So, how can we tell if our tiredness is “normal” or a symptom of a more serious condition? Photo / Getty Images
Fatigue is wearily accepted as an inescapable part of modern life, but in some cases it can be a sign of something more serious.
For many, persistent exhaustion is an inescapable part of modern life that we’re forced to cope with. In fact, the feeling of constant tiredness is now so common that doctors have named it: TATT (or “tired-all-the-time syndrome”).
Yet while tiredness is a wearily accepted part of life for some – often a result of inadequate sleep or excess stress – in other cases it can be a symptom of infection, disease or more serious illnesses. There are countless conditions that list fatigue as a key symptom, including anaemia, diabetes, thyroid disorders, depression, cancer, and heart disease.
So, how can we tell if our tiredness is “normal” or a symptom of a more serious condition? Dr Nisa Aslam, an NHS GP, explains how to combat fatigue and when to seek help.
We accept tiredness as a part of modern life, with three-quarters of us getting less than eight hours of sleep each night and the same proportion feeling so stressed that they couldn’t cope.
“When we look at lifestyle causes, people struggling with tiredness are often under-nourished, struggling with sleep problems and extreme stress,” Dr Aslam says. “I find that people who are sedentary and not exercising regularly often struggle with this too. They tell me they’re too tired to exercise, then we will have a conversation about the need for exercise to feel revitalised and to build strong muscles and cardiovascular health.”
While tiredness as a result of poor sleep, stress management or nutrition can be debilitating, the good news is that normally there’s something we can do about it. “If you’re not managing these basic pillars of health then you’ll feel tired, but by prioritising and better managing them, you’ll feel revitalised,” Aslam says. “These are the factors that are in our control, that we can modulate.”
While it can be tricky to manage, if you have a new lease of life once you start sleeping for longer, eating a better-balanced diet or managing your stress, then your tiredness could be considered “normal”.
“Tiredness is one of the most common concerns I see in patients,” Aslam says. “The key distinction between ‘normal tiredness’ and fatigue that warrants further assessment is its impact on daily life.” You should consider your baseline and what’s normal for you. If the severity or duration of your tiredness changes or you begin experiencing corresponding symptoms, this could signal you’re in the fatigue danger zone.
Perhaps you start struggling to carry out your usual tasks, begin relying on daytime naps, or your fatigue persists despite adequate rest. “These factors suggest your fatigue isn’t normal and should be checked,” Aslam warns. “Accompanying symptoms such as unexplained weight loss, persistent pain, shortness of breath, night sweats or mood changes are additional red flags.”
While fatigue can affect anyone, it tends to be more prevalent in older people, “who are more likely to have multiple health conditions, more profound nutritional deficiencies and may be on medications that contribute to tiredness,” she notes. “That said, prolonged or unexplained fatigue at any age deserves attention and should prompt a conversation with a doctor.” She defines a period of “prolonged fatigue” as lasting for four weeks or more.
There are a multitude of health problems with fatigue as a key symptom. Aslam highlights these chronic issues:
Underdiagnosis of type 2 diabetes can be a concern. “Because symptoms can be subtle and slow to develop, type 2 diabetes can remain hidden for years,” says Nikki Joule, a policy manager at Diabetes UK, speaking after the Lancet study had been released.
Warning signs
Feeling fatigued is one of the most common symptoms of type 2 diabetes. If you’re experiencing this, while also peeing more than usual, feeling thirsty all the time, and losing weight without trying to, then Dr Aslam advises you see your GP.
While different cancers have specific symptoms, fatigue is very common for those with the disease. Research suggests that 65 out of 100 people with cancer experience related fatigue, according to Cancer Research UK. It can be a symptom of the cancer itself or a side effect of treatment.
A cancer that affects your hormone levels – such as breast or prostate cancer – could cause fatigue because the imbalances disrupt the body’s ability to regulate energy. Blood cancers such as leukaemia and lymphoma affect the bone marrow, making it difficult for your body to produce healthy blood cells. This can also cause fatigue.
Warning signs
“If there’s an underlying condition, fatigue usually goes hand in hand with other symptoms,” Aslam says. “In the case of cancer, night sweats are often an accompanying problem.” If you experience these symptoms, or any other changes that aren’t normal for you that you’re worried could be a sign of cancer, then you should seek medical help.
