it is a supportive herb that does not suppress the immune system.

  • Cortef 5 mg 1 to 2 pills in the morning and 1 to 2 pills between 12 pm. Taking late in the day may disturb sleep.

For more information about why and hot to manage the adrenals in chronic Lyme disease see Heat Up, Speed Up: Thyroid & Adrenals in Lyme.

Low Thyroid

Natural medicines:

  • Ashwagandha 400 mg 1 to 2 pills in the morning and 1 to 2 pills between 1-2 pm. Taking late in the day may disturb sleep. Also use with
  • Zinc 20 mg, Selenium 100 to 200 mcg, and Iodine 200 to 300 mcg 1 time a day. (These are often found in multivitamins or you can supplement them individually.)

Use these natural medicines first for one to two months before adding or trying the prescription medicine option below. Often, working with these supplements corrects the thyroid so you do not need to take thyroid prescription medicines.

Prescription medicines:

  • Desiccated Thyroid 1⁄2 grain or Armour Thyroid 1⁄2 grain 1 pill in the morning 30 minutes before anything else and on an empty stomach with water only. Increase every 3 to 4 weeks by 1⁄2 grain if low thyroid symptoms persist.

For more information about how to manage thyroid, even if your tests are normal, read my comprehensive article: Hypothyroidism. The Best Tests, Meds, & Vitamins.

Why These Treatments May Help

Fixing low adrenals and/or low thyroid can help the immune system work better and possibly improves energy. A person could have normal range testing for each of the hormones, but still have clinically low hormones. Because of the unreliability of testing, treatment for low hormones should occur if there are clinical symptoms of low hormones as long as treatment does not increase hormone levels above the upper end of normal.

Diagnose Based on Symptoms

If you have a number of these symptoms, consider using the natural medicine approaches for each respective problem.

Adrenal Insufficiency: fatigue, recurrent infections, poor recovery from infections, low blood sugar with shakiness and irritability relieved by eating, low blood pressure and dizziness on standing, afternoon crashing, and sugar cravings.

Low thyroid: fatigue, achiness, dry skin, cold intolerance, weight gain, constipation, and changes in menstrual periods.

6. Essential Micronutrients

Treatment

Natural medicine:

  • Multivitamin. Use a vitamin that has numerous amino acids, antioxidants, minerals, and various vitamin Bs, including B12 and folate. I prefer powders by Thorne and Integrative Therapeutics and capsules by Researched Nutritionals.

Why This Treatment May Help

In my opinion, to heal and feel better requires a multivitamin with an essential set of vitamins, minerals, amino acids, and antioxidants. A good multivitamin can improve functioning of the immune system, muscles, brain and nerves, hormones, organs including the kidney and liver, and detoxification, in addition to decreasing inflammation. It also may protect the body from the toxic effect of prescriptive antibiotics.

7. Treat Your Infections

Ultimately to get rid of fatigue, you have to get rid of your infections.

  • At the beginning of treatment this means treating Lyme (borrelia), babesia, bartonella, and intestinal yeast.
  • Later in treatment at 6 months and beyond this can include viral infections. For more information see the chapters How to Diagnose and Infection Treatment Plans.

8. Next Steps: Six Months and Beyond

If energy and fatigue do not greatly improve by six to nine months, it is time to fix the energy factories found in every cell. These are called mitochondria.

Disclaimer

The ideas and recommendations on this website and in this guideline are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.

References

View Citations

Sleep:

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  2. Lu K,  Gray MA,  Oliver C,  Liley DT,  Harrison BJ, Bartholomeus CF, Phan K L,  Nathan PJ. The acute effects of L‐theanine in comparison with alprazolam on anticipatory anxiety in humans. Hum. Psychopharmacol. Clin. Exp. 2004;19:457-465. doi:10.1002/hup.611
  3. Lyon MR, Kapoor MP, Juneja LR. The effects of L-theanine (Suntheanine(R)) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. Altern. Med. Rev. 2011;16(4):348–354.
  4. Liu L, Liu C, Wang Y, Wang P, Li Y, Li B. Herbal Medicine for Anxiety, Depression and Insomnia. Curr Neuropharmacol. 2015;13(4):481–493. doi:10.2174/1570159X130415083112273.
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  7. Buysse DJ. Insomnia. JAMA. 2013;309(7):706–716. doi:10.1001/jama.2013.193
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Diet:

See the references sections for The Best Brain, Inflammation, Pain, Energy & Detox Diet Ever and Elimination Diet to Find Food Problems.

