I am exhausted all the time - help?
April 7, 2014 10:14 AM   Subscribe

I'm trying to figure out why I'm exhausted all the time. Of late, I have been generally getting 8-9 hours of sleep (sometimes more), and am very tired through the day, sometimes taking an accidental nap (that I don't have time for), and after dinner I am too tired to do anything and have to push myself and am not very productive. This can't be normal. Even figuring out the general genre of the exhaustion would be helpful, especially whether it results from some sort of clear-cut medical problem or whether it's psychosomatic. I'm about to get bloodwork done, and am trying to figure out what should be tested for. More inside, and I'd love any thoughts or pointers.

Things that may be relevant:

1. I was sick with what was probably the flu for virtually an entire month, about a month ago. I felt like I had been run over by a bus and could hardly get anything substantive done. I was sleeping all the time. I feel mostly better now but still very tired. I don't know what I had: my doctor believed it to be viral, but didn't know beyond that.

2. I have bad Seasonal Affective Disorder. The light is getting better now, but the late fall and winter is rough and I feel like I'm perpetually exhausted during that time every year. Cloudy days are particularly bad for me at all times of year, but that may be psychological, I don't know. I certainly have trouble waking up on cloudy days, and generally have to have my curtains open (and ideally a south or east facing room) in order to be able to wake up early.

3. I am in the latter stages of a PhD that I am finding very frustrating both in terms of my progress towards completion and also in terms of the fact that I have decided against academia. I am wondering whether this feeling generally drained is coming mostly from anxiety/depression over my current vocational trajectory, the fact that my funding will be running out in a few months, research stress, etc.

4. I eat reasonably well: a lot of yogurt for breakfast/lunch, nuts/fruit/hummus/chocolate for snacks, tea/coffee with whole milk throughout the day, and then typically a fairly balanced meal for dinner (typically comprised of meat, vegetables, a bit of starch). I would estimate I'm eating around 1500 calories a day, but I'm not keeping strict track of it nowadays. This amount of food is generally normal for me. I don't go to the gym (partly because I have been too exhausted), but I do walk at least two miles on most days, and sometimes do other exercise like lift heavy things.

5. My sister has just been diagnosed as being very anemic, and has just started on prescription iron supplements. I don't know whether this runs in families.

6. I have talked to my primary care doctor, who didn't have any ideas (he is generally extremely unhelpful, and I have been planning for some time to switch doctors, but haven't had the time yet to research a new one). He said he'd order bloodwork for me if I wanted. I am trying to figure out what tests would be best to order in terms of what the common things that would make me exhausted are. Ideas?

I'd love any general thoughts, including whether this sounds like it's more likely to be some sort of clear-cut medical problem or deficiency (thyroid? anemia?), whether it's residual exhaustion from the flu, something else like mono (or even parasites?), or whether it's stress from my PhD. I'd love ideas about possibilities that this could be. What bloodwork or other could I have done to try to eliminate or confirm possibilities? I know you're not my doctor, but any sense of direction would be helpful. I have seen previous questions on this, but I thought it would be helpful to post again to give all of my particular. Thanks in advance!
posted by ClaireBear to Health & Fitness (34 answers total) 14 users marked this as a favorite
I think it's possible your "flu" was mono. They symptoms are similar, and mono can leave you exhausted for many weeks. A blood test can check this.

Blood work can also look for anemia (I think it can indeed by hereditary), and thyroid problems, which also can cause low energy. Your diet seems like it might be a little low-iron.

So, I think getting those blood tests done would be the first step. Then maybe look for less-likely culprits. Depression can manifest as low-energy - it might be worth asking your doctor (or the new, better doctor you will be getting) to do a depression screen.

