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We use the terms broadly here, covering a range of presentations:
— the chronic depletion that follows prolonged stress, often work-related but not always. Real biology: HPA axis dysregulation, neurotransmitter depletion, sleep disruption, often inflammation and gut effects.
— a controversial term in conventional medicine, but the underlying biology (cortisol pattern dysregulation) is real, measurable, and addressable.
— the post-infectious fatigue syndromes increasingly recognized after acute viral illness.
— a more severe, often disabling condition with characteristic post-exertional malaise. We do not claim to "cure" myalgic encephalomyelitis (ME/CFS), but functional medicine investigation often reveals addressable contributors.
— the everyday version. Tired in a way that conventional workup doesn't explain.
The systems most consistently implicated in chronic fatigue:
Cortisol awakening response flattening, dysregulated diurnal rhythm, suppressed DHEA. The stress system that's been running too hard for too long. DUTCH testing maps the full pattern.
Cellular energy production at the heart of every fatigue presentation. NutrEval reveals organic acid patterns suggesting impaired ATP production, CoQ10 deficiency, carnitine status.
Standard TSH-only screening misses subclinical issues. Low free T3, elevated reverse T3, autoimmune thyroiditis. Often overlooked.
Low ferritin (well above the anemia threshold) commonly produces profound fatigue, especially in women.
Often missed at standard reference ranges. Functional B12 deficiency at the cellular level can produce fatigue and cognitive symptoms even with "normal" serum B12.
Dysbiosis, intestinal permeability, and food sensitivities all drive chronic fatigue through inflammatory and nutrient-malabsorption pathways.
Persistent viral reactivation (EBV, CMV, HHV-6), Lyme disease and co-infections, chronic bacterial infections — all can sustain fatigue states for years.
Untreated sleep apnea, REM disruption, insomnia — the body cannot recover from chronic stress without restorative sleep.
Perimenopausal hormone shifts, low testosterone in men, the "pregnenolone steal" pattern in chronic stress.
A meaningful subset of unexplained fatigue traces to indoor mold. Often unrecognized for years.
Magnesium, B vitamins, vitamin D, omega-3 EPA, zinc — all commonly depleted in chronic stress states and all directly affecting energy.
Reactive hypoglycemia, insulin resistance, hidden metabolic dysfunction.
Our seven-test bundle is exceptionally high-yield for chronic fatigue because the biology is so commonly multifactorial. Blood panel for thyroid, anemia, inflammation, metabolic, and nutrient markers. NutrEval for the deepest mitochondrial and amino acid view. DUTCH for HPA axis. GI Effects for gut microbiome and inflammation. KBMO FIT 176 with Gut Barrier Panel for food sensitivities and intestinal permeability. EnviroTOX for environmental toxicant and mold exposure. Genetics for individual processing variants.
For suspected post-viral or infection-driven contributors, additional testing — such as chronic infection panels — may be added; environmental toxicant and mold exposure is already covered by the core EnviroTOX panel.
If you’ve done extensive testing elsewhere, integrate it. Bring everything.
Phase one focuses on the foundational pieces — HPA axis stabilization, gut barrier, the most actionable nutrient deficiencies, sleep architecture support. We don’t introduce mitochondrial-stimulating protocols early in severely depleted patients — that can cause crashes. Pacing matters. Phase two addresses what remains — mitochondrial recovery, hormonal rebalancing, infection or toxin work where indicated, longer-term anti-inflammatory protocols.
For ME/CFS specifically, we work at a pace that respects post-exertional malaise. We do not recommend graded exercise therapy. The protocol is gentle, sequenced, and adjusted based on response.
Program structure: main services page
This works for people whose chronic fatigue has not been explained by standard workup, who suspect there's biology no one has investigated, and who are willing to engage with comprehensive testing and a structured, multi-phase roadmap. It works for people in burnout. It works for people with post-viral fatigue. It works for people with established ME/CFS who want to investigate addressable biological contributors alongside whatever symptomatic care they're already pursuing.