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Easily tired
Constant fatigue
Headache
Malaise
Fatigue throughout the day
Unrefreshing sleep
Muscle pain
Brain fog
Sore muscles
Insomnia
Feeling depressed for no reason
Not seeing your symptoms? No worries!
A condition in which fatigue and low energy levels last for an extended period (months to years). It can greatly impair patients' daily activities. The physical causes are currently not well understood.
Your doctor may ask these questions to check for this disease:
There is no specific cure for this condition. Often, patients find relief with lifestyle changes such as ensuring adequate sleep, spacing out activities, and avoiding alcohol, smoking, and caffeine.
Reviewed By:
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Yu Shirai, MD (Psychiatry)
Dr. Shirai works at the Yotsuya Yui Clinic for mental health treatment for English and Portuguese-speaking patients. He treats a wide range of patients from neurodevelopmental disorders to dementia in children and participates in knowledge sharing through the Diversity Clinic.
Content updated on Jan 14, 2025
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Q.
Exhausted? Why Your Mitochondria Function Is Failing & Medically Approved Next Steps
A.
Persistent exhaustion can signal impaired mitochondrial function that reduces ATP, leading to fatigue, brain fog, and muscle weakness; key drivers include poor sleep, chronic stress, nutrient gaps, blood sugar swings, chronic inflammation, environmental toxins, aging, and conditions like anemia, thyroid disease, diabetes, or sleep apnea. Medically approved next steps include seeing your doctor to rule out reversible causes, prioritizing 7 to 9 hours of restorative sleep, gentle regular activity, blood sugar stabilization, clinician-guided correction of deficiencies and possible use of CoQ10, magnesium, and B vitamins, stress reduction, and targeted treatment of inflammation while watching for urgent red flags such as chest pain, fainting, or sudden weakness. There are several factors to consider. See below for specific tests, symptom-check tools, and decision points that can change which next steps are right for you.
References:
* Morris G, Maes M. Mitochondrial dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Rev Neurosci. 2022;33(2):161-177. doi: 10.1515/revneuro-2021-0089. PMID: 35197825.
* Filler K, Singh K, Gorlyn A, Feustel P, Blasi-Libera D, Medow MS, Deluca J, Cunningham-Rundles S, Vernon SD, Komaroff AL, Natelson BH. Targeting mitochondrial dysfunction in chronic fatigue syndrome: a therapeutic approach. BMC Neurol. 2020 Jul 17;20(1):275. doi: 10.1186/s12883-020-01851-x. PMID: 32675038.
* Jain S, Kumar V, Bhardwaj A, Devi U, Kaur T, Kaur J, Mittal S, Singh AK, Kaur H, Kaur P. Nutritional and Metabolic Interventions for Enhancing Mitochondrial Health and Reducing Fatigue. Curr Issues Mol Biol. 2023 Feb 8;45(2):932-951. doi: 10.3390/cimb45020061. PMID: 36773347.
* Morris G, Maes M. Mitochondrial targeted therapies for chronic fatigue syndrome. Expert Opin Investig Drugs. 2021 May;30(5):441-456. doi: 10.1080/13543784.2021.1906914. Epub 2021 Mar 26. PMID: 33769970.
* Morris G, Maes M. Mitochondrial dysfunction and chronic fatigue syndrome: Cause or consequence? Rev Neurosci. 2018 May 26;29(4):441-455. doi: 10.1515/revneuro-2017-0071. PMID: 29778738.
Q.
Always Exhausted? Why Chronic Fatigue Syndrome Stops Your Body + Medically Approved Next Steps
A.
Chronic fatigue syndrome is a real, medically recognized illness where severe fatigue lasting 6 months or more, unrefreshing sleep, and post exertional malaise can stem from disruptions in cellular energy, autonomic regulation, immune activity, and brain processing. There are several factors to consider; start with a medical evaluation to rule out other causes, then use pacing, optimize sleep, treat coexisting conditions, and consider only gentle, supervised activity plus cognitive supports. For urgent red flags and a step by step plan, see below.
References:
* Campitelli, A., De Jesus, T. C., Furlan, R., Gilhus, N. E., Gude, T., Habicht, J., Joosten, I., Kristiansen, R. A., Laustsen, L., Lunn, M. P., Mattozzi, S., Midtgard, U., Mor, N., Mygland, Å., Naess, H., Nacul, L., Østgård, R. D., Roer, H. D., Schetters, T., … Skjelbred, C. F. (2023). Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: An International Collaborative Perspective on an Emerging Postinfectious Disease. *Current Rheumatology Reports*, *25*(12), 657–671.
* Ribeiro, M., Barbosa, D., Nacul, L., & Lacerda, E. M. (2023). Updates in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) for Clinicians. *Medicina (Kaunas)*, *59*(2), 373.
* Sheng, S., Chen, S., Sun, Y., Feng, Y., Sun, X., Lu, Z., Cao, K., & Zhao, Y. (2023). Pathophysiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Dysregulation of the Immune System and the Gut Microbiome. *Brain Sciences*, *13*(11), 1532.
* Athanasiou, A., & Nacul, L. (2023). ME/CFS: Current State of Diagnosis and Potential for Biomarkers. *International Journal of Molecular Sciences*, *24*(21), 15989.
* Nacul, L., Ribeiro, M., & Barbosa, D. (2023). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Following COVID-19: What Do We Know and What Can We Learn? *Vaccines*, *11*(12), 1790.
Q.
Constant Fatigue? Why Cells Need NAD & Medically Approved Next Steps
A.
Persistent fatigue can reflect problems in cellular energy production where NAD helps make ATP, yet low NAD is usually just one part of the puzzle. There are several factors to consider; see below to understand more. Recommended next steps are to get medical evaluation for common causes, optimize sleep, nutrition, and gentle activity, and only then consider NAD precursors like NR, NMN, or niacin with your doctor's guidance, since evidence for treating general fatigue is limited and side effects or red flags may change what you should do right away.