(FWIW I am also a late-stage PhD student...and it's been a physical and emotional roller coaster. Hang in there!)
posted by pantarei70 at 10:24 AM on April 7, 2014 [4 favorites]

I was the same way (tired all day, getting a full nights sleep but needing a nap) and was diagnosed with low functioning thyroid, which in conjunction with SAD was knocking me out all winter. Another symptom was that I just did not have an appetite, and wasn't eating much food, yet I wasn't losing any weight. I've started taking replacement thyroid hormone and my levels are back where they should be and after about 6 months I noticed a huge difference in my energy levels. It does require yearly monitoring to make sure my thyroid levels are where they should be.

Thyroid functioning is screened via a blood test. Basically they look at the amount of TSH in your blood. TSH is the signaling hormone that tells your thyroid to make T3 and T4 hormones. If your TSH level is high but your T3 and T4 levels are normal/low, that means your body is trying to signal to your thyroid, "You're not making enough stuff! Work harder!" but it has to make more and more TSH to keep up.

If your doctor didn't strongly suggest a blood panel and a Complete Blood Count to start then I'd really advise you to go to a new doctor. It's not normal to be tired all day and you shouldn't have to ask your doctor for blood tests to diagnose a cause.
posted by muddgirl at 10:25 AM on April 7, 2014 [3 favorites]

This sounds a lot a lot like depression to me. Have you considered your mental health apart from the SAD?
posted by Rock Steady at 10:25 AM on April 7, 2014 [1 favorite]

I've had this. A few thoughts:
- viruses are nasty buggers. Can take 4-6wks to start to feel normal again
- supplements: iron (liquid form is best)
- do NOT eat sugar
- no coffee or caffeine. Caffeine is like borrowing energy from the future and at some point you have to pay the piper
- are you sleeping deeply or micro sleeping?
- force yourself to get exercise. even if you're exhausted. you could be 'over tired' from not getting any exercise. Trust me on that one.
posted by St. Peepsburg at 10:26 AM on April 7, 2014 [1 favorite]

Is this just since you got that flu? The last time I had the flu (like 8 years ago, and I remember it well, because it was THE WORST), I was in rough shape for several weeks. Like, I had to push through the first week for practical reasons (because I was finishing up a graduate degree and had deadlines, basically), then I had to take a week off sick from work, then it was weeks, probably a month, before I felt back to 100%.

Basically, what you're describing sounds like it *could* be explained by getting the flu + PhD-related depression.

Another thing to consider: Is the sleep you're getting good-quality sleep? A full-scale sleep study can help you figure that out but you might even just want to try a phone app like Sleep Cycle (for iPhone, I'm sure there are android versions) that evaluates how much you toss and turn. Anxiety and depression can interfere with sleep big time.
posted by mskyle at 10:26 AM on April 7, 2014

Definitely go ahead with the blood work - that could at very least eliminate a lot of possibilities.

Do you get a lot of headaches lately, or any jaw discomfort? I couldn't for the life of me figure out why I was so tired until my dentist clued me in that I was grinding my teeth in my sleep.
posted by gohabsgo at 10:27 AM on April 7, 2014

I think your best bet is to find another doctor and have her/him order the bloodwork. If you're too exhausted to find another doctor, outsource that to a friend or a family member. It sounds like anyone would be better than your current one, so just pick one that takes your insurance and is convenient to you.

It might be psychosomatic, but I'd hate to waste time on the therapy route when it could have been solved with iron pills.
posted by desjardins at 10:27 AM on April 7, 2014 [1 favorite]

Response by poster: Thanks for the thoughts so far all - super helpful! I just wanted to clarify (and should have said in the post) that I am on a horrible insurance where I only get 5 or so primary care doctor visits per year that are subsidized (the rest I am on the hook for the total cost of, not just the co-pay). I only have a few left, and additionally am broke (PhD stipend running out this summer) so I *really* can't afford to shop around for a new primary care doctor right now, or lots of doctor visits. Ideally I will get bloodwork or whatever else at one last visit, so I can save my remaining one or two for any unforeseen problems later in the year.
posted by ClaireBear at 10:31 AM on April 7, 2014

IAYSOTI (I am your stranger on the internet), and I think you should take a closer look at the possibility of anxiety/depression.

