Sleepy Koala asking "what the hell is wrong with me?"
October 31, 2012 3:27 AM   Subscribe

(asking for sister) Why am I so tired? I feel like my brain is cotton wool, I wake up tired, all I want to do is sleep, and my short term memory is terrible.

It has been like this since high school. I'm 33. Female. Don't smoke, no drugs, hardly drink, mostly vegetarian. Crave sugar often. I work full-time but it wouldn't matter if I didn't -I'd still be this tired. I don't exercise due to overwhelming fatigue. I'm not depressed, I have a positive outlook on life, yet can't overcome my fatigue. Am in a great, stable marriage to an awesome man. Normal periods. History of iron deficiency/anemia but am taking supplements - doesn't make any difference.

It feels like chronic fatigue but I don't know - I guess I refuse to accept that diagnosis. I can get through the day of work but as soon as I sit down I just want to sleep.

I haven't had any caffeine for over 3 months.

I hardly ever get sick...

No sleep apnea. No thyroid issues. No physical manifestations. Good digestion!

I have a slight build and long limbs, if that means anything.

It really comes down to an overwhelming difficulty in focusing, concentrating and remembering.

Has anyone else experienced this for no apparent reason and overcome it? I would love to hear ANYTHING you might have to share.
posted by saturn~jupiter to Health & Fitness (43 answers total) 27 users marked this as a favorite
How much sleep do you get per night?
posted by EndsOfInvention at 3:29 AM on October 31, 2012

Response by poster: I can get up to 10 hours and feel unrefreshed. Average 8 hours, and I'm tired. If I get less I'm tired, if I get 10-12 hours I'm still tired.
posted by saturn~jupiter at 3:30 AM on October 31, 2012

any calcium/vitamin d abnormalities?
posted by saraindc at 3:33 AM on October 31, 2012 [2 favorites]

Crave sugar often. I don't exercise due to overwhelming fatigue. mostly vegetarian I haven't had any caffeine for over 3 months

Do you consume a lot of sugar? Try cutting it out and see what happens. Conduct an experiment. Absolutely no refined sugar or junk for a few weeks. How about protein? Are you getting enough?

Caffeine: A cup of coffee can help get rid of the cobwebs.

Are you working? Force yourself to take a walk on your lunch break or work in some sort of exercise, even if it's 10 minutes. Gradually increase your time.
posted by Fairchild at 3:39 AM on October 31, 2012

Response by poster: I used to drink coffee daily as well as multiple cups of tea - it made no difference.

Yes I work full time.
posted by saturn~jupiter at 3:45 AM on October 31, 2012

Have you been to the doctor? If not, that would be the first place to start. (And note that I am not a doctor.) Even if you have been to the doctor, it's worth going back and explaining, very specifically, how this affects your life, and requesting further testing. Among other things, they can follow up to make sure your iron supplements are actually working to correct the iron deficiency (if that hasn't been done before). They can also make sure it's not pernicious anemia, which has a different cause.

Vitamin D deficiency is one of the more common things they'll test for. My understanding is that it's worth getting tested rather than just taking Vitamin D, because if you're very deficient the usual OTC doses won't do much. (If you do already do supplement, make sure you're using D3, not D2. And make sure the doctor has followed up to confirm your dose is actually correcting your D levels.)

If you're vegan, or close to it, that's another possible cause to look at. Here's a good overview of potential nutritional issues and fixes -- also good to read if you're not actually vegan.

My understanding is that it's possible to have celiac and be asymptomatic apart from fatigue. If you get tested for this, make sure you're still eating gluten. You could also try cutting out gluten to see if it helps.

I'm reluctant to mention this, and please note that I am still not a doctor, but what finally helped me with similar symptoms (plus some additional ones), which I'd been through extensive testing and doctors visits for, was supplementing fat-soluble vitamins. I have no science behind this, but taking vitamins K2 and A (in addition to the D3 my doctor had already prescribed) has significantly improved (although not cured) my fatigue issues, and also (weirdly) mostly stopped my sugar cravings. I have no explanation for this and it may be placebo effect. I wouldn't try this without talking to a doctor first, and without looking into more likely explanations, like pernicious anemia or D deficiency.
posted by pie ninja at 4:10 AM on October 31, 2012 [2 favorites]

Has she had a bloodwork panel done to look at common issues of fatigue? Thyroid hormones, iron, vitamins, etc?

