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FATIGUE Fatigue is amedical mystery and recent research shows that avirus may be the cause

Mansi Verma was perpetually tired. She put it down to the daily challenges to be contended with: Long working hours, tiresome traffic jams, spousal and job demands and children's tantrums. Despite her daily exercise regimen and a healthy eating plan, she just couldn't combat this exhaustion. Most of us know what it's like to be tired, especially when we have a cold, flu, or some other viral infection. But when you suffer from a constant lack of energy and ongoing fatigue, and resting doesn't help you to recover your energy, you may need to take some action.

The medical causes of fatigue are depression, iron deficiency anaemia, low blood sugar, allergies, dysfunction of the immune system, and changes in hormone levels produced in the hypothalamus, pituitary gland or adrenal gland, mild or chronic low blood pressure. " Tiredness could also be a side effect of medicationwhich is easy enough to deal with. It is easier to tackle this syndrome when a medical condition is identified," says Dr Ashutosh Shukla, internal medicine specialist.

Doctors say that fatigue that is dramatic, prolonged, or unexplained can signal a serious medical problem like heart disease too. If this is the case then the long- term outlook may be good, as you can take active steps to get better.

But if all these conditions have been ruled out, and your fatigue persists and even worsens with physical or mental activity, you may be a victim of chronic fatigue syndrome ( CFS).

Though there are several theories about the causes of CFS, which range from viral infections to psychological stress, the cause is still unknown. One thing is certain though: Fatigue is a lingering tiredness that is constant and limiting. With fatigue, you have unexplained, persistent, and relapsing exhaustion. It's similar to how you feel when you have the flu or have missed a lot of sleep. If you have chronic fatigue, you may wake in the morning feeling as though you've not slept. Or you may be unable to function at work or be productive at home. You may be too exhausted even to manage your daily affairs.

This Syndrome is diagnosed two to four times more often in women than in men.

The reason why women are at a higher risk then men has, however, not been determined. Experts have suggested that the causes may be biological and psychological.

At the end of it all, Chronic Fatigue Syndrome is still a misunderstood illness and scientists continue to conduct trials and research in order to figure it out better. In the meantime the only way to combat it is by making lifestyle changes and finding strategies that help a person combat their tiredness better.


ONE of the biggest problems with fatigue is that its symptoms cannot be measured.

There is no specific test that confirms this syndrome and doctors only rely on symptoms.

This is probably why it is frequently brushed off as simple weakness or exhaustion. Unexplained, persistent fatigue for six months or more, along with at least four main signs of this condition are primary indications.

Primary signs include loss of memory or concentration, a sore throat, painful and mildly enlarged lymph nodes in the neck or arm pits, unexplained muscle pain, headache, pain that moves from one joint to another without causing swelling, unrefreshing sleep, and extreme exhaustion that lasts more than 24 hours after physical or mental exertion. Less common signals include weight loss or gain, bloating, abdominal pain, nausea, shortness of breath and an irregular heartbeat.

During this syndrome, symptoms may peak and then settle down soon, and then recur on and off. Some people may recover completely, while others feel progressively worse.

" Diagnosis is based on exclusion.

This means that before arriving at the diagnosis, one has ruled out other well- defined diseases or conditions that may be causing fatigue and related symptoms," says Dr Singhal, internal medicine specialist, BLK Memorial hospital.


RECENT research shows a link between extreme exhaustion and a virus. A study published in the October issue of the journal Science reported that many patients with chronic fatigue syndrome were infected with a recently discovered virus, the xenotropic murine leukemia virus- related virus ( XMRV) which probably descended from a group of viruses that cause cancer in mice. " This virus affects the immune system, can probably cause a variety of illnesses and may join forces with other viruses to bring on the syndrome," said Dr Judy Mikovits, the first author of the study who is convinced that the virus will eventually be found in every patient with CFS. But many doctors are dissatisfied with this explanation, and the debate about the causes of chronic fatigue syndrome continues. The general consensus appears to be that more work remains to be done to determine the precise role of this virus. Just detecting it in patients does not prove that this is the cause of their fatigue: some other underlying problem could make them susceptible to the virus, which could be just a passenger in their cells.