Being in a PhD program is frustrating and stressful under the best of circumstances (I've gathered from observation, not personal experience), and if you've already decided against academia, then you're putting a huge amount of energy into something that is not very meaningful for you. That is a recipe for depression.

Maybe consider (and consult with your MD about) therapy and/or meds. Meds are not bad, they can do some real good. But you need to do talk therapy at the same time to deal with the root causes. In any case, it would probably be good to get help with dealing with your academic exit strategy and coming up with strategies for post-academic life. You're talking about What You Will Do With Your Life. That's huge, and if it's all broken and janky, you're gonna get depression.

(I'm assuming you're a woman on 1500 calories/day. If you're a man, eat more.)
(I don't mean to leave out other genders, I'm just not really literate on those topics/biology+gender/etc.)

posted by univac at 10:33 AM on April 7, 2014

I've recently (the last few weeks) had similar symptoms and my PCP (who is amazing and makes all the vast amount of others I've had look like amateurs) ran a full blood work-up and it turns out I'm insanely anemic (even more than my baseline low anemia). So she set me up with a local hematologist and I'm probably going to end up doing iron infusion therapy. I'm told that it can really help give a boost to low iron levels if the body is having trouble absorbing iron supplements.

My advice - First: new doctor. Second: all the bloodwork! Third: give yourself a break for being tired - things will get less exhausting, you're working on making things better.
posted by Merinda at 10:34 AM on April 7, 2014

I expect that various vitamin supplements will help, (I'd do a multivitamin with iron, and maybe an extra vitamin D on top of that) but get your bloodwork done first; there's no point in skewing the measurement by filling yourself full of vitamins and minerals.

I suspect you'll have a very low Vitamin D level; it's related to light, as well as nutrition, and thought the symptoms are generally subtle rather than dramatic, energy levels are quite possibly relevant.

If your schoolwork inspires moments of panic and a desire to run away, if you don't want to get up and go to work/school, if you're not 100% enthusiastic about being done with your dissertation because then it means you have to know what's next, if you're avoiding any of these problems by not thinking about them - all this makes it hard to want to be awake and energetic and doing things, and really easy for your body to say "she's happier when we just stay in bed and slug our way through the day" and take the easy way out. I don't want to say "psychosomatic" so much as I want to say that it's a mind-body issue, a way that humans can process stress into pain or exhaustion. Working with a therapist on stress might help.

But yes, get bloodwork first. Vitamin D, iron, and maybe thyroid. Oh, just saw your update. Bloodwork can be pricey, and if it's your idea not the doctor's, the insurance can try to skewer you. Phone calls first, find out what that policy is.
posted by aimedwander at 10:34 AM on April 7, 2014 [1 favorite]

I struggle with my energy levels (as well as depression and SAD) and getting a solid workout done first the in the morning (~5:30am) does wonders for my energy level for the rest of the day. Yes, there is a bit of a break-in period while you adapt to waking up earlier, but it is GOLD I tell you! GOLD! Energy for the day, start every day with a sense of accomplishment, and I sleep better at night. Plus the workouts help my depression and seasonal workout disorder, so there's that too. (Agree with others that your SAD/Depression may be more of a player than you think.)
posted by PuppetMcSockerson at 10:34 AM on April 7, 2014 [2 favorites]

I want to respecfully half-differ from St. Peepsburg. Caffeine definitely has the potential to cause problems. I've even found that too much caffeine can cause me to tense up all over and then, paradoxically, get extremely tired.

But I've also found that small amounts of caffeine (cup of green tea periodically) can make the difference between only being motivated to scroll through the RSS reader and kicking ass all day & getting lots done.