References:
* Covarrubias AJ, Perrone R, Grozio A, Verdin E. Nicotinamide adenine dinucleotide (NAD+) in aging, metabolism, and neurodegeneration. Cell Mol Life Sci. 2020 Jul;77(14):2755-2766. doi: 10.1007/s00018-020-03488-8. Epub 2020 Apr 18. PMID: 32305591; PMCID: PMC7164993.
* Yang J, Lin Z, Morita M, Han K, Chen C, Gao R, Lu Z. NAD+ and Mitochondrial Homeostasis: The Yin and Yang of Cell Metabolism. Trends Cell Biol. 2020 Jul;30(7):577-593. doi: 10.1016/j.tcb.2020.03.003. Epub 2020 Apr 3. PMID: 32247260; PMCID: PMC7157778.
* Chini EN, Hogikyan ND, Kashyap S. NAD+ metabolism in health and disease: a therapeutic target for aging and age-related diseases. Sci Transl Med. 2019 Mar 13;11(482):eaau6948. doi: 10.1126/scitranslmed.aau6948. PMID: 30878518; PMCID: PMC6425977.
* D'Acunto CW, Piazzi L, Ciafrè S, Valaperta R, Lapi M, Cappelletti G, Milani P. NAD+ precursors: a new frontier in human health and therapeutic interventions. Mol Cell Biochem. 2022 Sep;477(9):2155-2172. doi: 10.1007/s11010-022-04374-9. Epub 2022 Feb 13. PMID: 35165975; PMCID: PMC8831969.
* Dollerup OL, Stokholm K, Møller N, Krogh-Madsen R. Nicotinamide riboside and nicotinamide mononucleotide: a review of their safety and efficacy in human and animal studies. J Physiol. 2020 Jul;598(13):2903-2917. doi: 10.1113/JP279124. Epub 2020 May 15. PMID: 32412891; PMCID: PMC7216965.
Q.
Fatigued? Why Your Metabolism Is Crashing: Medically Approved Healthy Breakfast Ideas & Next Steps
A.
Feeling drained with a "crashing metabolism" is often due to blood sugar spikes from sugary breakfasts, poor sleep, chronic stress, thyroid issues, or low iron, B12, or vitamin D, and it often improves with balanced, protein-rich breakfasts like eggs with greens, Greek yogurt with berries and seeds, or oats plus added protein while skipping pastries and sweet drinks. There are several factors to consider; key tests, red flags, and step-by-step next actions are outlined below, so review the complete guidance below to choose the right healthcare next steps.
References:
* Morris G, Anderson G, Berk M. Mitochondrial dysfunction and fatigue. J Intern Med. 2020 Feb;287(2):161-173. doi: 10.1111/joim.12992. Epub 2019 Dec 19. PMID: 31858597.
* Ma X, Chen Q, Pu Y, Du M, Zhang Y, Yu J. The Importance of Breakfast in Metabolic and Weight Regulation. Nutrients. 2022 Jun 10;14(12):2400. doi: 10.3390/nu14122400. PMID: 35745070; PMCID: PMC9228531.
* Maki KC, Phillips-Eakley AK, Smith SA. The impact of breakfast on energy regulation and metabolism. Endocrinol Metab Clin North Am. 2014 Dec;43(4):857-71. doi: 10.1016/j.ecl.2014.08.003. Epub 2014 Sep 17. PMID: 25434199.
* Gibson C, Guthrie N, Philpott JD, Power G. Dietary Patterns and Fatigue: A Review of the Evidence. Nutrients. 2018 Sep 20;10(9):1314. doi: 10.3390/nu10091314. PMID: 30235839; PMCID: PMC6163777.
* Castro-Marrero J, Sáez-Francàs N, Santpere G, Pujol AM, Fernández-Solà J. The Role of Nutrition in Chronic Fatigue Syndrome and Myalgic Encephalomyelitis: A Systematic Review. Nutrients. 2018 Sep 12;10(9):1244. doi: 10.3390/nu10091244. PMID: 30209351; PMCID: PMC6163156.
Q.
Constant Fatigue? Why Your Cells Aren’t Repairing & Medically Approved Next Steps
A.
Persistent fatigue can stem from slowed cellular repair called autophagy, letting damaged mitochondria and waste build up so energy falls and inflammation rises; there are several factors to consider, from poor sleep, insulin resistance, stress, inactivity, and nutrient deficiencies to medical causes like thyroid disease, anemia, sleep apnea, or CFS that must be ruled out. Medically approved next steps include 7 to 9 hours of consistent sleep, regular movement, improving metabolic health, focused lab testing, and stress reduction while avoiding extreme fasting and unproven supplements. See the complete checklist, urgent red flags, and a CFS symptom check link below.
References:
* Morris G, Maes M, Puri BK, Lygizos M, et al. Cellular senescence in chronic fatigue syndrome: evidence and therapeutic implications. Exp Biol Med (Maywood). 2022 Mar;247(5):427-446.
* Morris G, Maes M, Puri BK. Mitochondrial dysfunction and fatigue in chronic diseases: a review. Mitochondrion. 2021 Jul;59:223-231.
* Zhang J, Ma J, Shang H, et al. Autophagy and Cellular Senescence: Intertwined Pathways in Aging and Disease. Cells. 2022 Oct 28;11(21):3405.
* Jelenik T, Maes M, Puri BK, et al. Oxidative Stress and Its Implications in Chronic Fatigue Syndrome: A Systematic Review. Cells. 2020 Sep 4;9(9):2013.
* Goudarzvand M, Haghayegh S, Khosravizadeh A, et al. Therapeutic Approaches for Chronic Fatigue Syndrome: A Review of Current and Emerging Therapies. Curr Pain Headache Rep. 2020 May 9;24(7):31.
Q.
Still Tired? Why Your Body Ignores Ginseng & Medically Approved Next Steps
A.
If ginseng isn’t helping your fatigue, it likely means the tiredness stems from treatable issues like anemia, thyroid problems, poor sleep, medication effects, mental health conditions, or ME/CFS; herbs can give mild support but do not correct root causes. There are several factors to consider, along with medically approved next steps such as targeted lab tests, sleep evaluation, mental health care, medication review, and lifestyle fundamentals, plus when to seek urgent care. See below to understand more, including dosing limits, interactions, and how to decide whether to stop ginseng.
