4 Real Reasons Your Endo-Body is Tired AF
I wanted to write a post for Thanksgiving about something I’m most thankful to have healed out of nearly all of my endo symptoms: chronic fatigue.
This is no normal tiredness. You as an endo-warrrior understand the fatigue we experience with endo can be debilitating. Totally and utterly debilitating. And often it takes a hold slowly so that, years later, you have forgotten what normal energy and stamina feels like. My new normal - a few years after diagnosis with endo - was exhaustion when I woke up after 9 hours of sleep, a constant “pushing” myself to do pretty much everything, a vitally important IV drip of caffeine to get me through each day and then early wine to get me through the evening. It was a battle to go out and socialize, a battle to do regular chores or walk the dog. Life was a battle.
Looking back, I would have classified myself as a "spoonie", although I didn't know what that was at the time. If you don’t know either, it’s a term often used by those with chronic illness to convey how life’s little processes can take all the energy out of you. If you want to read the original article, it was coined by Christine Miserandino and is called The Spoon Theory.
If you want a quick download it’s thus: A normal healthy person wakes up with endless amounts of possibities and energy. Let’s call these spoons. They have LOTS of them. As for us? Us chronically ill, or endo girls, or spoonies? We wake up with a limited amount of spoons, and each day is different. Maybe some days we have 12 spoons, maybe some day it’s 22, or maybe just 1. But never unlimited amounts. That’s why we have to choose our activities, almost pay for them (with these imaginary spoons), and then go back to hibernation. We literally have Nothing. Left. To. Give.
This is when taking a shower is pretty much out of the picture. So is making decent food, playing with kids/friends/boyfriend/girlfriend, do any sort of exercise, and ummm, yah, do just about anything.
I remember googling this a lot. Dear Google, why am I so fatigued with endometriosis??? Google responded with: maybe it’s because you’re in pain, or feel isolated? Maybe it’s because you feel misunderstood, depressed, or miserable? I read that I should “rest” — what that means I don’t know when ALL I seemed to do was rest. The truth is my pain was much less than when I was first diagnosed (when it was chronic all the time), and although yes sometimes I felt misunderstood or isolated, it was mostly because I felt so freaking exhausted all the time. I wanted it gone. I had a burning desire to do anything to make it go away, to be normal again, but I never found a concrete reason I could actually tackle. Nope, all I could find was recommendations to “rest”.
OK, enough with that dark road, it turns out there are real reasons for chronic fatigue. Even better? They’re reasons you can actually fix!! That’s right, you can literally start collecting “spoons” so that one day you too will be able to wake up with endless amounts of possibilities and energy. I know, seems crazy if you’re stuck in your spoonie couch nest reading this right now, but it’s true. My old self from 2 years ago wouldn’t even recognize the new me… she’d probably even be cynically annoyed by my energy ;)
4 Reasons for Endometriosis Related Chronic Fatigue
Imagine the spoons right now, you only have so many right? Now, instead of spoons imagine micronutrients - you know, zinc, magnesium, phytonutrients, L-glycine, vitamin A, etc etc - and instead of you imagine a cell inside your body. Want help? Here’s an cellular picture of healthy fallopian tubes!
Like you want spoons, your cells (and fallopian tubes, and uterus, and brain) want micronutrients. It’s how they make energy, energy to be used by your body, energy that turns directly into SPOONS.
The most common deficiency we associate with energy levels is iron. Anemia is severe iron deficiency, and can cause not just fatigue but also bruising, headaches, shortness of breath, rapid heartbeat and more. In the case of anemia, you're lucky because it's easy to get tested for. Other micronutrients, however, are hard or even impossible to test for in a standard blood test. That's why you may also be deficient in calcium, magnesium, B vitamins, glycine, or everything else, and not know it. This too causes fatigue. Deep, death-like fatigue. You don't have to be anemic to have it.