On preview: seconding working out. Cardio can be magical when it comes to mood.
posted by univac at 10:37 AM on April 7, 2014 [2 favorites]

Get your blood work done as others have suggested. My husband kept getting bad SAD during winter and the doctor recommended Vitamin D & Magnesium tablets for him and they perked him up significantly, maybe not back to his summer energy levels but enough that he didn't feel like a zombie all the time

Also seconding viruses can take longer to get over than you think.
posted by wwax at 10:38 AM on April 7, 2014

Oh, and find a desk lamp, put in the brightest CFL that you can find, (with preference to bluer CCT rather than "warm white") and set it up on a stack of books so that it shines in your face for an hour in the mornings while you drink your coffee and surf the internet. The goal is to get as many blue photons into your eyes as possible before 11am. You don't have to buy a fancy SAD light, you just have to get a regular light close enough to your face that you're getting a high% of those photons into your eyes (i.e. before it spreads out). It should be uncomfortably bright but not painful, like trying to read a book outside in the summer. Ideally the light source should be above your horizon, mimicking the bright blue sky.
posted by aimedwander at 10:40 AM on April 7, 2014

If it wasn't mono and you want to rule out ordinary physical causes before exploring the possibility of this being another symptom of your depression, vitamin d deficiency is something else to look at.

If you live in a sunless area of the world, try taking some vitamin d supplements and seeing if it helps.

But, yes, you really should get those blood tests done. If you haven't got your health, you haven't got anything.
posted by zizzle at 10:50 AM on April 7, 2014

+1 on the fact that a virus can wear you out for a while, plus winter/SAD, plus stress.

But, I do think that blood work is not a bad idea. If you have arm twisted the current doctor into it, then maybe stick with him for now due to the insurance issues, or try to make sure you can do this with insurance coverage. With the blood work they should check for Mono, iron levels/anemia, thyroid, Vitamin D, Vitamin B12 (be sure they check B12 as well as the others; not everyone does.) I have had Mono, and it took me a year to recover my full energy, but a I also had a bad flu that took a couple of months to shake, and this year there have been some bad flus. A major symptom of my thyroid issues was tiredness.

Also, where are you? I wound up testing positive for a tick borne illness (not Lyme but similar) that presented as flu like symptoms. You may not be in a tick area and it may still be too much winter where you are to be an issue, but I'm just going to mention that.
posted by gudrun at 11:12 AM on April 7, 2014 [2 favorites]

There's lot of great suggestions here about checking internal factors, but one definite thing to check is external factors as well - not just your body but your environment, such as mold. Specifically, however, if you live in a cold weather climate I'd recommend checking for carbon monoxide in the places you spend most of your time: your residence and maybe your office.

What triggers this suggestion is this: I was sick with what was probably the flu for virtually an entire month, about a month ago. and I have bad Seasonal Affective Disorder. Low level, constant carbon monoxide poisoning can present itself as the flu, can cause depression, and can wreck havoc with your energy levels. I don't know where you live, but if your furnace is breaking/is broken, the colder weather will cause it to pump more CO into your environment as it works harder. As it got warmer your flu-like symptoms may have abated due to it working less, but as it's still spring with winter temps in many areas of the country it might still be on, particularly at night. You don't need the high levels that cause headaches and nausea to still be affected.

A carbon monoxide detector is relatively cheap - way cheaper than doctor's visits and bloodwork. You can and should test every room in the house as CO is actually lighter than air and rises (a common misconception is that it gathers in low spots) and check a few times over different times of the day over a few days. If you have an office at school it might be worth checking it as well. It's worth eliminating as a factor right off the bat before driving yourself crazy if it turns out you can't figure anything out, and your symptoms appear on cue next winter. Everyone should have a carbon monoxide detector anyway.

