Berkat OSH Newsletter #3 – Fatigue

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Greetings from Berkat OSH!

As we are still in the month of Aidilfitri, many of us have our weekends booked with Hari Raya open houses  and visiting our loved ones. In fact, we are certain that some of us have endured long hours on the road  thanks to the traffic jams, so much so that our backs began to ache. If your backs have been aching from  sitting in the car for too long, we hope you remember to practice the practical stretching exercises that we  shared earlier this month to help alleviate the pain and discomfort! 

But there is one more predicament that is brewed from traffic jams: fatigue. 

Fatigue is a familiar feeling for all. It often leaves us feeling sluggish, mundane and indifferent that we forcibly  drag our feet just to get through the day. While it is simple to dismiss fatigue as a symptom of lack of energy,  sleep deprivation or mere tiredness, what many of us might not be aware is that fatigue might be a sign of  more serious underlying causes, such as depression, poor diet, sleeping problems or iron-deficiency anemia. 

For today’s issue of Berkat Wellness, we will be taking a closer look at “fatigue,” from understanding the  possible causes of fatigue, to discovering when it is time to see a doctor, as well as learning the tips to combat  fatigue to prevent it from disrupting our daily lives. 

We hope that today’s issue will offer you some insight into how you can overcome fatigue, so that it may help  improve your energy efficiency and your quality of life. 

Warmest Regards,

Dr Sabariah Said
Chief Executive Officer

When fatigue leaves you drained, depleted, and dumbfounded

When fatigue is persistent, it’s essential to learn why.

By Maureen Salamon, Executive Editor, Harvard Women’s Health Watch

Reviewed by Toni Golen, MD, Editor in Chief, Harvard Women’s Health Watch; Editorial Advisory Board Member, Harvard Health Publishing; Contributor

If you feel as though you’re dragging through your days feeling weary, weak, and listless, fatigue has arrived at your doorstep. 

But what’s the line between feeling fatigued and merely tired? Fatigue means no amount of sleep helps you feel refreshed. Forget about mustering  joie de vivre — you can barely get through the day without becoming exhausted. 

“Being tired or sleepy is different from fatigue,” says Dr. Daniel Sands, a primary care doctor  at Harvard-affiliated Beth Israel Deaconess Medical Center. “It’s true they can overlap, because if you’re not getting enough sleep, you’ll feel fatigued. But fatigue is different — everyday things like walking to the bathroom or doing the dishes wear you out.” 

You might chalk it up to getting older, since fatigue is commonly viewed as a normal part of  aging instead of a symptom of an underlying ailment. But often, something is indeed amiss. Between 40% and 74% of older adults with a chronic condition deal with fatigue, according to a 2021 research review in Rehabilitation Nursing. 

When it lingers for weeks or months, fatigue is a problem that needs to be solved. A long list of both obvious and more opaque conditions can lead to it, some of them serious.

“I get worried when people have stopped doing the things they love — like going for walks, babysitting their grandchildren, or cooking,” says Dr. Soheyla Gharib, an internist at the Phyllis Jen Center for Primary Care at Harvard-affiliated Brigham and Women’s Hospital. “If they say they’re not doing those things, that’s a huge red ag and we definitely want to find out why.”

Gamut of causes 

Some contributors to fatigue are abundantly clear: if you’re not sleeping well, for instance, or have  allergies, a cold, the u, or COVID, you’re likely to feel drained. Chronic illnesses such as heart disease, cancer, diabetes, kidney disease, multiple sclerosis, or rheumatoid arthritis are also widely known to sap energy. 

But the list of less-recognized causes is just as long. You might not suspect 

  • sleep disorders 
  • depression or anxiety 
  • thyroid problems
  • infections 
  • iron-deficiency anemia 
  • poor diet 
  • medication use. 

Chronic fatigue syndrome — characterized by prolonged tiredness, fever, and aches — might be on  your radar if you have unshakable fatigue, but it’s rarely the case, Dr. Sands says, and only considered  after other reasons are ruled out. 

