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Ask the Doc :: Drifting Off

by Jason Faulhaber, M.D.
Thursday Jun 16, 2011

Dear Doctor Jason,

I used to be so energetic - going out dancing, active in sports, always happy and awake. Lately, it's all I can do to keep my eyes open past 9pm. I know I'm getting older (I'm upper 30's) but I don't think I should be this tired all the time, and I'm getting concerned that something else is going on. What's your advice?

Signed, Drifting off

Doctor Jason's Response:

Well, some say, "it's all downhill after 25."

Fatigue is a vague symptom, meaning that it is not associated with just one thing. It could be related to your overall metabolism, hormone concentrations, sleep patterns, diet, or blood counts. It can be an initial symptom of other more serious conditions too, but it would typically have other associated symptoms, such as fever, diarrhea, frequent urination, or headache.

The thyroid gland secretes thyroxine, a hormone that generally regulates your metabolism and consequently energy level. If the gland is underproducing thyroxine, then you very well may develop fatigue, sluggishness, weight gain (or inability to lose weight despite trying), or even hair loss. It can be hereditary, so it would be important to check your thyroid if you have any family members with known thyroid problems.

If your testosterone level is too low, you may also develop fatigue and muscle weakness, as well as decreased libido. If you suffer from sleep apnea or if your sleep is disturbed and not restorative, you can develop daytime fatigue and sleepiness.

A diet that is rich in carbohydrates may cause some sluggishness, as can changes in your blood sugar levels. Anemia can also cause fatigue, and this too can be caused by diet, such as iron-deficiency or vitamin B12 deficiency. If the fatigue is prolonged (daily or nearly daily for more than 1 month) or if any of these other symptoms are present, then it would be best to be evaluated by your primary care provider.

Stay healthy,
Doctor Jason

Dr. Faulhaber is a graduate of Tulane University in Psychology and Cellular and Molecular Biology and received his medical degree from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School. He performed his residency training in Internal Medicine and Pediatrics at Saint Vincent’s Hospital in Manhattan, where he then served as a Chief Resident in Internal Medicine. He completed his fellowship in Infectious Diseases at New York University, where he specialized in HIV/AIDS, Hepatitis, and fungal infections. Since fellowship, he has been working as an Internal Medicine/Infectious Diseases physician at Fenway Community Health in Boston. He is a Clinical Instructor in Medicine at Harvard Medical School, and he is affiliated with Beth Israel Deaconess Medical Center. He has been the lead author or co-author of several journal articles and textbook chapters on infections with HIV, other viruses, bacteria, and fungi. He is also accredited by the American Academy of HIV Medicine.

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