(Also, 2 quick, cheap experiments: 1) Try eating more - particularly more protein in the morning (i.e. a tablespoon of peanut butter when you first get up.) The mental energy from your doctoral program plus the flu might have pushed your energy needs up. It's an easy enough experiment for a few days, and might help you if you are having blood sugar problems or iron deficiency which your future bloodwork can pinpoint. 2) Have you checked how much water you're drinking? A lot of times people think they're drinking enough water, but they aren't. The first thing that happens with dehydration is that your energy levels go down. Even carrying a bottle of water with you isn't enough sometimes because it leads to the illusion that you're drinking enough water. For a few days, try upping your water intake and see if you feel any difference.)
posted by barchan at 11:17 AM on April 7, 2014 [2 favorites]

Well this is up my alley. I was hospitalized a few years ago for a mysterious virus that was flu ish but turned out not to be the flu proper. I was actually in a room alone for a week because my white cell count had been completely depleted due to said virus. I was tested for Erlichiosos, which is a tick borne illness and possibly what Gudrun is thinking of above, but that wasn't it either. Just "a virus".

I didn't feel normal for about 2 months.

I also have a tendancy to let stress take over and it seems to manifest in tiredness and lowered appetite, which makes for a bad cycle. Teh last time I felt so tired as you describe, I went to the doctor and they ordered a full blood panel (vitamins, iron, hormones for thyroid, lymes, AIDS, red and white count, everything, everything) and it came back..great. Vitamin levels were fine, iron was fine, thyroid doing good, and the only thing they could guess was thath it was depression / anxiety from the stress. Definitely don't downplay the possibility that your physical symptoms are due to your mental state.

Anyway here's a few things you can try: Eat double portions of meat / cheese / eggs / nuts with your normal salads and veg. Sometimes your will to nourish can drop so low you don't realize you're subsisting on a yogurt cup, a salad with one chicken finger, and a cup of brocoli per day. It ain't enough. Use a low powered tanning booth regularly. I started going to a tanning salon and using the lowest powered booth for 2 or 3 minutes 1-3 times per week. This helps with the whole SAD thing and stimulates vitamin D (and isn't a supplement that might just get pooped out). I find that i get only very very slightly tanned, other people, including those who see me everyday don't notice (nor do i want to be tanned). I see a few fellow pasty people in there regularly, probably using the booths also as a mood booster as opposed to a cosmetic thing.
posted by WeekendJen at 11:28 AM on April 7, 2014

There's plenty of good advice above. Something that hasn't been mentioned yet is sleep apnea, which may contribute to or cause your exhaustion. If you have it, you might get all the sleep in the world but still feel tired or exhausted throughout the day because the quality of your sleep is severely diminished. Is there anyone you can ask about your sleep habits? Specifically, whether you appear to stop breathing in your sleep? Do you snore? I don't think there would be any blood work that would indicate sleep apnea, it's typically diagnosed through a sleep study.

On another note - it may seem counterintuitive, but you should incorporate strenuous exercise into your life. One of the numerous benefits is that it's great for falling asleep and getting quality sleep.
posted by hootenatty at 11:36 AM on April 7, 2014

I am writing my PhD thesis right now, and hoo man, is it ever draining. Don't underestimate how goddamned crushing PhD programs are. When I take a weekend off and manage to actually get away from it all and get some rest, I am energetic and lively. Back to the thesis, and I am crushed by the weight.

Try cutting down on caffeine, especially in the afternoons. I bet you'll find you are goddamned exhausted all the time.
posted by PercussivePaul at 12:49 PM on April 7, 2014

I came in to say you may have mono, and to get screened for anaemia, thyroid and vitamin D deficiency.
posted by DarlingBri at 1:34 PM on April 7, 2014 [1 favorite]

What you describe sounds like mono. I had mono as a teenager and it took me a month to feel remotely human again.

