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Science Fact: Chronic Fatigue · Do You F*cking Mind?

• 0:10
  Speaker 1: Let's get straight into the brain factor to do. The
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  Speaker 1: brain fact is chronic fatigue syndrome and dealing with general fatigue. Okay,
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  Speaker 1: So chronic fatigue syndrome is also known as myalgic and cephalomyelitis.
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  Speaker 1: Say that ten times in a row when you're drunk, okay.
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  Speaker 1: So basically it's an illness which is defined by a
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  Speaker 1: combination of symptoms, and it is something that you need
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  Speaker 1: to get diagnosed with. You can't just self diagnose it.
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  Speaker 1: You need someone to kind of let you know what's
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  Speaker 1: going on. So the first thing is profound fatigue where
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  Speaker 1: you are feeling tired or fatigued. Then along with that
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  Speaker 1: is impaired memory and concentration, muscle and joint pain, headaches.
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  Speaker 1: And then something called post exertional malay is which is
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  Speaker 1: basically a worsening of those symptoms after exertion and relatively
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  Speaker 1: minimal exertion. So you'll do something that normally wouldn't require
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  Speaker 1: that much effort, that normally wouldn't tie you out, and
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  Speaker 1: then you feel a worsening of the above symptoms that
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  Speaker 1: I just mentioned, Like you'd be even more tied, you'll
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  Speaker 1: feel really sore, you'll get more of a headache, you'll
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  Speaker 1: your memory and concentration is just shot to pieces. So
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  Speaker 1: it's obviously very debilitating this chronic fatigue syndrome, and this
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  Speaker 1: post exertional malaise is also common in something called fibromyalgia
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  Speaker 1: as well. Now, there is a difference that doctors or
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  Speaker 1: scientists are able to see in the central nervous system
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  Speaker 1: of patients that suffer from this chronic fatigue syndrome, and
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  Speaker 1: it's got to do with the spinal fluid. So when
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  Speaker 1: they analyze the spin cerebral spinal fluid of patients with
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  Speaker 1: chronic fatigue syndrome versus control groups, they found low levels
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  Speaker 1: of something called catecholamines and other molecules which are responsible
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  Speaker 1: for regulating the nervous system. So catecholamines are any class
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  Speaker 1: of aromatic amines. So it just includes certain neurotransmitters such
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  Speaker 1: as adrenaline, neuro adrenaline, serotonin, histamine, dopamine, things like that.
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  Speaker 1: They act as both neurotransmitters and hormones and they're really
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  Speaker 1: important in maintaining homeostasis within the body via the autonomic
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  Speaker 1: nervous system, so they are released during physical stress. So
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  Speaker 1: if you're seeing that these levels of catacholamines are reduced.
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  Speaker 1: Then you see this association with poor motor performance, reduced
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  Speaker 1: performance in effort related behaviors, and also reduced cognitive performance.
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  Speaker 1: So here we see this link and why exactly it happens.
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  Speaker 1: It's still not really understood why it happens to some
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  Speaker 1: people and why it doesn't. But we see this link
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  Speaker 1: between the cerebral spinal fluid imbalances and the chemicals in
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  Speaker 1: the brain in people with chronic fatigue syndrome versus the
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  Speaker 1: those without versus the control groups. Now, it does affect
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  Speaker 1: the individual in various ways, which leads to a whole
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  Speaker 1: bunch of different cognitive and neurological symptoms. I just want
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  Speaker 1: to go through all the different things that are happening
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  Speaker 1: within the brain when someone has chronic fatigue syndrome so
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  Speaker 1: you can better understand it if someone you know or
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  Speaker 1: if you yourself has it. So the first thing is
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  Speaker 1: what I mentioned earlier, cognitive dysfunction. Okay, so it's something
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  Speaker 1: called brain fog, which I'd need to do a whole
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  Speaker 1: episode on brain fog. But many people with this ch
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  Speaker 1: fatigue syndrome experience brain fog, which is characterized by confusion forgetfulness,
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  Speaker 1: difficulty concentrating in general. We also in the band of
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  Speaker 1: cognitive dysfunction, we also get memory issues, so that's short
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  Speaker 1: term memory problems and it's hard to recall events or
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  Speaker 1: information in general, and also reduced processing speed, so they
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  Speaker 1: might find that tasks that require quick thinking are more
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  Speaker 1: challenging for them. The next thing is neuroinflammation. So we've
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  Speaker 1: got these inflammatory markers. So there's research that suggests that
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  Speaker 1: neuer inflammation or inflammation in the brain could be playing
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  Speaker 1: a role in chronic fatigue syndrome. So we've got elevated
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  Speaker 1: levels of something called pro inflammatory cytokines and they've been
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  Speaker 1: found in patients with chronic fatigue syndrome. So an inflammatory
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  Speaker 1: cytokine is basically a signaling molecule that is released, so
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  Speaker 1: it's immune cells such as T cells or macrofages, and
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  Speaker 1: this promotes inflammation. So there's this whole thing that goes
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  Speaker 1: down with the immune system and inflammation and why that
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  Speaker 1: all happens, and I have just discussed that in other
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  Speaker 1: brain facts. But basically we are seeing this inflammation and
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  Speaker 1: then because of this inflammation, we have this immune system
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  Speaker 1: activation and this response can basically affect the brain, which
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  Speaker 1: leads to fatigue, pain, and other cognitive issues. The next
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  Speaker 1: thing that we see is autonomic nervous system dysfunction. We're
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  Speaker 1: just basically getting a dysregulation of the ans, which control
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  Speaker 1: involuntary bodily functions. This is really common in chronic fatigue syndrome,
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  Speaker 1: so that's what leads to symptoms such as dizziness, lightheadedness,
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  Speaker 1: also problems with heart rate and regulating your body temperature.
