The Crunchy Allergist 0:03
Sick of the fatigue and fog? Fed up with the unpredictable flares? Hangry from the super restrictive diets?
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Hello, and welcome to the Crunchy Allergists Podcast. A podcast empowering those who like me appreciate both a naturally minded and scientifically grounded approach to health and healing.
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Hi, I'm your host Dr. Kara Wada, quadrupel board certified, pediatric, and adult allergy/immunology and lifestyle medicine physician, Sjogrens patient and life coach.
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My recipe for success combined the anti inflammatory lifestyle, trusting therapeutic relationships, modern medicine and mindset to harness our body's ability to heal. Now, although I might be a physician, I'm not your physician, and this podcast is for educational purposes only.
The Crunchy Allergist 0:53
Hello, and welcome to the podcast. If you may have noticed, we are making adjustments here at the Crunchy Allergists and formerly Success with Sjogren's podcast.
The Crunchy Allergist 1:06
If we are just meeting, one thing to know about me is I am always open to feedback and open to making improvements over time. One of the main tenants I really recommend through my work is making 1% improvements over time. But every once in a while we need to pivot we need to have a course correction. And as I've been talking with those that the podcast has been reaching, the discussion has been that the information we're covering applies to so many more people than those just with Sjogren's.
The Crunchy Allergist 1:41
So moving forward, we're going to continue to have segments and episodes that really are focused on showing Success with Sjogren's and focusing in on some of those symptoms particular to our our patient population. But I'm also going to be covering information that really can help anyone who's dealing with an immune system that's not reading the textbook, or as sometimes I lovingly referred to mine as misbehaving. I really like to envision my immune system as acting like my three and a half year old Josie, who is very sweet, but also mischievous. And that allows me to approach it and think about it with a little more joy and levity when it is causing a lot of issues.
The Crunchy Allergist 2:28
So today on the podcast, we are going to talk all about fighting fatigue. Fatigue is a symptom that can occur for many different reasons. We're going to go through some of the medical reasons that you would want to be evaluated for with your care team. But we're also going to talk about a lot of the lifestyle issues that are at play when it comes to fatigue. So fatigue is something that is much more than just being tired. It is that symptom that you can get a good night's sleep and just feel like you still cannot get out of bed in the morning. Feel like you are walking through quick sand. And it is just a really challenging symptom that can be very prevalent and persistent in particular with Sjogrens Syndrome, but also with other conditions. In particular, we see fatigue a lot with chronic fatigue syndrome also can accompany fibromyalgia, and other autoimmune conditions such as rheumatoid arthritis, lupus Hashimotos thyroiditis, and can be a part of mental health conditions too, such as depression and anxiety.
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So let's start off by talking about some of the medical conditions that as a physician, your primary care doctor or other people on your care team may be thinking about when you tell them that you are dealing with fatigue.
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One thing I want to focus on when I'm talking with my patients in the office is finding out what their sleep is like. In particular, I will ask how much they are sleeping, how the quality of their sleep seems to be what their bedtime routine, and morning wakeup routine looks like. And in particular, it's really helpful if you have someone who may be a bed partner or in the home when you're sleeping, to have them keep an eye and especially an ear out for your sleeping because one of the main causes of fatigue that we see is sleep apnea. This is when our breathing is affected while we sleep and our body is not getting enough oxygen to function adequately, overnight. Typically, this can be due to structural issues, but sometimes can be due to neurologic issues as well. And this would be a really important health condition to be evaluated for if there is concern for sleep apnea. Because long term at kin, it can lead to increased stress on the heart and the lungs and can cause high blood pressure in the lungs, which is very problematic. One of the other things I will talk to patients about while we're talking about sleep, comes in naturally in the conversation is what their consumption of electronics looks like, especially in the evening hours and overnight. In part, this is a little bit of projection, because I know that I have a tendency to take a look at my phone or my Kindle overnight, especially lately, I have a 12 week old as of when I'm recording this in February of 2022. And so I'm up nursing my baby in the middle of the night. And so it is very tempting to scroll, check my email, do those sorts of things in the middle of the night. But in doing so, we are exposing our eyes, even with our phone settings, limited to wavelengths of light that are not beneficial to getting real restful sleep. So do as I say not as I always do.
