BY FAR the most common complaint doctors hear is fatigue.
Whether patients are young and trendy, with a toddler on the hip and in the prime of life, or old and grey, most tell the same story: “Doctor, I’m tired, exhausted, worn out, finished!”

Fatigue certainly seems to be the disease of our time, a consequence of our hectic lifestyle; on average one in 10 people who visit a general practitioner does so because of fatigue.

The phrase “I feel tired” is so subjective, vague and broad and could be a symptom of so many diseases that sometimes doctors are baffled.

Where to start looking for the cause?
However, fatigue should not be taken lightly.

Is the person who complains of fatigue trying to say he has no energy?
Is he physically exhausted?
Dejected or perhaps depressed?
Does he find it hard to concentrate or does he run out of breath easily?
Does he feel sleepy?
This is where a doctor also has to be a psychologist and detective. Is there an obvious reason for the patient’s fatigue or are the causes more profound?

WHAT ARE THE MOST COMMON CAUSES OF FATIGUE?
Although many questions remain unanswered a persistent lack of energy is defi nitely not a fi gment of your imagination that will disappear if only you can manage to “pull yourself together”. Doctors now realise there are many underlying causes of fatigue.

2 - 5 per cent:
Only two to five per cent of people who’re tired suffer from chronic fatigue syndrome. Although the causes may differ all patients with chronic fatigue have been tired for more than six months.

20 - 30 per cent:
In 20 to 30 per cent of cases the cause of fatigue is either physical, such as infections, heart disease, diabetes or thyroid problems, or the medication you take. Fatigue is one of the main symptoms of depression.

75 per cent:
In 75 per cent of cases the cause is unhealthy eating habits, work stress, matrimonial stress, insuffi cient sleep or other forms of pressure. In many instances you’re simply trying to do too much.

WHAT YOU CAN DO

1. Get enough sleep You need at least eight hours a night; any less and the brain doesn’t get enough rest.
2. Eat healthily. Enjoy balanced meals with enough kilojoules for your level of activity.
3. Live a healthy lifestyle Achieve a balance of work, leisure and sleep.

YOU Pulse advises:
Fatigue doesn’t have to be a lifelong sentence.
Take the first step in the right direction: find the reason for your fatigue and treat the cause.

Identifying the problem is half the solution.

DOES YOUR LIFE EXHAUST YOU?
If you have a typical modern lifestyle your fatigue may be caused by the pace of your life. Unhealthy eating habits, work stress, relationship stress, insuffi cient sleep, too many responsibilities or other forms of pressure play a signifi cant role. Do you recognise yourself in one of these people?

TEENS: CLAPPED OUT FROM PARTYING

CAUSES:

• Partying all night.
• A starvation diet, especially one that is low in kilojoules.
• Attempts to build muscle tone through protein drinks while avoiding meat and carbohydrates.
• Iron defi ciency, especially in teenage girls.
• Drunken parties, many cups of coff ee, rave drugs.
• The after-eff ects of glandular fever.

SOLUTIONS:

• You need nine hours’ sleep a night. Get it.
• Eat enough carbohydrates. A girl of 60 kg who doesn’t exercise needs the equivalent of at least 21 slices of wholewheat bread a day. A boy of 70 kg who doesn’t exercise requires the equivalent of 27 slices of wholewheat bread a day. Get carbohydrates from cereal, bread, rice and pasta.
• Go slow on protein supplements. A boy of 70 kg requires only 100 g protein a day. Some boys take more than 800 g creatin and other protein supplements daily, then eat eggs and meat too.
• Don’t abuse alcohol or take rave drugs.
• If your menstrual fl ow is heavy take an iron supplement (talk to your doctor about the right one for you).
• See your doctor if the tiredness continues.

MOMS: THE MOTHER OF ALL FATIGUE

CAUSES:

• The extra progesterone at the start of your pregnancy and the discomfort later.
• A baby that keeps you up at night or toddlers that demand your attention all day.
• Over-tiredness that makes you sleep badly and worry about the baby and your budget.
• Too many daily demands. If you have to look after children as well as cope with a career it’s no wonder you’re always tired.

SOLUTIONS:

• Don’t always put your own needs last. • Get a special concentrated drink for moms who breastfeed.
• Sleep when your baby sleeps. Take the phone off the hook.
If you’re at the offi ce look for a place where you can snooze during your lunch hour. Ask your husband to take turns getting up at night if he’s not already doing so.
• Exercise boosts energy. Try lifting weights for 10 minutes or do quick stretches following an exercise video.

Go for a stroll with your baby. Sunlight, in the morning especially, makes you sleep better and wake up refreshed. Use a skipping rope, climb stairs or dance with your baby in your arms.
• Ask your husband to massage your body – it feels great and helps you relax.
• If your baby is still breastfeeding let her sleep in bed with you.