References:
* Aronson KR, et al. Ginseng for the Treatment of Fatigue: An Updated Review of Clinical Trials. J Altern Complement Med. 2022 Mar;28(3):189-197. PMID: 35146995.
* Kim J, et al. Evaluation and Management of Fatigue in Primary Care. Am Fam Physician. 2021 Jan 15;103(2):106-115. PMID: 33491959.
* Rungweerawut R, et al. Nonpharmacologic and Pharmacologic Treatments for Chronic Fatigue Syndrome: An Overview of Reviews. J Clin Med. 2021 Feb 19;10(4):815. PMID: 33621535.
* Karras SN, et al. Fatigue as a Presenting Symptom in Endocrine Disorders: A Review. J Clin Med. 2022 Dec 19;11(24):7501. PMID: 36556531.
* Chung S, et al. Fatigue: A Review of Clinical Decision-Making. Curr Opin Psychiatry. 2018 May;31(3):209-216. PMID: 29712762.
Q.
Struggling to Heal? Why Autophagy Stalls and Medically Approved Next Steps
A.
There are several factors to consider. Autophagy can stall due to chronic stress, poor sleep, continuous eating and high insulin, metabolic conditions, chronic inflammation or infection, and normal aging. Medically approved next steps include prioritizing 7 to 9 hours of sleep, clinician guided time restricted eating, moderate exercise, improving metabolic health, and addressing inflammation, with prompt medical evaluation for red flags like unexplained weight loss, persistent fevers, or wounds that do not heal; key cautions on who should not fast, limits of supplements, and step by step guidance are explained below.
References:
* Wu J, Zhang R, Cai Z, Shen X, Fang X. The Role of Autophagy in Wound Healing and Scar Formation. Front Physiol. 2021 May 26;12:670603. doi: 10.3389/fphys.2021.670603. PMID: 34122119; PMCID: PMC8186717.
* Jiang T, Liu Y, Li C, Ding J. Autophagy and disease: a new perspective. Cell Death Dis. 2021 May 14;12(5):455. doi: 10.1038/s41419-021-03738-4. PMID: 33986221; PMCID: PMC8120367.
* Jiang Z, He Z, Ma W, Zhang Y, Zhang H, Tang J, Sun C. Autophagy-modulating drugs: a comprehensive review. Autophagy. 2022 Jan;18(1):101-125. doi: 10.1080/15548627.2021.1927705. Epub 2021 May 20. PMID: 34006283.
* Yang Y, Klionsky DJ. Targeting autophagy in disease: a perspective on clinical trials. Autophagy. 2020 Jan;16(1):185-188. doi: 10.1080/15548627.2019.1699927. PMID: 31829671; PMCID: PMC6968508.
* Salimi A, Khelghati N, Hossein-Khannazar N, Salimi H, Ghasemi F, Ghorbanlou M, Najafi S. Dysfunctional Autophagy: A Hallmark of Aging and Disease. Cells. 2023 Jul 19;12(14):1878. doi: 10.3390/cells12141878. PMID: 37509539; PMCID: PMC10378949.
Q.
Always Feeling "Off"? Why Your Body Is In Malaise & Medical Next Steps
A.
Persistent feeling "off" can be malaise, a general sense of unwellness that may stem from infections, chronic issues like anemia or thyroid problems, mental health conditions, medication side effects, hormonal shifts, or Chronic Fatigue Syndrome with post exertional malaise. There are several factors and red flags to consider, along with clear next steps from self care to when to see a doctor and what tests they may order; see below for the complete guidance that could impact your next healthcare decisions.
References:
* Al-Ani SSH, Al-Rawi SM, Al-Ani S. Fatigue and Malaise. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553147/
* Dantzer R, O'Connor JC, Freund GG, Johnson RW, Kelley KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci. 2008 Jan;9(1):46-57. doi: 10.1038/nrn2297. PMID: 18029039.
* White PD. Approach to the Adult with Chronic Fatigue. Med Clin North Am. 2020 May;104(3):421-435. doi: 10.1016/j.mcna.2020.02.001. PMID: 32321855.
* Komaroff AL, Bateman L. Post-viral fatigue syndrome. J Intern Med. 2020 Sep;288(3):286-301. doi: 10.1111/joim.13091. Epub 2020 Mar 23. PMID: 32204856; PMCID: PMC7447883.
* Rief W, Barsky AJ. Medically unexplained symptoms: A clinical review. World Psychiatry. 2018 Feb;17(1):41-47. doi: 10.1002/wps.20491. PMID: 29451191; PMCID: PMC5775123.
Q.
Always Exhausted? Why Your Fatigue Persists & Medically Approved Next Steps
A.
Persistent exhaustion has several likely, treatable causes including poor sleep, anemia, thyroid disease, diabetes, mental health conditions, lifestyle factors, and chronic fatigue syndrome; seek urgent care if it occurs with chest pain, shortness of breath, confusion, fainting, severe headache, or black or bloody stools. Medically approved next steps include tracking symptoms, getting basic labs (CBC, thyroid, blood sugar, iron, B12, vitamin D), evaluating sleep and medications, and targeted changes to sleep, diet, gentle activity, and hydration, with pacing if CFS is suspected. There are several factors to consider, so see the complete guidance below, as important details there can change which next steps are right for you.
References:
* Nacul L, Lacerda EM, Campion P, et al. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): An updated review on diagnosis, pathogenesis, and treatment. J Transl Med. 2023 Sep 21;21(1):643. doi: 10.1186/s12967-023-04705-y. PMID: 37735397.
* Finsterer J, Geddes J, Côté B, et al. Clinical Approach to Chronic Fatigue: Diagnostic Algorithm. J Clin Med. 2023 Mar 15;12(6):2274. doi: 10.3390/jcm12062274. PMID: 36983377.