And remember, you also don’t have to be skinny to be severely malnourished. The world actually just recently hit the tipping point that there are now more overweight or obese people malnourished than those who are underweight. Why? Junk food. Simple. It's a global problem. If you’re an endo girl that has forsaken the proverbial junk food it's still very likely you're eating it’s healthier cousin - healthy junk food. Gluten-free fare, processed organics, food stuffs that arrive on grocery store shelves that are profusely marketed as “healthy” but, at the end of the day, are more refined carbs that leave your body utterly empty. You may also have been a chronic dieter, have grown up eating a standard american diet and never replenished what you lost in your youth, or have poor digestion that doesn't let you absorb nutrients.
If you have a chronic illness, you can assume your body is malnourished in some way, dare I say extremely malnourished. That's why we often need to eat a LOT of food for a while to fill up our coffers. Only nutrient dense foods though, which include organic/grass-fed meat, seafood, vegetables, fruits, and oils. Out go to “healthy” avocado toasts and sweet smoothie bowls, in go bone broths, sardine salads, grass fed beef stews, mounds of local veggies, dozens of pastured egg yolks, and perhaps 1-2 pieces of fruits. Eat. Eat for two. Read through all my FOODS posts to read more about the types of foods that will definitely start to fill up your micronutrient reserves.
2) Chronic inflammation, Gut Health, and Immune Response
Endometriosis is sometimes called an inflammatory disease. To me this is somewhat misleading because inflammation isn’t a root issue, it’s actually a symptom of immune response. It's like calling your cat scratch the problem, when really it's your psychotic cat that's the issue ;) See, when you get cut your immune system launches a defense, of which the first stage is to inflame the area. This brings nutrient rich blood and antibodies to the scene. This is a necessary component of an immune response.
However, in the case if chronic infection, stress, food allergies, too many pro-inflammatory foods, or nutrient deficiencies, your immune system's inflammatory response can actually become chronic. Systemic. Your body has gotten completely confused on what it’s fighting to it’s kind of picking fights with everything. You know when your sick how you get drained? Yah, same thing here, you’re utterly drained because your body is fighting this invisible battle all day long. This is when chronic inflammation arises.
The other side here is that - when your immune system is spread too thin - it has a hard time fighting the other underlying infections and pathogens that live in your body. Those are the viruses you got as a kid, like chicken pox or mono, as well as anything like cold sores, candida overgrowth, athletes foot, etc. Your body is an ecosystem that hosts love, so if your immune system is going haywire it will expend way too much energy fighting both yourself and invaders - often unsuccessfully, which is why you come down sick so much more than your best friend - leaving you absolutely exhausted.
Here's another cellular level photo, since I think they're a) cool and b) help us better understand our bodies are SO MUCH MORE than meet the eye.
The first step in calming an out-of-control immune system is to focus on healing the gut. This is why endo-warriors feel better cutting out gluten and dairy, since they’re one of the most reactive proteins we ingest and a huge contributor to immune chaos if we have any sort of intestinal permeability. This is also why I always recommend a STRICT healing protocol when first undertaking a Heal Endo approach - no grains of any kind, dairy of any kind (even raw), soy, caffeine, alcohol, etc - for at least a month. Yes, I hate strict diets as much as the next endo-warrior, but this one is vital to build a strong foundation. We have to help calm our immune system, which in turn will quell the inflammatory war it's raging.
Other other equally important step is to regulate your blood sugar. If your blood sugar is out of control, it literally means your blood has too much sugar in it, way too often. This sugar reacts to the proteins in your blood causing glycation. What is that? It’s like when you burn toast, the sugars in the bread reacted to the heat and stiffened. Same thing. When your blood sugar is too high, too often, it creates stiff and brittle cells that no longer function properly. In comes the immune system to help the area but instead ends up in a chronic cycle of inflammation.