Cytokines:

  1. Ballatori N, Krance SM, Notenboom S, Shi S, Tieu K, Hammond CL. Glutathione dysregulation and the etiology and progression of human diseases. Biol. Chem. 2009;390:191–214. doi:10.1515/BC.2009.033.
  2. Bocci V, Valacchi G. Nrf2 activation as target to implement therapeutic treatments. Frontiers in Chemistry. 2015;3:4. doi:10.3389/fchem.2015.00004.
  3. Butler T. (2017). The jarisch-herxheimer reaction after antibiotic treatment of spirochetal infections: a review of recent cases and our understanding of pathogenesis. Am. J. Trop. Med. Hyg. 96:46–52. 10.4269/ajtmh.16-0434
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  7. Lee DW, Gardner R, Porter DL, et al. Current concepts in the diagnosis and management of cytokine release syndrome. Blood. 2014;124(2):188-195. doi:10.1182/blood-2014-05-552729.
  8. Linus Pauling Institute, Oregon State University. Curcumin. Micronutrient Information Center; Phytochemicals website. lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/curcumin Accessed August 18, 2018.
  9. Lu SC. Glutathione synthesis. Biochimica et biophysica acta. 2013;1830:3143-3153
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  16. Strle K , Drouin EE, Shen S, El Khoury J, McHugh G, Ruzic-Sabljic E, Strle F, Steere AC. Borrelia burgdorferi stimulates macrophages to secrete higher levels of cytokines and chemokines than Borrelia afzelii or Borrelia garinii. The Journal of Infectious Diseases. 2009;200(12):1936–1943, doi.org/10.1086/648091
  17. Strle K, Sulka KB, Pianta A, Crowley JT, Arvikar SL, Anselmo A, Sadreyev R, Steere, AC. T-Helper 17 cell cytokine responses in Lyme disease correlate with Borrelia burgdorferi antibodies during early Infection and with autoantibodies late in the illness in patients with antibiotic-refractory Lyme srthritis, Clinical Infectious Diseases. 2017;64(7):930–938. doi.org/10.1093/cid/cix002
  18. Zhao F, Gong Y, Hu Y, Lu, M, Wang J, Dong J, Qiu F. Curcumin and its major metabolites inhibit the inflammatory response induced by lipopolysaccharide: Translocation of nuclear factor-κB as potential target. Molecular Medicine Reports. 2015;11:3087-3093. doi.org/10.3892/mmr.2014.3079

Adaptogen:

  1. Mishra L, Singh B, Dagenais S. Scientific Basis for the Therapeutic Use of Withania somnifera (Ashwagandha): A Review. Altern Med Rev 2000;5(4) 334-346.
  2. Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57. Published 2018 Nov 16. doi:10.1186/s13020-018-0214-9

Hormones:

