Fix Fatigue, Boost Your Energy: The 7 Basic Steps.

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

Most people with chronic Lyme disease have fatigue and low energy. There are basic steps you can take to 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 you should take to fix this problem.

Take These Steps From The Beginning to The End of Your Lyme Disease Treatment

1. Sleep

(Use either a natural medicine or prescription medicine. Do not mix natural medicines and prescription medicines together as a first treatment but you can do so later.)

What You Should Do

Natural medicines:
(You can mix these two herbal medicines together or use in combination with the prescriptions medicines if needed.)

L-­Theanine 100 mg 1 to 6 pills a night 1 hour before bed. Do not exceed 1200 mg a day if using for nerve pain or anxiety during the day too. Excessive amounts in the day are very sedating,


Herbal Combinations. 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 Integrative Therapeutics called The Revitalizing Sleep Formula.)

Prescription medicines:

Zolpidem (Ambien) 10 mg 1 pill 30 min before bed (Use if your primary problem is getting to sleep. It is short acting.)


Trazadone 50 mg 1/2 to 2 pills 30 min before bed time. (Use this if your primary problem is staying asleep.)

For More Information About These Items or for Additional Options:

See Sleep in Lyme Disease: The Basic Steps for more information about sleep hygiene.  For information about sleep herbs and supplements see Sleep: The Natural Medicines. And for more information and sleep prescriptions options see Sleep: The Prescription Medicines.

Why You Should Do This

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 7 to ­9 hours of sleep a night. Sleep in the few hours before midnight is most restorative.

Part 2. Diet

What You Should Do

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.

Another starting diet to consider is an elimination diet. For detailed information see Elimination Diet to Find Food Problems.

Why You Should Do This

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 found in every cell called mitochondria. Because it is low in sugar it also decreases inflammation.

An elimination diet helps a person find which foods they may have allergies or inflammation reactions against. 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.

Part 3. Cytokine Control

What You Should Do

Natural medicine:

  • Curcumin 500mg 1 pill 3 times a day.

Prescription medicine:

(There are no effective and safe options.)

Why You Should Do This

Cytokines are inflammatory chemicals made by the immune system in chronic Lyme disease. Lowering them with curcumin and antioxidants found in a good multi­vitamin (Part 5.) will help correct many problems and limit Herxheimer die-­off reactions. See Herxheimer Die-off Reactions: Inflammation Run Amok for more information and additional herbal medicine options.

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 causing a person to feel much worse. This is called a Herxheimer die­-off reaction.

Part 4. Adaptogen

What You Should Do

Natural medicine:

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

Why You Should Do This

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 great observed benefit. Based on animal experiments ashwagandha improves energy, immune function, and adrenal and thyroid function. It likely has additional beneficial effects that have not been researched.

Marty Ross MD Discusses Basic Steps to Fix Fatigue and Boost Energy

Part 5. Hormones

What You Should Do

A. Adrenal Insufficiency

(Start with the natural medicine or prescription medicine. Do not use both together in the first treatment, but you can do so later if the symptoms of low adrenals persist.)

Natural medicine:

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

Prescription medicine:

(I rarely use 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 am and 1­ to 2 pills between 1­ to 2 pm. Taking late in the day may disturb sleep.

B. Low Thyroid

Natural medicines:

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


Zinc 20 mg, Selenium 100 to 200 mg, 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 medicine:

Dessicated Thyroid 1⁄2 grain or Armour Thyroid 1⁄2 grain 1 pill in the morning 30 min 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 You Should Do This

Fixing low adrenals and/or low thyroid helps the immune system work better and can improve 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.

Part 6. Essential Micronutrients

What to Do


Natural medicine:

  • Multivitamin. Use a vitamin that has numerous amino acids, antioxidants, minerals, and various vitamin Bs including b12 and folate. We prefer vitamin powders from Thorne and Integrative Therapeutics. 

Why You Should Do This

To heal and feel better requires a multi­vitamin with an essential set of vitamins, minerals, amino acids, and antioxidants. A good multi­vitamin improves functioning of the immune system, muscles, brain and nerves, hormones, organs including the kidney and liver, detoxification, and decreases inflammation. It also protects the body from the toxic effect of prescriptive antibiotics.

Part 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 our chapters How to Diagnose and Infection Treatment Plans.

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.

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