Fatigue

[nlloyd]

The end of the year is coming up and it's probably not unusual to be feeling tired. I'm thinking, though, that I am feeling more tired than usual. I plan to discuss this with my doctor, but wanted to go in with more information than I currently have on possible causes of fatigue. I know one should check iron deficiencies and thyroid functioning, but are there other things to consider?

[MacMadame]

There are probably 100+ causes of fatigue. It's one of those vague symptoms that almost every condition includes. Some causes I know about are:

Vitamin D deficiency
Anemia (iron deficiency)
B12 deficiency
Sleep Apnea
Chronic Fatigue Syndrome
Thyroid
Blood sugar issues (diabetes, low blood sugar, hypoglycemia, eating the wrong kinds of food)
Depression
Anything that lowers the oxygen in your blood including Heart disease, COPD, Asthma, certain allergies, etc.
Too much caffeine

Here's a bigger list:
http://www.emedicinehealth.com/fatigue/page2_em.htm

[mkats]

If you try iron supplements, make sure to tell your doctor in case he puts you on Synthroid (for your thyroid) - the iron can essentially render the Synthroid useless and then neither of them is doing you any good.

Good luck Hope it improves soon!

[MacMadame]

And don't just start taking supplements because they get recommended to you. For some of them, it's harmless to take supplements you don't need because you just pee out the difference. But other supplements can cause big problems. For example, you can get heavy metal poisoning from supplementing iron if you don't need more iron.

I'm not saying you are planning to do this, but I've seen other people do it so I figure I'd warn about the heavy metal poisoning in particular. But any supplement that isn't water-soluble can be a problem.

[danceronice]

And don't just start taking supplements because they get recommended to you. For some of them, it's harmless to take supplements you don't need because you just pee out the difference. But other supplements can cause big problems. For example, you can get heavy metal poisoning from supplementing iron if you don't need more iron.

I'm not saying you are planning to do this, but I've seen other people do it so I figure I'd warn about the heavy metal poisoning in particular. But any supplement that isn't water-soluble can be a problem.

In fairness: for a normal-weight adult, it would take a LOT per pound of body weight to give yourself iron poisoning, more than a normal person would take in one go. (However, a small child can die very easily from adult iron pills.) Bigger problem with most OTC ones, especially the "slow-release", is they don't absorb well. Also iron alone can do a number on your stomach--I'm on pre-natal vitamins because I need the iron, but can't handle the normal pills. (Doctor's suggestion when she figured out I wasn't taking the iron.)

[LilJen]

If you try iron supplements, make sure to tell your doctor in case he puts you on Synthroid (for your thyroid) - the iron can essentially render the Synthroid useless and then neither of them is doing you any good.

Good luck Hope it improves soon!

You should be OK if you take the synthroid first thing in the am on an empty stomach, and don't take the iron until later. Has always worked for me.

Fatigue is a toughie. As a hypothyroid person, I always recommend getting a FULL thyroid panel, as measuring only the main hormone (TSH) doesn't necessarily capture any irregularities.

[nlloyd]

Thanks for these suggestions, everyone. My main concern is that when a blood test is done, we test for all the most obvious possibilities. I am not a fan of needles, and do not want to be going back and forth for blood tests if I can avoid it. Will take a closer look at the medical website MacMadame recommended.

[ArtisticFan]

As someone who has had issues with fatigue - a new issue right now too - my suggestion to you is to remember to make notes on how you feel. Doctors hear so many people complaining of fatigue quite frequently. In my experience it has gotten to be a symptom that is overlooked and overshadowed by other ones.

You know your body. You know when something seems off. If blood tests don't find anything, keep searching and keep pressing forward to find the answer. I know that when my first blood tests came back they were all in a relatively normal range. My doctor said to me..."see you're healthy." I responded back, "Then why am I here. Oh yeah, I can't stay awake. I am sleeping 10 or more hours to wake up more tired than when I went to bed. So something is wrong."

[Flatfoote]

Also, don't take iron and calcium at the same time. I can't remember which is which, but one of them inhibits the absorbtion of the other into the body. I learned this from my Mom, who was in a nursing home for rehab 2 years ago. When she came home, that was one of the things she told me was that she had to take the iron in the am and the calcium in the pm cause they couldn't be taken together (as they explained to her in the nursing home).

[Erin]

As someone who has had issues with fatigue - a new issue right now too - my suggestion to you is to remember to make notes on how you feel. Doctors hear so many people complaining of fatigue quite frequently. In my experience it has gotten to be a symptom that is overlooked and overshadowed by other ones.

I would agree with this. I tried all sorts of things for my fatigue and nothing seemed to have lasting help. It wasn't until I happened to mention that it was also accompanied by sinus pressure that the doctor put me on nasal sprays, which have generally been successful. I still feel tired sometimes, but most of the time it's now a "normal tired" that I can attribute to not enough sleep the night before, as opposed to the unrelenting fatigue that accompanied the sinus pressure where it didn't matter how much I slept. Anyway, the main point is that it could be something that won't even show up on a blood test, so being able to communicate what the symptoms are helps. (Now the other challenge is being able to actually get the doctor to listen to those symptoms and I don't have any suggestions for that...I'd tried to tell the doctors about the sinus pressure about 5 times before someone listened.)