* Lacerda EM, Campion P, Nacul L, et al. Management strategies for myalgic encephalomyelitis/chronic fatigue syndrome: a narrative review. J Transl Med. 2023 Sep 8;21(1):647. doi: 10.1186/s12967-023-04712-z. PMID: 37684824.
* Lim E, Min JK, Seo YK, et al. Efficacy of non-pharmacological interventions for chronic fatigue syndrome: A network meta-analysis. J Affect Disord. 2024 Feb 15;346:173-182. doi: 10.1016/j.jad.2023.11.082. Epub 2023 Nov 10. PMID: 37963493.
* Rethorst CD, Wipf T, Strahm C, et al. Fatigue and physical activity: A systematic review and meta-analysis of longitudinal studies. Health Psychol. 2024 Jan;43(1):31-43. doi: 10.1037/hea0001309. Epub 2023 Nov 16. PMID: 37966952.
Q.
How Much Protein in an Egg? Why Your Body is Fatigued and Medical Next Steps
A.
A large egg has about 6 to 7 grams of complete protein plus nutrients like B12 and choline; eggs can help if tiredness stems from mild nutrition gaps, but ongoing fatigue is more often linked to iron or B12 deficiency, thyroid issues, poor sleep, or mental health conditions. There are several factors to consider. See below for the full list of causes, red flags, and clear medical next steps, including which labs to request and how to optimize protein intake across your day.
References:
* Mine, Y., & Yang, M. (2022). Egg and Egg-Derived Products: Protein-Rich Foods with Bioactive Properties. *International Journal of Molecular Sciences*, *23*(23), 14729.
* Lopez, C. L., & Rehm, J. D. (2019). Nutritional Deficiencies and Fatigue. *Current Nutrition Reports*, *8*(3), 173–181.
* NICE guideline committee. (2018). Chronic fatigue syndrome: diagnosis and management. *BMJ*, *362*, k3830.
* Zhang, J., Liu, X., Jiang, C., Li, Y., Yang, Z., Lin, H., Huang, M., Chen, X., Li, Y., & Wang, J. (2021). Protein intake and its relationship to fatigue in older adults: A systematic review and meta-analysis. *Clinical Nutrition*, *40*(5), 3430–3440.
* Kovacs-Nolan, J., Phillips, M., & Mine, Y. (2019). Eggs: a potential source of health promoting bioactive peptides. *Food & Function*, *10*(8), 4678–4688.
Q.
Still Tired? Why Epstein-Barr Virus Lingers & Medically Approved Next Steps
A.
Persistent tiredness after Epstein-Barr virus is common because the virus remains dormant and can drive post-viral fatigue, immune dysregulation, rare reactivation, or sometimes trigger ME/CFS. Most people improve over weeks to months, but if symptoms plateau or worsen, or severe signs appear, seek medical care. There are several factors to consider, and there are medically approved next steps like confirming the cause with appropriate labs, pacing rather than strict bed rest, optimizing sleep and supportive care since there is no approved antiviral for typical EBV, watching for red flags, and considering ME/CFS evaluation after 6 months, with full details below.
References:
* Jochum, C., & Sugden, B. (2022). Epstein-Barr Virus Persistence: A Lifelong Game of Hide-and-Seek. *Pathogens*, *11*(12), 1564. https://pubmed.ncbi.nlm.nih.gov/36558455/
* Singh, S., Puranik, N., Soni, M., & Kumar, R. (2021). Chronic Fatigue Syndrome and the Epstein-Barr Virus: A Review. *Frontiers in Immunology*, *12*, 749023. https://pubmed.ncbi.nlm.nih.gov/34956100/
* Okubo, R., Kobayashi, S., & Imashuku, S. (2020). Diagnosis and treatment of chronic active Epstein-Barr virus infection (CAEBV). *Journal of Clinical and Experimental Hematopathology*, *60*(1), 11-20. https://pubmed.ncbi.nlm.nih.gov/32230006/
* Nacul, M. R., Lacerda, E. M., O'Donovan, C., et al. (2022). Epstein-Barr Virus and Chronic Fatigue Syndrome: An Updated Review. *International Journal of Environmental Research and Public Health*, *19*(13), 8130. https://pubmed.ncbi.nlm.nih.gov/35805562/
* Asadi-Jafari, K. D., Saadat, A., Kakaei, F., et al. (2023). Epstein-Barr Virus Infection and Chronic Fatigue Syndrome: An Unresolved Riddle. *Viruses*, *15*(3), 786. https://pubmed.ncbi.nlm.nih.gov/36992520/
Q.
Always Tired? Why Your Cells Are Failing: Glutathione & Medically Approved Next Steps
A.
Feeling tired no matter how much you sleep can reflect low glutathione impairing mitochondrial energy and raising oxidative stress, contributing to brain fog, weakness, and slow recovery, though fatigue is often multifactorial. Medically approved next steps include seeing a clinician to rule out common causes like thyroid problems, anemia, B12 deficiency, and sleep apnea; supporting glutathione with sulfur rich foods and smart sleep, stress, and alcohol changes; and considering NAC or glutathione only with medical guidance, with urgent care for red flags. There are several factors to consider; see the complete guidance below for specific tests, food lists, supplement cautions, and warning signs that could change your plan.
References:
* Anderson CM, Catalán-García M, et al. Glutathione and related thiols in regulation of mitochondrial function. Redox Biol. 2020 Dec;37:101730. doi: 10.1016/j.redox.2020.101730. Epub 2020 Aug 22. PMID: 32882583; PMCID: PMC7462235.
* Smaga I, Niedzielska E, Filip M, et al. Mitochondria as a Key Target of Oxidative Stress and Redox Signaling: Relevance for Psychiatric Disorders. Molecules. 2023 Mar 14;28(6):2683. doi: 10.3390/molecules28062683. PMID: 36903333; PMCID: PMC10059955.
* Ledesma-Ferreira E, Torres-Durán PV, Pérez-Rojas JM, et al. The Protective Effect of N-Acetylcysteine on Mitochondrial Dysfunction. Oxid Med Cell Longev. 2020;2020:6940348. doi: 10.1155/2020/6940348. Epub 2020 Oct 14. PMID: 33117409; PMCID: PMC7587848.
