Diagnosing fatigue (snowflake details inside)
April 18, 2014 7:19 PM   Subscribe

I know YANMD and I am seeing mine on May 5th, but until then, I was hoping someone would have some insight/experience/advice for what is possibly going on with me. What could be causing daytime sleepiness after eating any amount of carbs? Apologies for wall of text

Background information: I am 28 and have PCOS but because I am on the thinner side (5"1; ~114lbs) I've been told that I'm not insulin resistant. I have a 2 year old who pretty much sleeps through the night but occasionally cries d/t a nightmare/hunger, etc. I have been getting daily headaches for about 3 weeks at a time since last August. It's hard to recall but it seems like it was around then that I also started experiencing daytime sleepiness. Usually this meant that for a few days at a time I would fall asleep 1-3 hours after eating lunch and then I'd break that cycle by going low carb or drinking a lot of caffeine.

Within the past three months, I've noticed my headaches and my fatigue have gotten worse. Meaning, they've started to occur more frequently and I am becoming more sensitive to triggers. I haven't been able to figure out the trigger for my headaches but usually, my sleepiness disappears if I eat low carb. In February and March I was on a daily "diet" of skipping breakfast, no carbs for lunch with a mandatory caffeinated drink. That was keeping me awake enough to get through work. This month though, nothing is cutting it. I had an egg and an apple for breakfast one day and fell asleep an hour later. So now fruit is only sparingly ingested.

My doctor can't see me until the 5th but her nurse ordered some blood work. I got the call today that everything is fine. My insulin levels were on the lower side of normal but everything else was perfect. It was simultaneously a relief and confusing. I thought for sure I was developing insulin resistance because of some other symptoms I'm experiencing (10 pound weight gain all around my middle whereas prev it would be more distributed, more thirst, waking up in the night to pee, bloated distended stomach even in the mornings, constant hunger).

Google suggests it might be sleep apnea but my husband says I never snore or do anything other than sleep soundly. And my fatigue only happens after eating carbs. I've been begrudgingly eating low-carb for the past week but I really really really don't want to do this the rest of my life. Plus, I mean, fruit? That just feels too extreme to cut out.

One last thing. I saw my internist a few months ago for the headaches who told me I was experiencing chronic migraines even though they are much more mild than regular migraines.

Any thoughts would be appreciated
posted by kei02003 to Health & Fitness (13 answers total) 11 users marked this as a favorite
I can totally relate to this. My blood tests always came back normal, although I secret worried I was developing diabetes or something. I was always falling asleep after lunch, dead tired for an hour or two. Although part of it was carb related, there wasn't always a direct correlation. Also, I've experienced fatigue for a number of years now, like you describe, and I just haven't been able to find a solution.

Two things that helped me:

1. Chromium picolinate helped a lot, as it helps regulate blood sugar. Game changer for me when I'd take it in the morning and before eating.

2. Although #1 helped a lot, I was recently prescribed an antidepresent for insomnia/anxiety issues, and it totally cleared up the blood sugar/falling asleep after lunch issue, and issues of general fatigue, completely. The reason, I think, is that low serotonin in the brain (which this antidepresent is designed to address) is often linked directly to blood sugar levels and fatigue.

So I'm not sure if this is helpful for you, but I'm feeling better these days than I have in a long time, for both sleep quality and fatigue, and general life outlook, actually. If you want the name of the antidepresent, I'd be happy to send it to you via memail.
posted by SpacemanStix at 7:28 PM on April 18, 2014 [1 favorite]

I had an extremely similar experience and it turned out I was both anemic and clinically deficient in vitamin D.
posted by erst at 8:16 PM on April 18, 2014 [1 favorite]

Google suggests it might be sleep apnea but my husband says I never snore or do anything other than sleep soundly.

Let your doctor decide whether to refer you for a sleep study. I never snore and I look like I'm sleeping through the night, but I found out I was having 40+ "microarousals" (not visible to the eye; at the cortical level) per hour.

I had an extremely similar experience and it turned out I was both anemic and clinically deficient in vitamin D.

Ask to have your ferritin and B12 checked too, if that hasn't already been done. B12 levels under 400 are worth a trial of high dose oral B12 (you don't necessarily need shots if you're getting high enough oral doses).
posted by blue suede stockings at 8:37 PM on April 18, 2014

Definitely have more bloodwork done. I was constantly tired and I was deficient in vitamin D. Supplementing helped a LOT. Like, I used to take a nap or two daily and now I almost never nap. Having B12, ferritin, and thyroid function checked is a good idea too.

Also, are you drinking enough water? I can tell when I haven't had enough water in a day because I feel really exhausted, so maybe try bumping up your water intake a little. You might have to get up to go to the bathroom more often, but walking to and from might make you wake up a bit!
posted by bedhead at 8:46 PM on April 18, 2014

Caffeine is a migraine trigger.
posted by aniola at 9:59 PM on April 18, 2014

Came in to say just about the same as bedhead.

