Managing fatigue over the Christmas period and beyond

Are you suffering from constant fatigue or low energy levels?

This year has been like no other, one of the commonest symptoms patients are currently feeling is fatigue, a sense of  flatness, burnout, and even the prospect of a bit of christmas shopping can almost seem too much to face. Why have we all burned out when in fact many people are working from home. Tiredness all the time’ is one of the most common presenting complaints I see in general practice. The first steps I take when a patient comes to me is to exclude a medical issue such as anaemia, thyroid or other deficiencies. 90 per cent of the time it is related to stress, and the societal pressures we are all exposed to day-to-day, but there are some important and very treatable conditions. I use a checklist below which may be helpful in understanding whether there are factors that can be easily addressed. Taking a Functional Medicine approach is a really good way of looking at the root causes of these. 

1. An initial blood test should be taken to exclude anaemia (low blood count), thyroid, liver, diabetes and kidney disorders which can cause lethargy. I may check female hormones, testosterone, iron, Vitamin D and B12. A urine test can exclude a urinary infection, which can present with nothing more than fatigue in some cases.

2. Post-viral fatigue can sometimes present following a viral illness. It can take weeks or months to improve and may require the support of your doctor. The most likely organisms are EBV, CMV or Lyme’s disease, as well as ‘Long Covid’.

3. Most commonly, fatigue is a product of our increasingly busy and stressful lives, so stress management is crucial to alleviating this (regular exercise, meditation etc). There may well be an underlying, but treatable, anxiety or mood disorder (this can be checked using an online screening tool GAD7 or PHQ9.

4. Sleep apnoea, is usually an unrecognised condition, which cannot be diagnosed without a sleep study through a specialist (this can be done in the home setting). Do you snore or has your partner noticed any changes in your breathing whilst sleeping? If you feel unrefreshed in the mornings and sleepy throughout the day, this may be interrupted sleep due to apnoea, which literally means periods of ‘no breath’. Sleep apnoea has also been shown to cause high blood pressure, heart conditions and depression.

5. General poor sleep, related to mood disorders, stress and alcohol. Tackling the root cause will help improve your sleep quality. 

6. Seasonal affective disorder: in some people, reduced daylight during winter months can cause one to become sluggish and low in mood. Placing ‘light boxes’ in the house can regulate your light exposure (at least 10,000Lux), which may make you feel more alert and energised.

7. Supplements: there is no hard evidence for supplementation, unless you have an iron, B12, vitamin D or thyroid deficiency. Anecdotally, B12 injections can give people an energy boost, but this treatment is only really necessary if you have a deficiency. There is no harm in trying an over the counter ‘fatigue supplement’ which usually consists of B vitamins, iron, vitamin D and vitamin C.

8. Diet: This is a crucial aspect of overall health. Any gut malabsorption, such as lactose intolerance, Coeliac (gluten) and inflammatory bowel disease may contribute to fatigue. It is also important to avoid sugar and refined carbohydrates. A blood sugar spike will cause rapid insulin-driven ‘lows’ which can trigger fatigue. I would advise a ‘low Glycaemic Index Diet’. If you get hungry between meals, try roasted peas (protein) or nuts (good fats) instead of sugar/carbs. Try to avoid caffeine, despite it providing a short term fix, you may get caught in a cycle of playing catch-up, generating fatigue over time.

9. Rarely, silent heart conditions can cause general fatigue. If the heart muscle is struggling or you have an irregular heart rhythm, which is not always obvious. The only symptom may be general fatigue and mild breathlessness. Lung conditions, such as asthma and insidious chest infections may also cause fatigue over time.

10. If the fatigue is associated with joint or muscle pains, it is important to exclude either an autoimmune condition, Fibromyalgia or Chronic Fatigue Syndrome.

11. Dehydration can sometimes cause mental fatigue, so ensure you stay well hydrated (1.5 litres of fluid per day)

12. If you take any medication check if they have any potential side effects. Some have been shown to increase fatigue, such as cholesterol-lowering medication and beta-blockers.

13. Rarer causes could be carbon monoxide or heavy metal poisoning (mercury and lead). Diets particularly high in fish (especially tuna) can sometimes cause mercury poisoning.

Chronic fatigue can be challenging to treat, and we are fortunate to have our Energy Nutritionist Sam Varriale on hand who can guide you through some of the Nutritional challenges and myths with you to create a bespoke plan with Dr Dave. Why not take the time in January to book in and get a health assessment and start 2021 knowing all is ok and with a supported plan to reach your health goals. As the COVID-19 Vaccine becomes available, being ready to return to the commute, the gym, and most importantly reuniting fully with friends and family is going to require energy and motivation. Let us prepare you for launch!. To all our members thankyou for your support and I hope I have made a little impact in improving your health and wellbeing. Have a peaceful and quiet Christmas and let us all reflect and then move forwards to 2021 with hope, kindness and optimism. Dr Shilpa December 2020