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The other medical conditions that your primary care doctor or other people in your care team may be thinking about when you talk about fatigue are your thyroid function. So thyroid is a butterfly shaped gland that sits at the base of your neck and the top of your chest. And it is a main component of our body that functions with metabolism. So and it's also a an organ that very commonly can be the target of autoimmune inflammation or viral inflammation as well. When the thyroid gland is inflamed, it can either release too much of the hormone that it creates, or over time, it can secrete less of the hormone. And in these circumstances, we can have variations in our ability to lose or keep on weight, and also changes in our digestion and our energy levels as well. So this would be another medical condition that may be considered if someone is dealing with fatigue.
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Another common condition that can result or contribute to fatigue is vitamin D deficiency. So if I have a patient who talks to me about fatigue that they've had difficulty improving, with focusing on sleep and nutrition and other things, I very well may suggest we check a vitamin D level, and a blood count because anemia or low red blood cell count can also contribute to fatigue. So these are some of the medical conditions I think about.
The Crunchy Allergist 8:14
Additionally, I also will ask patients about their mood, because depression and anxiety are also huge contributors to fatigue. I will phrase it in one way to our auto immune community, that many times if we are under an immense amount of stress or worry, that stress and worry will steal extra spoons away from us. It'll take that energy away, it zaps us. And we're not able to make more spoons or more energy when we are using up that mental energy. Especially ruminating in our thoughts. And I have certainly been very challenged by this over the course of my Sjogren's diagnosis but also preceding this as a very type a go getter person. Ever since I was little thinking back, I've always had multiple things going on my mind is always racing, always thinking about that next thing, how am I going to do this better, so on and so forth, and that expends a lot of energy. We may not be literally running around, but our brain is continually going and our brain is a huge energy expenditure that we use and we need to fuel in our everyday life. So if you have untreated depression or anxiety, very well maybe high functioning that also can contribute to fatigue.
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Alright, so let's tap into some of the lifestyle elements that also come into play when we think about fatigue.
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Number one, we don't always give ourselves enough time to rest. I know we already talked about sleep to some degree. Most of us will need on average somewhere around eight hours of sleep. And that can vary from person to person. But rest is also very important. And sleep and rest are not all of the same thing. Rest can take forms and many different ways. One of which is disconnecting from others, just taking a break that social rest can be really helpful. And it's really important, especially for those who consider themselves to be more introverted, that they will tend to have energy suck if they're around too many people for too long. Some people need mental rest, just taking a break. Maybe playing a video game, watching a movie that really requires no thinking can be really important. Another way we rest sometimes is through play by having fun getting in touch with our inner child. I love taking some time on the weekends and doing crafts or coloring with my girls. Or we have one of those Marble Run contraptions that I always wanted as a kid. We picked up one of those for the girls for Christmas a couple years ago. And I love sitting down, building, playing creating with them without really a care in the world, just being silly. So those are some ways that we can help counteract fatigue by resting and playing, not just sleeping, which is also very important.
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The other way we can help counteract or fight fatigue is through nutrition.
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So our body needs fuel in order to fight that fatigue. And one strategy that I have found incredibly helpful that was taught to me by my good friend and colleague and collaborator, Jennifer Thrani, she's a registered dietician I collaborate with in our success for sjogrens program. But she taught me how to better balance my blood sugar. So one way of doing that is by balancing out slow burning carbohydrates or complex carbohydrates. So these are things that are generally speaking, not white and color their whole grains, things like sweet potatoes, oatmeal, and balancing that with protein and healthy fat. By having that balance, it helps keep us off this blood sugar rollercoaster that can result in plummeting energy, especially later in the day.
