    The list could also be extended to more serious conditions that have fatigue as an underlying cause.

Laboratory Assessment Of Fatigue
    The most common findings revealed on blood tests in cases of fatigue are anemia and less commonly, infections, or an abnormal serum glucose level. However, blood tests are normal in many cases of fatigue.

Hair Mineral Analysis. A properly performed hair mineral analysis is often a more useful method to assess the degree and causes of fatigue. Indicators of fatigue on a mineral analysis include:

1) Imbalanced Oxidation Rate. The oxidation rate is defined as the rate at which food is burned or oxidized. All biochemical oxidation has an optimum rate of reaction. When the rate is too fast or too slow, energy efficiency declines drastically. Dr. Paul Eck's research indicates an optimum oxidation rate is indicated in an unwashed hair sample by a calcium/potassium ratio of 4:1 and a sodium/magnesium ratio of 4.17:1. Indicators of a slow oxidation rate are a calcium/potassium ratio greater than 4:1 and a sodium/magnesium ratio less than 4.17:1. Indicators of an excessively fast oxidation rate are a calcium/potassium ratio less than 4:1 and a sodium/magnesium ratio greater than 4.17:1.
    Most hair tests of people with fatigue reveal a slow oxidation rate. In slow oxidation, the calcium and magnesium levels are elevated relative to the sodium and potassium levels. This pattern is associated with sluggish thyroid and adrenal glandular activity. Researchers such as Broda Barnes, MD have written extensively on the impact of hypothyroidism on energy levels. Eighty percent of the mineral tests at Accutrace Laboratories reveal sluggish thyroid and adrenal glandular activity.
    Less common, the oxidation rate is too rapid. In these cases, calcium and magnesium levels are low, while sodium and potassium levels are elevated due to adrenal hyperactivity. These individuals often appear energetic. However, it is often 'nervous energy', especially when the oxidation rate is very rapid or if the sodium/potassium ratio is less than 2.5:1.

2) Calcium/Magnesium Ratio less than 3.3:1 or greater than 10:1. An imbalanced calcium/magnesium ratio is an indicator of carbohydrate intolerance. Availability of glucose to the body cells is essential for the adequate generation of energy. Often an imbalanced calcium/magnesium ratio indicates excessive dietary carbohydrate intake.

3) Sodium/Potassium Ratio less than 2.5:1. When the sodium/potassium ratio is less than 2.5:1, fatigue is always present to some degree. A low sodium/potassium ratio indicates sugar and carbohydrate intolerance, chronic unresolved stress, adrenal exhaustion and excessive tissue breakdown. A ratio less than 1:1 is an important indicator of chronic fatigue.

4) Elevated Toxic Metal Levels. Toxic metals include lead, mercury, cadmium, aluminum, nickel, arsenic, copper and iron. They contribute to fatigue by displacing vital minerals, by causing an imbalance in the oxidation rate, or by impairing the energy pathway. Not all toxic metals are revealed on the first tissue mineral test. Toxic metals may be sequestered deep in body tissues. They may only be revealed on a later test, when energy levels improve and the body mobilizes the toxic minerals out of tissue storage sites and eliminates them through the hair.

5) Four-Low-Electrolyte Pattern. This is a less common mineral pattern in which the four electrolytes (calcium, magnesium, sodium and potassium) are all below normal. This mineral pattern is associated with a stress pattern that includes chronic fatigue.

6) Trace Element Deficiencies. Trace elements are needed for the energy pathway, for glucose metabolism and for many other vital functions. Low levels of zinc, manganese, copper, iron and chromium are common in individuals with fatigue.

Causes For Fatigue
    Fatigue is the prime symptom of a deficiency of adequate biochemical energy production in the body cells. Reduced energy production can be due to a wide range of factors including lack of rest, infection, chronic diseases, muscular tension, emotional upset and very often nutritional imbalances or deficiencies. Let us focus on biochemical factors in fatigue, including the energy pathway, oxidation rate, glucose tolerance and toxic metals.

