If you’re constantly tired, or exhausted, you’re not alone because chronic fatigue or persistent tiredness is a common symptom of endometriosis. Let’s just clarify here; this type of fatigue isn’t the same as acute tiredness which can be described as a normal reaction or response because of physical or mental exertion which will resolve after rest. Chronic fatigue is disproportionate to the activities exerted and is not fully resolved from rest.

WHY DOES THIS HAPPEN?

It’s believed excess fatigue is a result of chronic low-grade inflammation. There are links between many types inflammatory diseases such as endometriosis, auto-immune diseases and cancer and increases in plasma cytokines (1). There are a few reasons why low-grade inflammation may cause fatigue:

ALTERATIONS IN ENERGY PRODUCTION

Inflammation creates an increase of the need for fast production of cellular energy for immune cells and to meet this need, immune cells move to aerobic glycolysis for energy production which is less efficient (1). Ongoing reliance on aerobic glycolysis may lead to reduced nutrient availability and less energy available for other systems within the body with energy diverted to support the immune response (1). Animal studies have also shown that induced inflammation with administration of lipopolysaccharide (LPS) elicits behavioural changes such as reduced motivation (2). LPS are a bacterial endotoxin which are involved in the pro-inflammatory response and growth of endometriosis (3).

LESS EFFICIENT ENERGY PRODUCTION AND FREE RADICAL PRODUCTION

The production of energy may also be impacted due to reduced glucose uptake by cells, reducing functioning of mitochondria which produce aerobic energy (1). To compensate the body increases lipid and protein metabolism for energy production, however lipid metabolism is a slow process and unable to respond to fast energy requirements and reliance on protein metabolism compromises its’ other functions (1). Inflammation also causes an increase in reactive oxygen species (ROS) or free radicals which can be harmful to mitochondria, contributing to mitochondrial dysfunction (1). 

STRESS AND SLEEP

Inflammation can also lead to alterations in circadian rhythms and sleep, affecting sleep quality and circadian rhythms; these alterations are linked to fatigue and can lead to a misaligned circadian rhythm (1). It’s also believed that chronic stress is associated with a reduced capacity of stress hormones to regulate the inflammatory response, therefore it is another driver of chronic fatigue (4).

HOW TO IMPROVE ENERGY LEVELS IF YOU HAVE ENDOMETRIOSIS

Following the right diet and making some lifestyle changes will support your energy levels and help keep inflammation in check:

• Eat an anti-inflammatory diet rich in antioxidants; a Mediterranean diet is a prime example. However many women with endometriosis require a more tailored diet and may benefit from cutting out items such as foods high in FODMAP’s, gluten and/or cow’s dairy. If you have food intolerances, see a nutritionist to work out a tailored diet and address why you’re having a reaction to certain foods.

• Try supplementing with CoQ10 which is involved in energy production and is also an antioxidant. Other nutrients which may help are magnesium, B6, zinc, vitamin E and C, fish oil, curcumin and N-acetyl cysteine. Side note: speak to a health professional before starting supplements to ensure you receive quality ingredients with the right dose and the right formula of nutrients tailored to your needs.

• Regular mindfulness meditation can help manage pain and mood disorders such as anxiety and depression, but can also improve sleep quality. Try meditation twice a day; once in the morning and once in the afternoon, especially when you notice your energy levels start to dive in the early afternoon. Start with 5 minutes then work your way up to 10 minutes. 

• Take regular breaks and move your body throughout the day. Try it even if all you can manage is a walk to the kitchen or to stand up and stretch.

• Drink plenty of water; even mild dehydration can cause fatigue, plus drinking water has a host of other benefits such as assisting in the removal of unwanted waste from the body.

I’ll finish here by saying that fatigue isn’t only related to endometriosis or inflammation; it can be a symptom of a range of other conditions. If you have persistent fatigue that’s interfering with your life, it’s always best to get it checked out by your doctor. 

Yours in health,

Meredith

References

(1) Lacourt, T. E., Vichaya, E. G., Chiu, G. S., Dantzer, R., & Heijnen, C. J. (2018). The High Costs of Low-Grade Inflammation: Persistent Fatigue as a Consequence of Reduced Cellular-Energy Availability and Non-adaptive Energy Expenditure. Frontiers in behavioral neuroscience, 12, 78. doi:10.3389/fnbeh.2018.00078

(2) Lasselin, J., Treadway, M. T., Lacourt, T. E., Soop, A., Olsson, M. J., Karshikoff, B., … Lekander, M. (2017). Lipopolysaccharide Alters Motivated Behavior in a Monetary Reward Task: a Randomized Trial. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 42(4), 801–810. doi:10.1038/npp.2016.191

(3) Khan, K. N., Fujishita, A., Hiraki, K., Kitajima, M., Nakashima, M., Fushiki, S., & Kitawaki, J. (2018). Bacterial contamination hypothesis: a new concept in endometriosis. Reproductive medicine and biology, 17(2), 125–133. doi:10.1002/rmb2.12083

(4) Lacourt, T. E., & Heijnen, C. J. (2017). Mechanisms of Neurotoxic Symptoms as a Result of Breast Cancer and Its Treatment: Considerations on the Contribution of Stress, Inflammation, and Cellular Bioenergetics. Current breast cancer reports, 9(2), 70–81. doi:10.1007/s12609-017-0245-8