Humans who have disorders of these organelles often feel lethargic, as though they have no energy.

Overwhelming chronic fatigue is one of the biggest complaints our patients have when they come to see us for care. The fatigue we often hear about is not just inconvenient – it can be so debilitating that it interrupts one’s ability to complete even small tasks even to the point of being able to get through the day. In this article, we’re explaining how chronic fatigue and mitochondrial disorders are connected.

Anyone who’s experienced chronic fatigue understands how frustrating sheer exhaustion can be.

Until recently, people with chronic fatigue were often told that the condition was in their heads or that they were lazy. Doctors would frequently prescribe more exercise as a way to boost energy levels – a recommendation that was often impossible to implement.

Fatigue is caused on a cellular level by dysfunction in energy production, which translates to low overall body energy levels. So if you suffer from relentless fatigue, know that it’s not a lack of drive or motivation but possibly poor production of cellular energy. To understand why fatigue is plaguing you in the first place, we must get down on the cellular level and examine how it happens.

Meet Your Mitochondria – Your Key to Unlocking Energy

Your mitochondria are little “organelles” that exist inside all of your cells and are responsible for creating energy. The energy molecule on a cellular level is called “adenosine triphosphate (ATP)”. Often referred to as the “powerhouse generator of cells,” your mitochondria are working around the clock to convert sugars, amino acids from protein, and fatty acids into ATP.

It’s an understatement to say your mitochondria are responsible for your energy levels – because you need a constant supply of ATP to live. In fact, without ATP you would die in seconds. This is how the poison cyanide works. Basically, the drug cyanide suffocates your mitochondria and prevents the energy production cycle from occurring. This brings us to the next part of your energy story – the ever-important “Krebs Cycle”, which is the chemical cascade responsible for creating all of this energy.

Mitochondrial Disorders & Your Krebs Cycle

The Krebs cycle converts oxygen into ATP and occurs in your mitochondria. The Krebs cycle is directed by enzymes (chemicals that make a chemical reaction speed up). Many different toxins can get in the way or block this cycle from happening efficiently.

I often describe the Krebs cycle to my patients like pilots flying a plane. The pilots are enzymes directing the plane – telling it exactly what to do to safely navigate the airspace. Just as pilots need co-pilots, these enzymes require “coenzymes”. These coenzymes are usually nutrients like B vitamins and magnesium as well as the powerful antioxidant glutathione. 

Many different toxins can prevent this plane from getting where it needs to go, just like barricades on a runway or clouds that create turbulence. Common mitochondrial toxins can be heavy metals like mercury or lead and some prescription medications as well as the chemicals from plastics and manufacturing. A smooth flight with plenty of “copilots” and “plenty of fuel” and with no obstructions from toxins means plenty of energy production – that’s when you feel your best.

Whether you’re competing in a triathlon or just getting through the day, an efficient Krebs cycle is what supplies you with sufficient energy. When there’s insufficient fuel or blockages, and your Krebs cycle is producing at lower levels, you can experience fatigue, muscle weakness, depression, and a dysfunctional immune system.

What Impacts Your Krebs cycle?

Think of your Krebs cycle as your source of energy, anything that might get in the way can make you feel fatigued. When patients come to our office frustrated by their chronic fatigue, this is where we look first. We look for things known to impact the Krebs cycle and cause impaired mitochondrial function, or mitochondrial disorders.

Factors we’ve seen cause the Krebs cycle to become blocked or interrupted, include:

• Toxin exposure
• Mold mycotoxins
• Lyme disease
• Epstein-Barr virus
• Mast cell activation syndrome
• Underlying infections
• Thyroid hormone abnormalities
• Autoimmune disease
• Gastrointestinal disorders
• Intestinal permeability (‘leaky gut’)
• Multiple chronic conditions
• Nutrient deficiencies
• Poor diet

Symptoms of Mitochondrial Dysfunction

When you have impaired mitochondrial function and decreased energy production you can experience a wide range of symptoms, but generally, fatigue is the number one. Here are the signs and symptoms of an interrupted Krebs cycle, poor mitochondrial function, and the associated for mitochondrial dysfunction :

• Extreme fatigue
• A weakened immune system
• Muscle weakness
• Loss of appetite
• Digestive issues
• Nausea
• Muscle pains
• Inability to exercise
• Problems with vision
• Migraines
• Neurologic abnormalities

What are “Mitochondrial Diseases”?

The term “mitochondrial diseases” refers to congenital conditions where there are actual mutations of mitochondrial DNA (a defect in the “instruction manuals” (DNA) of the mitochondria). Examples include muscular dystrophy. You can think of mitochondrial diseases in the general sense as anything that interrupts the production of ATP.

Though the above-mentioned symptoms also occur in mitochondrial dysfunction, true congenital mitochondrial diseases develop into more serious problems. The later stages of congenital mitochondrial disease include strokes, seizures, and dementia. Because there are high levels of mitochondria in your brain, heart, lungs, and muscles, often symptoms are noticed there first.

