Q. I am 42 and suffer from fatigue. My comprehensive physical exam and blood work were normal. I am not depressed, and I sleep eight hours. What's wrong?
--T.S., Wilson, N.C.

A. I congratulate you for having a physical examination and blood test, since this is the first step I advise. Unfortunately, most cases of fatigue have multiple causes.

For example, though you sleep for eight hours, you might not be entering the deep, rejuvenating Stage 3 and Stage 4 sleep. During these stages your body recharges and restores your energy, allowing you to wake up refreshed.

But more important, if you are chronically fatigued, then it is likely you are in the "exhaustion stage" of what is called the General Adaptation Syndrome. Dr. Hans Selye researched the symptoms of this syndrome in the 1950s and discovered that as the body experiences physical stressors, it enters three distinct and progressive stages.

Alarm. In this first stage, a "fight or flight" reaction causes the hormones adrenaline and cortisol to elevate for a while, empowering the body for action. As the sense of alarm subsides, these hormone levels return to normal.

Resistance. The body is set up for this second stage when any stressor--such as divorce, financial difficulty, sickness, a child on drugs or other situations in which a person loses a sense of control--continues for a prolonged period. During resistance, the hormones can stay elevated for months and even years.

Exhaustion. After years at the resistance stage, the body eventually reaches exhaustion. By this time, adrenaline and cortisol are decreased, and further stimulation of the adrenal glands does not elevate these hormones adequately. This syndrome, I find, is one of the most common reasons for chronic fatigue that is unexplained during a physical exam.

Anyone in the exhaustion stage of the General Adaptation Syndrome is very susceptible to reactions to food and inhalant allergies and, thus, even greater fatigue. Fatigue is linked to decreased immune function and recurrent bacterial, viral and yeast infections.

For exhaustion, you first must restore adrenal function. For men, I recommend DHEA, 50 mg (milligrams) a day; for women, pregnenolone, 50mg-100 mg twice a day. Before starting, I suggest a DHEA-S and PSA blood test by your physician. I also recommend an adrenal glandular supplement.

You need to take both a comprehensive multivitamin and a chlorophyll drink, and it is critically important for you to get adequate sleep and follow a low-sugar diet.

Q. Many people have told me that the best time to exercise is in the evening, since it keeps the metabolic rate higher. Do you agree?
--J.A., Umatilla, Ore.

A. I believe the best time to exercise is when you are able to--and it's best to schedule it as you would any other appointment.

It's true that if you exercise late in the afternoon or in the early evening your metabolic rate will be increased. However, if you exercise too close to bedtime it may interfere with your sleep, so you should schedule your exercise for at least four hours before going to bed.

Probably the best time to exercise to burn the most fat is first thing in the morning--before you've eaten. This is because the body's sugar reserves, which it uses for fuel, are lower, and as the body depletes its sugar stores it starts to burn fat for fuel.

The body depends on sugar as its main fuel source, and to reserve that fuel it stores it in the liver and muscle cells as glycogen. During sleep, the body uses up much of its glycogen stores--and when the glycogen is depleted, the body shifts from burning sugar as fuel to burning fat.

When you wake up, drink 8 ounces to 16 ounces of water before you work out. Do weight lifting first because it will further deplete glycogen stores.

Work out for about 20 minutes to 30 minutes with weights and then begin an aerobic exercise such as brisk walking or cycling. As you do your aerobic activity, you will probably be burning primarily fat as fuel.

Donald Colbert, M.D., is a board-certified family physician who practices nutritional medicine. Visit his Web site at www.drcolbert.com for more on health and nutrition or go to www.charismawarehouse.com for his books by Siloam Press. Send questions to Doctor's Orders, 600 Rinehart Road, Lake Mary, FL 32746.

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