  1. Mishra L, Singh B, Dagenais S. Scientific Basis for the Therapeutic Use of Withania somnifera (Ashwagandha): A Review. Altern Med Rev 2000;5(4) 334-346.
  2. Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57. Published 2018 Nov 16. doi:10.1186/s13020-018-0214-9
  3. Jefferies, W. (2004). Safe uses of cortisol. Springfield, Ill.: Charles C. Thomas.
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  5. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM. Guidelines for the Treatment of Hypothyroidism. Prepared by the American Thyroid Association Taskforce on Thyroid Hormone Replacement. Thyroid 2014;24(12):1670-1751.
  6. Canaris GJ, Steiner J, Ridgway C. Do Traditional Symptoms of Hypothyroidism Correlate with Biochemical Disease? J Gen Intern Med 1997;12:544-550.
  7. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanik JI, Pessah-Pollack R, Singer PA, Woeber KA. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988-1028.
  8. Burch HB, Burman KD, Cooper DS, Hennessey JV. A 2013 survey of clinical practice patterns in the management of primary hypothyroidism. J Clin Endocrinol Metab 99: 2077-2085.
  9. Kelly G. Peripheral metabolism of thyroid hormones: a review. Alt Med Review 2000;5(4):306-333.
  10. Bianco AC, Kim BW: Deiodinase: implications of the local control of thyroid hormone action. J Clin Invest 2006;116:2571-2579.
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  13. Lukaczer D. Advanced assessment and treatment of thyroid dysfunction. Oral presentation at: The Institute for Functional Medicine Hormone Advanced Practice Module; July, 2017; Chicago, IL.
  14. Hoang TD, Olsen CH, Mai VQ, Clyde PW, Shakir MK, Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol. 2013 May;98(5):1982-90.
  15. Toulis KA Anastasilakis AD, Tzellos TG, Goulis DG, Kouvelas D. Selenium supplementation in the treatment of Hashimoto’s thyroiditis: a systematic review and a meta-analysis. Thyroid 2010 Oct;20(10):1163-73.
  16. Van Zuuren EJ, Albusta AY, Fedorowicz Z, Carter B, Pijl H. Selenium supplementation for Hashimoto’s thyroiditis: summary of a Cochrane systematic review. Eur Thyroid J 2014;3:25–31.
  17. Roy S, Loh HH, Effects of opioids on the immune system. Neurochem Res 1996;21: 1375-1386.
  18. Risdahl JM, Khanna KV, Peterson PK, Molitor TW, Opiates and infection. J Neuroimmunol 1998;83:4-18.
  19. Younger, Jarred, et al. Low‐dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double‐blind, placebo‐controlled, counterbalanced, crossover trial assessing daily pain levels. Arthritis & Rheumatism 2013 Feb;65(2):529-38.
  20. Smith JP, et al. Low-dose naltrexone therapy improves active Crohn's disease. American Journal of Gastroenterology 2007;102(4):820-828.
  21. Bruce AC, et al. Pilot trial of low dose naltrexone and quality of life in MS. Annals of Neurology 2010 August;68(2):145–150.
  22. Howell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2022: 489-499.
  23. Kratzsch J, Fiedler GM, Leichtle A, et al. New reference intervals for thyrotropin and thyroid hormones based on National Academy of Clinical Biochemistry criteria and regular ultrasonography of the thyroid. Clin Chem. 2005 51:1480-1486.
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  25. Flynn, RW, SR Bonellie, RT Jun, et al. Serum thyroid stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J Clin Endocrinol Metab 2010;95:1.
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  27. Gaby AR. “Sub-laboratory” hypothyroidism and the empirical use of armour thyroid. Alt Med Review 2004 (9)2:157-179.
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Essential Micronutrients:

  1. Teitelbaum, J. Chapter 6: "N" — Nutritional Support, the Building Blocks of Good Health. In: From Fatigued to Fantastic!. 3rd ed. New York, NY: Penguin; 2007.

Mitochondria:

  1. Nicolson GL. Mitochondrial Dysfunction and Chronic Disease: Treatment With Natural Supplements. Integr Med (Encinitas). 2014;13(4):35–43.
  2. Ellithorpe RR, Settineri R, Nicolson GL. Reduction of fatigue by use of a dietary supplement containing glycophospholipids. J Am Nutraceut Assoc 2003; 6(1): 23-28.
  3. Nicolson GL, Ellithorpe RR, Ayson-Mitchell C, Jacques B, Settineri R. Lipid Replacement Therapy with a glycophospholipid-antioxidant-vitamin formulation significantly reduces fatigue within one week. J Am Nutraceut Assoc 2010; 13(1): 11- 15.
  4. Ribas V, García-Ruiz C, Fernández-Checa JC. Glutathione and mitochondria. Front Pharmacol. 2014;5:151. Published 2014 Jul 1. doi:10.3389/fphar.2014.00151

Heavy Metals:

  1. Jaishankar M, Tseten T, Anbalagan N, Mathew BB, Beeregowda KN. Toxicity, mechanism and health effects of some heavy metals. Interdisciplinary Toxicology. 2014;7(2):60-72. doi:10.2478/intox-2014-0009.
  2. Sears ME. Chelation: Harnessing and Enhancing Heavy Metal Detoxification—A Review. The Scientific World Journal. 2013;2013:219840. doi:10.1155/2013/219840.

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About the Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State where he treated thousands of Lyme disease patients in his Seattle practice through late 2018. Marty is currently on sabbatical in Austin, TX. Dr. Ross plans to reopen his Seattle Lyme practice in early 2020.

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS) and The Institute for Functional Medicine.

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