So why am I SO TIRED all the time?

79 I have no energy and I’m tired all the time: is there something seriously wrong with me?

In THE vast majority of cases the answer is no: this is most often due to a poor diet, stress or poor sleeping patterns, says Dr Masud Haq, a consultant endocrinologist at Maidstone and Tunbridge Wells NHS Trust in Kent.

‘I’d estimate that less than 10 per cent of those who go to the GP about this issue have a medical condition — and if a medical condition is the cause of their tiredness, then they’ll normally have other symptoms, too.’

The reason stress leaves you tired is that it results in higher levels of hormones such as cortisol and adrenaline, which can interfere with sleep.

‘Meanwhile, a poor diet can lead you to become short of nutrients which can make you more tired than you think,’ says Dr Haq. ‘not getting enough exercise can also lead to a feeling of fatigue.’

That’s because a weaker cardiovascular system means blood and oxygen aren’t pumped around the body as effectively as they could be.

A lack of sleep will leave you feeling more than a bit low on energy. ‘It will actually make you feel sleepy in the day,’ says independent sleep expert Dr neil Stanley.

People often worry that their tiredness is a sign of an underactive thyroid gland, says Dr Haq. ‘The thyroid hormone controls the body’s metabolism and how the cells and tissues work — so if you have low thyroid levels your metabolism starts to slow and your cellular and tissue function declines, resulting in tiredness.

‘Yet if it is an underactive thyroid that’s the problem, then you may also have unexplained weight gain, an intolerance of the cold, hair loss or constipation,’ he explains.

‘Vitamin D deficiency — which we commonly see in our clinic — can be a cause of tiredness too, as vitamin D helps regulate calcium levels. Calcium is needed for muscle strength and to help the tissues, cells and muscles work.’

With vitamin D deficiency, as well as tiredness, there may also be other symptoms such as generalised aches and pains, and in severe cases, a waddling gait.

But the most common medical causes of tiredness is anaemia — a sign of a lack of the protein haemoglobin in the blood (usually due to a lack of iron).

‘As oxygen attaches to haemoglobin anaemia can result in less oxygen being transported around the body — hence the tiredness,’ says Dr Haq.

If your GP suspects anaemia or a lack of vitamin D you will be offered a blood test.

Diabetes is also quite a common cause of tiredness, especially in undiagnosed type 2 diabetes in adults.

‘But usually it’s also associated with obesity, increased thirst and increased passing of urine,’ he says.

The tiredness occurs because the hormone insulin is meant to drive glucose into the cells to help provide energy, but in people with type 2, the insulin does not work as effectively. Blood sugar is high but cells can’t utilise it ‘and this can leave people feeling more tired’.

Men may develop tiredness as a result of low testosterone, which is needed for normal muscle function and tissue health — low levels can lead to fatigue and a loss of muscle strength.

‘Levels start to drop off slowly from the age of 30, and by the age of 50, 60 or 70 this can cause an issue in terms of energy for some men,’ says Dr Haq.

‘ But in this case they will normally have a fall of libido and erectile dysfunction problems too.

‘The problem can be detected with a blood test, which is taken at 9am as testosterone levels peak in the morning — a GP can do this test.

‘If the levels are low then this can be treated with a testosterone gel or injection. The gel should be used in the morning and the injections are given at 12 weekly intervals.’ Tiredness can also be a symptom of chronic conditions such as heart failure and lung problems such as Chronic Obstructive Pulmonary Disease (COPD), an umbrella term for conditions such as chronic bronchitis and emphysema.

It can lead to tiredness because of problems getting adequate air in and out of the lungs.

Tiredness caused by heart failure will be accompanied by swollen ankles and breathlessness. Other symptoms include wheezing and coughing.

81 My memory is nowhere near as sharp as it was. Can you check me for dementia?

‘IF YOU have concerns about your memory the chances are you don’t have dementia,’ says Dr Tony Rao, a consultant old age psychiatrist at South London and Maudsley NHS Foundation Trust.

‘People with early dementia rarely think there’s anything wrong with them. They usually assume any changes they notice are just about getting older.’

Another key distinction is that someone with Alzheimer’s can forget something within a minute — unlike someone who’s suffering from an occasional lapse of memory (typically as a result of stress, anxiety or depression).

Someone under a lot of stress may struggle with concentration, so that hanging onto information in the long term is harder for them, ‘ but their short term memory should be OK,’ says Dr Rao. ‘ So their memory of something 30 seconds after they were told it should be fine.’

The first thing a doctor will do is take a detailed history of the symptoms. ‘About 80 per cent of the diagnosis comes from this — listening to how the patient has changed — and if they are forgetting things more than normal,’ says Dr Rao.

‘With early Alzheimer’s they will be forgetting things and misplacing things regularly, but the patient tends to think that someone else is moving things. Sometimes they will then think, “I’m going to hide it so only I know where it is.”

‘Another possible sign is forgetting names of close friends or family — things that normally trip off your tongue, such as the names of your grandchildren or everyday objects. Forgetting the name of someone you’ve just been introduced to is unlikely to be a sign of dementia, however.

‘Another important one is losing your way in unfamiliar surroundings. For example, someone might be on holiday but will have walked to and from the apartment a few times with others, but when they try on their own they get lost — even though it’s in a circumstance where you would expect them to be able to work out the route.

‘We also want to know if there has been a change in personality, if they have become more stubborn, awkward or irritable and if their symptoms are impacting on their ability to lead an independent life.

‘Much of this will need to be asked of a loved one who knows the patient well — that’s why you need to take a close friend along for these appointments.’

If the history suggests problems, the doctor will do a memory test. The most common one is the Mini-Mental State Examination, which involves questions about the time, day and date, for instance. The patient will be told about three objects and asked to recall them minutes later, too.

All the information given here should be taken in a general context — always consult your own GP with any health worries.