“Doc, I just feel tired all the time.”
This is the kind of vague complaint, along with dizziness, that challenges every physician. Such patients often show up on a Friday afternoon or mention the fatigue at the end of a visit for other matters. The issue is so common, yet complex, that up to 40 percent of those suffering from chronic fatigue may never receive a specific diagnosis.
Our medical students are trained to make sure a fatigue complaint isn’t caused by anemia or low thyroid. While these certainly can be a factor, it is rare to find the answer to chronic fatigue with a simple blood test.
Many medical conditions can cause fatigue. Loss of organ reserve in vital organs such as the heart, lungs, liver, adrenal glands, and kidney can all lead to fatigue. Chronic infections, cancer, chronic pain, poorly controlled diabetes, obesity, and sleep apnea make up a partial list of well over a hundred identifiable medical causes for fatigue.
In other words, if you suffer from persistent and severe fatigue, be sure to schedule a visit with your physician to address this problem and to provide plenty of time for him or her to evaluate it with you.
At the end of the work-up, what if no specific cause can be identified? What if you are in that 40 percent of mystery fatigue patients?
In my experience there are some key issues and common factors that need to be addressed along with some helpful remedies.
- Consider your sleep habits. It makes sense if your sleep pattern is poor, perhaps as a result of too many stimulants, light at night, worry, eating heavily before bedtime and so on, that you will feel fatigued during the day. Getting a good night’s rest along with refreshing naps during the day may solve the problem.
- Rule out depression. Occult depression leads to lack of energy, poor motivation, and a general malaise that can be interpreted as fatigue. There are a number of screening tools for depression such as the PHQ 9 that can help you identify and if needed treat depression.
- Increase your exercise, especially exercise earlier in the day. Paradoxically, more exercise stimulates energy by building up your cells mitochondria, the little energy batteries of the cell, improving muscle tone, increasing oxygen flow, and affecting serotonin and other brain chemicals to improve mood.
- If you are overweight, shed some pounds. Carrying the equivalent of a bag or two of dog food on your back all day would be expected to cause some serious drain on your energy.
- Consider your diet. Excess sugary foods can affect blood sugar causing it to go up like a rocket and down like a stick causing fatigue. Low intakes of nutritious vegetable and fruits can cause depletion of essential nutrients, vitamins, and minerals.
- Manage stress. Relaxation techniques, meditation, deep breathing, and sometimes counseling can help reduce the drain on you mentally and physically that chronic stress creates and that can lead to fatigue. Find the excitement in your life and don’t get stuck with the chronic stressors as your dominant emotional driver.
- Consider supplements such as CoEnyme Q 10, vitamin C, L-carnitine, ginseng, ashwagandha, ginkgo, licorice, vitamin B complex, DHEA, probiotics, digestive enzymes and others in consultation with your physician, nutritionist, or other health care professional as these may be useful depending on your clinical picture.