Fatigue is one of the most common and enigmatic problems I deal with in taking care of my patients. Patients come frustrated because of the taxing nature of fatigue. They want answers. Many have sought out answers, coming up empty handed. This blog will discuss the three-step strategy I recommend for my patients with fatigue.
Step 1: Common Problem, Common Cause
It never ceases to surprise me that people think that they can exist on minimal sleep without fatigue. The average human needs at least eight hours of sleep each night. Sleep is rather like a bank account in that we need to make up any deficits incurred in order to balance the account. It is common to buy energy on credit with caffeine, carbohydrates or other stimulants. The debt must eventually be paid, however, to get out of the red in the account. The result of this existence is fatigue.
So, the first thing I recommend is that fatigued patients purposely schedule at least nine hours of rest each night for at least a week and then observe for progress. I also make it a point to discuss “sleep hygiene.” A dark, quiet environment and at least two hours outside of TV or computer screen exposure can make all the difference in sleep quality. While the rest is the most important part, a short-term sleep aid may be used if necessary to establish a sleep pattern.
Step 2: Maintaining The Machine
Our bodies are super complex organisms of infinite biomechanical and chemical pathways. It’s amazing that they remain in line as readily as they do. While tiny, minute deficiencies can occur, I have found that global causes of fatigue are more common. Simple factors in the care of our bodies often correct accumulating causes of fatigue.
I recommend a balanced diet first in this step. Most important is avoidance of excess simple carbohydrate (sugar). Keeping consumed food in its natural, unprocessed state (avoid packaged, prepared/processed foods) allows for more deliberate accounting of carb-protein-fat portions to reach a better balance. Honing in on things like gluten, organic and GMO in an eating strategy to combat fatigue is starting too narrow in my opinion. When you are fatigued and looking for answers, pick the low-hanging fruit first. There is always room for testing these dietary factors down the road. Meals should further be moderated in size and spread through the day to avoid overtaxing the body to deal with a big energy load. Adding a daily multivitamin (not a multitude of various vitamins for this and that) is not a bad idea to fill in any nutrient gaps. Lastly, avoid dietary caffeine as mentioned prior.
The other side of the calorie balance from our diet comes from the calories we burn. It is important to maintain this balance in order to keep our metabolism primed. Regular exercise, especially aerobic is the best. In addition to maintaining energy balance in the body, exercise stimulates the metabolism of our body stores of adrenaline which yields energy and alertness.
Step 3: Medical Care
If a patient faithfully moves through part 1 and 2 to evaluate fatigue without improvements, further medical workup is recommended. In addition to a thorough review of the history of fatigue and a physical exam, laboratory studies (blood work) should be done. Labs should include:
- fasting blood sugar to rule out diabetes
- hemoglobin to rule out anemia
- white blood cell count to rule out infection or blood cancer
- liver/kidney function studies to rule out disease in these organs
- thyroid stimulating hormone to rule out thyroid disease
- testosterone levels may be warranted in men
Red Flag Symptoms
If the following symptoms are present, a medical evaluation is recommended prior to completing part 1 and 2:
- Unexplained weight loss
- Mood disturbance (significant depression or anxiety)
- Bowel changes (blood in the stool, long-standing diarrhea, black stools)
- Heavy periods
- Vision changes, tingling in the toes, frequent urination (symptoms of diabetes)
Fatigue is common. Its causes are also usually common rather than obscure. A simple, methodical approach can often bring success to overcoming this problem.
Live, and live well!