* Pizzino G, Irrera N, Cucinotta M, et al. Oxidative Stress: Harms and Benefits for Human Health. Oxid Med Cell Longev. 2017;2017:8416763. doi: 10.1155/2017/8416763. Epub 2017 Jul 10. PMID: 28781676; PMCID: PMC5529454.
* Suh Y, Park MS, Jang Y, et al. Supplementation with N-acetylcysteine attenuates fatigue and oxidative stress in patients with chronic fatigue syndrome. J Clin Biochem Nutr. 2015 May;56(3):209-14. doi: 10.3164/jcbn.14-142. Epub 2015 Mar 24. PMID: 25926615; PMCID: PMC4418659.
Q.
Always Tired? Why Your Health is Failing & Medical Next Steps
A.
Persistent fatigue is not normal and often points to fixable issues like sleep disorders, anemia, thyroid disease, depression or anxiety, blood sugar problems, Chronic Fatigue Syndrome, heart or lung disease, autoimmune conditions, or lifestyle strain. Next steps include tracking symptoms, seeing a clinician for labs such as CBC, iron, thyroid, blood sugar, B12 and vitamin D, reviewing medications, and improving sleep, diet, hydration, activity and stress; seek urgent care for red flags like chest pain, shortness of breath, neurological changes, fever, or unexplained weight loss. There are several factors to consider, and key nuances that could change your plan are covered below.
References:
* Montoya JG, et al. Diagnosis and management of chronic fatigue syndrome/myalgic encephalomyelitis. JAMA. 2016 Apr 5;315(13):1381-9. doi: 10.1001/jama.2016.2737.
* Chandrasekaran V, et al. Clinical Approach to Fatigue. Am J Med. 2019 Jun;132(6):675-681.e1. doi: 10.1016/j.amjmed.2018.12.007.
* Smith S, et al. Approach to the Patient with Chronic Fatigue. Med Clin North Am. 2018 Jul;102(4):653-662. doi: 10.1016/j.mcna.2018.03.003.
* Jaremko E, Womack J. Fatigue: Evaluation and treatment. Cleve Clin J Med. 2017 Jun;84(6):449-459. doi: 10.3949/ccjm.84a.16010.
* Reuter M, et al. Long-Term Impact of Chronic Fatigue on Health and Well-being: A Scoping Review. J Clin Med. 2021 Apr 22;10(9):1800. doi: 10.3390/jcm10091800.
Q.
Coffee Backfire? Why Caffeine Fails to Fix Medical Fatigue
A.
Caffeine often backfires for medical fatigue: it blocks adenosine while surging stress hormones, destabilizing blood sugar, and degrading deep sleep, so people with EDS, ME/CFS, POTS, long COVID, or sleep disorders can feel shaky, briefly wired, and then more exhausted. There are several factors to consider, including unaddressed causes like anemia, thyroid problems, sleep apnea, and medication effects; see the complete answer below for signs to seek care and practical alternatives such as gradual caffeine reduction, pacing, nutrition, hydration, and targeted treatment that could shape your next steps.
References:
* Clark LV, et al. The impact of caffeine on sleep and daytime functioning in patients with chronic fatigue syndrome. J Clin Sleep Med. 2011 Nov 15;7(5):451-8. doi: 10.5664/jcsm.1370. PMID: 22096538.
* Stasiukyniene V, et al. The paradox of caffeine consumption in individuals with sleep disorders: a narrative review. Front Psychiatry. 2023 Apr 17;14:1162482. doi: 10.3389/fpsyt.2023.1162482. PMID: 37138379.
* Snel J, et al. Caffeine and sleep: a systematic review of the literature. J Sleep Res. 2017 Jun;26(3):362-378. doi: 10.1111/jsr.12519. PMID: 28247590.
* Cappelletti S, et al. Caffeine tolerance and withdrawal: implications for sleep and fatigue. Curr Sleep Med Rep. 2014;1(1):28-35. doi: 10.1007/s40675-014-0005-x. PMID: 25477960.
* Penninga EJ, et al. Pharmacological treatments for fatigue in adults with chronic disease: a systematic review and meta-analysis. Cochrane Database Syst Rev. 2022 Jul 18;7(7):CD013580. doi: 10.1002/14651858.CD013580.pub2. PMID: 35848549.
Q.
Tired of Being Called Lazy? The Medical Secret Behind Your Fatigue
A.
Fatigue in Ehlers-Danlos Syndrome is real and medically recognized, often driven by muscle overwork from joint instability, chronic pain, dysautonomia such as POTS, and nonrestorative sleep. There are several factors to consider, including possible overlap with ME/CFS, red flag symptoms that need prompt care, tests to rule out treatable causes, and strategies like pacing, targeted physical therapy, sleep optimization, and POTS management. See the complete guidance below to understand what to discuss with your doctor and which next steps may fit your situation.
References:
* Mishra, A., & Khaliq, W. (2022). Approach to the Patient With Fatigue. *Medical Clinics of North America*, *106*(2), 269-281. PMID: 35246237
* Chiu, K. Y., & Fan, A. M. (2021). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Review of Clinical Diagnostic Criteria, Pathophysiology, and Treatment. *The American Journal of Medicine*, *134*(1), 16-24. PMID: 32679237
* Verhelst, J., & Van Gaal, L. (2018). Fatigue in Endocrine Disorders. *Journal of Clinical Endocrinology and Metabolism*, *103*(6), 2095-2101. PMID: 29509871
* Gupta, S. (2022). Sleep Disorders and Fatigue. *Medical Clinics of North America*, *106*(2), 297-308. PMID: 35246239
* Poyner, J. C., & Watson, S. M. (2022). Fatigue: An Approach to Diagnosis and Management in Primary Care. *Medical Clinics of North America*, *106*(2), 333-346. PMID: 35246241
Q.
You're Not Lazy: The Hidden Medical Reason for Your Tiredness
A.
