My job can be very unpredictable, simply because it is not possible to know with any great certainty what the next person to walk through my door is going to say. I might think that because I saw them two weeks ago, checked their blood pressure and advised them that it needed to be rechecked in two weeks that this is the reason for their visit – it never fails to surprise me just how wrong I can be. However, there are general trends. I have just survived the worst of flu season and am enjoying a slight lull before the onslaught of hayfever/stressed student season which will be followed by ‘you must make me better before I go on holiday’ season, then the ‘you must deal with all the horrible diseases I caught while on my holiday’ nightmare, which leads nicely into the pre-Christmas rush and the whole cycle starts again.

Throughout that time I can pretty much guarantee that some things will happen every day.Someone with a drug or alcohol problem will come in wanting another sick note.Another will pitch up with a mild cough wanting some antibiotics. There will be a snotty kid. And it seems that absolutely every day that I go to work at least one person comes to see me because they are ‘tired all the time’.

I sympathise with this, I really do! I was tired every single day for more than adecade, through medical school, junior doctor jobs and parenting two small children, and it came as quite a shock to me when I woke up one day in 2006 with spare time and energy – both of these things had been quite alien to me since my teens and I had forgotten (if I had ever really known) that it is possible to not be permanently exhausted and running around frantically juggling life.

One of the great problems with being tired all the time for whatever reason is thatit brings with it a tendency to overeat in an attempt to find some energy - and munch on all the foods that are high in comfort value and therefore calories along the way. In short, being tired generally leads to weight gain. The obvious solution to this is to sleep more, which can be difficult in itself with our 21^st century hectic lifestyles, but sometimes there is more to the story – tiredness can be a clue that something else is wrong.

Thereare so many ‘medical’ causes of tiredness that it can take me a while to get to the root of an individual’s problem. In no particular order, let’s have a lookat some of the more common ones:

ANAEMIA

Anaemia,or a low blood count, can be exhausting. It is usually caused by a diet that is low in iron or excessive blood loss, for example through heavy periods. It can also be caused by rarer, more worrying conditions but this is unlikely. It can be detected in a simple blood test and usually treated very easily with dietary advice and supplements or treatments to reduce blood loss during periods etc

THYROID DISORDERS

In my experience people with both under and overactive thyroid glands can become tired easily – in hypothyroidism (underactive), being tired is a natural consequence of the hormone imbalance itself while in hyperthyroidism(overactive) it is the running around in overdrive all the time that can be simply exhausting for some. As with anaemia this is easily detected and treated and the results can be dramatic!

DIABETES

In adults this would usually be late onset diabetes, and while there may beexcessive thirst and running to the loo frequently and a tendency towards infections that take a long time to resolve, tiredness can be the only symptom of diabetes in some people. Good and bad news here, the tests are even easierthan for anaemia or thyroid issues but diabetes is a big deal and it means looking after yourself properly in the long term – if you are overweight anddiabetic then getting down to a healthy weight is crucial.

COELIACDISEASE

People with coeliac disease can be tired for a number of reasons, not least because until they are diagnosed and the condition controlled they will have problems with absorbing all the nutrients they need from their food – this can cause anaemia among other problems, and once again the results of diagnosing and treating this condition can be life changing. A blood test can give an indication of coeliac disease but some not so pleasant tests under the watchful eye of a gastroenterologist are needed if coeliac disease is a possibility.

GLANDULAR FEVER

I end up testing for glandular fever in many of my aforementioned stressed students who struggle to believe that it is the university work that is the problem and that they must be about to fall apart because of some hideous disease instead. If you are one of the younger generation and have had a sore throat that won’t go away and have struggled to get out of bed more than usual for a while then it may be worth checking in with your doctor to check this one out, and you guessed it, a blood test is the way forward!

CHRONIC PAIN

This one is really about not being able to sleep because of the pain. Whether it is arthritis or muscular back pain or anything else, with modern painkillers there should be a way of reducing your pain to the extent that you can actually get some shuteye. I’m not promising a pain free (or if pain free, not side effect free) life but it should be possible to get you through the night in one piece– if this applies to you then a trip to your doctor may be more helpful than you think!

STRESS

The associated lying awake worrying and the frantic running around trying to sortthe cause of your stress can be exhausting – whatever the cause, you should be able to at least get enough help to allow you to sleep at night. Whether you need to improve your time management, learn to trust God more, say no to a few more things, get some counselling, get out of that job (even if only temporarily) or do anything else appropriate that will help you calm down,de-stress as much as you can. Your doctor may have some other suggestions that may help.

DEPRESSION

There is nothing like depression to make you sleep and comfort eat! Some of the most exhausted people I meet turn out to be purely depressed. If you think this might be you, very much like stress there is a lot that can be done – get the help you need, and do it soon.

CHESTDISEASES

Not being able to breathe properly is very draining. If you know that you have asthma or chronic bronchitis and are more tired than usual then it may be that you need different treatment that is more effective for you – check in withyour doctor, they won’t think you are wasting their time and if you have lung problems they are contractually obliged to see you at least once a year todiscuss this kind of thing so they will probably actually be pleased to see you! A different inhaler may be all that is needed.

DIET

I have included this one last as it is more the remit of someone like our resident nutritional therapist, but in reality I have an interest in all things nutrition and after sleep issues the next thing I tend to discuss with patients who are tired is what they eat. Essentially the typical modern highly refined ,high additive, processed ready meals that many people exist on today can be exhausting. Try reducing the sugar, caffeine and ‘junk’ foods and eating more fresh (or frozen) fruit, vegetables, nuts, seeds, whole grains and lean meats instead.

There are many more medical causes of tiredness, and if you do find that you are dragging yourself through every day thinking mainly about when you can next put your head on a pillow then it is well worth checking out. If you have cleared your diary a bit so that you actually have time to go to bed once in a while,you have managed to get some nights of decent rest and you are still tired then a quick visit to your doctor to run through the above list and any other issues you/they can think of is probably a good idea. And my top tip for being lesstired once your sleep is sorted? Exercise! You will sleep better, want to eat better, lose weight so there is less of you to carry around, and generally have more energy just because of the internal changes that occur when you increase your activity levels.

Being less tired may not seem like much of an issue when it comes to weight loss, but if you have sorted out other issues, lost weight and now hit a plateau then this is one possible explanation. Even if being less tired does not result in you losing more weight it will benefit you in so many other ways that it is surely worth a try!

Sweetdreams...............