William Reeves, principal investigator for the Centers for Disease Control and Prevention ( CDC)' s CFS public health research programme, says the findings are " unexpected and surprising" and that it is " almost unheard of to find an association of this magnitude between an infectious agent and a welldefined chronic disease, much less an illness like CFS."


SCIENTISTS have started to question the belief that fatigue involves only the muscles. It is also in the brain, claim researchers who published a study in February this year in the Journal of Physiology. Taking exercise as a measure of fatigue, until recently, most researchers believed that the brain played a small role in determining how hard we can exercise and our tiredness. Physiologists thought that muscles failed due to biochemical reactions: Too little oxygen or too much lactic acid or calcium caused them to stiffen and have a seizure.

But this idea falters at some level. " We know that people speed up at the end of an exercise regimen," says Ross Tucker, a researcher with the Sports Science Institute of South Africa, who has extensively studied fatigue in athletes. If calcium or other biochemical changes in the muscles caused muscle failure, speeding up exercise would be impossible at the end, when these changes are at their greatest levels, he adds.

Instead, many physiologists now believe that exhaustion isn't just in the muscles but also involves the brain. They believe that the muscle isn't acting on its own, and that the interplay of central processing and muscular exertion can be blamed. The brain tracks and measures the amount of fuel in the muscles and as this amount drops, the brain decides that some danger zone is being approached. It starts reducing the amount of force the muscle needs to apply.

In other words, the mind recognises that the body may be going too hard, starts sending fewer of the messages that tellthe muscles to contract. The muscles contract less frequently and more feebly. In effect it is the brain that lets the muscles behave as if there is fatigue.


No specific medication has been proven to treat CFS successfully but a number of drugs can be used to alleviate the symptoms of the disease, which range from high blood pressure to an irregular heart beat. Anti- inflammatory drugs such as Ibuprofen can help get rid of body aches and pains while antihistamines can help with the allergies. As there is a strong link between Depression and Chronic Fatigue Syndrome, so antidepressants are sometimes useful treatment.

Drugs and therapies on trial include a natural vitamin nicotinamide adenine dinucleotide, which has lead to a significant improvement in the symptoms of many people. Gamma globulin injections may also be effective: A study showed that 60 per cent of those injected over a seven year period returned to normal. The side- effects are bothersome though and more research is needed.

Doctors also advise moderate activities and a good night's sleep. Eating three meals a day and getting adequate rest is important in any plan to combat fatigue. A regular exercise routine which relies on moderate activity is also recommended.

This should take your own energy level into account; reports support the findings that 75 per cent of people who suffer from CFS and engaged in aerobic exercise reported less fatigue after a year. Emotional support from family and friends can help a person to deal with the uncertainties and upheavals associated with this illness.

Cognitive behavioural therapy has also been found to help those with CFS by helping them gain a sense of control over their problems. Some of the components of such a therapeutic programme are daily journalling, useful for recording energy highs and lows, and identifying tasks that cause the most tiredness.

Those with fatigue are advised to tackle the most tasks at the time of the day when their energy is high, and relax when it starts flagging. Changing the way you see things by focusing on constructive thoughts reduces the feelings of tiredness.

Instead of taking on more than they can handle, people are encouraged to take on a single project at one time.



THE JUICE of raw guavas can provide relief to those with a cold. It loosens and reduces mucus, disinfects the respiratory tract, throat and lungs and inhibits microbial activity due to its astringent properties. Guavas have a high content of vitamin C and iron, which helps prevent colds and viral infections.

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Publication:Mail Today (New Delhi, India)
Date:Nov 3, 2009
Next Article:REST CURE.

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