Finding a Doctor Who Specializes in Mitochondrial Disorders and Fatigue

The mitochondria affect every organ in the body, which results in confusing multi-system symptoms. Because of this it takes time working with a certified Functional Medicine Physician to reach a full and accurate diagnosis. We’ve developed a Fully Functional® process to treat complex medical conditions like chronic fatigue and mitochondrial dysfunction.

Drs. Ellen and Scott Antoine have years of experience in mitochondrial dysfunction, chronic fatigue, and alterations of the Krebs cycle. A lot can be done to manage your condition so you can live a Fully Functional® life. If you’re looking for a doctor who specializes in mitochondrial dysfunction and chronic fatigue and are in Carmel, Indiana, you can book an appointment by clicking  here . We are also happy to speak with you at (317) 989-8463, Monday-Thursday, from 8AM – 5PM Eastern time.

Picard’s purview was perhaps more descriptive than prescriptive. “Energetic constraints, energetic flow, and the forces that drive energetic flow—these questions aren’t taken into account as much as they should be,” he said. “The way of the future is understanding personalized energy flows. The last ten years of personalized medicine has been taken over by genomics. The premise is that if you can sequence it you’ll know whether you’ll get sick or stay healthy. That’s where all the money goes. It’s a lucrative hypothesis, but it’s doomed to yield incomplete answers. The genome is static. Health is so dynamic.”

“People are somewhat gorgeous collections of chemical fires, aren’t they?” Harold Brodkey wrote, in the story “Angel.” “We are towers of kinds of fires, down to the tiniest constituencies of ourselves, whatever those are.” Some years ago, without thinking, I introduced two friends of mine, B. and M., to each other, in a loose crew of people meeting up in a bar before a concert. B. and M. were both married. “I love your energy!” B. told M. Everyone laughed: such cheese. The next day, he called me and asked for her number. Such trouble. M. began referring to him, when discussing him with others, as “Energy”; she liked his, too. Their marriages didn’t survive the radiative flux, and B. and M. now live together, in a gravitational field of their own, otherwise known as Essex County, New Jersey. (When I told M. recently that I was writing about energy, the kind you feel, she said, “Talk about how annoying it is that everyone says they are tired. Tired is universal. We are exhausted until we die.”)

B. and M.’s energy is of a different, albeit related, category—the kind you project, or perceive in others. This one has something to do with vigor as well, but also charisma, aura, and temperament. It has a spiritual dimension, to those who perceive or credit such phenomena, and a social one. In some circumstances, good energy may just be a matter of radiance, of good skin, teeth, hair, posture, which are in many respects themselves functions of robust health. Or it may comprise kindness, attentiveness, optimism, humor—the ability to make other people feel good about themselves. There may be intangibles at play. Pheromones, assurance, electromagnetics, pixies.

To the extent that there is an overlap between the kind of energy you feel and the kind you project—a three-part Venn diagram of bio, mojo, and woo-woo—the concept has an array of ancient antecedents. In the Upanishads, prana, Sanskrit for “breath,” is the vital breath that animates body and soul, and all of existence, much like chi. Posidonius, the Stoic, proposed the existence of a life force that emanates from the sun. (Picard, the mitocentric, also cites the sun: it initiates a life cycle—photosynthesis, glucose, oxygen, ATP—that happens to have mitochondria as its linchpin.)

Many of the variations on such ideas are pseudoscientific, the purview of quacks and crazies, or of spiritual adepts who may have been mistaken for them. Esotericism encompasses a variety of impossible-to-substantiate phenomena that persist best, in our quasi-scientific era, as metaphors or abstractions. In the eighteenth century, Franz Mesmer introduced his concept of mesmerism, or animal magnetism, involving a universal vital fluid that passes in and out through our pores. Baron Carl von Reichenbach, some decades later, described an electromagnetic substance he named the Odic force, after the Norse god Odin, which sensitive souls could perceive emanating from others’ foreheads. Early in the twentieth century, the French philosopher Henry Bergson identified an “élan vital,” which impels consciousness and evolution. Schopenhauer had his “will to live,” and, of course, for Freud, the source of the oomph within was the libido. Freud got some of his ideas from the work of the American neurologist George Miller Beard, who, in the years after the Civil War, had identified a condition called neurasthenia, arising out of the exhaustion of the nervous system. Headaches, fatigue, and impotence were the symptoms of what Beard called “American nervousness.” The cause, he proposed, was the stress of modern civilization, the most salient manifestations being “steam-power, the periodical press, the telegraph, the sciences, and the mental activity of women.”