That said, if you have SAD and you're getting 8-9 hours of sleep but still napping, I'd definitely have your vitamin D levels checked, as well as thyroid and iron levels. Have your doctor check for pernicious anemia as well, which is a vitamin B12 deficiency. (I realize many others have suggested these already, but I am adding my voice to the chorus.) Ask your doctor for a full thyroid panel too, not just TSH.
posted by bedhead at 1:55 PM on April 7, 2014

Have you got any other symptoms like a sore throat, aching joints, or difficulty concentrating? If so yo could have chronic fatigue syndrome. This can be brought on by a bad viral infection.
posted by Ranting Prophet of DOOM! at 2:12 PM on April 7, 2014

My tick disease was Babesiosis, though there are a variety out there. Babesiosis often causes only mild (or no) symptoms and can have a long incubation period. If you are in the NE U.S. especially, tick diseases are something to at least rule out. Sleep apnea, carbon monoxide, and allergies, are other good thoughts. Cutting back on caffeine, upping your protein a bit, and good hydration are all worthwhile things in general.
posted by gudrun at 3:37 PM on April 7, 2014

Response by poster: Just to clarify, my "flu" symptoms were chills, entire body aching, really exhausted, sore throat, headache, and just generally feeling like death warmed over. That persisted in the extreme for a couple of weeks, and then I started to get a bad cough as well, which I imagine was me being hit by something unrelated on top of whatever I had. The whole thing was pretty acute for a month, but, as I said, I still feel exhausted.
posted by ClaireBear at 4:57 PM on April 7, 2014

Response by poster: These answers have been incredibly helpful - thank you!

In terms of bloodwork, it looks like I should request tests for: mono, iron, anemia, thyroid (TSH), complete blood count, vitamin D, Vitamin B12, and tick-borne illnesses (I am in the NE US). Are there specific blood tests for various tick-borne illnesses that the lab can run? Anything else I should be including? Are all of the above tests clear, or are there different tests for, say, iron that test for different things? I'll try to make sure my insurance will cover the bloodwork before my doctor orders the specifics.

Additionally, I should also consider more strenuous exercise, medication for depression/anxiety, morning bright light exposure, cutting caffeine, eating more protein (I'm hesitant to add calories as I'd like to maintain my weight if not lose a bit of weight [although I'm too tired to embark on that project at the moment], but I'll try to add a bit of protein), drinking more water, sleep apnea, carbon monoxide, and allergies. Anything that I'm missing?

Thank you so much again! Hopefully I will get to the bottom of this! I'm going to start with bloodwork to see if there is anything specific that is identifiable, and then I will move on to the other possibilities if that is unsuccessful.
posted by ClaireBear at 5:09 PM on April 7, 2014 [5 favorites]

Hey, you don't live anywhere where coccidioiodomycosis (Valley Fever) is a possiblity, do you? If so, ask for a screening for that as well.
posted by WidgetAlley at 5:22 PM on April 7, 2014

Just "yes" to what you just posted! I was severely anemic and had a lowish thyroid... holy moly. I also know Ph.D. students (*ahem* former) who struggled with depression. Bloodwork + exercise + apptointment with campus counseling should just about cover you! (I will say you should probably see a counselor anyway - graduate school is tough, finishing is tough, starting a career is daunting, feeling crappy is tough, and having health problems (potentially) is tough. If you have access, I'd use it!)

I've had similar bloodwork done - The doctor requested basically everything you listed. I took the order form to the lab, they took a bunch of vials of blood (one pin prick for me, but I had to sit there while they swapped the bottles out). The results all came back at the same time. May require a follow up, or they might be willing to email you (to the effect of "you're fine, take iron" or something). She emailed me my lab results too. It's pretty straightforward.

Eating protein helped, but I really really need to be on iron supplements... just sayin'. (ymmv)

Celiac disease is diagnosed with a blood test - you might have them throw that in with the rest of your bloodwork too. (Do not stop eating wheat first, or there will be nothing to detect!) Celiac isn't an allergy in the same way as other good allergies/sensitivities so a skin-prick test won't pick up celiac.

Athsma at all? Ask if you can blow into a peak flow meter to check your lung capacity - should take two seconds. Not enough oxygen can also make you feel seriously shitty.
posted by jrobin276 at 6:04 PM on April 7, 2014

mono, iron, anemia, thyroid (TSH), complete blood count, vitamin D, Vitamin B12, and tick-borne illnesses

Just chiming in to say that sounds exactly right. I could have written your post a few months ago, and my doctor ordered bloodwork that included exactly those things, except for mono (no flu-like symptoms in my case). (It came back low for D and B12, so I supplemented and now I feel fine again.)