The Energy Pathway
    The energy pathway is the series of steps through which foodstuffs are converted into usable energy. The process begins with the ingestion of food. Food must be chewed, digested and the nutrients absorbed in the small intestines. Nutrients are then transported, stored and converted in the liver. They pass back into the blood stream and cross cell membranes into the body cells. Within the glycolysis and citric acid cycles in each cell, sugars, amino acids and fatty acids undergo conversion to produce ATP, the form in which energy is used in the body cells.

Minerals in the Energy Pathway. Minerals perform key roles in the energy pathway. They act as catalysts, activators and co-factors that enable the energy system to function. For example, magnesium is a catalyst for several hundred enzymes, including adenosine triphosphate or ATP. ATP is the molecule used as fuel for all cellular activity. Iodine is involved in the production of thyroid hormones. Potassium helps sensitize the tissues to thyroid hormones. Energy production in the Krebs cycle requires iron and copper. Manganese is needed in the mitochondria for energy production within all cells. Insulin production and release require zinc. Chromium is also involved in insulin metabolism. Hemoglobin, the oxygen-carrying molecule, requires iron and copper for its synthesis.

Vitamins in the Energy Pathway. Many vitamins are involved directly or indirectly in the energy pathway. B vitamins are involved in many steps in the glycolysis and citric acid cycles. Vitamins A, C and E protect delicate enzymes from destruction by free radicals. Vitamin F, or the essential fatty acids, are needed to maintain cell membranes. Vitamin and mineral deficiencies are a common cause of energy loss and fatigue.

Causes of Deficiencies. Low levels of minerals and vitamins are caused by:
1) reduced intake, due to soil deficiencies, unbalanced diets and diets high in processed and refined food.
2) increased nutrient requirements, due to physical or emotional stress, biochemical individuality, cigarette-smoking, use of sugar, alcohol, or prescription medications.

Oxidation Rate And Fatigue
    Biochemical energy output also depends upon the rate of biochemical reactions in the body. This is somewhat equivalent to the tune of an engine. As in the internal combustion engine, the body has an optimum rate at which maximum energy efficiency occurs. Dr. George Watson originally coined the term 'oxidation rate' to describe the rate at which the body burns food. Dr. Watson used blood tests to determine the oxidation rate. Dr. Eck continued Dr. Watson's research and developed a way to measure the oxidation rate using the hair mineral analysis. An imbalance in the oxidation rate is a common cause of fatigue.
    The oxidation rate is determined primarily by two endocrine glands, the thyroid and adrenal glands. Their activity is regulated in part by the autonomic nervous system. However, many factors affect the oxidation rate. The balance between the electrolytes — calcium, magnesium, sodium and potassium — significantly affects endocrine gland activity. An increase in tissue calcium and magnesium, for example, tends to slow the oxidation rate. An increase in sodium and potassium levels in the tissues tends to increase the oxidation rate. One's dietary intake affects the oxidation rate. Fat has a slowing effect on one's rate of metabolism, while protein has a stimulatory effect. Sugar and carbohydrates have a temporary stimulatory effect, often followed by a slowing of the rate. Vitamins including B1, B3, B5, B6, C and E enhance the oxidation rate. Others such as choline and inositol tend to reduce the oxidation rate. Minerals that increase the oxidation rate include manganese, potassium and chromium. Minerals that tend to reduce an abnormally fast rate include copper, calcium, magnesium and zinc.

Glucose Intolerance And Fatigue
    A steady supply of glucose at the cellular level is essential for optimum energy production. Many times fatigue is caused by some degree of sugar intolerance, or the inability to properly regulate cellular glucose levels. The result may be either high or low sugar levels in the blood. However, at the cellular level the effect is always a deficiency of available glucose, which can result in fatigue.
    Causes for carbohydrate intolerance include improper diet, psychological stress and various nutritional imbalances. A diet high in refined sugars interferes with sugar metabolism principally by causing a zinc and magnesium deficiency. Dietary sugar is rapidly absorbed. Repeated sugar 'jolts' force the insulin apparatus to overwork to maintain normal blood glucose levels. The result is a depletion of the nutrients involved in insulin production and secretion, principally zinc.

Insulin Metabolism and Zinc. Insulin is a hormone which is necessary for the utilization of glucose in the body. Insulin allows glucose to pass across the cell membrane into the cells, where the glucose is burned or oxidized for energy. The presence of excess sugar in the blood stimulates the release of insulin from the beta cells in the Islets of Langerhans of the pancreas. Zinc has a complicated relationship to insulin. Research reveals the following:

•	addiction to stimulants
•	allergies
•	cold hands and feet
•	constipation
•	cravings for sweets or salt
•	difficulty concentrating
•	diminished perspiration
•	distaste for animal protein and fat
•	excessive sensitivity to stress
•	feelings of apathy and mental depression
•	impaired thinking and memory loss
•	inability to cope with stress
•	insomnia
•	intestinal gas and bloating
•	joint pains
•	low blood sugar (hypoglycemia)
•	low blood pressure
•	mental confusion
•	muscle weakness
•	negative thoughts
•	poor digestion
•	proneness to infection or other illnesses

    The Role of Manganese. Manganese is required in the mitochondria of all body cells, for the production of ATP from glucose. Manganese deficiency is widespread today due to the depletion of soil manganese. Also, most refined and processed food has been stripped of its manganese.

    High Carbohydrate Diets. Excessive consumption of sugar and refined carbohydrates upsets calcium and phosphorous metabolism. It also increases the need for the B-complex vitamins that are necessary to burn sugar. Grains also contain phytates. Phytates bind to calcium, magnesium and zinc, reducing their absorption. A low carbohydrate diet tends to spare these essential nutrients.

    Other Minerals and Carbohydrate Tolerance. The release of insulin is facilitated by calcium and inhibited by magnesium. Thus, the proper ratio of calcium to magnesium is critical for optimal insulin secretion. Also of importance is the tissue sodium/potassium ratio. A ratio less than 2.5:1 indicates a stress condition associated with impaired glucose tolerance and fatigue. It is an indicator of adrenal weakness and the breakdown of tissue protein due to an inability to utilize glucose for energy production.

Toxic Metals And Fatigue
    A hidden cause of fatigue is oftentimes an excessive level of toxic metals. Toxic metal levels in the body are oftentimes overlooked, so they are largely ignored as a cause of ill health. Yet toxic metals play an important role in fatigue by interfering with cellular energy production and normal glucose metabolism.
    Lead, mercury, cadmium, nickel, iron and copper are absorbed from food, drinking water, polluted air, household chemical products, or through occupational exposure. Toxic metals are also passed on from mothers to their children. Toxic metals are insidious, cumulative cellular poisons which interfere with energy production by displacing vital minerals in critical enzyme binding sites. Thousands of enzymes require minerals as activators or as an integral part of their structure. When toxic metals replace the essential minerals, the activity of the enzyme is reduced or ceases all together. A build-up of these toxic substances can have a devastating effect upon energy levels.
    Cadmium antagonizes zinc and can replace zinc in vital metallo-enzyme binding sites. Because zinc is necessary for the production of glucocorticoid hormones and insulin, a zinc deficiency will result in hypoglycemia and fatigue.
    One specific diabetic pattern is associated with elevated tissue iron levels. While iron is an essential mineral, in excess iron can cause health problems. The most probable mechanism in high-iron diabetes is that iron, which is antagonistic to chromium, causes a chromium deficiency. This interferes with the utilization of insulin. Iron is also antagonistic to manganese, which is essential for normal carbohydrate metabolism.
    Copper, an essential mineral, is commonly excessive or biounavailable in people suffering from fatigue. Excess copper antagonizes zinc and raises tissue calcium levels. Copper imbalance often results in a reduction in the oxidation rate by impairing adrenal and thyroid activity. Slow oxidation with hypoglycemic symptoms can often be traced to an excessive accumulation of tissue copper. A copper deficiency can also cause fatigue, as copper is needed in the electron transport system where most ATP is generated.
    Anemia and Copper Imbalance. When a person complains to his physician of fatigue, commonly the doctor orders a blood test. If microcytic, microchromic anemia is present, an iron supplement is usually given. At times, however, the anemia is difficult to correct and the fatigue persists. In these cases, often the anemia is due either to a copper deficiency or biounavailability. Available copper is needed for the incorporation of iron into the hemoglobin molecule. In these cases, iron alone fails to cure the anemia.
    The solution to this cause of fatigue is to correct the copper imbalance. Correction of this anemia requires improving adrenal gland activity, so as to increase ceruloplasmin synthesis by the liver. Ceruloplasmin binds copper so that it becomes available. Iron supplements may not be necessary, providing the diet contains adequate iron.