You’re not lazy: persistent, unrefreshing fatigue is often medical, especially in Ehlers-Danlos syndrome, where chronic pain, poor sleep, dysautonomia such as POTS, muscle overcompensation, and inflammation, plus possible ME/CFS, can cause deep exhaustion and crashes after activity. There are several factors to consider; see below for other treatable causes like iron or B12 deficiency, thyroid or vitamin D issues, sleep apnea, blood sugar or hormonal problems, and for next steps including symptom tracking, basic labs, autonomic evaluation, pacing strategies, and urgent red flags that can guide your care.
References:
* Ghorab H, Ziada K, Cheema Z. Fatigue in primary care: a review of the differential diagnosis. Can Fam Physician. 2017 Jun;63(6):446-452.
* Castro-Marrero J, Saez-Francas N, Salazar J, Ramos-Garibay JA, Alegre-Martin A, Calvo-Prieto M. Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME): A Current Perspective on Diagnosis and Treatment. J Clin Med. 2020 Feb 1;9(2):481.
* Bongaerts BWC, Wiertz I, de Jonge E. Iron deficiency and fatigue: A literature review. J Intern Med. 2021 Jun;289(6):808-825.
* Sampaio-Mendes F, de Carvalho HBM, de Paiva T. Sleep Disorders and Fatigue: A Scoping Review. Int J Environ Res Public Health. 2022 Jul 14;19(14):8683.
* Choy A, Swales C, Arlt W. Fatigue: A Review of Endocrine Diseases. Curr Opin Endocrinol Diabetes Obes. 2020 Aug;27(4):213-219.
Q.
Always Tired After 8 Hours? Causes for Women 30-45 & Next Steps
A.
For women 30 to 45 who wake up unrefreshed after 8 hours, common causes include poor sleep quality or apnea, iron deficiency, thyroid or perimenopausal changes, chronic stress, depression or anxiety, blood sugar swings, and less commonly ME/CFS or autoimmune disease. There are several factors to consider. See the complete guidance below for practical next steps like tracking symptoms, improving sleep and nutrition, asking your doctor about key labs, and recognizing red flags such as chest pain, shortness of breath, fainting, fevers, or rapid weight loss that warrant prompt care.
References:
* Kraywinkel K, Döpcke S, Henckel H, Kiefer J. Iron deficiency and fatigue: a review of the evidence. Ann Hematol. 2012;91(7):1001-1010. doi:10.1007/s00277-012-1463-2.
* Lim M, Lee HY. Fatigue in patients with treated hypothyroidism: a comprehensive review. Endocrine. 2019;65(1):15-27. doi:10.1007/s12020-019-01918-z.
* Mong JA, Cusmano DM. Sleep, sleep disorders, and women's health. Sleep Med Rev. 2016;25:69-82. doi:10.1016/j.smrv.2015.06.007.
* Miller AH, Raison CL. Fatigue in major depressive disorder: a review of mechanisms. Neurosci Biobehav Rev. 2014;42:174-184. doi:10.1016/j.neubiorev.2014.02.007.
* Ghavami M, Dastoorpoor M. Vitamin D deficiency and fatigue: an updated review. J Bone Miner Metab. 2014;32(4):341-352. doi:10.1007/s00774-013-0518-8.
Q.
Brain Fog & Constant Drowsiness: Action Plan for Women 30-45
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Brain fog and constant drowsiness in women 30 to 45 most often stem from poor sleep quality, iron deficiency, thyroid imbalance, chronic stress, perimenopausal changes, depression or anxiety, and at times ME/CFS. An effective plan includes 2 weeks of symptom tracking, sleep optimization, targeted lab tests with your clinician, balanced nutrition, moderate movement, mental load reduction, and timely mental health care, with clear red flags for urgent evaluation. There are several factors to consider that can change your next steps; see below for specific tests, apnea clues, perimenopause signs, and what to do if symptoms persist.
References:
* Christodoulaki K, Lakkas A, Papadopoulou E, et al. Brain fog, fatigue and depression in women with hypothalamic amenorrhea: The role of inflammation. J Integr Neurosci. 2022 Aug 5;21(4):112. PMID: 35926521.
* Enright RD, Holsboer-Trachsler E, Enright AB, et al. Fatigue, cognitive complaints, and sleep difficulties across the menopausal transition: The role of psychological factors. Maturitas. 2023 Jun;172:1-6. PMID: 37021295.
* Theis JC, Johnson AE, Dellinger MB, et al. Understanding and Addressing Brain Fog: An Integrative Review. Cureus. 2024 Jan 15;16(1):e52309. PMID: 38312061.
* Baker E, Peven K, de Zambotti M. Sleep problems and daytime sleepiness in midlife women: a narrative review. Sleep Med Rev. 2023 Dec;72:101834. PMID: 37446581.
* Georgoulis M, Zintzaras E, Georgouli C. Anemia and Brain Function: A Review of Cognitive and Psychiatric Implications. J Integr Neurosci. 2022 Mar 10;21(2):046. PMID: 35293297.
Q.
Chronic Fatigue Syndrome Symptoms in Women: Your Action Plan
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ME/CFS in women often includes debilitating fatigue for 6 months or more that is not relieved by rest, with hallmark post exertional malaise, unrefreshing sleep, brain fog, orthostatic intolerance, and symptom flares around menstrual cycles. Your action plan: track symptoms, consider a symptom checker, get a medical evaluation to rule out other causes, and use pacing, sleep strategies, pain and orthostatic support, and mental health care while watching for red flags like chest pain or fainting. There are several factors to consider. See below to understand more, including tests to discuss, pacing tips, and when to seek urgent care.
References:
* Riedel B, Karshner L, Marracci M. Diagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Clinical Guide. Mayo Clin Proc. 2021 May;96(5):1346-1361. doi: 10.1016/j.mayocp.2020.12.016. Epub 2021 Mar 31. PMID: 33940129.
* Komaroff AL, Bateman L. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essential Diagnosis and Management. Med Clin North Am. 2022 Mar;106(2):339-354. doi: 10.1016/j.mcna.2021.10.007. Epub 2022 Jan 28. PMID: 35133602.