This is why I say throw out those sweet smoothie bowls and starchy avocado toasts. Most green juices and fruit smoothies too - their base is often sweet fruit and almost always fat-free. Oh yah, and pastas, breads, anything processed. In fact, oatmeal, quinoa, and other grains are neat and all but cut those out too for a while if you’re a spoonie. When you need to eat a sweet tasting breakfast every day - even if it’s “healthier” than before - it’s a sign you need a blood sugar overhaul. It causes inflammation, sorry to say. Like, lots of inflammation.
3) Your Adrenals are burnt out. Yes this is real.
Adrenal fatigue is real, although it’s hard to diagnose at a doctors office, and some old school MDs don't even acknowledge the severity (or even possibility) of this issue. Adrenal fatigue is real, however, and just like any endocrine gland or organ in the body, when they get tired they start to malfunction.
Let me explain something about your adrenals: they’re in charge of a lot. So if they get over-worked, for a long period of time, they can become just as burned out as you were senior year of high school. What do adrenals do on the daily?
- Regulate blood sugar: If you have too much or too little glucose, these are the guys that kick in to gear to keep you alert. When you feel “hangry” or have “blood sugar drops”, shakiness, etc, you know your adrenals are pumping as you speak. If this happens daily, you’re truly kicking their butt for no reason.
- Make your stress hormones: cortisol and adrenaline. That means if you’re stressed regularly you’re kicking their proverbial arse again. Even when you’re getting a stress response from perusing Facebook, or watching Stranger Things, your ancestral body can’t differentiate between screen stress or real life stress - like literally being chased by lions. So remember, any stress is draining for these little glands
- Make your sex hormones: Yup, your adrenals do this too. That’s why so many of us endo girls are actually progesterone deficient (symptoms being terrible PMS, spotting before period, and even severe menstrual cramps), because our adrenals are so tired they simply cannot pick up the slack. For those of you well-read on endo, I know, it’s also because our estrogen-progesterone balance is skewed. WHY it’s skewed, though, is not often because we’re making way too much estrogen like we’re told - even with all the endo implants - but more often because of estrogen mimicking chemicals from our environment PLUS the inability of our livers to properly dispose of the estrogen, so it gets recirculated. More on that in another post :)
So you now see that your adrenals are primo-regulators of many of the daily activities going on in your body. This is why, after years of undue mental stress (think of how secretly stressed you’ve been since, like, 6th grade), physical stress (insert gut dysbiosis here), blood sugar imbalances, and lifestyle factors they can stop working so well. Not to mention they need a lot of nutrients to make all those hormones, so if you’re malnourished it just gets worse.
This can eventually lead to chronically low levels of cortisol, resulting in even more blood sugar imbalance, low blood pressure, weight gain, anxiety, an actual inability to cope with stress, and finally, the extreme exhaustion that we associate with adrenal fatigue. What would this look like in your day to day? Examples include:
- Inability to cope with stress like a normal human being: chronic negative thought loop, get over-stressed about little things, and upset easily about wayyyy too many small things. Simply cannot deal with it all.
- Get “tired and wired” phase, which is why so many endo-warriors deal with insomnia. Waking up around 3 am wide awake? Yah, thank your exhausted adrenals for that one.
- Anxiety about minute things. Inability to conquer life's hurdles like you used to.
- Utter exhaustion
Healing adrenal fatigue is complex, but still very possible. Simply - very simply - put, it's much more than taking a long holiday once a year, but it’s really about removing stressors/triggers every day. Check out my Stress-less page on specific directions on how to do this. It’s also about eating a seriously nutrient rich diet, getting good sleep, avoiding too strenuous exercise and all stimulants. I know, it's hard to tell an exhausted person to cut out coffee and alcohol, but it really is essential to heal these little buggers.
P.S. you’ll also need some mega doses of vitamin C and B vitamins.
Also, you can get a diagnosis, which I highly recommend if you think you’re in this category of burn out, but you might have to seek out a naturopath or specialist if your MD looks at you like you're a crazy hippy when you ask. What you’re looking for is someone to measure your cortisol levels through saliva testing throughout the day to complete an Adrenal Stress Index (ASI). Ask your doctor or naturopath for the best way to accomplish this.
