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The 5 main causes of fatigue

Dr Ross Walker
15 February 2022

A recent study looked at a quantitative estimate of fatigue known as the Pittsburgh Fatigability Scale [PFS] and related the degree of physical and mental fatigue to a scoring system.

The researchers surveyed about 3000 people older than 60 in a study known as the “Long Life Family study” asking 10 specific questions related to the degree of physical and mental fatigue related to walking, household chores, both indoor and outdoor. They also enquired about the fatigue experienced with sitting, involving activities such as watching television or sitting quietly for half an hour. They also reviewed the effects of high-intensity activities along with the physical and mental fatigue experienced with social events.

If you scored more than 25 points on the PFS compared with those people who scored less than 25 points, your risk of death over 2.7 years follow up was 2.3 times higher.

One of the problems with determining the level of fatigue is neglecting to assess the underlying causes. 

Apart from the diagnosis of chronic fatigue syndrome, which is a topic for another article, I split the causes of fatigue into five groups.

1) Stress – if you work too hard, play too hard or don't sleep well, then you may be tired. Any new stressors in your life may make you feel tired and this, in reality, is the most common cause of fatigue.

2) Sleep apnoea - All adult males and all postmenopausal females, to some extent, suffer a degree of sleep apnoea. The primary question as to whether you need your sleep apnoea investigated further is whether you wake up feeling refreshed. If you wake unrefreshed then you need to be fully evaluated for either sleep apnoea or one of the relatively common other sleep disorders such as periodic limb movement, restless legs syndrome etc.

3) Depression - if someone you love dies or your relationship splits up and you feel depressed, this is not true chemical or endogenous depression but rather grief. Endogenous depression, however, is characterized by feelings of fatigue throughout the day, loss of interest in daytime activities and typically waking in the early hours of the morning finding it difficult to get back to sleep. If you have any of these symptoms, this is where a full medical assessment and potentially anti-depressants or other therapies are appropriate.

4) The pauses – At about the average age of 50 there is typically a reduction in sex hormones in both males and females. Menopause is a very well accepted condition that affects all females near this age whereas the male equivalent – andropause is still somewhat controversial. A key feature of both these conditions in men and women is increasing fatigue.

5) Medical disorders and drug therapy - If you are feeling tired, the worst thing you can do is go to your local pharmacy or health food store and ask for a tonic to improve your energy levels. You may be experiencing an undiagnosed serious medical disorder such as an iron deficiency, another different type of blood disorder, a problem with your thyroid or any other medical conditions such as heart disease, autoimmune disease, kidney or liver disease. Regardless, if you are significantly tired and finding it difficult to maintain normal day-to-day activities, you require a full assessment with your doctor looking for any of the above.

Many people are on chronic medical therapy such as antidepressants, statins and therapy for diabetes, high blood pressure and other heart disorders and, in certain cases, fatigue is a common side effect of these medications.

If you have had a full assessment and no specific abnormalities are found, ubiquinol 150 mg daily (the active component of CoQ10), along with magnesium orotate, 400 mg twice daily may improve your energy levels.

As with all medical conditions, you should not suffer in silence but have a full assessment to establish a firm diagnosis.


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