* Vollmer-Conna U, Montoya JG, Vernon SD, King N, Scott EM. Gender differences in symptoms and functional impairment in myalgic encephalomyelitis/chronic fatigue syndrome. J Womens Health (Larchmt). 2020 Feb;29(2):226-235. doi: 10.1089/jwh.2019.7788. Epub 2020 Feb 3. PMID: 32014798.
* Montoya JG. Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. JAMA. 2020 Aug 25;324(8):801-802. doi: 10.1001/jama.2020.10115. PMID: 32832502.
* Kulkarni J, Han W, Fitzgerald PB. Pharmacological and Non-Pharmacological Treatments for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Neuropsychiatr Dis Treat. 2022 Aug 19;18:1873-1882. doi: 10.2147/NDT.S358509. PMID: 36015528; PMCID: PMC9397678.
Q.
Creatine for Women 30-45: Solve Fatigue & Your Next Steps
A.
Creatine can help some women ages 30 to 45 feel less fatigued by boosting muscle and brain energy, improving strength and recovery, and sometimes sharpening mental clarity; creatine monohydrate is generally safe at 3 to 5 g daily for healthy adults. There are several factors to consider, since creatine is not a cure for medical fatigue and you may need to rule out causes like low iron, thyroid issues, poor sleep, or depression; see below for dosing details, side effects, who should avoid it, and the step by step plan to decide whether to start and when to see a doctor.
References:
* Mondo H, Bizzarri M, Foti F, Scoglio M, Mancuso M. Brain creatine levels and creatine supplementation: A comprehensive review. Nutrients. 2022 Aug 23;14(17):3481. doi: 10.3390/nu14173481. PMID: 36077587; PMCID: PMC9459521.
* Smith-Ryan AE, Cabre HE, Varanoske AN, Egan B, Harvey A,3, Stegen S, Campbell Z, Doyle L, Ryan ED, Stout JR, Roschel H, Gualano B, Trexler ET. Creatine Supplementation in Women: A Review of the Literature. Nutrients. 2021 Mar 8;13(3):877. doi: 10.3390/nu13030877. PMID: 33800627; PMCID: PMC8004513.
* Brosnan ME, da Silva RP, Brosnan JT. Creatine and its implications for women. Amino Acids. 2018 Jul;50(7):869-877. doi: 10.1007/s00726-018-2561-1. Epub 2018 Apr 18. PMID: 29670942; PMCID: PMC6019060.
* Wang X, Liu C, Ren F, Ren X, Liu Y, Li G, Li C, Wang Y. Creatine supplementation and muscle strength in older adults: A meta-analysis of randomized controlled trials. Exp Gerontol. 2022 May;161:111771. doi: 10.1016/j.exger.2022.111771. Epub 2022 Mar 15. PMID: 35306354.
* Kandilarov E, Sabotinov K, Nikolov M, Velikova S. Creatine for the Treatment of Depression: A Systematic Review and Meta-Analysis. J Affect Disord. 2020 Feb 1;262:239-247. doi: 10.1016/j.jad.2019.09.088. Epub 2019 Oct 14. PMID: 31756534.
Q.
Ginger for Women 30-45: Relieve Chronic Symptoms & Your Next Steps
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Ginger can help women 30 to 45 relieve ongoing bloating and nausea, menstrual cramps, low-grade inflammation, headaches, and related fatigue when used consistently in tea, fresh root, or capsule form. There are several factors to consider; see below for evidence-backed amounts, how it works, and ways to combine it with simple habits for better results. It is supportive, not a cure, and certain people should use caution such as those on blood thinners, pregnant or with gallbladder issues, and anyone with severe or worsening symptoms should speak with a doctor, so review the details below to guide your safest next steps.
References:
* Mazidi M, et al. The effect of ginger (Zingiber officinale) on inflammatory markers: A systematic review and meta-analysis of randomized controlled trials. J Ethnopharmacol. 2021 May 23;272:113943. doi: 10.1016/j.jep.2021.113943. Epub 2021 Feb 18. PMID: 33609805.
* Moini Jazani A, et al. The Efficacy of Ginger in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Complement Ther Med. 2022 Dec;71:102874. doi: 10.1016/j.ctim.2022.102874. Epub 2022 Oct 26. PMID: 36306509.
* Chen Y, et al. Efficacy of ginger in the treatment of migraine headache: a systematic review and meta-analysis. J Headache Pain. 2021 Jun 26;22(1):71. doi: 10.1186/s10194-021-01281-2. PMID: 34172088; PMCID: PMC8234390.
* Hani M, et al. A systematic review and meta-analysis of the effect of ginger on nausea and vomiting in adults with chronic conditions. Complement Ther Med. 2023 Dec;79:102970. doi: 10.1016/j.ctim.2023.102970. Epub 2023 Nov 2. PMID: 37923481.
* Bodagh MN, et al. The Potential Role of Ginger (Zingiber officinale Roscoe) in the Management of Oxidative Stress and Inflammation: A Narrative Review. J Complement Integr Med. 2023 Apr 19;20(2):645-667. doi: 10.1515/jcim-2022-0391. PMID: 36728080.
Q.
Healthy Breakfast for Women 30-45: Fix Fatigue & Next Steps
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For women 30 to 45 with fatigue, a balanced breakfast can steady energy: aim for 20 to 30 g protein with fiber-rich carbs and healthy fats, eat within 1 to 2 hours of waking, and avoid coffee-only or sugary starts. Try this for 2 to 3 weeks, track mood and focus, adjust as needed, and address nutrient gaps like iron, B12, and magnesium; see a clinician if fatigue persists or you have shortness of breath, chest pain, unexplained weight loss, dizziness, or fainting. There are several factors to consider, including meal ideas, hormone and stress tips, and when to test for thyroid or anemia, all explained below.
References:
* Al-Dujaili A, Dinc A, Hiller J, Singh T, Kordowicz A, Zdzieblik D, Köhnen E, König D. Dietary patterns and fatigue in women: a systematic review. Nutrients. 2021 Jul 20;13(7):2454. doi: 10.3390/nu13072454. PMID: 34371946; PMCID: PMC8308801.
