Persistent and severe fatigue is a common part of the presentation of a diverse range of diseases. However, efforts to provide a comprehensive definition of fatigue are ongoing and not without controversy. Most definitions begin by distinguishing between neuromuscular fatigue and cognitive fatigue, the former being a result of strenuous physical exertion that is relieved by rest. Cognitive fatigue, however, refers to a combination of exhaustion and somnolence, perceived increased mental effort in initiating or sustaining mental and physical effort, poor concentration and reduced motivation. It is very common that symptoms of cognitive fatigue are of a chronic nature and are minimally, if at all, relieved by rest or sleep. This being so, extensive research has been undertaken in order to develop strategies that assist in the management of cognitive fatigue. For example, research in complementary medicine has focused primarily on the impact withania and rhodiola provide in enhancing cognitive performance and mood. Moreover, there is minimal research concerning the role withania, rhodiola and ginseng (siberian) play in stress induced fatigue. However, it is not my intention, in this article, to focus on the role of the foregoing herbs.

Fatigue often presents with a cluster of symptoms including exercise intolerance, post-exertional malaise, frequent presentations of pain and affective disorders such as anxiety and depression. It is fatigue of this nature that is common in diseases with significant inflammatory involvement. A common presentation observed in my clinic is an acute 'flu-like' illness followed by weeks or months of fatigue, indicative of the aforementioned symptoms. This being so, it is important to understand the mechanisms by which inflammation contributes to fatigue. Currently, scientific evidence suggests that exogenous inflammatory cytokines (small proteins involved in cell to cell communication), induced by various bacterial species, initiates the acute 'flu-like' responses outlined. This process is common to sickness behaviour, an adaptive response to infection, characterised by fatigue, depressive behaviour, anhedonia (lack of pleasure), psychomotor slowing, anorexia (lack of appetite), circadian alterations in sleep patterns and increased sensitivity to pain. This is indeed a common theme I see presenting in my clinic.

In the last 2 years there has been research to show that the fatigue induced by exogenous inflammatory cytokines can be ameliorated by the administration of anti-inflammatory interleukin-1 receptor antagonists. However, this is considered a novel therapy, in which your blood is incubated to stimulate white blood cells to produce increased levels of anti-inflammatory interleukin-1 receptor antagonists and then re-injected at a particular site. For example, it has been utilised effectively for individuals suffering from osteomyelitis. Nonetheless, what I find exciting is the possibility that the well known traditional Chinese medicinal plant, Astragalus Membranaceus, potentially can invoke a similar response. However, there is little science to make this conclusion at this point.

If you have a question concerning fatigue please contact Mark Hinchey Naturopathy on 0432234822 or at info@markhincheynaturopathy.com.au


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