The Crunchy Allergist 12:40
The other aspect to nutrition that can be really important in keeping our energy levels stable, is getting ourselves off of the caffeine roller coasters. Well, I love coffee, you will have to pry coffee out of my cold dead hands. I really enjoy it. It is one thing that adds to my quality of life. But what I've found is I do much better if I keep the amount moderated. So I'll have one to two cups, I'll drink it slowly over the course of the morning. And I will have it along with my breakfast so that I am not having this huge rush of caffeine early on and then tanking out later in the day. The other thing I tend to do is I will have a tiny bit with my lunch. So I usually will have a green tea, either matcha latte made with some oat milk. Or I'll have a cup of green tea which has just a little bit of caffeine. It also encompasses some really great antioxidants that are found in green tea as well. And that will give me just that little bit to have energy later in the day when I tend to have lower energy. Get me through the rest of a busy clinic day. And also not stay in my system too long where I am wide awake come bedtime. If you are someone who is more caffeine sensitive. This may be a situation where you want to try to slowly wean down and see how you do especially if you are needing to really refocus on your sleep and sleep quality as well.
The Crunchy Allergist 14:21
The other aspect of nutrition to think about is working on decreasing the amount of alcohol, especially alcohol you're drinking later in the evening, because that also can impact the quality of your sleep. There are significant changes in our sleep architecture or kind of what our brain is doing when we are asleep if you have had alcohol within a couple hours of going to bed, so that's something else to keep in mind. Maybe keeping that glass of wine to once or twice a week as opposed to every night. Or for some people who aren't certain immune system medications perhaps alcohol is already off the table.
The Crunchy Allergist 15:03
The other last piece to nutrition is dehydration. So drinking plenty of fluids, especially water is a very important to help keep our energy levels up. You wouldn't think that water would play such a critical role, but our brain is almost all water. And so when we are dehydrated, that really slows our thinking down slows our energy down. And by staying hydrated, making sure you're drinking a good eight to 10 glasses of water if not more per day, what I tend to recommend is you want to see that your urine is more clear than yellow. If you're noticing it's bright yellow or darker, that's more concentrated, you're probably needing to drink more water than what you currently are. You also don't want to be drinking so much that you're running back and forth to the bathroom all day long. That's not super practical either. But making sure you're adequately hydrated is really important when it comes to fatigue and energy level.
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I am super fortunate today that despite it being wintertime in central Ohio, it is a beautiful sunny morning when I'm recording this. And so I am trying to get that exposure to that natural sunlight early in the day. That is one other technique that can be really helpful with adding energy to your daytime and getting your circadian rhythms on track. Circadian rhythms are our body's natural rhythms that we fall into have day and night. Our entire body will follow these day and night patterns, even our skin, which is pretty amazing. But exposure to bright sunlight, if you're able to early in the day can be really helpful in resetting and restoring those natural rhythms that are going to be really helpful when it comes to trying to deal with ongoing fatigue.
The Crunchy Allergist 17:13
Two or three other things I'm going to mention, this is a whole list. This is why fighting fatigue can be so challenging, because many times it's what we call multifactorial, there are lots of different things at play that may be contributing to fatigue.
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And one thing that we skipped over was medications. I am notorious in the clinic for recommending medications that can contribute to fatigue. Antihistamines or allergy medications are a huge contributor for many people in causing brain fog and fatigue and sleepiness. So talk with your care team, maybe make an appointment with your pharmacist where you fill your medications. In order to see are there particular medications you're on that may be contributing to fatigue? Are there strategies that you might be able to take, for instance, certain medications and certain antihistamines are less likely to cause fatigue, for instance, fexofenadine or Allegra are much less likely to cause fatigue than diphenhydramine or Benadryl. So if I have a patient who's having issues with fatigue, we may make that change in the type of medication. We also sometimes may change when they're taking the medication. So for instance, if I have a patient who's taking their antihistamine in the morning, it's causing sleepiness. We may say, "Okay, let's try it in the evening at bedtime and see if that is a better fit." I would always as always talk with your own care team to work through some of these trial, or in think about these situations together as a team. Because these are just generalities and for educational purposes only. You need to work with your own care team in order to develop a personalized approach that's going to work for you and your unique circumstances.
