Print Eric Van De Graaff, M.D.

I love coming in from a long run and collapsing on the couch in utter exhaustion, especially on a weekend.  For the next hour I’m content to drift into a daze while I catch a rerun of High Plains Drifter or Goldfinger on AMC.  My body slowly melts into the furniture and not a single digit wants to move.  That kind of fatigue is enjoyable; not because of how it feels, per se, but because of what it signifies: I’ve just accomplished what I set out to do—completing a challenging run.

Feeling wiped out without doing a 2-hour workout, though, would be terrible, but that’s how a lot of people feel all the time: “I don’t have any energy” or “I’m always tired.”  This is a complaint that patients commonly express to cardiologists in the belief that overwhelming fatigue is a marker for some underlying cardiac pathology.

I’m no expert on energy—half of what I know about the subject I learned from watching the “Electricity” segment on Schoolhouse Rock—but I’ve put a lot of thought to energy and fatigue over the past few months.

What, exactly, is “energy” composed of?  For a person to have a normal amount of energy, the following conditions must be met:

  1. Adequate physical conditioning to allow participation in daily activities.
  2. Absence of certain disease states that impair exertional capacity.
  3. The mental energy to initiate physical activity.

If any one of these requisites is not present a person would conceivably feel what people describe as a lack of energy.  Examples: Mr. Brown, a deconditioned, sedentary man—but one who has no illness—will struggle to find the strength to meet the challenges of a physical job despite a desire to perform.  Mrs. Green might be in great physical shape and sunny disposition, but if she were to develop severe anemia she’d feel like she’s dragging a ball and chain around with her all day.  Mr. White, whose physical health is pristine, suffers from deep depression and can’t muster enough strength to crawl out of bed.  Each of these theoretic patients is missing only one component of the list noted above, yet each ends up with the same result: no energy.

The problem with any one of these three conditions is that once you begin suffering from one, the other two tend to follow closely behind.  Mrs. Lavender decides that exercise is for the birds and sits in front of the TV for a decade.  When she finally decides to become more active she has become overweight and suffers from diabetes, sleep apnea, chronic leg swelling and back pain.  Now that she doesn’t have enough energy to get off the couch she descends into mental depression.

As noted above, there are numerous health conditions that can lead to profound fatigue, such as anemia, hypothyroidism, sleep apnea, insomnia, and diabetes.  Surprisingly, most cardiac problems (such as coronary artery disease and arrhythmia) don’t cause fatigue.  Rather, the most common presenting symptoms of these are shortness of breath and lightheadedness.

For those of you who lack energy, here are my recommendations:

  1. See your doctor to exclude the possibility of reversible medical conditions such as those mentioned above.  A good exam and a couple of blood tests should get you the answer.
  2. Force yourself to get back into a regular exercise program.  I know—when you feel wiped out all the time the last thing you want to do is strap on your shoes for a brisk walk around the neighborhood.  As I’ve previously pointed out, there are stacks of research studies showing that regular exercise improves a person’s energy level.  Once you’ve excluded the possibility of a concerning medical condition you need to get back in action.
  3. Improve your sleep habits. Obstructive sleep apnea (OSA) is one of the most common causes of persistent fatigue and has become epidemic in our country with the rise in obesity.  The symptoms of OSA are snoring, daytime sleepiness, night-time breath-holding, and bruises on your legs from where your spouse kicks you in the night.
  4. Avoid stimulants and alcohol.  You get a brief burst of energy from these popular products but no lasting effect (beyond the new tattoo that you have no recollection of).
  5. Eat right.  For guidance on this bullet point I turned to Jill Koegel, the owner of Certified Nutrition of Omaha and food expert.  She maintains that skipping breakfast, eating lots of sugar (which, like caffeine, gives you an immediate boost but later wipes you out), and eating large meals are really good ways to bring on fatigue.  To improve your energy level try eating small meals consisting of complex carbohydrates and proteins, and avoid the sugary snacks.
  6. Seek treatment for depression.  You need mental energy to harness physical energy.  If you think you have depression you should talk to your doctor about it.

Overwhelming fatigue is not a natural state for human beings and there are ways to address this all-too common problem, but it may take work.  Then, perhaps, the only time you’ll feel utter exhaustion it’ll be after a long, brisk walk and while you’re recovering in front of a Clint Eastwood classic.



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