[Ageless]

If you feel that your level of fatigue is not normal for you, then definitely discuss it with your doctor. Many years ago I made the assumption that I was exhausted because I was running around more for the holidays, not eating right, etc. I went to the doctor on an unrelated issue, and they discovered I had mono. This can be confirmed with a simple blood test.

[barbk]

I agree with Ageless & some of the others -- don't try to diagnose it yourself, but do talk with your doctor about it. Try and keep a log for a few days or weeks where you record each morning what time you went to bed, what time you woke up, how you slept (good, took forever, woke up a lot,...) and then make some notes about your fatigue during the day. Are you falling asleep (or working hard to keep yourself from falling asleep)? Or does it seem that you're exhausted without feeling sleepy? Or does it feel like every single effort you make to do anything takes a lot out of you? Does it start right away in the morning, or as of some predictable time? Are you taking any other medications, and have you changed any medications? (Even over-the-counter.) For example, ibuprofen makes me very, very sleepy. Years ago I took a prescription pain reliever and found myself feeling unbearably sleepy. It was a brand name, but it turned out to be a "profen" in a much stronger dose than the OTC ibuprofen. I had to switch to a different type of NSAID.

I know a number of people with sleep apnea whose primary symptom was fatigue, fwiw.

[professordeb]

I agree with keeping a log cause I tried and all my "regular" bloodwork came back as just fine. No anemia, nothing! However, I also had nausea all day every day with it worsening 45 -90 minutes after eating. I also have a lot of bloating that increases as day goes on, with some pain in the abdomen. Doctor sends me for a blood test for gluten -- for which I had to pay! surprise, surprise!! Result came back indicating a high likelihood of celiac (gluten allergy) so had scope done, biopsy confimed blood work. After speaking with a dietician, she spoke to me about the being tired and said that once my body adjusts to the new diet and I get my villi back to normal, it's quite possible I won't be so weary. She explained that while I have been eating gluten, nutrients in my food are not be absorbed into my body because my villi are "lying flat". Once they become healthy again, my body will begin to receive the nutrients it should have been getting and some of the weariness may disappear. I say all this to tell you that it may take more than just one testing of blood.

As for me, well, I am still tired but then I've only been on my new diet for a week. I've been told it can take anywhere from a few weeks to months before my villi are back to normal. Here's to eating somewhat dry and dense breads and trying to learn to bake!

[MacMadame]

Also, don't take iron and calcium at the same time. I can't remember which is which, but one of them inhibits the absorbtion of the other into the body.

Calcium. It's a bully. However the heme form of iron is absorbed differently and you can take that with calcium. Also, our bodies can't absorb an unlimited amount of calcium at a time so try not to take more than 500mg at once. And calcium citrate is the most easily absorbed. Calcium carbonate is cheap but it requires a highly acidic environment to be absorbed and a lot of people don't absorb it well and no one absorbs it as well as calcium citrate.

[nlloyd]

My blood tests came back and I found I had both an iron deficiency and a Vitamin D one. I then took supplements for a month, and did further tests, but the iron problem wasn't fully resolved. Am going to take the supplements for another month and double the dosage (300 to 600 mg a day) and get another test. If things haven't improved by then, we will consider iron shots or infusions.

Does anyone have suggestions for increasing iron absorbtion or for foods that are high in iron (beyond red meat and spinach)? Any info. on the iron shots or infusions would also be great.

[algonquin]

I agree with Ageless & some of the others -- don't try to diagnose it yourself, but do talk with your doctor about it.

I agree but want to add this:

Fatigue is a strong indicator of sinus infection

I was horribly fatigued this time last year becasue of a sinus infection. It went on for weeks.

[Alixana]

I have iron deficiency anemia as well and don't tolerate red meat well so need to get most of my iron from supplements and vegetables. For non heme iron (the kind that doesn't come from red meat) your body needs vitamin C to help absorb a greater amount of iron. I usually eat a small orange as my dessert. (And I was happy to find out that most of the iron in a potato is in the skin .. love my baked potatoes with skin on!)

I found these resources helpful (but not comprehensive by all means)
Livestrong explains this in simple language
list of iron rich foods with portion sizes
info for vegans (I'm not one, but found this helpful)

[MacMadame]

The best absorbed iron supplements are the heme version of iron. It's like eating liver only without the smell or taste. Not only is it well absorbed but you don't need to take it with something acidic (like Vitamin C) but you can take calcium with it!

Second best is carbonyl. That does need to be taken with something acidic though and can't be taken with calcium.

Both are more gentle on the stomach than things like ferrous sulfate which is the most commonly available kind.

[nlloyd]

Thanks for the tips, everyone. I am taking the ferrous sulfate version, but was not taking it with anything acidic. The doctor didn't mention that. I will look into the heme version of iron.

And thanks, MacMadame, for suggesting in an earlier post that we look at Vitamin D deficiency. The doctor hadn't thought of that when we did the tests, and was glad to add it when I asked her to.

[FigureSpins]

My sister always to cook her tomato sauce in a cast-iron pot. She said the acid in the tomatoes drew some of the iron into the sauce. It was her standard treatment for cold sores. I don't know if it really works, but I do it now and then. Only drawback is that it removes some of the pot's seasoning.