4) Thyroid Issues
Last but not least the thyroid, the grand maestro of your energy production. Women in the North are getting diagnosed with thyroid issues at an unprecedented rate of 1 in 8. Not only that, women with endometriosis have a much higher likelihood because the two are somewhat sister diseases, meaning women with endo are more likely to develop hypothyroid issues than a woman without endo. Aren't we lucky ;)
The symptoms of an under-active thyroid include fatigue (obvy), being cold, constipation, dry skin, painful or heavy periods, and fertility trouble. Sound familiar? Also, about 60% of people with hypothyroid don’t realize they have it. Instead they assume they’re in a slump of sorts, feeling low and tired, perhaps mood swings partnered with an inability to lose weight. I know for many endo girls we attribute a lot of these symptoms to endometriosis when in fact there are often deeper issues like this at play that, if addressed, could help turn these devastating “endo” symptoms around.
Being diagnosed for hypothyroid is easy IF and only IF you’re already extremely hypothyroid. So before you run out the door to get tested at the doc, know that many women are testing in the “normal” range, yet have a thyroid that’s still drastically underperforming. I of course still encourage testing, but If you’ve been tested and fell in the normal range but are still experiencing symptoms, then I have a bio-hack to help you: check your basil body temperature (bbt) every morning.
Your bbt is your temperature, taken at the 10th of a degree, first thing in the morning before you do anything else. You need to purchase a sensitive bbt thermometer for this - don’t worry, not expensive. Your bbt will be different pre-ovulation (follicular phase) and post-ovulation (luteal phase), with the luteal phase temps being higher. However, in general, follicular temps that stay below 97.2 F, or luteal temps that don’t go above 98 F, are strong indicators your thyroid is under-performing. Below is an example of a bbt chart exhibiting signs of hypothyroid. [If you're post menopausal temps will stay in the follicular phase range]
Why is your thyroid going kaput? Stress is a huge contributor (duh), but perhaps just as important is back at #1-3, malnourishment, gut/immune issues, and weak adrenals. Women who are malnourished have a higher likelihood of gut issues or intestinal permeability. Both of these issues combined with stress lead us to #3, weak adrenals. All of this is coupled with now chronic stress leads to a sinking thyroid.
Can I make a Titanic reference real quick, since I heard the movie is being re-released and I’m totally a dork? It’s like when the Titanic was sinking and the bilges filled up one by one, over flowing and bringing down the ship until - finally - the generator went out. Yah, that generator is your thyroid.
Fixing a thyroid isn't necessarily an easy task, nor would it be fair of me to try to tackle it in this simple blog post. In fact, I’ll write a separate post on this sophisticated issue. In the meantime, I will say that if your thyroid is indeed exhausted, then you have to “pump the bilges” before you can actually really address the thyroid. Because the thyroid is the last in line to go, it can’t function without a proper foundation, so first you must address underlying micronutrient deficiencies and gut issues, then your adrenals, then your thyroid. That's why starting with your diet alone will have enormous benefits to this delicate gland, all without addressing it directly.
In the meantime, get a better understanding of where you are on the spectrum: go to the dr. and get tested, and also chart your bbt.
Endo Fatigue Uncovered
I hope these 4 real reasons have helped you better understand the nuances of this mysterious yet completely debilitating symptom: chronic fatigue. Maybe Google is right sometimes - that pain and misery wipe us out - but it’s plainly not the answer as to the extent which we experience crippling exhaustion. It shouldn’t be such a battle to simply get out of bed and take care of ourselves, and it’s not okay to make us think we have to live with this for the rest of our lives. Not okay at all.
If you're ready to start conquering your fatigue once and for all, start in the kitchen. It's the easiest way to begin refueling your body properly. Of course I also highly recommend working with a holistic health professional who can help you see your opportunities as well as your triggers, especially helpful when you don't really have the energy to be doing all the research yourself :)