Why Am I Fatigued? What Can I Do About It? Why am I fatigued? Many people who see a heart specialist commonly ask this question. They say they don't have any pep. Everyday they wonder why they feel so weary. Perhaps their fatigue is new. They used to be able to do things, but now they always feel worn out. When I see these patients, often what I find is that they have a medical illness or frequently even have more than one medical problem. They may have a blockages of their heart arteries as well as 1-2 other medical illnesses- diabetes, high blood pressure, or obesity. A patient who I'll call Marie illustrates this point. Marie was a 35 year old woman who had come to see me recently complaining of palpitations. Marie was anxious and fidgety. I noticed that her lower lip quivered with nervousness. Marie was also overweight. She was five feet two inches tall and weighed over 230 pounds "My heart is jumping out of my chest," she remarked. "I notice it when I do anything physical such as walking. But it also happens at night when I down to go to bed and lay on my left side I'll feel it racing." When I first saw her I had obtained an EKG in the office. Her EKG showed that she had an abnormal heart rhythm called a Supra-Ventricular Tachycardia or SVT. An SVT is a rapid beating of the heart that can be extremely annoying but rarely causes serious complications. It is sometimes caused by obesity and often by high blood pressure. Marie suffered from both these conditions. Because her heart was racing at 120 beats a minute in the office I placed her on a commonly prescribed used medication called a beta blocker. Beta blockers block the effects of the hormone adrenaline. They are extremely safe but can cause fatigue. I ordered a sound wave test of the heart called an echocardiogram to access her heart function and chamber size. If the heart is damaged or enlarged it can cause racing. I also had her get a holter monitor. This is a 24 hour EKG recording. A month later I saw Marie back in the office. Marie's echocardiogram showed that her heart's function was normal and her chambers were all normal sized. All excellent signs that her heart rhythm problem wasn't serious. The racing of her heart was gone, but now she felt exhausted. "I feel so tired. I can hardly get through the day and do my work." she complained. In Marie's case her fatigue was new, and since I knew that it wasn't heart racing or weakening of hear heart muscle, it had to be the medication. Indeed, I switched her from a beta blocker to another type of medication and the fatigue went away. Although people often want a quick answer, Discovering why a person feels tired is fairly involved. First, as a physician we want to make sure nothing serious is happening to the person. Because a malfunctioning thyroid gland can be the culprit, one of the first things to be checked is their thyroid levels. Anemia, low hemoglobin from bleeding or a variety of sources is also a common cause of fatigue. Checking this requires a simple blood count. Next, for anyone suffering with fatigue we need to be sure they don't have a systemic illnesses: diabetes, low blood pressure, excessively high blood pressure, kidney disease can all account for fatigue. Infections may also be implicated in fatigue. A routine blood count will measure the white blood cells picking up any serious infections. A urinalysis is useful for excluding a urinary infection- a common cause of fatigue if it reaches the blood and causes what is called sepsis. Cancer is another grave concern that must be ruled out when a person complains of fatigue. Excessive weight loss that is not explained, or any lumps or masses found in the body are tip-offs for cancer. Often a whole battery of tests will need to be conducted to truly exclude cancer as a reason for being tired. Next the medications a person is taking should always be a examined. Beta blockers, and what are called ace inhibitors can cause tiredness. In addition, muscle relaxants, anti-anxiety meds, and any medication that works to alter the mood may cause fatigue. Because depression can be a serious concern for people complaining of tiredness, a thorough questioning to exclude depression should be undertaken. So the basic overall approach to fatigue is first to exclude any medical illness or condition which might on a be causing tiredness. If a diligent search has been made and no real medical reason is found, then the next step is to begin looking a life style habits. What we do to our bodies as far as food, exercise, sleep, or the lack of these things may all be playing a role in feeling sapped of our energy. The first thing to examine is a sleep. What is the person's sleep like? Are they getting enough sleep? If a person is only getting 4-5 hours