It is common for vegetarians to have iron or vitamin b deficiencies. I had a vitamin D deficiency and feel much better when I take my supplements.
posted by shortyJBot at 4:10 AM on October 31, 2012 [1 favorite]

My first thought was to rule out a Vitamin D deficiency with a blood test. It made all the difference for me.
posted by zizzle at 4:19 AM on October 31, 2012

Just a thought: could the fact you're vegetarian and perhaps, maybe, consume a high-carb diet be contributing?

I've been eating low carb for a couple of weeks now and my fuzzy head and lack of energy are gone. I find if I eat bread, about half an hour later, I just want to go and have a nap. Since cutting out refined flour and absolutely no sugar, it feels like I've finally woken up.

We're all different of course, so what I suggested might not work at all.

I would though go and see a doctor because the cause could be fairly straightforward and perhaps easily treatable.
posted by stenoboy at 4:32 AM on October 31, 2012 [4 favorites]

Get a blood workup including thyroid and blood sugar, anemia, as well as vitamin D. Proceed from there on cutting down carbs, changing diet etc but start with a checkup and blood work.
posted by mermayd at 4:47 AM on October 31, 2012

Humans need to eat animal products. If she's a vegan or close to it, I am going to guess that that is at least a contributor here, if not a cause. It could still be a contributor if she's ovo-lacto, and adding fish might do her a world of good.

Seconding the suggestion to check vitamin D levels. Avoid synthetic D if you can and go for sunlight.
posted by parrot_person at 4:53 AM on October 31, 2012 [1 favorite]

You also need to get your vitamin B levels checked by your doctor. Mine were too low and I was tired and fuzzy-headed. There is a very large healthy range--even if you are in the low end of healthy, it may not be enough for you. Serious B12 supplements helped me a lot (think 8000x the RDA for a couple of months, the kind that dissolve under the tongue, which aren't excreted so much in your urine). Also, you may not want to hear this, but eating beef 3-4 times a week (up from 1-2x month) has really, really helped me. Unfortunately it is the most direct food source to get a lot of iron and B easily and quickly.
posted by min at 4:57 AM on October 31, 2012 [2 favorites]

She doesn't have apnea, so she has had a sleep study? Did it include a Multiple Sleep Latentcy Test the day after? If not it probably should have and it's worth returning to the sleep doctor to discuss. Your sister needs eval for idiopathic hypersomnia and an MSLT is how this is evaluated. Of course that is just one avenue to explore and IANY(sister's)D.
posted by teamnap at 5:22 AM on October 31, 2012 [1 favorite]

This screams vitamin deficiency to me, D/iron/B are the most likely candidates. Extra warning bells due to the vegetarianism, particularly with iron.

Plant iron is rarer and in a harder to digest form than animal-based iron, and iron pills are yet another kind, which don't work for everybody. Eating red meat a few times a month solved my anemia.
posted by zug at 5:32 AM on October 31, 2012 [4 favorites]

I had a very similar thing happen to me. Turns out that my not eating red meat for 13 years was the problem. I went to a hemotologist because I was so anemic.

After all kinds of testing, the only thing he could suggest (and he was REALLY frustrated) was to eat red meat. I'm back to being an omnivore and I feel a LOT better.

Pushing for more and better testing, especially vitamin deficiency is the way to go.
posted by Ruthless Bunny at 5:54 AM on October 31, 2012 [1 favorite]

Response by poster: So she (the sister) does not eat meat but does eat a lot of eggs, so that takes care of Vitamin B. Has had D levels checked and they were okay.

Maybe it is just that she needs red meat. I (sister, ie saturn~jupiter) am also vegetarian and dairy-free (but eat eggs) and do not have this problem AT ALL. I have never been anemic and have plenty of energy etc etc.

We were both wondering about gluten...

