“I’m so tired…” It seems like we hear at least one person say this every day, right? Fatigue can be a symptom of many health problems, so be sure to get a medical evaluation before chalking up your symptoms to “old age” or just being “too busy.”

The most serious health concerns can often present with fatigue, especially if you feel shortness of breath and a decreased capacity to manage the activities of daily life. The symptoms can be acute and sudden or gradually progressive, too. Heart disease can often present with fatigue, especially in women. Symptoms might include breathlessness when going up and down your stairs at home or having dull aches and pains in your chest, arms, back, neck and head. Check your blood pressure, your lab tests and ask that you have an EKG tested if you have new symptoms of chest pain, shortness of breath, weakness and/or headache associated with a change in your activity or exercise tolerance. 

When you’ve been reassured that it’s not a cardiac or pulmonary problem (like a blood clot in the lung), then you can consider the more common and non (acutely) life-threatening causes of fatigue. 

Anemia is a loss of the hemoglobin in the blood which carries oxygen to your vital organs. Anemia can be from heavy menstrual periods or a slow bleed in the gastrointestinal tract, too. Be sure that your hemoglobin is tested and also that your ferritin level (the iron storage marker) is also within a healthy range, too.  Women of child bearing age with anemia may benefit from having a pelvic ultrasound to look for uterine fibroids which may explain their heavy bleeding and fatigue. An occult blood test of the stool can be used to screen for blood loss in the colon which can be an early sign of colon cancer or a bleeding gastric ulcer, too.

Other common causes of fatigue can related to dietary and nutritional deficiencies. Magnesium, calcium, potassium, B12, folate, zinc and Vitamin D deficiencies can all cause fatigue and can be treated with dietary modifications and targeted supplementation. 

Many of us are dehydrated and feel more energy when we increase our intake of water. Take your weight in pounds and divide by two, this is a rough estimate of how many ounces of water you should drink daily. For most adults, that is at least two liters of water a day. Does your urine look clear? That is usually a sign of adequate hydration.

Hormonal imbalances can certainly cause fatigue, too. Low levels of cortisol can make you feel sluggish, this is common after great periods of stress in one’s life. We all need cortisol to manage stress, but when stress is very high over extended periods of time, we are left “wired and tired.” Cortisol imbalances cause irritability, exhaustion and weight gain with a common condition of “chronic fatigue.”  Thyroid disorders can also cause fatigue since the thyroid hormones regulate our metabolism and energy levels. Similarly, estrogen and testosterone decline as we age and these changing levels can significantly alter the energy levels of women and men, too. 

Sleep is fundamental to proper hormone balancing. The energy and light of our electronic devices can significantly disrupt melatonin production which is essential for our bodies to maintain a healthy circadian rhythm. Unfortunately, there are many environmental disruptors of healthy hormones in our diet and environment, too. Eliminating processed foods and sodas from your diet can help to increase energy levels by allowing your endocrine system to function optimally. 

Don’t let another day go by feeling “so tired!” Be sure to rule out correctable causes  of fatigue that can be an early sign of an illness or hormonal imbalance. For many of us, sleep and proper nutrition will be restorative. Remember, this is the youngest you will ever be… today! So, live well and in optimal health!

Dr Catherine