These days, it’s not uncommon to hear ‘tired’ in response to a casual ‘how are you?’ As the pace of life has picked up, so too has the incidence of fatigue. But sometimes lethargy is about more than stress or lack of sleep. It can point to other areas of your health needing attention.

‘I hear complaints of tiredness in more than half of my consultations,’ says Dr Antonie Rod, a specialist physician at Mediclinic Milnerton, Cape Town. ‘It’s one of the main reasons people visit a GP, physician or endocrinologist.’ While doctors assess this common complaint by first looking at common culprits – poor sleep hygiene and routines, stress, a snoring partner and so on – they’ll also listen for other symptoms. And so should you – extreme tiredness is a chief symptom of many health conditions. ‘Almost every form of disease can present with chronic fatigue,’ says Dr Rod. If your tiredness is prolonged, sudden or has no discernible cause, pay attention. Here’s what your body may be warning you of…

‘Stressful work, bereavement, recent parenthood and significant life events should all be considered when it comes to tiredness,’ says Dr Daksha Jivan, an endocrinologist at Mediclinic Morningside and Wits Donald Gordon Medical Centre in Joburg. These factors commonly disturb rest – as does depression. ‘Depressed patients may have a feeling of being tired or a perception that they’re not getting enough sleep than they actually do and feel tired, or they have actual sleep disturbances. Sometimes a depressed person will experience hypersomnia, where they sleep excessively,’ explains Dr Rod.

Getting proper rest takes some self-care. You may know too little exercise can make you lethargic, but did you know that too much can do the same? Exercise elevates your adrenaline (stress hormone) levels, so don’t train too hard or too late at night. Avoid other stimulants like caffeine, alcohol, nicotine and even social media. ‘Studies on the UV light given off by computer screens, cellphones and tablets show they might cause you to have difficulty falling asleep, so don’t work too late or read electronic media in the bedroom before bed,’ says Dr Rod.

Nutritional deficiencies can contribute to tiredness. In particular, you could be lacking in vitamins B1, B12, D, iodine, iron, magnesium or zinc, says Dr Jivan. Over time, these deficiencies add up.

The most common nutrition-related deficiency, particularly among menstruating women, athletes and vegetarians, is anaemia – a lack of iron that makes it hard for red-blood cells to transport oxygen to the body’s cells. What else could tell you you’re anaemic? Your skin could seem unusually pale, your heart could race and you could feel irritable. Blood tests can determine whether this is the case and, if necessary, your GP will prescribe iron supplements. You may be advised to follow an iron-rich diet, including red meat, dark leafy greens and legumes.

‘Any condition associated with an inflammation of the liver will cause persistent tiredness,’ says Dr Rod. These include hepatitis B and C, cirrhosis or drug-induced liver toxicity. Unfortunately, liver conditions are often ‘silent’, revealing themselves late. Other signs and symptoms of poor liver health include jaundice, loss of appetite, easy bruising and confusion after eating a heavy-protein meal (in the case of cirrhosis). ‘There are a number of common blood tests for liver function that your doctor can do,’ says Dr Rod. ‘Fortunately, the liver is fairly resilient and may bounce back if treated with the right care.’

On average, Dr Rod sends one to two patients for sleep studies each week, as sleep apnoea is increasingly common. Sleep apnoea, a sleep disorder characterised by night-time breathing disruptions, is associated with obesity, diabetes, hypertension and heart failure. While it’s fairly common, Dr Rod says it’s sadly often only diagnosed after a catastrophic event, such as a car accident. If you have unrefreshing sleep, if your partner says your breathing stops at night, if you seem to choke or if you have high blood pressure that’s hard to treat, visit one of the Mediclinic sleep centres.

Thyroid malfunction, particularly hypothyroidism (an underactive thyroid) can cause exhaustion. But a number of other endocrine conditions (diabetes mellitus, adrenal insufficiency, growth hormone deficiency and more) have fatigue as the predominant symptom, says Dr Jivan. ‘Other symptoms may be vague and non-specific, so it’s important that people are aware of their symptoms and go for a medical consultation if in doubt.’ Look out for bouts of dizziness, depression, memory loss, carb cravings, poor concentration, early-onset osteoporosis, lack of sexual arousal, changes in weight. Women may have excessive body hair growth, breast discharge and irregular periods.

Chronic inflammation fatigues the body. It can occur when the body’s immune system attacks itself, as it does with autoimmune conditions such as rheumatoid arthritis, lupus and fibromyalgia. These tend to occur in the middle-aged and elderly, and they’re accompanied by the tell-tale signs of joint and muscle pain. ‘Most cancers, specifically the haematological malignancies affecting blood, bone, marrow and lymph nodes, produce cytokines that also cause inflammation and fatigue,’ says Dr Rod. Warnings here: unusual paleness, bruising, dark spots (called petechiae) on your skin or gums, and bleeding when you brush your teeth.

Fatigue could be a warning sign of a heart attack in women, along with sweating, pain or discomfort in the chest, arm or stomach, shortness of breath, dizziness or nausea. Researchers have found severe or unusual tiredness is an important early warning sign, given that many women don’t experience chest pain or other symptoms at all. So look after your heart: follow a heart-healthy diet, get regular exercise and visit your GP for regular assessments.

Medical disclaimer
When to see your doctor: If you have any major concerns, please see your general practitioner for an assessment. If there is any cause for concern, your GP will be able to direct you to the appropriate specialists.

The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.