As for apnea, she doesn't have any of the risk factors, doesn't wake during the night, etc etc.

Yes she has seen multiple doctors about this problem. She is, in fact, a doctor (an intern).

Idiopathic hypersomnia? Might be a good thing to check out...
posted by saturn~jupiter at 6:04 AM on October 31, 2012

As for apnea, she doesn't have any of the risk factors, doesn't wake during the night, etc etc.

Is this based on her impression of whether she wakes during the night, or someone else's observation of her? I have friends with sleep apnea who videotaped themselves sleeping and were SHOCKED at the amount of times they woke up — they had no idea.
posted by heatherann at 6:18 AM on October 31, 2012 [4 favorites]

Actually, exercise can make you more energized, not more tired. Before I started exercising regularly I was fatigued and sluggish all the time. Now, I only really feel tired if I haven't gotten enough sleep. So when you feel fatigued, try some kind of exercise- a brisk walk even- and see if that makes you feel more energized. It can make a world of difference! (assuming you have no vitamin deficiencies or illnesses causing the fatigue)
posted by bearette at 6:28 AM on October 31, 2012 [2 favorites]

Yoga is also good because it gets your blood flowing all over your body, and doesn't have to be super intense (but lots of classes are so check beforehand).
posted by bearette at 6:33 AM on October 31, 2012

How are her sinuses? Pressure from chronic sinusitis can give a lot of those symptoms. I can barely think straight when I have sinusitis.
posted by ShooBoo at 6:54 AM on October 31, 2012

Some ideas which would require bloodwork:

1. Sub-clinical hypothyroid: I would suggest a workup from an endocrinologist. Primary care physicians, in my experience, do not have the skill set or interest to manage anything other than textbook cases of thyroid conditions.

2. B12 deficiency. Some very common medications have been linked to diminishing B12 levels. If you take PPIs (proton pump inhibitors) for acid reflux, you are at risk for low B12. Also, there are several autoimmune conditions that affect B12, like pernicious anemia. You can start taking a B12 supplement to see how you feel.

3. Vitamin D deficiency. So many people are deficient in Vitamin D. It's almost not worth getting checked; just start taking a supplement (check with a pharmacist for the right dose) and see how you feel later. (I see you said she had them checked--maybe take a supplement anyway, and see if that makes a difference?)

I would also suggest your sister have a clinical screening for depression. I see she denies it, but this is not the time for self-diagnosis.

Another important question: Does this go away during vacation? If so--could it be stress related? This potentially goes along with depression.

Is there enough fat in her diet?

(Very) Longshot: Is hepatitis (or another viral infection) a possibility? Any swollen lymph nodes not related to acute illness?
posted by FergieBelle at 6:56 AM on October 31, 2012

If I don't eat chicken or red meat at least once a day, if not twice, and I don't eat red meat for three days, I become overwhelmingly spacey and tired. I've found nothing that can overcome this. HMMV.
posted by zeek321 at 7:22 AM on October 31, 2012

Came here to nth checking blood sugar - high blood sugar can definitely make you feel exhausted.
posted by brilliantine at 7:37 AM on October 31, 2012 [1 favorite]

Has anyone else experienced this for no apparent reason and overcome it?

I experienced this for no apparent reason for about 12 years before the reason became apparent.

It started when I was in college. I'd get hit with episodes of mind-numbing fatigue that would just stop me in my tracks. I could usually fight my way through them, but I certainly wasn't as productive as I was otherwise.

This continued through my twenties. Luckily I had a flexible job, so if I needed to lay my head down on my desk and nap for an hour after lunch I could do that.

I tried various things to address it: acupuncture and massage were both helpful in that they gave me periods of deep relaxation. But the problem didn't go away.

I started going to the gym. Working out helped me push through it, and generally gave me more energy, but I still had the episodes.

Changes to my diet also helped. When I was around 32 I started eating meat again after many years as a vegetarian. I found that eating more protein helped reduce the postprandial fatigue episodes.

Then when I was thirty-three I had some other symptoms and was diagnosed with MS. My neurologist said that probably explained my fatigue going all the way back to my early twenties.

But, I still had the fatigue. What eventually knocked it out was a prescription for modafinil (Provigil). I've been on it for about ten years now and it's been a miracle drug. No side effects that I've been able to detect and the fatigue is pretty much gone.

It feels like chronic fatigue but I don't know - I guess I refuse to accept that diagnosis.

Why do you refuse to accept this diagnosis? Do you think that chronic fatigue is just a psychosomatic illness? Do yourselves a favor and get over that. Perhaps even more important, since you're in the process of becoming a doctor, do your future patients a favor and accept that chronic fatigue is real. Seek treatment for it. It exists.

Chronic fatigue does not always respond to modafinil, but it sometimes does. I have a coworker who for many years had to sleep about 18 hours a day. He gave up his job, moved back home, and basically gave up his life for about a decade. He never knew how long he was going to be able to stay awake --- an hour, a few hours maybe. He started on Provigil a few years ago and he has his life back. He still has issues, but he's able to function.

I don't want this post to sound like a modafinil advertisement. It's possible that some of the dietary changes people have suggested will work. But you shouldn't rule out a diagnosis out of hand. That's not good medicine. And you shouldn't rule out treatments in advance. You should go where the signs and symptoms point and try the treatments indicated by those signs and symptoms.

Good luck!
posted by alms at 7:39 AM on October 31, 2012 [1 favorite]

It could be allergies - I feel this way when I don't take a daily antihistamine. (Google 'allergy fatigue') Have her take a daily claritin or zyrtec for a week and see if it helps. If it does, she can either continue that course or see an allergist for specific testing. Warning though, the only real way around the daily antihistamine route is allergy shots.
posted by 8dot3 at 8:17 AM on October 31, 2012

Could be some kind of imbalance or disbiosis like candida, SIBO, H. pylori, etc. Could also be food intolerance, like gluten. Go to a gastroenterologist or ask a GP to test you. But insist on being tested! Even well-established gastros can pull a, "well you don't have digestive issues so it's none of the above, go away silly woman". And they couldn't be more wrong.

Also, if you have access to a farmers market, get pastured eggs from them. Significantly more vitamins and minerals than the "pastured" or "cage-free" eggs you buy at even high-end supermarkets.
posted by Neekee at 9:20 AM on October 31, 2012

Has anyone else experienced this for no apparent reason and overcome it?
Yes. And it was the gluten. Not only was my body producing anti-bodies to attack itself, I also wasn't absorbing nutrients properly. Other than occasional constipation before my period, zero gastro symptoms.
posted by Neekee at 9:25 AM on October 31, 2012

It feels like chronic fatigue but I don't know - I guess I refuse to accept that diagnosis. I can get through the day of work but as soon as I sit down I just want to sleep.

Chronic fatigue does not present itself in only one way. It sounds like you have some sort of fatigue disorder.

My first thought? Allergies. I have terrible seasonal allergies, and I have a lot of problems with fatigue. Allergy shots have helped.

We were both wondering about gluten...

As someone who legitimately cannot digest wheat gluten, I'm a little baffled by the gluten free=more energy thing. Does your sister have digestive problems? It sounds like her diet is probably fine, and something more serious (chronic fatigue disorder, fibromyalgia, something with the thyroid) or seasonal allergies is going on. I have a very restricted diet, and I don't recommend going down the rabbit hole of food intolerance first.
posted by ablazingsaddle at 9:25 AM on October 31, 2012

To your sister.

The mostly vegetarian is the first clue to me you need to get checked for vitamin deficiencies assuming you haven't already had them checked when they checked your Iron levels Also you might want to up your protein levels and make sure you are getting enough good fats and Vitamins B and D. My mother suffered from anemia when she went mostly vegetarian and was told that supplements don't always work as well as iron rich food she also had very low vitamin B levels which messed up her energy levels so you might want to get those and your vitamin D levels checked too. Go see a doctor, get some blood work done and make sure you are getting the basics right and then worry about allergies and CFS.

Also are you taking any medications, I went long term feeling very much like that, though ended up laying in bed sobbing all because of my allergy meds. Switching from Zyrtec to Allegra made a HUGE difference in a day or so. Lots of other meds including Birth Control can mess you up too.