of sleep a night this could be causing fatigue. People who work the night shift commonly complain of feeling exhausted. Next, are they waking a great deal at night, or napping during the day? Interrupted sleep can lead to feeling poorly. Sleep apnea is a medical condition in which sleep is interrupted frequently and commonly leads to lethargy and weariness. It is also prudent to examine a person's activity level. Regular exercise has been shown to help with a person's energy level. Is the person walking, bicycling, swimming- doing some form of aerobic exercise? If you are not exercising regularly then consider starting. Exercise also will often be all that it takes to get rid of fatigue. Another way to increase the energy is through weight loss. People who are heavy frequently complain of lacking the will to do much. Just losing 10-15 pounds can make a tremendous difference in the way a person feels. You should also be concerned with your eating habits. People who eat excessive sugar or soda beverages often complain of fatigue. You'll want to avoid eating simple sugars if you are having fatigue. Try to avoid excessive intake of carbohydrates and move towards protein, and vegetable. Certain people tend to feel sluggish if they overdo the carbohydrates. Also you'll want to stay away from caffeine ingestion. A common complaint of people who use too much caffeine is lethargy, particularly in the morning. I know this from personal experience. I used to feel very tired in the morning. I was drinking 64 oz of caffeinated diet beverages a day. When I markedly reduced my consumption of caffeinated soda I had a very good rise in energy. It may take up to a week to get rid of the symptoms of fatigue after a person has relinquished caffeine. Also water intake is critical. Try to drink a minimum of 1/2 gallon a day provided is alright with your physician. If you avoid caffeine, and stay away from soda beverages while drinking plenty of water, you may see a pick up in your energy level. Our mental state can also create fatigue. People suffering with depression often complain that they lack energy. If you have depression, try exercising. Daily exercise has been shown to combat depression. Worry, anxiety, and stress also can cause fatigue. Checking your emotional health will help you discover if this could be the cause of your low energy level. Activities that get us more in touch with our bodies have a particularly helpful effect on our energy level. Try to spend some time each day doing yoga, gentle stretching, or meditation. These activities will get you more in touch with your body, and are helpful for relieving stress which frequently makes a person tired. I like the technique called Practicing Remembrance. This is a skill I teach that combines body awareness with breathing. It works well for reducing stress and increasing energy. Something else that seems to cause fatigue, is eating large meals. People feel better when their stomach's are empty. Waiting to eat till you are hungry, and pushing away from the table before you become full can help with the energy level. Although may people have never tried it (and you should always consult your physician before you begin) is to try fasting by drinking only juices for 2-3 days. I have had a number of people say that they had a significant increase in their energy level while fasting. A personal observation that has never been proved scientifically, is that certain foods can help a person pick up their energy level. Ginseng is touted as an energy booster, but other foods also seem to work. A few favorites of mine are the following: I sometimes will have people try eating more lemons. Squeeze 1/2 a lemon in a glass of water with a teaspoon of honey before bed. Do this for two weeks. Also fenugreek may be helpful. Fenugreek is an Indian spice that can be found at most health food stores. You can often find it in tea bags. Place 1-2 tea bags in 1/2 cup of boiling water and steep for 10 minutes. Add some honey to counteract the bitterness. Drink twice daily. Cranberries can also be useful. Find whole frozen cranberries and unthaw. Blend enough berries to make 1/3 cup, eat this morning and evening with 1-2 teaspoons of honey (they're very sour). Don't eat anything for 1 hour after taking the cranberries. Try this for 2 weeks. Camomile can also increase a person's energy level. Tea bags of camomile are easy to find. Drink 1 cup twice daily on an empty stomach for 2 weeks. I hope you find these information about fatigue useful. It is a problem that can be particularly frustrating. Remember to consult with your doctor embarking on any of these suggestion. Kirk Laman, D.O., F.A.C.C. Assistant Professor of Medicine Michigan State University College of Osteopathic Medicine.