WORKERS: BITING OFF MORE THAN YOU CAN CHEW

CAUSES:

• Long work hours and work pressure.
• Too little or fitful sleep. Shift workers may have trouble sleeping during the day when it’s noisy.
• Ongoing tension as a result of relationship problems, concerns about money and work pressure.
• Coffee. Yes, it can upset your sleep.
• Bad eating habits and being overweight.

SOLUTIONS:

• Sleep eight hours a night and get a good, uninterrupted night’s sleep.
• Learn good time management and make time for exercise and relaxation.
• Use electronic aids such as the internet for banking and shopping.
• Do something to escape the tension spiral: change your job, get marriage counselling, learn relaxation techniques.
• Stop smoking. Cigarette smoke reduces the oxygen available to the lungs.
• Don’t drink too much coff ee or alcohol.
• If you’re overweight make a plan to lose weight.
• If you’ve been very tired for more than three weeks it may be a sign of depression, heart disease or another medical problem.

THE ELDERLY: RUN OUT OF STEAM?

CAUSES:

• Insomnia as a result of worries, financial or otherwise.
• Sleep apnoea (characterised by snoring and pauses in breathing), pain, depression, cardiac disease and other medical problems.
• Many herbal potions have an adverse effect on sleep. Ginseng, passion flower, verbena and ginkgo biloba are used for energy and to combat tension. Tell your doctor if you’re taking any natural remedies because many of them have side effects.

SOLUTIONS:

• Stick to a healthy sleep routine.
• Don’t drink herbal stimulants after 4 pm.
• Discuss your concerns with your loved ones and find solutions.
• Visit your doctor if you’ve been feeling overly tired for too long.
• Try to walk a little every day.

DO YOU HAVE A DISEASE THAT MAKES YOU TIRED?

In 20 to 30 per cent of people who feel tired the cause is a disease of some sort. If a disease is causing your fatigue you may suddenly or gradually feel more and more tired.

If you feel too weak to go for a walk, go to work, take a bath or get dressed it may be serious. Is your fatigue the symptom of a disease?

1. Depression and melancholy.
One in 10 people suffers from depression at some stage. Many depressed people complain of being tired.

An imbalance in neurotransmitters such as serotonin may cause fatigue, apathy, a fuzzy feeling in the head and headache.

2. Anaemia.
Low iron levels or insufficient red blood cells cause the blood to carry much less oxygen and if the brain, muscles and other tissue don’t get enough oxygen you will feel tired, especially if you walk or do anything that requires physical effort.

3. Rheumatoid arthritis and other connective tissue (auto-immune) diseases.
In these diseases the body forms antibodies against healthy tissue and causes damage. The attack on the immune system drains the body of energy.

Diseases include lupus erythematosus and keratodermia (hardening of the skin).

4. Thyroid problems.
The thyroid secretes hormones that determine the pace of your metabolism. If your thyroid hormone level is too low your metabolism will be slow.

You’ll feel tired, your skin and hair will be dry and dull, you may gain weight because your body is slow at burning kilojoules, your feet may swell and your heartbeat may be slower. You may be so exhausted that you become depressed. Up to 10 per cent of women and a slightly lower proportion of men suff er from thyroid problems.

5. Diabetes and insulin resistance.

Whether you suffer from type 1 diabetes (where the body produces no insulin and insulin injections are imperative) or type 2 diabetes (where the insulin becomes increasingly ineffi cient, as often happens when people are overweight) your cells don’t get enough energy to function.

Even slight exertion may cause diabetics to feel exhausted.

6. Blood pressure problems.
High as well as low blood pressure may cause fatigue.

Some blood pressure tablets cause fatigue as a side eff ect. Fatigue is also an important symptom of some kidney problems such as renal failure that lead to high blood pressure and anaemia, either of which can make you feel tired.

Low blood pressure often causes dizziness and apathy.

7. Diseases with fever and infection.
Most infections leave you feeling weak and tired, especially when they go hand in hand with fever. If the disease also affects vital organs such as the lungs, bone marrow or heart muscle, the fatigue may be even worse.

Examples of such diseases are endocarditis, myocarditis, asymptomatic pneumonia (especially in older people), HIV (as a result of weight loss, diarrhoea, lung infections and anaemia), tuberculosis and hepatitis.

8. Sleep apnoea and other ear, nose and throat problems.
A chronically blocked nose (as a result of allergies), sinusitis, enlarged tonsils and sleep apnoea may disrupt sleep and reduce the oxygen supply to the body.

Eventually you’re perpetually sleepy, exhausted and irritable. Sleep apnoea is caused by a soft, fl accid palate that relaxes during sleep, thereby blocking the air passages.

Although you wake up and change position as soon as the body’s carbon dioxide levels become too high, you are mostly unaware of this. Often the only symptom is loud snoring during deep sleep. Some people may wake up as often as 30 times a night.