Other Toxic Substances And Fatigue
    Pesticide residues, low-level ionizing radiation and thousands of toxic chemicals used in industry and in the home have a detrimental effect on our energy system. Their mode of action varies. Many toxic chemicals block energy production by blocking or damaging critical enzyme systems. For example, common water additives such as chlorine and fluorine suppress thyroid activity. Over 3000 food additives are allowed in the food in America. Many of their effects, especially in combination with one another, are unknown. Hormones and antibiotics in animal feed may also have long-term effects of which we know little. We have also become a heavily medicated society. Numerous medications can cause fatigue, including antihistamines, beta blockers, analgesics and anti-inflammatory medication.
    Chronic muco-cutaneous yeast infection is another cause of fatigue. Yeast overgrowth is common today due to the extensive use of antibiotics, birth control pills and steroid hormone therapy. A diminished rate of metabolism, adrenal burnout and copper imbalance also contributes to the increased incidence of yeast infection. Yeast overgrowth produces alcohol and acetaldehyde, which cause fatigue among other symptoms.

Negative Emotions And Fatigue
    Frustration, resentment, hostility and fear are powerful emotions that deplete vital nutrients and can even shut down the adrenal glands. The adrenal glands are designed to respond either with a fight or a flight reaction. Emotions that paralyze a person, such as fear or intense frustration, interfere with the functioning of the adrenal glands and other glands. Such emotions are powerful contributors to fatigue in many people today. Scientifically applied nutrition programs can offset the biochemical damage caused by the emotions. However, if the emotions remain uncontrolled, the response to nutrition therapy will be less than ideal.

Other Topics Related To Fatigue

The Common Denominator Of Disease
    That fatigue is the underlying link in all disease may seem an extreme viewpoint. However, all body systems depend upon adequate biochemical energy production. The body's ability to cope with stress, the integrity of the immune system, wound healing, the integrity of the mucus membranes, digestion, elimination, liver function and mental and emotional functions depend upon adequate levels of energy. Fatigue is indeed a common denominator of illness.

Fatigue Versus Burnout
    We distinguish between fatigue and burnout. Many individuals who feel fatigued are actually in adrenal burnout. The difference between fatigue and burnout is one of degree. Burnout is a more severe disturbance of the energy-producing system of the body. Symptoms of burnout include chronic, unrelenting fatigue, even upon arising in the morning after a full night's sleep. Mineral ratios are usually more imbalanced in cases of burnout.
    In burnout, symptoms improve little even with prolonged rest such as a vacation. Emotions, work performance and personal relationships are more affected. More time and diligence is required to recover from burnout.

