This formerly healthy 43-year-old came into my office worried that "something might really be wrong." When I asked her to describe what was going on, she said, "I have no idea what hit me. I was doing fine, but suddenly I feel like I've been run over by a truck. I have no energy, and I'm tired all the time. I even wake up feeling exhausted."
She continued to rattle off her symptoms: a lack of desire to connect with her friends, falling asleep easily only to wake up in the middle of the night, and no color in her cheeks.
I did an exam and blood work, but as Paula kept talking, I began to see an obvious culprit. She was working 12-hour days as a human-resources manager for a large corporation. The company was having a bad year, and Paula was responsible for laying off hundreds of people around the country. She felt awful at the end of most days, and even worse at the end of the week. When I asked her to name the last time she'd spent an evening simply relaxing, she just laughed.
"Listen to yourself," I said gently. "What do you mean?" she asked, looking surprised.
When we don't pay attention to our bodies, fatigue can seem to work in mysterious ways. Life is a matter of balance -- a connection between supply and demand. At a very basic level, we feel tired when the scales tip toward the "demand" side, but in the short run, most of us have energy in reserve to compensate. If that imbalance continues, however, we eventually deplete our reserves, and feeling tired turns into exhaustion. Fatigue sets in -- a state that can't be remedied by an invigorating massage or a good night's sleep or two.
In the case of Paula, I asked her to take an inventory of her life, using what I call the Five Centers of Wellness -- movement, nutrition, mind, sensuality, and spirit. In my experience, fatigue manifests itself when either your body or your soul -- or both -- need your attention. Knowing this, you can make adjustments that will allow you to refuel. But if you remain disconnected and continue to drive full steam ahead, depleting your reserves, you hit a wall.
Feeding Your 5 Centers of Wellness
Recover from fatigue by tuning in to five essential parts of your self. Use a journal to assess each on a regular basis and make changes accordingly.
Ask yourself: Do I have a workout routine? How often do I really follow it? When's the last time I did something physical that brought me a sense of joy?
Why: Without regular exercise, you miss an opportunity to release stress and gain energy. When you choose an activity you love, you invigorate your soul as well.
Take action: Make exercise a habit; if possible, schedule your activity for the same time every day. Your body will come to expect and look forward to it.
Ask yourself: What's my relationship with food? When I'm tired, how does it change? Do I reach for "quick energy," such as sugar, caffeine, or potato chips?
Why: "Quick fix" foods start us on a dangerous cycle: They let us keep going after our bodies have said "Enough!," thus further depleting our stores.
Take action: Choose foods that help you sustain energy. Exchange coffee for green tea, refined grains for whole, and chips and dip for carrots and hummus.
Ask yourself: What is my level of internal stress? Regardless of circumstances or life events, am I generally relaxed and happy, or tense and sad?
Why: Although life events often affect the way we behave, sometimes the way our mind functions is unrelated to our surroundings. Responding to situations while chronically stressed will tucker you out; feeling happy and calm feeds your energy.
Take action: Before starting a new activity, take a few moments to center yourself by simply closing your eyes and breathing. Schedule 20 minutes during the day -- every day -- to "unplug" from the world, whether by meditating or taking a walk.
Ask yourself: Do I feel connected to my body, sensually and sexually? Do I notice textures that feel good, scents that relax me, and tastes that satisfy me?
Why: Our five senses are essential for both physical and spiritual survival. When we ignore our senses, we create a primal void that hurts us spiritually.
Take action: Surround yourself with stimuli that make you happy. Do you love the smell of lavender oil? Dab some on your neck. Does the feel of soil in your hands ground you? Don't just repot your houseplants; dig into the earth.
Ask yourself: Do I feel connected to things bigger than myself? Am I blessed with work that feels meaningful?
Why: Lives that provide meaning, purpose, and inspiration can be tremendously invigorating, and lack thereof is spiritually draining.
Take action: Replenish the connections in your life that fill you with a sense of purpose. Grab a camera and go for a hike, snapping photos of your favorite flowers along the way. Spend a day with a childhood friend. Whether you find inspiration in a church or temple or a star-filled sky, make time for it.
Paula and I came up with a plan to stem the energy drain. She'd set limits at work and not stay later than 7 p.m. After difficult meetings, she'd practice breathing exercises to help prevent the stress from seeping into her day. At home, she'd ask her husband to split caretaking duties more evenly. And perhaps most important, she would start engaging in activities she used to love that fed her body and spirit: a daily jog, watercolor painting, and friendships that had fallen by the wayside.
Three months later, Paula reported that her energy had returned to baseline; a year later she said she felt healthier than she had in 10 years.
Deep fatigue often takes a long time to manifest -- and there's no quick fix. If you're struggling with it, make an appointment to talk with your physician. Whether or not a physical ailment is to blame, it should serve as a wake-up call from your body and spirit. Take it seriously, look at the balance of your life, and honor yourself by making some changes.
Is It Adrenal Fatigue?
When looking into a patient's complaint of fatigue, I always begin by investigating the common medical culprits, such as anemia (due to heavy periods), depression, severe allergies, insomnia, and the side effects of certain medications. Fatigue can also stem from an underactive thyroid, as well as conditions like chronic fatigue syndrome and fibromyalgia.
I've had a number of fatigued patients wonder whether they might be suffering from "adrenal fatigue," a popular diagnosis among some alternative-health practitioners.
Although there's a rare, life-threatening condition marked by adrenal shutdown, known as Addison's disease, mainstream medicine doesn't recognize adrenal fatigue -- there's no medically sound test for it. Some providers give patients tests they claim can make this diagnosis, but these tests haven't been scientifically validated. Adrenal fatigue, then, is said to be "subclinical," below the levels of what doctors can measure.
Does that mean it doesn't exist? It's hard to say. Conventional medicine is primarily focused on disease, and the more concrete the disease, the more easily it's recognized, understood, and often treated. The concept of adrenal fatigue is compelling; the adrenal glands excrete hormones that ready your body for action in times of extreme stress. If this response is triggered continually because of the nature and pace of your life, it's not inconceivable that the adrenals would become "fatigued."
Whether or not adrenal fatigue is validated by mainstream medicine, the proper treatment is rest, good nutrition, reducing caffeine and alcohol intake, and rebalancing what fuels and drains your energy. The need for treatment is based on your life and symptoms, not a laboratory test. Steer clear of glandular supplements, as they pose at least theoretical risks, and only consider DHEA under the supervision of a physician, as it can affect many aspects of your physiology. Addressing the balance of your life is the healthy long-term response.