The Crunchy Allergist 19:09
The other aspect that contributes to fatigue can be chronic pain. So chronic pain is incredibly challenging. We know that it wears on us and having dealt with chronic pain in my low back for many years. I know that also played into my mood symptoms as well. If you haven't had a chance to listen to my episode with Dr. Martina a few weeks back, we talked a lot about the role of neuro plastic pain. So I don't have time to do this topic complete justice in today's episode, but if you haven't had a chance to listen to that episode, I would recommend you take a listen to it, and think about listening to her podcast Winning at fibromyalgia. Even if you don't have fibromyalgia, she has some incredible information and education and sharing this idea of what is neuroplastic pain.
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Essentially, if you have dealt with pain in a particular area of your body, an area of your body that has in the past, dealt with inflammation or injury in that tissue, whether it's the muscle tissue, the joint, what have you, the nerves that connect that part of your body to your brain, essentially become a superhighway. And so pain that originally started in your elbow, and that impulse would travel up to the brain, and you would sense pain in your elbow, over time, will switch directions. And so what can happen with neuroplastic pain is that pain impulse generates or starts in the brain, but you still feel it in your elbow. Just the actual elbow itself may not show any signs or symptoms of injury, or inflammation on exam, or an x ray, ultrasound, what have you. And so there are new, newer techniques that are available to help treat this neuroplastic type of pain more effectively, and with less medication over the long term than actual acute pain. So that's this whole concept of neuro plasticpain that can be really helpful. And to be quite honest, when I learned about it was completely mind blowing. So I am on a mission to share what Dr. Martina and her colleagues are sharing with the world that there are some other strategies to approaching chronic pain that can be really transformational.
The Crunchy Allergist 22:03
Alright, the last but not least movement. So even though you may feel like just getting out of bed in the morning may be incredibly challenging, especially if you're dealing with a lot of fatigue, a little bit of movement, or exercise, however, that can look for you can be really beneficial. Now, the one caveat is if someone is dealing with chronic fatigue syndrome, or me, this needs to be done very slowly and with care of your care team. In situations such as chronic fatigue or in fibromyalgia, as well, doing too much, can be just as harmful as not doing enough. And so really working with someone to figure out how much to push your limits can be really helpful. But in generalities, getting some movement, whether it's a walk around the block, a little bit of stretching, whatever your body will tolerate and allow can be incredibly helpful in fighting fatigue. For me lately. It looks like a short ride on my exercise bike, a walk around the block, and we're good to go.
The Crunchy Allergist 23:28
So, as we're thinking about fighting fatigue, we're going to do a quick recap, we need to focus on ruling out the medical causes. So what could those be thyroid, vitamin D, blood count issues, sleep apnea, those are all things that need to be thought about. Additionally, diabetes or blood sugar issues may come into play as well. We need to look at what sleep looks like what rest outside of sleep looks like making sure we have a little bit of time for play every week. Thinking about nutrition, balancing our blood sugar, making sure we're getting enough calories, enough water, enough vitamin D and balancing out that blood sugar with a good balance of complex carbohydrates, healthy fat and anti inflammatory proteins. We also can get ourselves off the caffeine roller coaster and thinking about incorporating some of those other antioxidants into our routine. For me it looks like a little bit of green tea at lunch or early afternoon. Exposure to sunshine can be really beneficial. Treating our mental health just as we would treat our physical body is absolutely a huge part of fighting fatigue, tackling chronic pain and incorporating movement all while thinking about medications that may be adding fuel to the fire. So that is a quick, not so quick, but all encompassing way at how I look at fatigue and fighting fatigue and techniques I use in dealing with my own fatigue I have encountered off and on with my sjogrens disease and diagnosis.
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So I am really excited that you were able to join us today. I hope you are enjoying the Crunchy Allergist podcast formerly known as Success with Sjogren's. And I would hope that you may think about sharing this with friends or family who also may be dealing with an immune system that's not quite reading the textbook. Someone who you may know is also looking for a naturally minded and scientifically grounded approach to health and healing especially as a revolves around immune system health. I thank you so much for helping spread the word and sharing this information with those who you love. So that we can get the word out that it doesn't have to be all or nothing. It doesn't have to be this or that that we really can take this and approach of marrying the two together. I hope you have a wonderful rest of your week and stay tuned for our next episode next week.