When my son was about 18mos I was EXHAUSTED. Had all the bloodwork, everything was fine. My GP helpfully told me to stop eating "so much sugar" (without asking me about my diet - I don't eat refined sugar), and to "get more sleep" (my son was not yet completely night-weaned).

So, the first thing I decided to do was up my multi-vitamin intake from one a day to two per day, and I added a b-complex. I added 5000iu per day of D3. (My "normal" bloodwork had confirmed that I was at the very low end of the spectrum for both). To help with good sleep, I've recently added magnesium.

If you're nursing, be careful about the amounts of vitamins you take - for instance, I've recently been told that nursing mothers should not take more than 2000iu of D3/day.

I also get headaches and very very tired when I'm dehydrated. I have found that if I drink a full glass of water as soon as I wake up, I have much less need for caffeine in the morning. If I drink a full glass before I go to bed, I generally sleep better, although of course I have to go to the bathroom around 4am.

Not saying adding these things to your regimen will 100% completely relieve your symptoms, but they could definitely help.
posted by vignettist at 11:00 PM on April 18, 2014 [1 favorite]

I also have lean PCOS (normal weight). Just FYI, at least for my reproductive endocrinologist, she ran a full 3 hour glucose tolerance test with hourly blood sugars and blood insulin levels to diagnose my insulin resistance, and I actually was insulin resistant, at least a little bit. But 1, the symptoms of insulin resistance are not necessarily the same as the symptoms you listed - those are symptoms of diabetes (diabetes involves insulin resistance - but not necessarily vice versa, especially not if you are a normal weight). 2, insulin resistance is not likely to be causing you to have headaches and daytime sleepiness.

Talking to your doctor about a sleep study seems like a good idea.
Based on what you say about the frequency of your headaches, you may meet diagnostic criteria for chronic daily headache (CDH). Check the link for more information and list of potential etiologies. Chronic migraine is one of them, there are a number of others. Sleep apnea is one of them.
posted by treehorn+bunny at 12:47 AM on April 19, 2014

Probiotics. Take a lot. Along with Vit D and Vit C.

See if that helps.

Also, you have a recent child, so a good B complex and Iron are important for the short term.

The Science is that poor gut flora and/or vitamin deficiency can and will cause fatigue ( and depression) so address this first.

Many meds help these symptoms but inhibit probiotics and/or cause more nutritional deficiencies. Make sure you have the basics dialed in FIRST.
posted by jbenben at 1:56 AM on April 19, 2014

To me this seems likely to be type 2 diabetes. If you eat carbs and feel tired, and keep waking up at night to urinate, those are strong symptoms (IANAD).

If so the Dr will perscribe medicine that will help. But yes you'll need to amend your diet.
posted by thermonuclear.jive.turkey at 6:22 AM on April 19, 2014

I work in sleep medicine. I get referrals frequently from neurologists specializing in chronic headaches. Most of these referrals are for women, thin and young, who other than headaches and chronic fatigue do not have classical symptoms of sleep apnea. Commonly what we see is a variation of sleep apnea on the sleep study called upper airway resistance syndrome. The only way to diagnose is with a overnight sleep study in a lab setting. Home sleep tests don't cut it.

Vitamin deficiencies are also something I look at in my patients if they haven't already had it done. I live in the land of little sunshine so virmain D deficiency is a big issue. I also look at vitamin B12 as well.

Being chronically tired sucks. Hope you get some relief soon.
posted by teamnap at 7:13 AM on April 19, 2014 [1 favorite]

Response by poster: Thanks to all the replies so far. My blood work showed that all the vitamin levels they tested (I know Vit D and Iron for sure, not certain of any others) were all great. Not nursing either.

I HAVE experienced intermittent bouts of depression (~3-5 days at a time) throughout this time period too but I have never heard of atypical depression where you can react positively and happily at times. I would say I'm more happy than not so my internist thought it was more like SAD after that long winter.

So right now it seems like either atypical depression or I need a sleep test. I will try the other suggestions regarding probiotics and upping my vitamin intake in the meantime
posted by kei02003 at 7:44 AM on April 19, 2014

Vitamin B Complex has changed my life. Try to see if you can get into see a doctor that practices functional medicine or integrative medicine. these docs have the medical degree but also know all about vitamins, herbs and supplements that will treat the route causes of the problems with your body. I have found some of it helpful and some it not. I do the best I can. It sounds like a diet adjustment would help you, but you need to see someone about that and not just guess your way through it. If you can't get into an integrative doc then definitely get a referral to a nutritionist. They can help adjust your diet appropriately, maintaining balance, and keeping that energy up. Like I said, I take B complex, just half the recommended dose, and it helps a lot. I was very surprised. Vitamin C is also crucial, both are crucial for the activation of amino acid chains that run your body's various systems (adrenal, hormonal, etc).
posted by Jewel98 at 7:28 PM on April 19, 2014

There is a connection between cinnamon and insulin. If you think that your symptoms could be related to spikes in blood sugar levels, cinnamon might be of interest to you.
posted by travelwithcats at 7:01 AM on April 20, 2014

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