He also said that if all of those were ruled out, we could assume that it was atypical depression and treat for that. (I have had major depressive episodes before, but this felt different because I wasn't sad, just really really exhausted.)
posted by lollusc at 6:32 PM on April 7, 2014 [2 favorites]

In addition to TSH, you should get free T3 and T4. TSH doesn't always tell the whole story.
posted by kathrynm at 9:07 PM on April 7, 2014

Yes to your list. Except I would say not to consider more strenuous exercise until your results are back. When I was in college I had such severe mono it put me on disability for three months, and it is not a condition you can address with exercise. It's a condition you address with sleep.
posted by DarlingBri at 4:25 AM on April 8, 2014 [3 favorites]

I'd lay off major lifestyle changes until after the bloodwork's back. Like Darling Bri, I had mono in high school which presented pretty much as you described, right down to the cough. You'll be doing yourself a major disservice if you take up marathon training right about now, and if it's anemia you'll wind up pretty wrecked afterwards with poor recovery.

This too will pass. Especially the PhD.
posted by Jilder at 5:25 AM on April 8, 2014


I'm posting this because I was in your position 6 months ago and was reading metafilter and didn't get any good answers. I went from working on wall street to wanting to sleep all day within a period of 6 months and didn't know why. I am 25 years old and have Hashimoto's disease, which is one of the most common causes of the symptoms that you are experiencing and is an vastly under-diagnosed illness. Here is what I recommend:

Here are the don'ts.
1) Don't let anyone tell you to ignore how you feel ever! Do not let anyone tell you it is in your head. It is not in your head and no one deserves to feel this way. Do not believe stuff like "this too shall pass" unless you know that there is nothing medically wrong with you. Not everything is in your head and if you experience persistent cases of fatigue despite sleeping properly, eating properly, and being pretty young, then it is not in your head. There is a difference between "being a fighter" and knowing when people telling you "get over it" are full of crap.
2) Do not let anyone tell you "diet and exercise" is the reason why you are feeling this way. Diet is a very large component of our health and so is exercise, but it is important to call bullshit on this when it is appropriate. In my case, I had probably the healthiest lifestyle of all of my friends and yet I still felt this way. This was a warning sign that the cause of my fatigue was NOT due to lifestyle factors alone. If you are the same way, then do NOT fool around with diet and exercise thinking that this alone will fix your problem.
3) Do not go to just any doctor and expect that they will have a solution to your problem. Doctors are very poor at diagnosing vague illnesses where the symptom is fatigue. Doctors are trained such that they need clear physical symptoms to assess what is wrong. Moreover, most doctors have their hands tied in running bloodwork in that insurance companies, since insurance companies often are skimpy on paying for proper testing.
4) DO NOT let them diagnose you with depression or something similar unless you have been checked for hormonal issues first. SO MUCH research shows that cases of persistent depression/fatigue is actually a hormonal issue it's not even funny. Most doctors do not know this.

Here are the do's:
1) Go to a rating website for doctors like Vitals dot com or a similar site (just google for doctor rating website) and find the very BEST doctors in your area. For vague issues like fatigue it is of UTMOST importance to see a very good doctor for a diagnosis, since only they will have the balls to get all the proper testing done. DEMAND that you get a full bloodwork done.
2) DEMAND that you get proper hormone testing and endocrine testing done. If your primary care physician will not do it, see an endocrinologist. If they refuse you, keep calling endocrinologists until one will see you without a referring physician. Do not put up with their crap if you are suffering and cannot get the proper tests done.
3) Be your own advocate. Once you get a diagnosis, find the best doctor you can afford. Learn as much as you can about your illness so that you can live the healthiest life that you can.

Best of luck.
posted by sben789 at 8:18 PM on May 13, 2014

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