Pathway to answers 

How do you know it’s time to see a doctor about your fatigue? Not only when it’s unexplained, prolonged, and debilitating, but also if it’s joined by other symptoms such as 

  • weight loss or gain 
  • frequent headaches 
  • chronic pain 
  • muscle weakness 
  • thinking or memory problems 
  • mood changes 
  • sleep problems such as insomnia, severe daytime sleepiness, or restless sleep. 

“If you have actual weakness, like you can’t climb stairs; shortness of breath; or trouble getting  dressed or making meals — or if you’re nodding off in the middle of the day when you never used to  — those are all big warning signs,” Dr. Gharib says. 

In addition to performing a thorough physical exam, your doctor will likely ask about your sleep habits  and use of alcohol and other substances as she carefully reviews your medical history. Additionally,  comprehensive blood testing can unearth a variety of fatigue culprits, including anemia, thyroid issues,  certain infections, and liver or kidney problems, as well as guide further testing.

Typically, doctors follow a well-worn credo when investigating fatigue and other such nebulous  symptoms: “When you hear hoofbeats, think horses, not zebras.” That means they first consider the  obvious causes before looking to less likely possibilities. 

“If someone gets almost no physical activity and tells me she’s worn out all the time now, most likely she is deconditioned. I get more concerned when I see a patient who runs a 5K three times a week and suddenly can’t run a mile,” Dr. Sands says. “What goes along with fatigue often tells us whether something is serious or not. But in someone with no obvious clues, it’s rare there’s something serious going on,” he adds. 

To combat fatigue, rise up and exercise 

When you’re tired, the last thing you may feel like doing is exercising. Yet that’s exactly what can help  break the cycle of persistent fatigue and reboot your energy levels, a recent study suggests. 

The analysis, published June 3, 2022, in Frontiers in Psychology, reviewed 81 earlier studies that involved a total of more than 7,000 adults. Researchers found that regular exercise leads to small-to moderate improvements in fatigue as well as feelings of energy and vitality. Regular exercise was defined as exercising at least once a week and included resistance training (such as weight lifting) and aerobic exercise (such as brisk walking, cycling, or swimming). 

How can exercise beat back fatigue and boost energy levels? By increasing blood ow to muscles and organs, releasing feel-good chemicals called endorphins, and improving sleep quality, says Dr. Daniel  Sands, a primary care doctor at Beth Israel Deaconess Medical Center. 

“It increases your cardiovascular reserve — the ability of your heart and lungs to pump blood and extract oxygen from it,” Dr. Sands says. “You’re toning up your system.” 

If you feel you can’t begin exercising on your own, ask your doctor for help devising a plan to incorporate more physical activity into your days, Dr. Sands says. And start small by taking the stairs instead of an elevator, parking farther from the front door of a store, or getting off a train a stop earlier than planned and walking the rest of the way.

Vitality-enhancing tactics

If your check-up didn’t unearth anything worrisome — or you’re now being treated after a new diagnosis — the next step is to proactively boost your oomph. Try these strategies: 

Move more. Staying active helps maintain muscle mass and strength, which helps stave off fatigue.  (See “To combat fatigue, rise up and exercise.”) “It’s paradoxical — you can’t get good sleep if you’re  not exercising,” Dr. Gharib says. “You’ll feel even more tired, ironically. If you’re starting from zero, even 15 minutes a day of exercise will get you going, with the goal of getting to 30 minutes of physical activity a day, five days a week.” 

Optimize your diet. You can’t drink from an empty cup, as the adage goes. Fuel your body appropriately by filling your plate with high-protein options such as lean meat or fish, along with  complex carbohydrates such as whole grains, fruits, and vegetables. These choices will help you  avoid the plummeting energy levels common after eating processed, high-sugar foods. “Healthy eating and good hydration will do wonders for making you feel better,” Dr. Gharib says. 

Use caffeine strategically. There’s no question it can help you feel powered up, but caffeine can also disrupt sleep patterns, especially when consumed in midafternoon or later. 

Limit alcohol use. Alcohol has a sedative effect, ultimately causing an energy slump. Additionally, while it may help you doze off, the effect often wears off in the wee hours, leaving you awake when  you should be sound asleep. 

Top image: © Kathrin Ziegler/Getty Images

Copyright 2022 by Harvard University 

No content in this article, regardless of date, should ever be used as a substitute for direct medical  advice from your doctor or other qualified clinician.