EP.119/ 10 Root Causes of Fatigue and Brain Fog with Endometriosis
In the past few months I’ve been speaking to hundreds of you about your worst endometriosis symptoms and fatigue and brain fog have often come out on top.
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But why does endometriosis cause these symptoms and is endometriosis alone the sole culprit?
I may now sound like a broken record, but it’s very unlikely that endometriosis can take the glory for being the one and only true cause of brain fog and fatigue. In fact, especially for those of us with endo, there’s usually a couple of other things at play.
So today, I’m continuing with my series on root causes with 10 root causes of fatigue and brain fog with endometriosis. This list isn’t exhaustive, but it is an overview into some of the most common causes I see with clients, in the research and reported by the endo community.
1. Dysregulated blood sugar - Your blood sugar levels have a direct impact on your energy and cognitive function. Glucose is the body’s primary source of fuel and comes from carbohydrates.
Complex carbohydrates like vegetables, beans and wholegrains (some of us however, do find grains to be blood sugar spiking) take longer to break down in the gut due to their fibre content and so release glucose over a steady period of time.
Simple carbohydrates like honey, maple syrup, white sugar, pastries and refined carbohydrates break down extremely quickly and so the blood is flooded with sugar across a short period of time. This spike results in a sharp dip in energy, as the body rushes to send all the glucose to the cells - leaving no glucose in the blood and causing a sugar crash. We then feel hungry, hangry, shaky, sleepy and dizzy and need to reach for more quick fixes to pick up our energy levels again.
This creates unstable energy that yo-yos up and down across the day, especially after meals and during the night. In contrast, if we balanced our blood sugar levels we would experience stable and consistent levels.
Blood sugar instability also causes inflammation and hormonal imbalances like oestrogen dominance.
2. HPA axis dysfunction - Your hypothalamic-pituitary-adrenal axis is a system which allows your hypothalamus, pituitary and adrenal glands to communicate in order to manage various functions in the body, but primarily to control your stress response and your internal body clock (circadian rhythm).
Your HPA axis releases cortisol in the morning to wake you up, this rises for about an hour after waking and then begins to gently dip across the day, taking a sharp drop mid-afternoon and then really declining over the evening to allow the sleep hormone melatonin to rise.
If we’ve been experiencing chronic stress (whether that’s a busy job and lifestyle, over exercising, trauma, chronic inflammation, etc.) we’re constantly pumping out cortisol and adrenaline as part of the stress response. However, the body is only designed to deal with acute moments of stress and eventually, it will become resistant to the stress signals and stop sending out so much cortisol.
This affects our circadian rhythm, often creating low cortisol all day and night so we’re exhausted all the time or causes cortisol to be low during the day and high at night, leaving us exhausted but unable to sleep.
3. SIBO - Small intestine bacterial overgrowth is when bacteria that should live in the large intestine, end up in the small intestine and cause a number of health issues.
Symptoms of SIBO include brain fog and fatigue. This is in part due to the inflammatory reaction they trigger from our immune system - their cells walls, known as endotoxins or lipopolysaccharides, are toxic to us.
Additionally, hydrogen sulphide type SIBO is literally toxic to the body and can often cause issues such as brain fog, fatigue, anxiety and depression.
4. Nutrient deficiencies and dehydration - If you have SIBO, leaky gut, IBS or some other gut health condition, you may not be absorbing your nutrients properly. Brain fog and fatigue are often signs of low iron, vitamin D, vitamin B12 and folate to name a few, and these deficiencies are associated with SIBO.
You can get tested for nutrient defs with your local GP, though for more extensive testing you may need to go private.
Dehydration also causes fatigue, brain fog, memory problems and trouble concentrating. You should at minimum be drinking half your body weight (in lbs) in ounces. See the references for a urine colour chart that helps to determine whether you are dehydrated or not.
5. Coeliac disease - Coeliac disease is a severe reaction to gluten that causes the immune system to attack the body. Research has found an association between endometriosis and coeliac disease and in a study of over 200 women with endo, 75% experienced a reduction in symptoms after eliminating gluten for 12 months. Coeliac disease can cause symptoms like bloating, cramps, diarrhea and bran fog, to name a few.
Coeliac disease patients often report brain fog and fatigue and research is now starting to confirm these reports. One small study found a significant improvement in patients with CD and cognitive impairment after a year on a strict gluten free diet
6. Hypothyroidism - The thyroid is integral to our health and helps to control energy production as well as many other functions in the body. Hypothyroidism has not only been associated with endometriosis, but it is one of the fastest growing conditions in women across the world, with 1 in 8 now developing some kind of thyroid problem.
