A lot of people who feel tired all the time wonder if taking vitamins or supplements will help their fatigue. For most, it will not, because most people do not have nutritional or deficiencies. For example, taking an iron supplement or vitamin D pill won’t help with fatigue unless that person actually has Iron deficiency or vitamin D deficiency. Perhaps, it will have a placebo effect, but nothing more.

In most young people feeling tired has nothing to do with having a physical problem. Lots of time being (chronically) stressed out, and/or being depressed, saps you of all your energy, causing fatigue. Some people simply work too hard for too long.

Fatigue has so many potential causes, and trying to diagnose the underlying cause can be a frustrating process, both for the patient and for the doctor. CFS is only truly diagnosed when the other possibilities have been ruled out. The problem is, most people don’t have a specific cause of fatigue, so this sort of becomes the default diagnosis. The question for doctors is, do we really need to rule out every single possible cause of fatigue? And the answer is no because that wouldn’t be practical. The decision to carry out different tests depends on clinical suspicion because testing carries its own set of risks. Never mind the added cost.

There are literally thousands of potential causes of fatigue. But let’s talk about the most common causes.

Anemia, meaning low blood levels, is a common cause of fatigue, and there are many causes of anemia. Anemia most in females who have heavy periods. The increased blood loss leads to iron deficiency, and these patients will benefit from iron supplementation.

But, there are other causes of anemia as well. Things like sickle cell disease, thalassemia, alcoholism, cancer, infections, and medications, just to name a few.

Hypothyroidism is another common cause of anemia. The thyroid gland in the neck is responsible for making thyroid hormone, and some people have their thyroid not making enough thyroid hormone, causing hypothyroidism. The most common cause of hypothyroidism is fatigue.

The same holds true for when those with adrenal insufficiency. The adrenal glands sit on top of the kidneys, and there are various diseases that can cause the adrenal glands do not make enough cortisol. When this happens, patients are diagnosed with adrenal insufficiency, typically after experiencing chronic fatigue.  

Obstructive sleep apnea (OSA), is another common cause of fatigue. Most patients with sleep apnea will have large necks. Most patients will sometimes gasp for air during their sleep, which can sometimes scare their partner in the middle of the night. This gasping is a result of the flow of air in the throat being obstructed and often causes the person to wake up during their sleep. The more frequently this happens, the more tired they feel after waking up. The diagnosis cant is made until a sleep study is done. The good news is that if a patient does have sleep apnea, it can be treated by wearing a CPAP mask during sleep. The CPAP raises air pressure in one’s throat, which acts to splint open the throat during sleep so that there is no more obstruction in the airway.

Depression, fibromyalgia, infectious mononucleosis (mono), Lyme disease are other common causes of fatigue, and those conditions are sometimes hard to diagnose because they have many overlapping symptoms.

Fatigue is also common in chronic medical conditions, like emphysema (COPD), congestive heart failure, cancer, infection, and many other diseases.

There also is a condition we don’t really know exactly what it is, but its called chronic fatigue syndrome (CFS), aka systemic exertion intolerance disease (SEID). Chronic fatigue syndrome (CFS), also known as systemic exertion intolerance disease (SEID), is a disorder that causes unexplained, persistent, and sometimes debilitating fatigue. Some say experts think it’s related to the immune system.

Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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