Loss Of Awareness And Positive Thinking
    An important consequence of fatigue and burnout is the alteration of one's perception of reality. With fatigue comes diminished awareness. This occurs due to biochemical changes such as a rise in tissue copper and calcium levels, which alter one's perception of reality. On a psychological level, there can be diminished awareness because a person can no longer cope with the sad truth of their lives. When fatigued, a person receives negative messages from the body, which affect his perception of reality.
    Often one's thinking becomes negative. Fear and apathy commonly set in and often cynicism and escapism. To compensate, some people take up jogging, aerobics, or other stimulating activities. Exercise can be very positive, but should not be used to mask an underlying problem of fatigue. Other people react by joining a positive thinking church or support group. In our experience, the ability to think positively and to be optimistic is closely related to one's health. A successful life requires energy. It takes energy to generate creative thoughts, to take risks and to pursue ideas through to completion.

Learning Disability
    Fatigue in children and even infants, is increasingly common today. It is not always apparent from appearances, although many such children have dark circles under their eyes and suffer from recurrent ear infections or upper respiratory infections. Recognizing fatigue may be tricky because many tired children become hyperactive, running on nervous energy. It appears that they have plenty of energy, but such is not the case. A hair analysis will usually reveal a fast oxidizer pattern with a low sodium/potassium ratio. When the sodium/potassium ratio is low, or the oxidation rate is abnormally slow, we know that the child is suffering from chronic fatigue.
    The tragedy is that often these children are very intelligent. However, they are unable to learn because of difficulty concentrating or other behavior problems. Our schools attempt to deal with these problems through special education. However, this misses the biochemical aspect of the problem. Children with attention deficit disorder are given ritalin or dexadrine. However, these medications fail to correct the underlying condition. In our experience, only an individualized nutritional balancing program can correct the underlying biochemical imbalances.

Work And Interpersonal Relationships
    While low energy should never be an excuse for lack of caring, there is a physical component to caring that requires energy. Individuals suffering from fatigue are less interested in their work, or in their marriage partners or families. What little energy they possess they need for themselves. They often appear selfish even when they are not. They will often claim that they have trouble coping and "need their space". Life is a chore. Work and personal relationships can sap their minuscule energy reserves. When parents are exhausted, children may not receive all the love and attention they require. This in turn causes further family difficulties. This syndrome is quite common today.

The "Pepsi Generation" And The Drug Culture
    Widespread fatigue and burnout contribute to many of our national habits and pastimes. One common habit is the desire for stimulants such as soda pop. Cola drinks contain caffeine, sugar and phosphoric acid, all of which have a temporary stimulating effect. Those in burnout also commonly crave alcohol, cigarettes, coffee, loud music, sexual excesses and perversions and 'thriller' or horror movies. All of these temporarily serve to stimulate the adrenal glands and provide a short-term energy boost.
    As people become more fatigued, they require more powerful stimulants just to feel alive. Prescription and recreational drugs become attractive, including amphetamines and cocaine. Although willpower is important to conquer a drug habit, the connection between drug and alcohol abuse and an imbalanced body chemistry is an intimate one. A healthy, energetic person will generally not be interested in stimulants. He or she will feel worse on these drugs, not better.

Juvenile Delinquency And Criminality
    People with adequate energy levels are more likely to be successful in their everyday endeavors. They are better able to work hard all day, think clearly and learn quickly. They are flexible enough to tolerate the problems and pettiness associated with most work situations. They are more able to work toward goals, think long-term and postpone their pleasures and rewards. This is less true, however, as people become chronically fatigued. Tired people become irritable, less able to concentrate and think clearly and less able to interact with others. They are also less inclined to take a long-term view of life. They usually don't feel like the future holds much hope for them — just more fatigue and suffering.
    For these reasons, chronic fatigue creates a climate for delinquency and crime. Although there are many reasons for increased crime, a lack of faith in the future and trouble dealing with realities of the work place increases the temptation to engage in criminal activity. The breakdown of family values, in part due to fatigue and burnout in parents and spouses, also contributes to this problem. Numerous studies indicate much lower recidivism rates in delinquents and other offenders when body chemistry is brought into balance through diet and nutritional supplementation.

Correction Of Fatigue
    Symptomatic remedies for fatigue include working fewer hours, taking a vacation, increasing rest and sleep and anti-depressant medication. While these remedies are useful in some cases, they do not address many of the causes of fatigue.