Hypothyroidism is a condition where the body stops making enough thyroid hormones and this results in symptoms like hair loss, brain fog, fatigue and weight gain to name a few symptoms. Causes include Hashimoto's thyroiditis, an autoimmune condition where the body attacks the thyroid, and chronic stress (cortisol lowers thyroid hormones), among others. People with endometriosis are significantly more at risk of developing autoimmune diseases and are also often under chronic stress for sustained periods of time due to the difficulties of endometriosis.
Your GP can test your thyroid levels, but these tests only identify if there is an actual thyroid problem and misses if you’re leaning towards one. You can get a private test that looks into your thyroid function in more detail.
7. Depression and anxiety - Research has shown a strong association between endo, depression and anxiety. Studies have shown that chances of developing mental health conditions with endo increase if your symptoms are severe or you don’t have a support network. There’s also research showing that chronic pain can lead to mental health problems too.
Depression and anxiety can affect cognitive function, including memory and ability to focus, and depression can cause feelings of fatigue as well.
8. Sleep deprivation - We all need 7.5 to 8 hours of sleep at a minimum, though some of us with chronic conditions may need more. Sleep deprivation has been shown in research to cause serious health and cognitive issues. The cognitive impairment that occurs from not getting the minimum amount of sleep includes problems with long-term and short-term memory, attention and decision making. Reaction time and thought processing slows down so much that it is equivalent to being drunk!
Of course, it goes without saying that sleep deprivation also affects energy levels too.
9. Chronic inflammation - Inflammation is a normal healing process in the body, but when it becomes chronic, as is the case with endometriosis, it can cause damage. Inflammation actually negatively affects mitochondria, the parts of our cells which process and make energy, leading to fatigue. Research has also found that it damages brain cells, leading to cognitive decline.
10. Chronic pain - It’s not in your head, pain makes it harder to think and is exhausting!
The same parts of your brain that are responsible for attention and memory are also used for processing pain (along with many other areas in your brain), this literally means your brain has less capacity to learn or focus when you’re experiencing pain. Having to juggle normal functioning with pain is mentally exhausting because your brain is trying to do two jobs at once in particular areas of the brain.
Of course, being in pain can also be physically exhausting too!
Again, remember these are clues to what’s worsening your symptoms but you don’t have to start picking apart each one right this moment. Just begin with one or two that you recognise yourself in and map out your next step; it could be as simple as booking a blood test at with the doctor.
For more info on how to identify these issues or to learn more, scroll to the show notes below.
Show Notes
Blood Sugar
Reduce Fatigue, Endometriosis Symptoms and Oestrogen Dominance with A Better Breakfast
HPA Axis Dysfunction
How to Recover From HPA Axis Dysregulation
SIBO
The SIBO, Endometriosis and Interstitial Cystitis Connection wth Dr. Allison Siebecker
How To Treat SIBO with Dr Allison Siebecker
Understanding The Endometriosis Belly, Part 3: SIBO Symptoms
How Do You Know When to Test for SIBO?
Nutrient deficiencies and dehydration
Why Drinking Enough Water Is Key For Reducing Endometriosis Symptoms
Nutrition for Bladder Pain and Endometriosis with Brianne Thornton, MS, RD of IC Wellness
Coeliac Disease
Risk of endometriosis in 11,000 women with celiac disease
The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis
Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?
“Brain Fog” Improves in Celiac Disease Patients After Starting a Gluten-Free Diet
Is Gluten a Cause of Brain Fog?
Depression and anxiety
The Connection Between Endometriosis and Mental Health
Sleep Deprivation
5 Ways That Sleep Deprivation Affects Endometriosis
How Lack of Sleep Impacts Cognitive Performance and Focus
Inflammation
Systemic LPS Causes Chronic Neuroinflammation and Progressive Neurodegeneration
Outsmart Endometriosis: The Elimination 'Undiet' for Endometriosis with Dr Jessica Drummond
Antioxidants for Endometriosis
Anti-inflammatory Living for Endometriosis
Chronic pain
Download my free natural pain relief tool kit.
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My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.
If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at hello@thisendolife.com or visit my website.
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My free guide ‘Managing Endometriosis Naturally’ is perfect for anyone just starting out on this journey of managing and reducing their symptoms. Download here.
My free Endometriosis Diet Grocery List is a pdf list that includes all the foods I buy on a monthly basis, categorised into easy sections. I share my personal endometriosis diet plan, free recipe resources, recommendations to help you get started with the endometriosis diet and nutrition tips. Download here.
My free “Endometriosis Symptom Tracker” could help you begin to understand the subtle patterns in your endometriosis symptoms. As always, this guide doesn’t replace your medical treatment and is not intended to treat or cure endometriosis, but provides you with options that helped me to live well with endometriosis. Download here.
This episode is sponsored by Semaine Health, the anti-inflammatory, plant-based pain relieving supplement. Now priced at $28.99 for subscription. Shop here.