Doctor, Why Am I Always So Tired?


PARADE Magazine, October 31, 1999, p. 18-19
How often do I hear, "Doctor, why am I so tired? What can I do about it?" In my experience, it's the most common health complaint of adults of both sexes. Everyone is tired now and then, and the reason is usually obvious: You may not have been sleeping well because you're depressed, anxious, have a large prostate that makes nature call too often, or are taking caffeine or some medication that keeps you awake. Or you're taking a medication that sedates you during the day, such as a tranquilizer, a blood-pressure-lowering drug or a painkiller. Or you're suffering from jet lag. If you can identify the problem - whatever it is - and correct it, your energy will return. Continuous fatigue for no apparent reason is nature's signal to you that something is wrong. In addition to the causes mentioned above, a variety of other conditions - ranging from some that are easily managed to serious diseases like cancer - can make you tired. You may he anemic for any one of several reasons, or perhaps your liver, thyroid or kidneys aren't working properly. The list is long.

However, there is one kind of fatigue unlike any other - bone-breaking tiredness that prevents you from getting out of bed in the morning even after a good night's sleep. You continue to feel worn out no matter how much you rest. You can't work or play, and all you're able to do is vegetate at home. When you tell your doctor about it, he or she performs a thorough checkup, but the tests come back "normal." The diagnosis? Chronic Fatigue Syndrome (CFS).

This condition was first formally characterized as a real illness by the Centers for Disease Control and Prevention (CDC) in 1988. In 1994, with no specific test yet available to identify the disease, the CDC expanded and refined its criteria for Chronic Fatigue Syndrome (see box below). Fatigue is so common in daily life that reliable statistics are difficult to obtain, but an estimated 800,000 Americans suffer from the profound symptoms associated with Chronic Fatigue Syndrome. Though it can strike anyone at any age, it's three times more common in women, for reasons unknown. Despite its acceptance as a clinical entity, some doctors (and probably most of your friends) still view CFS as nothing more than depression. They insist that a real "condition" would produce some abnormalities in a physical exam or blood tests.

I too used to be skeptical about CFS. I was sure it was "all in the head." But I've changed my mind. I'm now convinced that it is a real disorder - probably due to some derangement of the immune system, possibly triggered by a still unidentified infection, viral or bacterial, or an allergy or hormonal imbalance. The bottom line, however, is that the cause or causes of the syndrome remain a mystery.

Patients with Chronic Fatigue Syndrome are more than just profoundly tired. They have other typical symptoms too. Most are depressed – and who can blame them, feeling the way they do? In addition, they complain frequently of flulike symptoms and are likely to have low blood pressure, poor short-term memory, trouble thinking clearly and a tendency to be irritable. From time to time they have a sore throat, and the glands in the neck and armpit may be enlarged and tender. Some patients also complain of joint and muscle pain and are diagnosed as having fibromyalgia (see PARADE, July 18, 1999). Even mild exercise aggravates and prolongs their fatigue.

For you to be diagnosed with Chronic Fatigue Syndrome, your symptoms must have persisted for at least six months, and a complete medical evaluation must have failed to reveal any other cause. There is no specific test for Chronic Fatigue Syndrome. It's not like diabetes or hepatitis or heart trouble. When you describe how poorly you feel to your doctor, he or she will take a detailed history, perform a thorough
physical exam and then obtain a battery of blood tests, looking for clues to some other disease that might account for your symptoms. These tests should include a careful search for microorganisms not

immediately apparent in the routine workup. In addition, you'll be checked for sleep apnea (which leaves you very tired the next day, because sleep is so disturbed during the night); for a major depression that is the cause-and not the result of your fatigue; and for an underactive thyroid gland, chronic mononucleosis, a reaction to some medication, a hidden cancer, chronic alcohol or substance abuse, HIV infection, an autoimmune disorder or massive obesity.

The outlook for Chronic Fatigue Syndrome varies from patient to patient. In most studies of this illness, approximately a third of the patients improve significantly within five years, nearly half within 10 years. But even "recovered" patients may continue to have some symptoms.

Despite what some medical entrepreneurs would have you believe, there is no proven treatment for Chronic Fatigue Syndrome. However, some measures may alleviate your symptoms. For example:

  • Eliminate any food, medicine or environmental factor (dust, feathers) you may be allergic to.
  • Avoid doing anything that tires you further. Unlike most other conditions, including fibromyalgia, exercise does not usually help Chronic Fatigue Syndrome, although some doctors recommend moderate aerobics.
  • If, in addition to the fatigue, you have flulike symptoms, you may be helped by aspirin, Tylenol or one of the nonsteroidal anti-inflammatory agents, such as ibuprofen.
  • Antidepressants may improve your sleep and lessen fatigue and muscle pain.
  • Make sure you eat a wholesome, balanced diet. This is no time for fad diets. Emphasize whole grains, beans, rice, fish, fresh fruits and fresh vegetables, and take it easy on alcohol and high-fat foods.
  • Intravenous injections of gamma globulin are being tried on an experimental basis. The theory is that CFS patients have an underlying disorder of the immune system and that gamma globulin, which fights abroad range of disease causing microorganisms, might help.

If you're unlucky enough to develop chronic Fatigue Syndrome, remember: It's not all in your head.

Dr. Isadore Rosenfeld's most recent book is the national best-seller "Live Now, Age Later" (Warner Books).