Oh and fatigue and weakness can be a sign of too much iron as well as too little so you might want to get your levels of that rechecked as well.
posted by wwax at 9:38 AM on October 31, 2012

I also have a history of anemia and supplements don't help me much. When my iron dipped very low during my second pregnancy my symptoms were similar. I had several IV iron infusions and that did the trick. Oral iron absorption just wasn't working, even though I took very large doses of iron with orange juice multiple times a day and avoided dairy, etc.
posted by bq at 9:51 AM on October 31, 2012

As for apnea, she doesn't have any of the risk factors, doesn't wake during the night, etc etc.

As someone who said this very thing before being diagnosed with sleep apnea, it may be worth a test after ruling out easier fixes like vitamin deficiencies, allergies, and the like. I had no risk factors and no idea I was waking up 40 times a night and neither did anyone else, but I had small airways that would get smaller with allergies and a certain sleeping position. The fatigue you describe is familiar. It didn't matter how long I slept.
posted by *s at 9:55 AM on October 31, 2012

So she (the sister) does not eat meat but does eat a lot of eggs, so that takes care of Vitamin B

I am not sure if this means that your sister hasn't had her B levels checked? You can have extremely low levels of B12 even if you eat animal protein
posted by unlaced at 10:28 AM on October 31, 2012 [1 favorite]

This sounds exactly like me when I was a vegetarian and not eating enough protein and eating too many carbs (this includes complex carbs). I KNOW, vegetarians can get protein from plant sources, and also that complex carbs are supposed to be "good"-- but for me personally, I could not feel energized from eating eggs, nuts, beans, tofu, seitan, quinoa, brown rice, etc. I immediately felt better when I started eating some fish, cut out all grains, and greatly reduced my bean intake (too many carbs, again, even though they are supposed to be "good carbs").

Maybe try a low-carb pescatarian diet for a little while to see if it helps?
posted by joan_holloway at 11:42 AM on October 31, 2012

I think you need more protein and healthy fats.
posted by Ideefixe at 12:39 PM on October 31, 2012 [1 favorite]

agree with ideefixe regarding healthy fats. Coconut oil, flax seed oil, primrose seed oil.
posted by ohshenandoah at 1:44 PM on October 31, 2012

Lots of good advice here, just want to further encourage you to do the blood tests for celiac disease. It could explain both fatigue and why the iron supplements don't help. (If you do have celiac, your body isn't absorbing all the nutrients from food the way it should.) Get your B12 levels checked too. I ate lots of eggs and still had a deficiency.
posted by purple_bird at 2:21 PM on October 31, 2012

Many autoimmune diseases have this sort of unrelenting fatigue as a major symptom. A doctor should check out that possibility. Finding a doctor who will take fatigue seriously, though, is a big challenge.

Exercise and sensible dietary changes are good things to try. If they help, great! If they don't help, that's another clue that some underlying illness may be present.
posted by Corvid at 2:24 PM on October 31, 2012

I had the same experience, along with more than usual of my hair falling out and other little niggling things when I was vegetarian and it continued when I added eggs to my diet as well. It got better when I added chicken, beef and fish to the menu but the most dramatic improvement was when I gave up all grains, dairy (because I am allergic since I was a kid), and switched to a lower carb and higher fat diet. Then it was like I was transformed into a superhero in comparison to how I used to feel. Now I wake up after 8 hours of restful sleep ready to go, not dragging myself out of bed like the old days.

I suggest she plug her daily food for a typical day (or even better, a week) into one of the online databases like myfitnesspal or something and see where her protein, fat and carbs fall, as well as where her levels of various nutrients are. Diet-wise, if she's willing to make a drastic change she might try something like the Whole 30 challenge or something like primal or paleo diets for 30 days to see if it makes a difference for her.

If she isn't willing to make a drastic alteration like that, some really valuable baby steps would be adding fatty fish like sardines, wild salmon, mackerel, adding in organ meats like liver, adding in more fat from good sources like coconut oil, free range duck fat and other animal sources, grass-fed dairy if she tolerates it and ghee. If she is eating a lot of grains and legumes and fruits she should sub in a variety of non-starchy vegetables to replace these and make sure to eat plenty of fat with those so that she can reap the fat-soluble nutrients.

