A 45-year-old patient who recently attended my practice noted that the last time she felt energised for an entire day was when she was in her late 30s. Since then, even after a restful night’s sleep, she reports that she runs out of steam by midday. In a somewhat exasperated tone, she stated, “I’m tired of being tired”. Shortly thereafter I began the process of trying to ascertain the reason for this lady’s chronic fatigue with the ultimate goal being to treat and alleviate such.

Unfortunately, many of us have come to normalise fatigue, assuming that it is part and parcel of life and adulthood. While fatigue may be commonplace, it does not mean that it should be accepted as part of the course and that there is nothing that could be done about it.

Fatigue is classified depending on how long it has been present.

● Recent fatigue (symptoms present for 1 month)

● Prolonged fatigue (symptoms present for 1-6 months)

● Chronic fatigue (symptoms present 6 months).

The causes of chronic fatigue can range from mundane to life-threatening with a plethora of treatable causes between these extremes. Once successfully treated, a significant improvement in one’s quality of life follows.

The more common reasons for fatigue are outlined below:

Suboptimal Diet – Your diet provides the fuel responsible for supplying the body’s energy needs. If the fuel is qualitatively poor or quantitatively inadequate the body’s energy and or nutritional needs will be compromised.

Poor quality food can include but is not limited to:

● Highly processed foods – e.g ham, hot dogs, pepperoni, bacon, canned meats, chicken nuggets, etc.

● Unhealthy fats – e.g. beef and pork fat, poultry skin, whole milk, butter, margarine, shortening, etc.

● Foods with high sugar content – e.g. ice cream, sweetened drinks, cakes, cookies, sweets, pastries, doughnuts, sports drinks, breakfast cereals, canned fruit, ketchup, BBQ sauce, spaghetti sauce, etc.

● Fried foods – e.g. French fries, potato chips, deep-fried eggs, fishcakes, fried chicken, fried fish, fried rice, fried plantain, fried breadfruit, pumpkin and banana fritters, bakes, madongo dumplings, etc.

Significantly restricting calorie intake and or nutritionally unbalanced diets can result in a range of nutrient deficiencies (common ones listed below) thereby compromising the body’s energy supply:

● Vitamin B12

● Iron

● Vitamins B2, B3, B5, B6, B9

● Vitamin C

● Vitamin D

● Magnesium

Sleep – Not getting enough quality sleep is a common reason for prolonged fatigue.

● Too little sleep

● Obstructive sleep apnea

● Daytime napping may compromise nighttime sleep

Lifestyle

● Smoking

● Excess alcohol consumption

● Drug use

● Inactivity

● Too much exercise

● Shift work

● A new baby

Medications

● Antihistamines/ Allergy meds

● Cough medicines

● Steroids

● Antidepressants

● Anti-anxiety

● Certain blood pressure medications

● Some herbal supplements

Medical conditions

● Anaemia

● Diabetes

● Heart conditions

● Infections – HIV, COVID, Hepatitis A, B & C, Infectious mononucleosis

● Under-active thyroid (Hypothyroidism)

● Pregnancy

● Autoimmune diseases – SLE, Rheumatoid arthritis, Sjogren’s Syndrome, Inflammatory bowel disease, fibromyalgia, polymyalgia rheumatica

● Cancer

● Parkinson’s

● Chronic fatigue syndrome

● Adrenal insufficiency

● Reduced vitamin levels – B12, D

● Kidney disease

● Liver disease

● Lung – COPD

● Psychological – Anxiety, depression, grief, recent break up

● Neurological – Multiple sclerosis, ALS

● Obesity

Initial Investigations

The initial tests that may be ordered, include:

● Complete blood count (CBC)

● Erythrocyte sedimentation rate (ESR)

● C-reactive protein (CRP)

● Thyroid-function tests

● Kidney function

● Liver function

● Blood sugar

● Calcium

● Creatine kinase (CK)

● Infection screen – HIV, Hepatitis B, EBV

● Chest x-ray (If there are any chest-related symptoms).

When should you see a doctor for fatigue?

If the fatigue is persistent, recurrent, or unexplained you should consider seeing a doctor for your fatigue, especially if it is associated with:

● Change in weight

● Change in appetite

● Change in urination

● Change in bowel movements

● Change in the colour of the urine or stool

● Weakness

● Shortness of breath

● Yellowing of the eyes

● The presence of tremors

● Obstructive sleep apnea

● Heavy periods

● Missed period

● Recent abnormal/ irregular period

● Blood in/ from stool, urine, sputum, nostrils, breast nipple, or other

● If you have been on a protracted vegan diet

● Joint swelling

● Skin rash

● Feeling anxious, depressed, or suicidal

● Swelling of glands in the neck, armpit, groin, or any other areas

● Muscle and or joint pains

● Smoking

● Consuming excess alcohol and caffeine

● Swelling to the front of the neck, in the breast, or any part of the body.

● Headaches

● Unexplained fevers or night sweats

● Change in vision

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale. For appointments: clinic@familycaresvg.com, 1(784)570-9300, (Office), 1(784)455-0376 (WhatsApp)

Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm
Grant, Family Care Clinic or The Searchlight Newspaper, or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided.