Fatigue: Why Are You So Worn-Out?

It’s all you can do to put one foot in front of the other – even maintain upright posture. Heck, you barely have the energy to think. You’re worried and looking for resources, ’cause you have no idea as to what’s going-on. What say we learn about fatigue?  

Doc’s Opinion: Dr. Axel F. Sigurdsson

I had the good fortune of bumping into a blog called Doc’s Opinion, featuring the work of Axel F. Sigurdsson, MD, PhD, FACC. Dr. Sigurdsson is a cardiologist in Iceland and has published scads of scientific work in journals and textbooks around the globe.

His article, 19 Important Causes of Fatigue – Tiredness and Chronic Fatigue Explained, especially grabbed my attention. In fact, it was so good that I knew I had to bring it to you. I believe you’ll find the content really informative and helpful.

Now, Dr. Sigurdsson put a ton of thought and information into his piece. But that means I can only present highlights. So you’re going to want to read his entire article – link at the end.

Let’s roll…

Tiredness & Chronic Fatigue

Dr. Sigurdsson opens his piece by pointing-out that though fatigue and tiredness are common medical complaints (more prevalent in women) that can seriously disrupt one’s life, a specific medical disorder is seldom revealed.

And he follows that up by observing that mood and anxiety disorders – primarily depression, panic disorder, and somatization disorder – are commonly associated with fatigue. In fact, psychiatric illness is present in 60-80% of chronic fatigue patients.

The good doctor reports that fatigue caused by an underlying medical condition, which occurs in only 10% of cases, will usually go away when the condition is treated. But chronic fatigue, fatigue that’s present for more than six months, is obviously persistent.

Before we move-on, it’s really important to understand the difference between daytime sleepiness and fatigue. According to the doc, sleepiness is the inability to remain fully awake or alert during the day. Fatigue is a subjective lack of physical or mental energy interfering with daily activities. More specifically, fatigue is a perception of weakness or feeling worn-out, drained, or depleted.

Causes of Chronic Fatigue

After laying a firm informational foundation, Dr. Sigurdsson lists his 19 important causes of chronic fatigue.

Before we get into them, will you promise that you won’t believe you have each and every disorder listed? Come on, you know what I’m talking about. Just go easy, okay?

Again, I only have space to highlight, so you’re going to want to read Sigurdsson’s article for a full education. And I’m telling you, it’s worth it.

Here we go…

1. Chronic Fatigue Syndrome (CFS): CFS is characterized by chronic fatigue, orthostatic intolerance, and cognitive issues with no apparent medical cause. It’s also been named systemic exertion intolerance disease (SEID) because of its hallmark massive energy crash after relatively minor exertion. Though cause is unknown, CFS is believed to be an infectious disease with immunologic manifestations.
2. Idiopathic Chronic Fatigue: Chronic fatigue with no underlying medical condition or psychiatric illness. Criteria for CFS aren’t met.
3. Fibromyalgia: A chronic pain syndrome characterized by widespread nonarticular (muscles, not joints) pain, stiffness, and fatigue. Cognitive complaints (“fibrofog”) are present in 90% of cases. Fatigue is most often noted when arising from sleep.
4. Anemia: A medical condition in which the red blood cell count is below normal. Fatigue and loss of energy are significant symptoms. The most common type is iron-deficiency anemia.
5. Hypothyroidism: A medical condition in which the thyroid gland doesn’t produce enough of the thyroid hormones T3 and T4.
6. Diabetes Mellitus: Many with diabetes describe themselves as feeling tired, lethargic, or fatigued at times. The fatigue may be caused by an imbalance in blood sugar levels. However, the chronic fatigue that may be experienced, known as diabetes fatigue, isn’t related to blood sugar levels.
7. Other Endocrine Disorders: In addition to hypothyroidism and diabetes, other endocrine and metabolic disorders may be at play with fatigue. Examples: hypogonadism, hyperparathyroidism with associated hypercalcemia, adrenal insufficiency (adrenal fatigue), apathetic hyperthyroidism, growth hormone deficiency, glucocorticoid resistance.
8. Chronic Infections: Examples: endocarditis, tuberculosis, mononucleosis, hepatitis, parasitic disease, HIV infection, cytomegalovirus.
9. Autoimmune Disorders: At times, in response to an unknown trigger, the immune system may begin producing antibodies that attack our own tissues. This can lead to a chronic inflammatory response, which is characteristic for most autoimmune disorders. Examples: rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple sclerosis, Hashimoto’s thyroiditis.
10. Cancer: Known as cancer-related fatigue or cancer fatigue.
11. Sleep Disorders: Daytime sleepiness is a key symptom of obstructive sleep apnea. But, remember, sleepiness and fatigue aren’t synonymous. Still, people with sleepiness due to obstructive sleep apnea may use descriptive terms like “fatigue.”
12. Central Nervous System Disease: Fatigue can be a prominent symptom of stroke, multiple sclerosis, Parkinson’s disease, and others.
13. Neuromuscular Disease: In some cases, muscle weakness and other signs of neuromuscular disease are evaluated in the face of fatigue.
14. Gastrointestinal Disorders: Fatigue can present in peptic ulcer disease, gastroenteritis, irritable bowel disease, and others. Typically, though, symptoms like pain, nausea, vomiting, constipation, and diarrhea accompany.
15. Cardiovascular Disorders: Fatigue can be a sign of underlying heart disease. It’s important to look for symptoms such as chest pain and shortness of breath.
16. Chronic Obstructive Pulmonary Disease (COPD): COPD refers to a group of conditions that cause airflow blockage leading to shortness of breath, mucus production, and wheezing. It includes emphysema, chronic bronchitis, and in some cases asthma. Fatigue is a common complaint.
17. Anxiety and Depression: Up to 75% of patients with chronic fatigue also have mood or anxiety disorders. Some have suggested that chronic fatigue is an atypical form of anxiety or depressive states. So it may be that chronic fatigue is yet another version of anxiety or depression.
18. Somatization Disorder: A person with somatization disorder is preoccupied with numerous “somatic” (physical) symptoms, which can’t be explained by an underlying medical disorder. Fatigue is a common complaint, along with pain. And it’s important to understand that the patient isn’t faking.
19. Pharmaceutical Drugs:  Fatigue is believed to be a common side effect of many pharmaceutical drugs. These may be over-the-counter and prescription. Name ’em: antihypertensives, statins, antihistamines, antidepressants, antipsychotics, benzodiazepines, opioids. Fatigue can be a factor.

I might add, Dr. Sigurdsson recommends general measures focusing on sleep, healthy diet, regular exercise, and stress reduction in the treatment of fatigue.

Off We Go

Fatigue – feeling entirely worn-out – is the real deal. And as if we didn’t know from personal experience, Dr. Sigurdsson emphasizes what a huge issue it is for mood and anxiety disorder sufferers.

I’m hoping this summary provides enough information to whet your appetite for more knowledge if a thing or two hit home. And that, of course, includes intervention strategies.

Be sure to read Dr. Sigurdsson’s article. Much more info I couldn’t include here: 19 Important Causes of Fatigue – Tiredness and Chronic Fatigue Explained.

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