Feeling fatigued? There may be a good reason

Illustration by Bryan Nielsen/Standard-Examiner
Story by Jamie Lampros
(Standard-Examiner correspondent)
Tue, Jun 21, 2011
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In our fast-paced world, it’s probably no surprise that fatigue is one of the most common complaints that brings a patient to visit the doctor.

Although it’s normal for people to be low on energy from time to time, long-term fatigue can be a warning signal that something in the body is out of whack.

The causes of fatigue are many — ranging from simple lack of sleep to end-stage cardiopulmonary disease, said Dr. Grace O’Brien, a family physician in South Ogden.

“Fatigue is real,” said Dr. Brent Williams, a family physician at Intermountain Healthcare in South Ogden and owner of Timeless Medical Spa and Weight Loss Clinic. “We’re a high-paced, pushed society. We’re overcommitted. We don’t get enough sleep. All of us are tired.

“But there’s no question that fatigue can also be caused by some very serious illnesses, so it’s very important to see your doctor and get a thorough exam.”

Thyroid disease, diabetes, liver failure, kidney disease, anemia, heart disease, obesity, viral illnesses, vitamin D and B12 deficiency, cancer and respiratory diseases can cause persistent fatigue.

Dr. Julie Rothgery, a family physician at Farr West Family Medicine, said normal fatigue usually doesn’t interfere with a person’s daily life. It also doesn’t generally show up abruptly, and it doesn’t persist.

“Often, there are normal reasons for fatigue,” she said. “Taking care of young children, lack of exercise, a little iron deficiency and medication taken for some other medical issue. It will often take us a while to figure out what all is going on and get it fixed.”

O’Brien said when someone comes to her office complaining of fatigue, she questions the duration.

“People can have good days and bad days. They can be sick and fatigued with colds, flus and viruses, but if fatigue persists over several weeks, doesn’t seem to be going away and there are no obvious causes, then a workup should begin,” she said.

Get an exam

Dr. Marc O. Anderson, a family physician at Tanner Clinic and Davis Hospital and Medical Center staff member, said it’s important to get a complete history and physical exam as well as appropriate bloodwork to diagnose the possible causes of fatigue.

Some diseases, such as anemia and hypothyroidism, can be detected in the blood.

“Hypothyroidism ... is one of the basic blood tests that should be done with a person presenting with fatigue,” Anderson said. “It can run in families and can also present with hair loss, constipation, dry skin, irregular periods and feeling cold all the time.”

If both the physical and bloodwork are normal, other causes of fatigue, such as sleep apnea, depression and obesity, are considered.

Sleep apnea

“Sleep apnea is a cause of fatigue that is becoming more and more common as our society becomes more overweight,” Rothgery said. “This is not only an important cause of fatigue, it can also be dangerous to your heart and lungs if not treated properly.”

People with sleep apnea often find they sleep a normal amount but don’t feel rested upon waking, said O’Brien.

“Sleep apnea is more common than you might think. It does not always just affect the obese, snoring male with the big neck,” she said. “Sleep apnea can easily be checked by starting with a nocturnal pulse oximetry. This is an apparatus that checks your oxygenation while you sleep.”

Weight problems

Obesity is another reason some people may feel exhausted.

“There’s no question that extra weight causes fatigue,” Williams said. “Put a 10-pound bag of sugar around your waist and walk around with it, and see how you feel. When you are carrying around that extra weight, you are wearing out your joints and causing stress on your body. It’s exhausting.”

Williams suggests starting small, building more exercise into your routines to lose weight. Walk around the block, park your car farther away from the door, take the stairs more often.

He also recommends eating more protein and fewer carbohydrates. Eliminating processed foods and sugar is also a good idea.

“A lot of people like carbs and that’s OK, but focus on complex carbs and instead of drinking orange juice, eat an orange,” he said. “Forty to 45 percent of your calories should come from carbs.”

Chronic Fatigue Syndrome

Chronic Fatigue Syndrome may be another reason people are exhausted. All three physicians said they are careful about diagnosing someone with this condition because it is diagnosed by a constellation of symptoms and there is no test as of yet to confirm its presence.

The National Institutes of Health characterizes CFS as extreme fatigue lasting six months or longer. The fatigue is not alleviated by rest and cannot be explained by other conditions. Other symptoms may include headaches, sore throat, tender and swollen glands, muscle soreness, pain that moves from joint to joint, loss of memory or ability to concentrate, and trouble sleeping.

The Centers for Disease Control and Prevention report 1 to 4 million people in the U.S. have CFS, and 17 million worldwide.

A new study out of the University of Miami Miller School of Medicine recently discovered biological markers associated with CFS, as well as a set of proteins in the spinal fluid that are different from healthy people. Although more research is needed, the authors of the study are hopeful it will lead them to a cause and a cure.

“We do know that it can run in families, it is not fatal and it can wax and wane in its intensity,” O’Brien said. “It can be precipitated by a traumatic event such as an illness or trauma. It’s difficult to treat, but there have been some positive outcomes with some antidepressant medications.”

Because nothing has proved to be a cure, O’Brien cautions people to be careful what they pay for when it comes to CFS.

She recommends resting when needed, eating a well-balanced diet, exercising in moderation, reducing stress and getting proper sleep.

Anderson said scientists have looked at a lot of infectious agents, such as mononucleosis, but have found no correlation relating to CFS. However, the latest is a virus called XMRV, which is a retrovirus.

“The first study showed a high correlation, but subsequent studies have had conflicting results,” Anderson said. “There are a number of studies to be released in the next year that may answer this question.”

Insufficient sleep

O’Brien said getting the proper amount of sleep isn’t just for people with CFS.

“It’s not uncommon to have people who have two jobs, six kids and less than four hours sleep a night,” she said. “This will most definitely catch up to them and they will be exhausted.”

O’Brien said it’s important to shoot for at least seven or eight hours of sleep each night. If you suffer from insomnia, try to find the underlying reason and don’t discount the benefit of a sleep aid.

“Oftentimes people are afraid of sleep aids because they think they will become addicted,” she said. “The type of sleep aids available today are better than they used to be and rarely cause a morning hangover like the old barbiturates.”

O’Brien also said it’s important to avoid caffeine and other stimulating activity for several hours before bedtime. Sleep in a cool, dark room and get rid of distractions such as television and computers. Make it a ritual before bed to do something relaxing such as a warm bath or drinking a cup of warm milk.

Anderson also recommends a multivitamin, a positive attitude and stress reduction.

Getting a regular massage can also help induce sleep and provide more energy, said Lori Hoaglin, a licensed massage therapist at Borrowed Earth Emporium in Ogden.

“Massage gets the body and lymphatic system working more efficiently, helping the body to eliminate toxins that can help with the relief of stress and fatigue,” Hoaglin said. “When the body eliminates toxins, it alleviates the sluggish feeling that comes from a buildup of environmental, chemical and food toxins.”

Fatigue, Health
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