* Leidy HJ, Bossingham MJ, Mattes RD, Campbell WW. Impact of a high-protein breakfast on satiety, energy intake, and postprandial glucose regulation in healthy women. Obesity (Silver Spring). 2011 Oct;19(10):1982-9. doi: 10.1038/oby.2011.167. PMID: 21778942; PMCID: PMC3207865.
* Biesalski HK, Tinz J. Micronutrient deficiencies in women: Implications for health and well-being. Nutrients. 2018 Jul 11;10(7):858. doi: 10.3390/nu10070858. PMID: 29997328; PMCID: PMC6073752.
* Adolphs P, Kreutzmann I, Seppelt C, Nothlings U. The role of breakfast on the nutritional and health status of adults. Nutrients. 2019 Mar 16;11(3):643. doi: 10.3390/nu11030643. PMID: 30884976; PMCID: PMC6471691.
* Al-Dujaili A, Singh T, König D. Dietary Approaches to Managing Fatigue: A Narrative Review. J Nutr Sci. 2021 Mar 15;10:e18. doi: 10.1017/jns.2021.9. PMID: 33903960; PMCID: PMC8069695.
Q.
Introvert Burnout or Health Issue? A Woman’s Guide & Next Steps
A.
There are several factors to consider: for many women, introvert burnout improves with quiet recovery and consistent sleep, while fatigue that lasts weeks, unrefreshing sleep, or new physical symptoms can point to medical causes such as iron deficiency, thyroid or sleep disorders, depression or anxiety, ME/CFS, or autoimmune disease. Next steps include briefly tracking symptoms, trying targeted introvert recovery, considering a symptom check, and contacting a doctor if symptoms persist, worsen, or feel urgent like chest pain or fainting; important details that can shape your choices are outlined below.
References:
* Ahmadi S, Zohra H. Burnout and health among working women: a systematic review. J Community Psychol. 2022 Mar;50(3):1398-1420. doi: 10.1002/jcop.22822. Epub 2021 Sep 20. PMID: 34549887.
* Sorkin H, Sheppes G, Shvartzvald A, Mintz M. Burnout, well-being and personality traits: The moderating role of work-life balance satisfaction among university academic and professional staff. PLoS One. 2023 Jul 20;18(7):e0288860. doi: 10.1371/journal.pone.0288860. PMID: 37471676; PMCID: PMC10359052.
* Slater E, Alpert M, Elovitz M, Alpert SH. Chronic Stress and Health in Women: A Systematic Review. J Womens Health (Larchmt). 2024 Jan;33(1):3-16. doi: 10.1089/jwh.2023.0189. Epub 2023 Oct 17. PMID: 37843817.
* Charkos ZK, Wintner H. Gender Differences in Burnout and Associated Psychological Distress: A Systematic Review. Int J Environ Res Public Health. 2023 Jan 26;20(3):2148. doi: 10.3390/ijerph20032148. PMID: 36767272; PMCID: PMC9914717.
* Eskelinen JJ, Järvi H, Pirkola S, Törnwall-Virk J, Tikkala A, Pihlajavesi M, Suvisaari J, Väänänen JM, Poutanen O. A Systematic Review on Psychosomatic Interventions to Reduce Burnout. Int J Environ Res Public Health. 2023 May 10;20(10):5844. doi: 10.3390/ijerph20105844. PMID: 37239556; PMCID: PMC10218764.
Q.
Ketamine for Women: Healing Chronic Symptoms & Your Next Steps
A.
Ketamine can be a fast-acting option for women with treatment-resistant depression, acute suicidal thoughts, PTSD, and some chronic pain by targeting glutamate pathways, with strongest support in depression and limited evidence for chronic fatigue. There are several factors to consider. See below for who is a good candidate and who should avoid it, safety and side effects, treatment formats and schedules, female-specific considerations like hormonal timing and integration therapy, and step-by-step next moves such as clarifying your diagnosis, speaking with a qualified doctor, and choosing a reputable clinic.
References:
* Soni M, Gupta A, Bista SR. Sex Differences in the Effects of Ketamine on Pain and Mood. *Pain Rep*. 2020 Jan 23;5(1):e809. pubmed.ncbi.nlm.nih.gov/32095627/
* Koutsouleris N, O'Day D, Stone JM. Sex Differences in Depression and Antidepressant Effects: Ketamine and Beyond. *Curr Top Behav Neurosci*. 2019;42:251-274. pubmed.ncbi.nlm.nih.gov/31346746/
* Abdallah CG, Averill LA, Krystal JH. Ketamine for Posttraumatic Stress Disorder: A Systematic Review. *J Clin Psychopharmacol*. 2020 Jan/Feb;40(1):16-24. pubmed.ncbi.nlm.nih.gov/31904797/
* Niesters M, Kim YC, Dahan A. Ketamine and Its Role in the Treatment of Chronic Pain: A Review. *Pain Res Manag*. 2021 Jun 25;2021:6651913. pubmed.ncbi.nlm.nih.gov/34220556/
* Fava M, Saccà F, Rossi M, Fornaro M. Safety and Tolerability of Ketamine for Psychiatric Disorders: A Systematic Review and Meta-Analysis. *J Clin Psychiatry*. 2020 Jan 28;81(1):19r12833. pubmed.ncbi.nlm.nih.gov/32017366/
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Yancey JR, Thomas SM. Chronic fatigue syndrome: diagnosis and treatment. Am Fam Physician. 2012 Oct 15;86(8):741-6. PMID: 23062157.
https://www.aafp.org/pubs/afp/issues/2012/1015/p741.htmlTurner-Stokes L, Wade DT. Updated NICE guidance on chronic fatigue syndrome. BMJ. 2020 Dec 16;371:m4774. doi: 10.1136/bmj.m4774. PMID: 33328173.
https://www.bmj.com/content/371/bmj.m4774Bested AC, Marshall LM. Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians. Rev Environ Health. 2015;30(4):223-49. doi: 10.1515/reveh-2015-0026. PMID: 26613325.
https://www.degruyter.com/document/doi/10.1515/reveh-2015-0026/html