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  Speaker 1: Then the fourth thing is reduced blood flow, so that
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  Speaker 1: cerebral blood flow. So studies have found that there's reduced
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  Speaker 1: blood flow to certain areas of the brain, which of
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  Speaker 1: course then will contribute to cognitive difficulties and fatigue. Sleep disturbances,
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  Speaker 1: so we're getting this non restorative sleep, which is a huge, huge,
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  Speaker 1: huge problem because sleep is where you have most of
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  Speaker 1: your restoration and if you have chronic fatigue syndrome and
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  Speaker 1: then you're getting non restorative sleep, then it's just making
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  Speaker 1: the problem so much worse. So you could have long
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  Speaker 1: periods of sleep, but many people with chronic fatigue will
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  Speaker 1: wake up feeling really unrefreshed, and that of course is
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  Speaker 1: going to exacerbate cognitive and neurological symptoms, and then you
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  Speaker 1: also see sleep disorders such as sleep apnea, restless leg syndrome,
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  Speaker 1: and insomnia that's more common with people with chronic fatigue syndrome.
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  Speaker 1: Then number six out of eight, there's eight in total.
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  Speaker 1: Number six is hyperthylamic petuitary adrenal axis dysfunction. So this
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  Speaker 1: HPA axis is something that regulates stress response. I think
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  Speaker 1: I need to do a whole brain fact on that,
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  Speaker 1: and it seems to be dysfunctional in people with chronic fatigue,
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  Speaker 1: so it can lead to abnormal cortisol levels and then
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  Speaker 1: contribute to fatigue, stress intolerance, and also cognitive impairment. Number seven,
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  Speaker 1: we've got neurotransmitter imbalances, so that serotonin and dopamine, which
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  Speaker 1: of course then affects mood, motivation, cognitive function. If you've
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  Speaker 1: got imbalances in serotonin and dopamine, your willingness to do
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  Speaker 1: things might go down, and also your enjoyment of that
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  Speaker 1: thing might also go down, which leads to less willingness
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  Speaker 1: to do that thing. And then we've also got gabba
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  Speaker 1: and glutamate, So if you've got abnormal levels of gabba
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  Speaker 1: and glutamate, you're having issues with this excitability inhibition and
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  Speaker 1: ability to relax problems going on within the brain as well.
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  Speaker 1: And then lastly, we've got structural and functional brain changes.
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  Speaker 1: So MRI and PAT scans, these imaging studies have shown
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  Speaker 1: that there's actual structural and functional changes in the brain
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  Speaker 1: of people with chronic fatigue syndrome. So these changes include
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  Speaker 1: alterations in white matter, reduced gray matter volume, and abnormal
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  Speaker 1: brain connectivity patterns. So, just to quickly summarize, white matter
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  Speaker 1: in the brain is fat. It is surrounding the axon
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  Speaker 1: part of the neuron. The axon is the part of
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  Speaker 1: the neuron that sends the message from one neuron to
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  Speaker 1: the other neuron. And to make that axon perform at
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  Speaker 1: its peak, you have this fat it's called myelination that
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  Speaker 1: wraps around the axon and there's several diseases that actually
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  Speaker 1: attack the mylin off the cells, which then causes neurological dysfunction.
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  Speaker 1: But basically, when the fat is not there surrounding the axon,
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  Speaker 1: imagine like a hose with all these holes punched in it,
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  Speaker 1: there's less pressure. By the time you reach the end
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  Speaker 1: of the hose, there's only a little bit of water
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  Speaker 1: going through, versus a properly sealed hose where you're getting
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  Speaker 1: a really good conduction from one end to the other.
