What is Fatigue?
Do you lack the energy to get up and start your day? Do you feel tired and exhausted all day long with no motivation to do anything at all? Do you find it difficult to concentrate on your work? Do you find it difficult to fall asleep or stay asleep? “Fatigue” is the term used to describe all these symptoms.
It may also include constant dull headaches, dizziness, body pains, and irritability. People consulting their doctor about fatigue are numbered in millions every year. Fatigue is a symptom of many underlying physical, social, psychological, and emotional problems. Many underlying medical conditions can lead to fatigue.

Major Causes of Fatigue
Fatigue can be physical fatigue or mental fatigue.

  1. Physical fatigue is a state in which body muscles are not able to function optimally. It may develop gradually due to prolonged physical exertion, lack of sleep, decreased body energy, or generalized body weakness.
  2. Mental fatigue is the inability of your brain to perform cognitive functions adequately. It may happen after a prolonged cognitive activity beyond individuals personal capacity. Lack of sleep and general health problems also play a part in its development. Mental fatigue can lead you to a state where you will no longer be able to make any decisions or perform any cognitive function.

Recently, WHO has classified fatigue as a disease in the international classification of diseases for the very first time. According to WHO fatigue is a term strictly related to your workplace and should not be used in other areas of life. Fatigue has recently been redefined as a syndrome caused by chronic stress at the workplace and is now considered a disease itself. Fatigue is a combination of tiredness, exhaustion, negative feelings towards work, and professional inefficiency. (Xiao et al. 2020)

Medical Conditions That Cause Fatigue
Diseases that cause extreme fatigue include diabetes, anemia, thyroid disorders, autoimmune diseases, and cancer. Congestive cardiac failure, Chronic obstructive lung disease, chronic liver, and kidney disorders may also cause fatigue. Hormonal disturbances, anxiety, and depression are also included in the list of culprits.

You must see a doctor if you have fatigue without any obvious cause, raised body temperature, unexplained weight loss, or symptoms of any other medical illness.

Diagnosing a patient with fatigue and digging its underlying cause requires dedication from the health care professionals.

From history, examination, and laboratory investigations the physician has to reach the root cause of the fatigue which is different in almost every patient. Sometimes it takes a year or more to reach an accurate diagnosis. Among the patients who reach a diagnosis, musculoskeletal and psychological problems are the leading causes.

Lifestyle changes including having a healthy diet plan to nourish your body, proper sleep, daily exercise, and meditation can help you reduce fatigue. Avoiding a sedentary lifestyle, alcohol, drugs, and caffeine may also help. After doing all this if you still feel fatigued you may have an underlying medical condition causing fatigue that needs to be diagnosed and treated.

Lab Test for Fatigue
Intensive workup is required to reach a diagnosis and for that we have put together a complete “fatigue panel test” that can help diagnose your underlying medical cause for fatigue. It will help you know the underlying cause, get it treated, and get rid of fatigue.
Fatigue panel test includes;

  • Glucose
  • Calcium
  • Albumin
  • Total serum Protein
  • Sodium
  • Potassium
  • CO2 (carbon dioxide, bicarbonate
  • Chloride
  • BUN (Blood Urea Nitrogen)
  • Creatinine
  • ALP (Alkaline Phosphatase)
  • ALT (Alanine Aminotransferase or SGPT)
  • AST (Aspartate Aminotransferase or SGOT)
  • Bilirubin
  • CBC or Complete blood count helps test blood for the number of red blood cells, white blood cells (including differential cell count), and platelets. It is one of the basic tests to evaluate overall health, anemia, and infections.
    It includes following tests;

    • WBC
    • RBC
    • Hemoglobin
    • Hematocrit
    • MCV
    • MCH
    • MCHC
    • RDW
    • Platelet Count
    • MPV and Differential (Absolute and Percent – Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Basophils)
  • Ferritin – it tests the amount of iron stored in your body. Low iron can be an underlying cause of fatigue.
  • TFTs- Thyroid function tests help us in accessing your thyroid status. Disturbance in the levels of thyroid can lead to fatigue. It includes
    T3 Uptake (Triiodothyronine)
    T4 (Thyroxine)
    TSH (Thyroid Stimulating Hormone)
    Free T4 Index (T7)
  • HbA1c – hemoglobin A1c tests average blood sugar levels over the past 2-3 months. It helps us diagnose diabetes which is a leading cause of fatigue.
  • Vitamin b12 – low vitamin b12 levels are a major cause of anemia. It is required to make red blood cells which transports oxygen to all parts of the body. Reduced vitamin b12 can lead to anemia which is a major underlying factor causing fatigue.
  • **Testing vitamin D is also instrumental but unfortunately it is not a part of this panel. You can add this as an additional test.

Even after intensive laboratory workup, sometimes no underlying cause for fatigue is found. Extreme fatigue for longer periods with no explainable underlying cause can be referred to as chronic fatigue syndrome. Such fatigue worsens with physical or mental activity but is not cured by rest. It is triggered by inflammation and viral infections. So far, no underlying cause has been detected for this syndrome. Treatment can help improve symptoms but there is no definite cure for chronic fatigue syndrome at this moment.

How to Avoid Fatigue
You can avoid fatigue by drinking plenty of fluids to stay hydrated, consuming healthy food, indulging yourself in regular exercises, and having good sleep hygiene. Avoiding stress, anxiety, tobacco, alcohol, and drugs can also save you from fatigue. If these lifestyle modifications don’t work, it’s time to visit a physician who will look for the underlying cause and treat it. Untreated fatigue can have disastrous effects on your mental as well as physical health. So, if you are experiencing fatigue you must see a physician, get yourself tested and treated as soon as possible.

Xiao, Canhua, Jonathan J. Beitler, Kristin A. Higgins, Cynthia E. Chico, Janice S. Withycombe, Ying Zhu, Hongyu Zhao, et al. 2020. “Pilot Study of Combined Aerobic and Resistance Exercise on Fatigue for Patients with Head and Neck Cancer: Inflammatory and Epigenetic Changes.” Brain, Behavior, and Immunity, April.