I’m tired all the time. What’s going on?

-J.T. in Beverly Hills

Dear J.T.,

Fatigue is an extremely common complaint that patients present with. Obviously, the way to get rid of fatigue is to fix the problem that is causing it.

You have provided me with no related information about yourself; so all I can do is talk about common reasons for low energy issues.

Let’s start with hormone imbalance. People lacking progesterone (men and women) will over-produce insulin. When insulin goes up, blood sugar will drop. These people will complain about fatigue between 3 and 4 PM, while driving in a car (even as a passenger), and possibly sleepiness after eating. In

addition, the body often responds to low sugars by releasing adrenaline, the fight-or-flight hormone, to raise sugar. This hormone can result in people keeping muscles tight even while sleeping. This is an extremely common cause of fatigue, and is the reason why people with fibromyalgia complain about a lack of energy.

People with low thyroid function will often complain of dry skin, poor nails, clots with periods, and commonly, fatigue. A low testosterone level in men can cause a drop in energy and their joie de vivre.

In addition, there are certain medications that can cause fatigue. These would include: psychoactive drugs, beta-blockers, anti-histamines, sleeping pills, and statin drugs.

There are medical conditions that can result in a lack of energy: such as, anemia, congestive heart failure, and chronic lung conditions -i.e. illnesses that can cause a decrease in oxygenation. Perhaps the most common condition resulting in fatigue is depression.

If you want to determine why a patient is tired, you have to sit down and talk to them. This will lead to the diagnosis in 90% of the cases. Most doctors spend about 5-6 minutes with each patient; they only have time to write out a prescription. Getting patients well represents the art of medicine.

Unfortunately, the art of medicine has been generally eliminated by pharmaceutical companies who teach doctors how to practice medicine, insurance companies who determine what’s covered and what isn’t, and a medical bureaucracy enforcing an extremely low standard of medical care and by placing roadblocks to a higher standard of care.