Fatigue Treatment: The Energetic Triad

Fatigue Treatment: The Energetic Triad
Image by Scott Resnick MD

Over the past decade of my medical career, I have retrained myself to rethink the treatment of fatigue by changing how we look at the acquisition, storage and utilization of energy in our bodies. I wanted to challenge the reader to consider this perspective of energy. Too often physicians compartmentalize the individual components of energy in the body, instead of looking at how they interact as a whole.

In my experience of working with patients, I have found that energy management is crucial, in particular when the focus was on the general diagnosis of fatigue, or more specifically CFS/FM. I believe that these fall within a similar spectrum.

Fatigue Treatment: The Big Picture

To fully address the big picture of energy management, we need to start at the 30,000-foot level. You’ll see what I mean.

In nature, the human animal (and really, any living being) needs to acquire energy from the environment. Energy has value. There’s a reason that ants swarm to a drop of fruit juice on the floor, hummingbirds chase one another from the feeders, and lions fight over a piece of meat.

For most of our existence on the planet, food has been a scarce commodity. We were more likely to go hungry than to be belly-full. Along the way we have developed resources to ensure that every drop of energy was harvested from the food that we may have been fortunate enough to encounter.

We have three hormones that oversee the allocation of our energy: thyroid hormone, insulin and cortisol. When we see how they work individually, their collective function becomes even more apparent.

Insulin is a growth hormone. It is secreted when we eat, and its job is to store away every extra calorie that is not being used for, well, staying alive in the present. It’s an anabolic hormone, and stocks up the supply of the storage molecule glycogen in the liver and muscles. When they are full, the liver converts the glucose to free fatty acids, which gets readily stored as fat.

When Fat was Sexy

Fat, in an evolutionary perspective, makes sense. It yields 9 calories per gram when burned, versus 4 of protein and carbs. So if you had to carry your stay-alive rations on your back (or belly, or butt) why not use the fuel that gets you twice as far. I mean, if you could get 20 miles per gallon on one fuel, but 40 on a gallon of another, which would you choose?

Cortisol, as I discussed in an earlier post, counter-regulates the actions of insulin, along with its sidekicks adrenaline (epinephrine and norepinephrine). Cortisol is catabolic, and in direct opposition to insulin, breaks down the glycogen stores to liberate the stored energy. Whether the glucose and amino acids liberated are used to keep the home fires burning, or to rev up and escape from the tiger attack/war/famine, insulin is suppressed as cortisol is released and the blood sugar goes up.

All of this occurs at a cost. A catabolic hormone weakens tissues as they are “sacrificed” for the animal’s survival. But we also see loss of muscle mass, weakening of the bones, thinning of the skin. Changes in mood, concentration and memory are soon to follow, along with changes in the immune system. I’ll use another car metaphor here. It’s like driving with the tiny little spare tire. It is going to keep you going for a while, but the car isn’t made to use this back-up exclusively.

Thyroid: Survival Thermostat

And finally, we have thyroid hormone, the “thermostat” of the body. The free hormones, T4 and T3, stimulate our metabolism (actually it’s primarily T3, but we’ll discuss them together here). If the crops didn’t come in that year, the buffalo migrated farther South, and the groundhog sees his shadow, we needed a resource to reduce our energetic demands and conserve. If we could make it through to the springtime, the berries and bunnies might return.

Is it any wonder, then, that thyroid is so dependent on cortisol? It all makes sense. When we are under a great degree of stress, our primary stressor being not the infrequent tiger but the all too common periods of conflict and famine, our body maintained a way to “tamp down” our metabolism.

Sure, it sucks to have cold hands, dry skin, thinning hair and no libido wile shivering on the floor of the cave. But we were alive! There was always a hope for the cornucopia of future harvests and hunts when the seasons changed. The hair grew back, the skin’s luster would return along with the libido. And perhaps, as we now moved to rebuild our energetic stores stores, we might find the drive to reproduce again.

Cortisol: The “King” of Hormones

I like to think of cortisol as the master planner. “Cortisol is King.” Our body continually defers to the stress response. Do we need to be a bit diabetic to stay alive? Done. So we need to be a bit hypertensive and tachycardic (high pulse) to escape the tiger? No problem. Fighting, migrating AND starving? Probably not a good time to have a baby. Cortisol reigns over all of these functions.

Recall that cortisol actively inhibits the effects of insulin. But what happens when we are exposed to sustained high stress with ample, or even excessive calories? Our evolutionary bodies didn’t consider this scenario. Here we begin to see insulin resistance, fat deposition and the sine qua non of aging, inflammation.

Now follow this. The winter ends. We found/grew/foraged/killed food and are eating again. The insulin begins to rise, and in the absence of our primary stressor of starvation, the cortisol goes down. We no longer need to break down, catabolize our tissues to stay alive. We begin to rebuild muscle, strengthen bone. Menstrual cycles return to normal, sexual drive increases in both men and women.

Our thyroid function increases as well. We are no longer in survival mode, now is the time to restock and resupply. It is any wonder that thyroid hormone is similarly required for anabolism?

In conclusion, to really understand how our body is managing energy, we cannot examine these hormones in a bubble. They need to be considered collectively. They are dynamically related to one another.

The Energetic Triad: Thyroid, Insulin and Cortisol

This is what I refer to as the energetic triad: insulin, thyroid and cortisol. It is a foundational system that needs to be aligned for all of our other organs to work well. A balanced triad returns energy, clarity and focus. With balance, we can then metabolically attend to other systems; our leaky gut whose metabolically active cells regenerate every 3-4 days, our impaired detox systems and our sex hormones.

Fatigue Treatment: Summary

If you read this far, here’s the secret. Our ground-floor foundation for health is our nutritional state. Without nutrients we can’t run the machinery. These need to be evaluated and fixed first. With nutrients, we can then make the energy, and attend to our energy production and storage. Our biology begins to work well. All these steps require minerals, nutrients, vitamins and cofactors.

The next stratum comprises balanced energy. And paramount to this energy energy is the integration of insulin, thyroid and cortisol.

All right, enough for now. Did this stimulate anyone’s thinking? Have I encouraged you to think different about the way your body’s energy is managed? This way of thinking is a tool that has helped me to reconcile so many patients’ fatigue. I wanted to share it with y’all.

Hopefully this will help you to more fully understand some important factors contributing to your health challenges. Be well!

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