“I just feel so tired all the time.” I hear this usually once, if not two or three times a day from different patients. Depending on who I’m looking at, here are a few of the conditions I consider:
- Hypothyroidism–A blood test is used to determine if the thyroid is functioning the way it should. Besides fatigue, it can also cause constipation, cold intolerance, and dry skin.
- Iron Deficiency Anemia will cause fatigue in men and women. Women who have heavy periods are at risk for this. For men, a blood count, or hematocrit, of less than 40 is generally considered low, and should be seen by a Gastroenterologist (GI) for evaluation of possible bleeding in the gut. Women who have stopped menstruating , but are anemic, should also be considered for referral to a GI doctor.
- B12 Deficiency Anemia— Most B12 deficiencies are caused by not eating enough foods with B12 in them, such as meat, fish, poultry, shellfish, eggs and dairy products. A blood test is used to find out the B12 level in the blood; lower than 300 ng/ml means a deficiency. The quickest way to replace B12 is through an injection once a week for four weeks, then once monthly after that. Any person who has any kind of gastrointestinal disease, such as Crohn’s or Celiac Disease, or who has had any part of their gut removed such as with gastric bypass or colon resection, will need to replace their B12. Alcoholics also need B12 replacement.
- Diabetes— High blood sugars cause fatigue. Any person who is obese, has high blood pressure, high cholesterol or a family history of diabetes should be screened for this.
- Depression— There are two questions used to screen for depression:
- “In the past two weeks, have you felt down or sad on more days than not?”
- “In the past two weeks, have you lost interest or pleasure in doing things you used to enjoy?”
If the answer is “yes” to either of these two questions, than a more thorough evaluation for depression is done. If depression is diagnosed, treatment options would be counseling, medication, or a combination of these. A healthy lifestyle is also encouraged as mood can be affected by diet and exercise.
If you think that you are more tired than you should be, or than you used to be, please see your healthcare provider to see if you need to be screened for these common conditions. ¡Salud!
Keep in mind, this is not meant to be a comprehensive list, and each patient’s assessment is based on his/her health history and physical exam.