Little note from my own experiences: It's typical for long time vegetarians to have a hard time digesting meat due to chronically low stomach acid. If she does transition, she should look into adding enzymes and betaine HCL for a while to make things easier.
posted by tinamonster at 3:52 PM on October 31, 2012 [1 favorite]

As someone who legitimately cannot digest wheat gluten, I'm a little baffled by the gluten free=more energy thing.

Fatigue is a very common symptom in celiac disease & non-celiac gluten intolerance. Both have extensive symptoms list and each individual only displays some of those symptoms, hence why people seldom suspect it.
posted by Neekee at 5:01 PM on October 31, 2012

As for apnea, she doesn't have any of the risk factors

Agreeing with those above who mentioned that this doesn't mean she doesn't have sleep apnea and that 8-10 hours of consistent unrefreshing sleep should trump any other negative risk factors. On top of that, there are many other possible sleep disorders... so it's strange she has not had a sleep study. Get a sleep study and make sure Upper Airway Resistance Syndrome (UARS) is ruled out in addition to the traditional sleep disorders. UARS is not necessarily recognized by the medical community, but Stanford is one of the top sleep centers and they (among others) diagnose and treat it.
posted by ghostmanonsecond at 5:46 PM on October 31, 2012

Thanks everyone for the suggestions. We will investigate all these possibilities!
posted by beccyjoe at 12:48 PM on November 1, 2012

I am a former vegetarian who ended up, after many years, with substantial iron deficiency. It has taken a very long time to correct, and I am still on iron replacement. Stopping the treatment resulted in a worsening of my symptoms, so I'll probably be on this for another year and it's even likely I will need some form of iron replacement indefinitely.

I had huge problems with concentration, focus and memory.

If you are on iron and it's not helping, there are lots of factors that could be responsible:

- how much are you taking? A single, 35 mg pill is almost never enough to correct a deficiency. I am now on a maintenance dose of 70 mg a day, (that's two 325 mg ferrous gluconate pills, taken together), but for six weeks I was on 160 mg a day.

- when are you taking it? If you are taking it with meals, which is what some people recommend in order to mitigate the gastrointestinal side-effects (which can be a problem) then you can just about forget it having any impact. It won't get absorbed. Lots of foods bind iron (dairy is really terrible, coffee, tea and chocolate are also baddies). How I do it: I take it on an empty stomach, in the mornings, an hour before breakfast. Sure, it's a pain, but when I take it this way, it works.

- what are you taking it with? Especially if you have a history of absorption issues, you need to take it with something that enhances the uptake. I always take mine with vitamin C.

- how long have you been taking it? It takes forever. No, really, days and weeks aren't enough, and three months won't be, either. The basic blood tests can be deceiving. I was out of frank anemia after six weeks, but my Hb was low (138 µg/L, I'm a guy) as late as 5 months after starting, and things didn't look really great haematologically until 7 months -- at that point I had been on a maintenance dose of 100 mg for three weeks after interrupting it. It was only at that point that I really started to feel much, much better.

Some people are nervous about iron, but everybody is different. Some absorb it really well (and my personal feeling is: the fear of iron comes as a result of the not insubstantial number of people in the population who carry genes for haemochromatosis; the genetic tests for this haven't been around very long and people who only carry variants of the genes don't develop full-blown haemochromatosis, but will have elevated iron levels, while some of us struggle to maintain good iron status even with "adequate" intake).

I would say: you have a history of iron-deficiency anemia, so you have your answer. Correct that properly, and you may find -- as I did -- that it makes all the difference in the world.
posted by rhombus at 8:03 AM on November 10, 2012 [1 favorite]

A very late in the game comment: Corvid mentioned autoimmune diseases as having fatigue as a component. I, after a lifetime of fatigue/low energy levels was diagnosed with lupus. It's nice to know that officially it's not just that I am lazy.
posted by 8dot3 at 7:14 AM on July 10, 2013

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