Multiple Sclerosis and Fatigue – Why Are You So Tired?

Fatigue as defined by Webster’s medical dictionary is as follows: weariness or exhaustion from labor, exertion, or stress, and the temporary loss of power to respond induced in a sensory receptor or motor end organ by continued stimulation. Essentially, fatigue is the lack/loss of energy needed to maintain normal function – whether it is temporary or chronic. According to estimates from the Centers for Disease Control approximately 25,000 million Americans suffer from severe fatigue (lasting longer than one month). We all experience fatigue from time to time, but the devastating problem of persistent fatigue is the inability to carry on normal daily activities essential for health, family and livelihood. Fatigue is a significant problem in Multiple Sclerosis (MS). What are the reasons for fatigue in MS? Is fatigue in MS different than someone with classic Chronic Fatigue Syndrome or a person with another disease condition? What can be done to help with fatigue in MS?

The list of medical problems that can lead to fatigue is quite lengthy. When a patient presents to a physician with complaint of fatigue the doctor will look for clinical signs of recent illness such as a virus. They may ask questions about sleep habits, diet, issues related to potential depression, unexpected loss of weight, and other associated complaints, such as weakness, headaches, etc. The doctor will usually perform some blood testing for thyroid function (a good reason everyone with MS should have their thyroid assessed via Thyroid Stimulating Hormone, Free T3 and Free T4 levels), anemia (either iron and/or vitamin B12 and folate), metabolic panel looking at electrolytes such as sodium, potassium, and chloride, blood sugar (to rule out hypoglycemia or diabetes), and a complete blood count (to evaluate immune function). However, in MS a person’s fatigue is often not caused by anemia or blood sugar problems (although it is important to check).  The fatigue manifests at a much deeper level, in part from the cellular machinery called the mitochondria, as well as the associated immune dysfunction that defines the disease.

Mitochondria are our cells energy factories. They produce a tremendous amount of energy currency needed by the body, i.e. brain, heart, muscles to function properly. Mitochondria receive nutrients from our diet, as well as oxygen from the air we breathe to burn fuel (proteins and fats) for energy production. Deficits in certain nutrients like CoQ10 can leave the mitochondria vulnerable to malfunction. Certain nutrients have been shown to help some people with fatigue such as L-Carnitine (helps to transport fat into the cell as a fuel source – 500mg to 1000mg daily), CoQ10 (supports the inner workings of the mitochondria – 200mg to 300mg daily), NADH (necessary for mitochondria activity – 5mg to 10mg daily), and Ribose (needed for energy production – 5g to 10 g daily).

Another possible link for fatigue in MS has to do with a deficiency of cyclic AMP (cAMP). cAMP is a cellular messenger responsible for a variety of functions such as stimulating myelin production (protective coating around nerve cells that is damaged in MS) and helping to maintain the blood brain barrier (damaged in MS which can lead to brain inflammation). One brain structure responsible for cAMP production is the Pineal Gland. The pineal gland is best known for its role in sleep regulation through the production of melatonin. The pineal receives input from a chemical called Histamine 2 which has been found to be deficient in MS. Without adequate H2 people suffer many of the common problems seen in MS including fatigue, heat intolerance, digestive problems, symptoms of allergy, hormone imbalances, i.e. thyroid, poor sleep. A therapy called Prokarin has shown benefit for many individuals with MS. Prokarin positively influences the histamine 2 system in the body with improvements in symptoms such as fatigue and weakness. There is much to discuss with respects to these important biochemical systems and how they related to MS. I will discuss Prokarin therapy and other related topics seen in MS in future writings.


  1. Dr. Woeller~
    Thank you very much for this information. I am using ProKarin every day. Trish and I interviewed Elaine DeLack, the creator of ProKarin last April. Elaine jokes about being ‘just a nurse’ but in reality she is a gifted, she is definitely NOT just a nurse! I had a hard time keeping up with the information as she shared. I know that ProKarin is helping many people with MS. I look forward to more of your posts, information written in ways that I can understand.

  2. Elaine is a unique individual with a definite scientific mind to looks at complex diseases from a different perspective. I have a tremendous amount of respect for her.
    Dr. Woeller

  3. Really fabulous article Dr Woeller! Thank you so much for bringing your wisdom and heart to ~Trish:-)

  4. I found this article so very helpful , you cannot even imagine. Right now I am going through a period for the last 3 months ( been Dx with MS for 12 yrs) were my fatigue is getting worse and worse. Doc just upped my Provigil from 200mg t0 400 mg. I know smoking isn’t helping but I am falling asleep without me even knowing it, so while I am smoking I have come to, with the cig burnt out, I burnt the small whole in daughters laptop so it dont close. I set my aghan on fire, woke up to heat and smoke, I was very lucky.
    I am sooo exhausted and groggy all day, EVERY DAY. I will feel wide awake at 8 next thing I know I am waking up and it is 11:30 am.
    Neurologist is ordering sleep Study, I know I have sleep apnea but it isn’t what is causing this, something more is wrong. Your article is what is wrong with me , I really think so. Wish me luck. Thank you so much for such an informative article.

    • Rae,
      I am glad you found the article helpful. Please be safe, especially with cigarette in hand:)
      Dr. Woeller

      BTW – there are some useful diagnostic tests for adrenal function (saliva) and mitochondria function from various labs that I work with. My specialty is providing, as well as integrating this type of testing for individuals such as yourself. Obviously, discontinuing the smoking would help (you know this :)), but starting to work on things nutritionally is important too.

  5. Great article and well done on including the symptoms of anemia, My wife has recently been diagnosed with Anemia and i have started a blog to help spread awareness. most people see Anemia as harmless or a minor disease.With anemia you must act swiftly to prevent long term effects and improve your quality of life.

    Thanks Dr Kurt

  6. I do a lot of writing about snoring / sleep apnea and one of the many symptoms or direct results of a bad nights sleep is fatigue. I was very interested to read this article which associates fatigue with MS. I guess their are many things that fatigue our bodies but MS was not one that I would every have considered. Will ensure I include some data in my site and link back to this article. Thanks for a well presented article Dr Woeller.

  7. Thanks for your feedback on the article. Fatigue is a major issue for so many people, especially those with MS.

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