9. Heart disease.
Fatigue may be the first sign of cardiac failure, arrhythmia, vascular diseases and a heart attack.

According to researchers at Harvard University in America 71 per cent of women complain of fatigue a month before a heart attack and 43 per cent during a heart attack. The most important symptom of a heart attack in diabetics is severe shortness of breath and fatigue, not pain.

10. Coeliac disease is a chronic malabsorption disease caused by gluten intolerance.

Gluten is present in wheat and rye and to a lesser extent in barley and oats products.

Malabsorption of B vitamins in particular can lead to anaemia and fatigue.

SYMPTOMS YOU SHOULD NOT IGNORE

Some symptoms combined with the sudden onset of fatigue may indicate serious disease. Alarm bells should start ringing when you experience:
• Chest pain, shortness of breath, dizziness, muscular weakness or suicidal thoughts.

These may indicate a heart attack, stroke or an imminent suicide attempt respectively. See a doctor immediately. Shortness of breath, especially when you lie down or during exercise, may indicate cardiac disease such as cardiac failure, as well as lung diseases such as emphysema or asthma.
• Sudden unexplained weight loss may indicate cancer, thyroid problems, diabetes or chronic infection.
• Fever and night sweats may indicate serious infections such as tuberculosis, HIV, Malta fever or endocarditis.
• A pale or yellow skin or yellow eyes could be symptoms of anaemia or hepatitis.
• Excessive urinating may indicate diabetes, chronic renal failure or other problems.
• Other symptoms such as double or blurred vision, swollen glands in the neck, the armpits and the groin, severe persistent stomachache, a rash on the cheeks, subcutaneal haemorrhage, lack of feeling in the skin, muscular weakness and balance problems also require medical attention.

IS YOUR MEDICINE MAKING YOU TIRED?

You may be tired because of medicine you take. These are commonly taken medicines that may cause fatigue:

Antihistamines (eg Allergex) taken for an allergy. If an antihistamine does not contain the stimulant pseudoephedrine, it’ll make you drowsy and tired. An antihistamine has a stimulant effect on children.

Blood pressure medication (eg beta blockers)
Sleeping tablets (eg Normison)
Cortisone (eg Meticorten)
Hormone tablets (eg progesterone)
Dehydration tablets (eg Moduretic)
Tranquillisers (eg Valium)
Muscle relaxants (eg Robaxin)
Painkillers (eg Adcodol)
Some antidepressants (eg Tryptanol)

The following medicines and supplements may stimulate you to such an extent that you’re unable to sleep and get up tired the next day:

pseudo-ephedrine or ginseng
 

• Herbal remedies containing guarana,
• Asthma medicines (eg Ventolin) which facilitate breathing but act as a stimulant


• Cold cures that dry out nasal mucous membranes (eg Coldcaps) which often contain stimulants.

Some of these stimulants such as pseudo-ephedrine are prohibited in Olympic sport.

WHAT YOU CAN DO

Speak to your doctor or pharmacist about the side eff ects of any medication you have to take long term. A different blood pressure medicine, painkiller or sleeping tablet may not tire you as much. Do not take medicine containing stimulants in the evening; you’ll be tired the next morning.

Read the information leafl et inside the packaging carefully to find out if the medicine can tire or stimulate you. Avoid over-the-counter medication that causes fatigue.

BANISH FATIGUE

1. ADOPT A HEALTHY SLEEP ROUTINE

Try going to bed and getting up at the same time.
Relax for at least an hour before going to bed. Take a bath, read a relaxing book.
Write down your concerns and problems before going to bed, then forget about them. Count your blessings once you have switched off the light.
Do relaxation exercises before going to bed. Sit up straight, take deep breaths, clear your mind of thoughts. Certain aromas help you relax.

Crush a mint or rosemary leaf, put lavender flowers under your pillow, drink a cup of peppermint tea.

Don’t look at the alarm clock when you wake up in the middle of the night.

2. EAT PROPERLY

Too much fluctuation in insulin levels makes you tired. Rather eat fi ve or six smaller meals a day and choose carbohydrates with a low glycaemic index such as seed loaf rather than white bread and basmati rather than white rice.

Too many refined carbohydrates and too much sugar also cause fluctuations in insulin levels and leave you feeling hungry and tired an hour later.

Drink enough water.
Milk contains tryptophan which induces deeper sleep.
High fat intake causes weight gain – 60 to 80 g fat a day is more than enough. Make sure these are good fats, for example those found in sardines, tuna, mackerel, trout, etc.

Avoid drinking more than five cups of coff ee and other caff eine drinks a day. Eat supper early and drink your last cup before 4 pm.

3. CHANGE YOUR LIFESTYLE

Regular exercise is vital. Scientists suspect there is a strong link between depression, insufficient exercise and fatigue.

If you do not like jogging or the gym, try healthy and fun alternatives such as yoga, Pilates or t’ai chi.

Why am I always tired?

Chronic Fatigue Syndrome

This story originally appeared in the first edition of Pulse magazine. Buy the latest copy, on newsstand now, for more fascinating stories in the world of health and wellness.