Symptomatic Nutrition
    Some physicians recommend dietary changes and nutritional supplements for fatigue. However, too often their recommendations are not guided by testing. General supplementation will help some individuals. However, it is much less effective than an individualized nutrition program based on a tissue mineral analysis.

Nutritional Balancing
    Nutritional balancing as developed by Dr. Paul Eck utilizes the hair mineral test as a guide. Correction of body chemistry involves balancing the oxidation rate, removing toxic metals, replenishing vital minerals and improving sugar and carbohydrate tolerance. An appropriate diet for one's oxidation type is very important. Slow oxidizers require adequate protein, low fat and moderate amounts of complex carbohydrate in their diet. Fast oxidizers need more fats and oils and often feel better on low carbohydrate foods. Diet must take into account one's sugar tolerance, as this is a common hidden cause of fatigue. Even fruit and fruit juices can upset blood sugar levels in many people.
    Nutritional supplement programs must be individualized. We find the hair mineral test and the oxidation concept excellent guides to help design a supplement program. The slow oxidizer requires more B-complex vitamins and often manganese, zinc, chromium, vitamin C and E and thyroid and adrenal glandular substance. Fast oxidizers require more calcium and magnesium, copper, zinc, choline and inositol and thymus and parathyroid glandular substance. Digestive aids, extra minerals and specialty products may also be helpful, depending upon the mineral balance and other factors.
    The tissue mineral test should be repeated every few months to monitor progress and to adjust the supplement program as body chemistry changes. Energy often improves rapidly. In some cases, however, several months to several years may be needed to restore health. Patience and persistence are essential for the success of any healing program.

Lifestyle
    A healthful lifestyle is important in overcoming fatigue. This includes adequate rest and sleep, healthful eating habits, freedom from worry and fear, control of emotions and exercise within one's capacity.

Other Therapies
    Other natural therapies that balance and strengthen the body are excellent in conjunction with scientific nutrition to help overcome the causes of fatigue.

Conclusion
    Chronic fatigue and adrenal burnout are much more serious concerns than we are led to believe. In addition to physical discomfort, fatigue is the underlying cause or common denominator for many ailments. It is also the hidden cause for many work-related and social problems.
    While not yet accepted by the medical orthodoxy, tools to assess the nutritional aspects of fatigue are available today. This takes the matter of assessment and correction out of the realm of guesswork and converts it into a scientific discipline that can be verified and repeated by anyone willing to investigate the matter. By presenting this brief overview, it is our hope that others will be prompted to explore the importance of fatigue, its true causes and its correction through modern applied nutritional science.

•	At the pH of the pancreas, insulin can only be crystallized in the presence of zinc, cadmium, cobalt and nickel ions.
•	Crystalline insulin is coated with zinc. The more zinc that can be made to adhere to the insulin molecule, the longer the duration of insulin's action.
•	There is evidence that zinc is utilized in the beta cells of the pancreas to both store and release insulin as required. Release of insulin from the beta cells is accompanied by a loss of zinc.
•	Zinc seems to have a similar action to insulin in stimulating the uptake of glucose by adipose tissue. A deficiency of zinc results in reduced uptake of glucose by adipose tissue.
•	Injection of dithiazone, a zinc chelating agent, produces diabetes in experimental animals.
•	Pancreatic tissue of diabetic individuals has been shown to have one-third the zinc concentration of that of controls.
•	Zinc may be necessary for the retention of chromium, which plays a vital role in glucose metabolism.

•	Chromium may stabilize the structure of the insulin molecule in its most effective form.
•	Chromium may affect tissue insulinase. Insulinase terminates the biological activity of insulin.
•	Chromium may increase the binding of insulin to the tissues.
•	Chromium may be a co-factor for a cell membrane transfer mechanism of insulin.
•	Chromium may facilitate the initial reaction between insulin and a specific cell membrane receptor site.