Fatigue is one of the most common symptoms I hear in my clinic. If I line 10 people up with the symptom of fatigue all 10 of them may have a different underlying cause but I can guarantee you that at least 9 of them have been told they were just depressed and needed an antidepressant. Sound familiar? There is a big difference between fatigue and depression but there can be some overlay. If you have been tired for so long it can be depressing and depression can set in. On the flip side, if you are suffering with depression the motivation to get up out of bed is often not there and can be mistaken for fatigue. If you have depression that is affecting your day to day life then seek help! If you are the other 9 out of 10 people who are just tired of being tired then READ ON and we will explore the many underlying causes of fatigue….
Fatigue is often tricky because there is not just one reason why you are tired. I always have to step back and take a look at the whole picture. Often many different systems are involved so you have to start checking all the boxes of the different systems that may be culprits. Here are some areas that I often evaluate…
- Thyroid – everyone always looks at the thyroid but they don’t look at the whole picture. A simple TSH is not enough. You need the free T4, free T3 and thyroid antibodies (thyroglobulin as well as thyroid peroxidase). Just because they are in “normal” range does not mean they are optimal. Carefully looking at these values can often tip you off that something else is going on like the adrenals or low nutrients.
- Anemia – anemia is a low red blood cell count. If you are anemic you will be tired. This is checked easily by doing what is called a complete blood count (cbc).
- Low iron – you can have low iron and not be anemic so unless this is specifically checked it will often be missed. There are lots of ways to measure iron but the value I like the best and follow is the ferritin level. Ferritin is a representation of the amount of iron stored so it not as affected by what you have eaten the few days prior. Again, just because it is in the “normal” range does not mean it is normal. If you are on the low end of normal then you are most likely iron deficient. Low iron also affects how you use thyroid hormones so the thyroid levels free T4/T3 might be on the lower side if this is the case.
- Mono – Epstein Barr virus (EBV) is a herpes virus. Once you have had mono you can have symptoms that resurface years later. I call these mono ‘flares”. The most common symptom with a flare is feeling like you are coming down with something, feel like the flu but it’s not the flu and overwhelming fatigue. Episodes may last a few days or weeks. Some people will have a sore throat but this is not always present. Traditional EBV panels will miss this chronic form so specialty testing looking for the reactivated form must be done.
- Adrenal fatigue – traditional blood tests are not good enough to diagnose adrenal fatigue. A low DHEA can tip you off that the adrenals are involved but the DHEA in blood work is often normal even with adrenal fatigue. Traditional medicine doesn’t believe in adrenal fatigue, only adrenal failure which is called Addison’s. I have become a believer in adrenal fatigue though as the countless symptomatic people with optimal blood tests prove they have low adrenal hormones using saliva and urine. When these are addressed the symptoms improve.
- Sleep issues – If you aren’t sleeping, then you aren’t restoring so efforts to improve your sleep quality must be addressed. Sleep apnea is a huge cause of fatigue. You do not have to be overweight to have sleep apnea. You do not have to be a man to have sleep apnea. If you snore, wake up startled or gasping or wake up fatigued then you might have sleep apnea and this needs to be evaluated. Undiagnosed sleep apnea can not only cause fatigue but can contribute to high blood pressure and diabetes.
There are so many more underlying causes of fatigue. If you are tired of being tired then don’t stop looking for the issues!
To your health,