People with arthritis often experience severe and overwhelming fatigue. Many people with the condition say it’s one of their biggest challenges, according to Arthritis UK.
Osteoarthritis is the most common type of arthritis in the UK and most often develops in people in their 40s or older. It often manifests with joint pain, stiffness and problems moving the joint. All of these symptoms can lead to inactivity, stress, and poor sleep – with fatigue being a common result.
For those with rheumatoid arthritis, the body’s immune system targets affected joints, which leads to pain and swelling. This can cause fatigue as the body tries to cope with the release of inflammatory cytokines (proteins) in the blood.
Warning signs
While there are lots of different types of arthritis and each has its own symptoms, if you’re fatigued and suffering joint pain, tenderness, stiffness, restricted movement of the joints, weakness, or inflammation, then it’s worth a trip to the GP.
Women are six times more likely to suffer from the condition, according to Aberdeen University. “An underactive or overactive thyroid disrupts metabolism and energy levels,” Dr Nisa says.
An underactive thyroid (hypothyroidism) occurs when the butterfly-shaped gland in your neck doesn’t make enough thyroid hormones, which are important for regulating heart rate and body temperature. An overactive thyroid (hyperthyroidism) is where it produces too much of these hormones.
Warning signs
If you feel extremely fatigued, colder than usual, putting on weight, struggling with constipation and concentration, then you may have an underactive thyroid and should have your symptoms checked by a GP.
If you are struggling with nervousness and anxiety, mood swings, difficulty sleeping, alongside persistent fatigue and weakness, then you may have an overactive thyroid. Once again, these symptoms require GP investigation.
Fatigue is a common symptom of many mental health conditions including depression, anxiety, and post-traumatic stress disorder (PTSD), Nisa says. In fact, it’s recognised that up to 95% of patients will experience fatigue as a symptom of depression, according to 2023 research published in European Child & Adolescent Psychiatry.
Stress triggers the nervous system to go into “fight or flight” mode, causing the body to release chemicals like cortisol and adrenaline. While these hormones give us energy to cope with stressors in the short term, the body’s stress reaction can cause fatigue and tiredness after a sustained period.
Warning signs
If you feel fatigued all the time and experience continuous low mood, irritability, changes in appetite or weight, disturbed sleep, obsessive thoughts, breathlessness, feeling sick, and pain for a sustained period of time or you’re struggling to cope, you should see your GP.
This list is by no means exhaustive as there are hundreds of conditions that list fatigue as a key symptom. If you’re tired all the time, you don’t know why and it’s impacting your daily life, then it could be a sign of a problem and you should seek medical help, Nisa reiterates.
When Nisa is assessing a patient with fatigue, she says that establishing their baseline is key. “I ask them about their activities of daily living [ADLs - the basic, self-care tasks we do to stay alive and well, such as eating, bathing, and dressing], whether they can still perform these as usual, whether their sleeping patterns have changed, and one of the big clues is normally whether they’re having naps during the day.”
Gaining a sense of the patient’s daily life, what has changed, and how this has impacted their work, family life, social life and mood is important. “The extent of a person’s fatigue usually goes hand in hand with the severity of their changes in mood,” she explains. Once Nisa has established her patient’s baseline, this will inform their testing, treatment and diagnostic pathway.
By Dr Nisa Aslam
1. Eat foods with a lower glycaemic index
Opt for wholegrains, beans, lentils, oats, and plenty of vegetables. These foods release energy slowly and steadily, helping to avoid dips in blood sugar that can make you feel tired.
2. Boost your iron intake
Include iron-rich foods such as lean red meat, chicken, fish, lentils, beans, dark green leafy vegetables, and fortified cereals. Pair plant-based sources with vitamin C-rich foods (like citrus fruits or peppers) to improve absorption.
3. Ensure adequate vitamin B12
Eat foods such as fish, eggs, dairy, fortified plant milks, and fortified cereals. B12 is vital for red blood cell production and energy levels.
4. Include folate-rich foods
Add leafy greens, beans, peas, lentils, and fortified breads or cereals. Folate works together with iron and B12 to support healthy red blood cell formation.
5. Consider taking multivitamin and multimineral supplements
A daily vitamin D supplement is recommended for most people in autumn and winter. A good quality multivitamin and mineral supplement can also help cover any nutritional gaps that may contribute to fatigue.