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Why am I so tired?

The term fatigue has been used to describe a sense of weakness, getting tired easily, difficulty with concentration and memory, a depressed mood, sleepiness or an uncontrollable need to sleep.

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In early 2020 B.C. (Before Covid), I used to complain of being tired after long days of making hospital rounds and seeing patients in the clinic. Then lockdown happened, and even though I was just at home, I still felt rundown, more of a psychological fatigue.

The term fatigue has been used to describe a sense of weakness, getting tired easily, difficulty with concentration and memory, a depressed mood, sleepiness or an uncontrollable need to sleep.

Patients may report one or a combination of these symptoms, and they may occur alone or with other complaints. Feeling tired and having low energy is one of the common reasons patients seek help from a doctor.

Despite being so common, it is often challenging to come up with a diagnosis, as many medical problems can cause fatigue. Fatigue is a vague symptom with a broad range of causes, including acute and chronic medical disorders, psychological conditions, medication toxicity and substance use.

In the search for a diagnosis, often initial test results yield no explanation. It can be frustrating for both doctors and patients when a clear-cut diagnosis remains elusive. This has led to the development of an attractive theory, called adrenal fatigue, that links stress to adrenal exhaustion as a possible cause for this lack of energy. But is adrenal fatigue a real disease?

The adrenal glands are two small glands that sit on top of the kidneys and produce a variety of hormones essential to life, such as cortisol. When under stress, the body produces and releases short bursts of cortisol into the bloodstream.

STRESS and anxiety contribute to fatigue. / PHOTOGRAPH COURTESY OF UNSPLASH/zoe

If the adrenals don’t produce enough cortisol, this is known as adrenal insufficiency (Addison’s disease) and is a result of an underlying disease. Adrenal insufficiency can be diagnosed by blood tests and special tests that show inadequate levels of adrenal hormones.

Proponents of adrenal fatigue claim this is a mild form of adrenal insufficiency caused by chronic stress. The unproven theory behind adrenal fatigue is that your adrenal glands are unable to keep up with the demands of constantly being stressed. According to this theory, existing blood tests aren’t sensitive enough to detect such a small decline in adrenal function even though you may have symptoms of adrenal insufficiency, thus the normal blood tests.

There are numerous websites, blogs and so-called experts that mention how to diagnose and treat adrenal fatigue, often pushing expensive and possibly harmful treatments. But professional medical societies and many scientific publications categorically agree that there is no scientific proof that exists to support adrenal fatigue as a true medical condition.

The adrenal fatigue theory may fit like a glove to explain your symptoms, which are very real. But before you turn to the internet to diagnose yourself, you should first have a thorough evaluation with your doctor. Fatigue can be caused by many medical conditions — anemia, sleep apnea, depression, autoimmune diseases, infections, other hormonal impairments like hypothyroidism and diabetes, heart and lung problems, kidney and liver diseases, and fibromyalgia, to name a few.

Fatigue refers to a mental or physical state of extreme tiredness and lack of energy. / PHOTOGRAPH COURTESY OF UNSPLASH/ASHLEY BYRD

Mental health conditions, such as depression or anxiety, may also be the cause of these symptoms. This can also be real, and some patients who do not believe that their fatigue is due to a mental health concern may refuse counseling and medications.

A word of warning regarding unproven remedies for so-called adrenal fatigue. These may leave you feeling sicker, while the real cause is left untreated. There are unqualified practitioners who prescribe steroids to treat adrenal fatigue. Steroids can be dangerous even in small doses and can have unintended consequences such as weight gain, osteoporosis, diabetes and heart disease. And if you take steroids for a prolonged amount of time and stop them abruptly, you can induce real adrenal insufficiency, because the intake of steroids prevents your own adrenal glands from producing cortisol.

So, before buying into a diagnosis that we’re not even sure exists, talk to your doctor. Be it a physical or psychological diagnosis, frequent follow-up visits and a strong patient-doctor partnership are important to get you the help you need.

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