And then there was orgone, discovered, or imagined, by Wilhelm Reich, the Austrian psychoanalyst and fallen Freudian. Reich—who fled Germany in 1933 and pursued his experiments in Norway and New York before settling in rural Maine, where he could keep an eye out for U.F.O.s—sought to find physiological proof of the libido. In the lab, he hooked his subjects up to an oscillograph (one of them was a young Willy Brandt, the future West German Chancellor) and, with a microscope, discerned pulsating particles he called “bions,” which he claimed were the source of a mysterious life force called orgone. Orgone, he said, was blue, and was responsible for the color of the sky. Later, he invented a device called the orgone accumulator, an insulated shed the size of an outhouse, lined with metal panels. Among other things, it was said to enhance orgasms; the subject, preferably naked, would sit inside and accumulate orgone. It accumulated adherents, anyway—including Norman Mailer, Saul Bellow, J. D. Salinger, and Sean Connery—despite there being no legitimate evidence of orgone’s existence or benefits. Reich’s machine inspired the Orgasmatron, in Woody Allen’s “Sleeper,” and Dr. Durand Durand’s Excessive Machine, in “Barbarella.” The federal government, suspicious of Reich’s free-love evangelism and his associations with Communists, hounded him for years, and eventually jailed him for shipping orgone accumulators across state lines. He died of a heart attack in 1957, at Lewisburg Federal Penitentiary.

A year ago, my wife gave me, as a gift, an Oura ring, my first so-called wearable. A hint, perhaps. I slipped it on next to the wedding ring, and it began feeding data about my exercise and sleep to an app on my phone. Yes, people have been using technology to track their steps and heart rates for a long time now—Fitbit, Apple Watch—but I’d considered such devices dorky, and vaguely sinister. Self-improvement can grate; data tracking can infringe. But maybe I needed a shove, and I was curious to see some numbers behind the brownout afternoons.

“The apes accepted you, but my sister’s a whole other story.”

The Oura motivated me to get out and move—steps, miles, calories. I took long, aimless walks that I imagined would add weeks to my life, like injury time in a soccer match. (It would take a lot of injury time to make up for the hot dogs, if, as a recent study suggested, each one shortens the life span by thirty-six minutes.) Harder work, not surprisingly, yielded higher scores. Jog, or bike, or run stairs, then excitedly check the app. The lure of better numbers, more carrot than stick, was energizing in itself, even if the ring’s criteria seemed kind of arbitrary, maybe overgenerous. The instrument is blunt, but it will cut.

The ring also conditioned me to begin each morning with a Christmas-stocking jolt of anticipation. Oh boy, new data. “How’d you sleep?” my wife would ask, as one does.

“Don’t know yet.”

Most days, the numbers weren’t good: Santa leaves a lump of coal. My sleep patterns were lousy and seemed to augur an early demise. It turned out that what might feel like restorative slumber—after a keen night out, for example, or a bout of hard work—was instead my body struggling to process the poison I’d put into it. The time in bed was more work than rest.

The Oura emphasized the concept of “readiness”—a measure of recuperation. The relevant data point was heart-rate variability, or H.R.V. Your heart rate, like most of the body’s involuntary functions, is controlled by the autonomic nervous system, which has two components: the sympathetic nervous system and the parasympathetic one. The former fires the fight-or-flight impulse; it activates when you experience stress, or excitement, or overindulgence. The latter is the restorative impulse: “rest and digest,” “feed and breed.” The sympathetic system stimulates adrenaline, which dilates your pupils, raises your pulse, opens your airways, and interferes with signals to your bladder. (This is why fear can cause people to piss themselves.) The parasympathetic does the opposite—it settles you down. Ideally, these two systems achieve balance. You rev up, you calm down. You push, you heal. H.R.V. supposedly measures this state of concord. Counterintuitively, higher variability is said to reflect greater balance, and better health. Low H.R.V. correlates to a range of diseases and to earlier mortality. My H.R.V., especially after I’d had a few, was very low.

“You can only manage what you measure,” Will Ahmed, the founder of Whoop, another tracking device, told me last month. By now, I had on three wearables: the Oura ring, a Whoop band on my left wrist, and a Levels glucose monitor behind my left triceps. I’d heard about Whoop from a doctor and journalist named Bob Arnot, a standup-paddleboard masters world champion and competitive ski-mountaineering racer, and the author of the recent book “Flip the Youth Switch.” Dr. Bob, who is seventy-three, is a high-energy guy—maybe a freak.

Clearly, despite our best efforts, energy is not evenly distributed, whether because of genetics or fate, nature or nurture. People blessed with it may ascribe it to their own virtue, perseverance, or self-discipline, and will sometimes wield the descriptor “low-energy” as a slight, as though Eeyores are contagious. The idea that you can train, will, or even medicate yourself into a permanent state of pep, charisma, and accomplishment lends an atmosphere of piety to the energy-assessment dance. It’s all a matter of attitude, they say, as though attitude were not itself determined by energy. Think positive! It takes energy to change habits and alter circumstances. One can adjust certain knobs, but it can feel like a chore to deduce which knobs do what.

“I fundamentally believe this is something you have control over,” Arnot said, when I called him. He credited his apparently prodigious mental energy to what he called “associative thinking.” Lately, he’d been composing a trumpet concerto and studying Python, calculus, machine learning, Arabic, and Swahili. “I don’t sleep much. I’ve always been a hopeless overachiever. Whatever I do is the opposite of what I call ruminating.” Whoop, he said, had helped him maximize his workouts and his downtime. His H.R.V. readings got better each month (H.R.V. typically worsens as you get older), and he reckoned that his biological age was much lower than his chronological one.