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  Speaker 1: That's kind of what mylin does. That's white matter. So
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  Speaker 1: if someone has high levels of white matter, we're seeing
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  Speaker 1: highly myelinated axons, we're seeing really good conduction of signals
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  Speaker 1: getting sent through. That's white matter. Gray matter is then
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  Speaker 1: the rest of the neurons. So if you've got good
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  Speaker 1: levels of gray matter as well within the brain, you've
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  Speaker 1: got good cognitive reserve, You've got a lot of connections
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  Speaker 1: between brain regions. If you've got low levels of gray
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  Speaker 1: matter in the brain, you're likely seeing atrophy, which is
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  Speaker 1: where the brain is kind of wasting away. Okay, so
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  Speaker 1: that's what you see when we talk about structural changes,
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  Speaker 1: and then structural also has an implication on functional brain
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  Speaker 1: changes as well. You're seeing these cognitive networks that get disrupted,
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  Speaker 1: which are responsible for attention, executive function, and working memory
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  Speaker 1: as well. Now we can understand why someone with chronic
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  Speaker 1: fatigue syndrome is not just tired, it's not burnt out,
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  Speaker 1: it's not I'm stressed and I just need to sleep.
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  Speaker 1: We're talking about a chronic, ongoing problem here. So the
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  Speaker 1: question is does it go away on its own, key
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  Speaker 1: thing being on its own, No, it does not typically
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  Speaker 1: go away on its own. So this, of course, the
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  Speaker 1: illness can vary greatly from individual to individual. Some people
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  Speaker 1: can experience periods of improvement or remission, but complete and
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  Speaker 1: permanent recovery is very very rare without intervention. Okay, so
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  Speaker 1: there's a few important things that you want to consider.
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  Speaker 1: The many people experience fluctuating symptoms, so we've got periods
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  Speaker 1: of improvement followed by relapses, but it is a long
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  Speaker 1: term condition that requires ongoing management. Symptoms can go on
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  Speaker 1: for years, and for some people it can go on
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  Speaker 1: for decades. So it's important to identify a if you
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  Speaker 1: have it, and b what treatment you need, because with
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  Speaker 1: treatment a lot of things can be done. But to think, oh,
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  Speaker 1: this will just go away, I would not recommend you
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  Speaker 1: do that because this could be an issue that affects
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  Speaker 1: you ongoing. And also if you're not if you don't intervene,
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  Speaker 1: you could actually get worse. So there's currently no definitive cure. However,
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  Speaker 1: there's a lot of treatments and management strategies that really
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  Speaker 1: really help alleviate the symptoms, improve your quality of life,
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  Speaker 1: and then that can then lead to ultimate remission. Okay,
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  Speaker 1: so let's go through a bunch of the treatments and
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  Speaker 1: then we're going to get into the episode of today.
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  Speaker 1: So the first one is medical management, so you may
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  Speaker 1: be prescribed to medication to address things such as your
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  Speaker 1: sleep disturbances, your mood disorders, antidepressants, sleep aids, pain relievers.
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  Speaker 1: And then the other management is cognitive behavioral therapy, so
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  Speaker 1: it helps you manage your symptoms by improving your coping strategies,
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  Speaker 1: by addressing psychological aspects of chronic fatigue. So if you
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  Speaker 1: can have better cope strategies, then it's going to help
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  Speaker 1: how your brain processes certain things, and then it's going
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  Speaker 1: to help you actually overcome this. The next one is
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  Speaker 1: lifestyle modification, so it's pacing an energy management that's learning
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  Speaker 1: to balance activity and rest which prevents feeling exacerbated. Graded
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  Speaker 1: exercise therapy that's called GET, so it's a gradual and
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  Speaker 1: careful monitoring a physical activity which can help improve your
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  Speaker 1: stamina and reduce fatigue. And then of course sleep hygien
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  Speaker 1: which I talk about a lot, So it's improving your
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  Speaker 1: sleep patterns, your sleep schedule, your sleep environment techniques around
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  Speaker 1: that I've spoken about that heaps before, and I think
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  Speaker 1: I've got a whole podcast on sleep, so go check
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  Speaker 1: that episode out. Diet and nutritions. Of course, a well
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  Speaker 1: balanced diet, making sure that you're hitting all your nutrients
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  Speaker 1: is very very very very very important, especially for your
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  Speaker 1: brain health, and also paying attention to how your body
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  Speaker 1: responds to caffeine, how your body responds to sugar, you
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  Speaker 1: might respond differently to people who do not have chronic
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  Speaker 1: fatigue syndrome. And then of course there is alter if
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  Speaker 1: therapy is some people have found that acupuncture is really helpful,
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  Speaker 1: that yoga tai chi meditation a lot of people find
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  Speaker 1: that really really helpful, and also massage therapy which helps
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  Speaker 1: reduce the muscle pain, and then it improves relaxation, which
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  Speaker 1: improves sleep and all of that. So basically, that is
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  Speaker 1: chronic fatigue syndrome. If you think you have it, go
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  Speaker 1: see your GP and then get referred. I think it's
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  Speaker 1: so important to start to manage it properly so you
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  Speaker 1: can actually start to feel like you're getting more out
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  Speaker 1: of your life. Don't just think it's going to go away.
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  Speaker 1: Do something about it to help manage it. That does
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  Speaker 1: the brain fact of today,