Exhausted, knackered, bone tired, wiped out? These are the answers many midlifers give to the question, how are you? There’s even an acronym for it (presumably for those so tired they can’t get their words out): TATT. Tired all the time.
One in five of us reports feeling unusually fatigued, according to the Royal College of Psychiatrists, with one in ten suffering from prolonged tiredness. GPs report that a fifth of all patient appointments are about tiredness. “Tiredness is a common reason that clients come to see me,” confirms Dr Sara Khan, a nutrition consultant and founder of avicennawellbeing.com.
If you’ve ruled out the obvious — staying up late binge-watching Netflix, or insomnia — there may be some underlying medical reasons why you’re feeling so fatigued.
It’s easy to self-diagnose: the internet is full of “helpful” advice about what one might be deficient in. But despite the supplement industry booming, Khan says that “it’s important to get tested first, to see if you really do need supplements. They have their place, for a short time to get some people back to normal levels, but we should aim to get everything we need from our diets.”
“If someone has less than adequate magnesium, common symptoms include low mood and low energy levels,” Khan, who is one of the few practitioners in the UK to use an Oligoscan, a device that scans a section of a patient’s hand to check for deficiencies in the tissue, says.
“Magnesium is one of the most important elements in our body and is involved in more than 300 enzymatic reactions. It is essential for our musculoskeletal health, nervous system and energy production,” she says.
Many of us are low in magnesium, because we don’t eat enough green leafy vegetables, nuts, seeds and legumes. Stress, medication and diets that rely on preservative foods can all reduce magnesium absorption.
Khan recommends first trying to improve levels through diet, but that supplements work too, as long as you consult an expert, rather than trying to self-prescribe. Other ways to up magnesium are to have an Epsom salts bath, which allows the magnesium to be absorbed by the skin.
“If you have an underactive thyroid, you are not producing enough thyroxine,” Vishal Shah, medical director at the at-home blood testing company Thriva explains. “Too little thyroxine, and the metabolism slows, and this results in tiredness.”
Doctors look for levels of TSH (thyroid-stimulating hormone), T3 and T4 (inactive and active form of thyroid hormone). If levels are underactive, there is a medication that replaces the thyroxine, but Shah says it’s preferable to address underlying causes with diet tweaks. It’s the usual suspects that we need to eat more of: nuts and seeds (Brazil nuts are especially high in selenium), eggs, meat and leafy greens.
“Certain foods can disrupt thyroid function, including broccoli, cauliflower and cabbage,” he warns. “But unless you’re eating these foods in huge amount, they shouldn’t cause any problems.”
Bottom line: don’t strip these foods from your diet without consulting a professional.
Lack of sunshine
Multiple studies have shown that low vitamin D can lead to tiredness. “Vitamin D is not just any ordinary vitamin. It is vital for our immune function and energy levels,” Khan says. She says there’s a vitamin D deficiency “epidemic”; many of us are running on empty.
From late autumn the UK National Health Service (NHS) recommends everyone, including babies and children, take a Vitamin D supplement of 10 micrograms. But if a person has very low levels, they might need a stronger dose to get them back up to normal. “It is vital that we are tested, and levels are restored to optimum,” she says.
When your skin is exposed to sunlight, it makes vitamin D from cholesterol, but in the winter months in northern Europe, it’s hard to get enough sunlight. You can also get it through diet, as it’s found in fatty fish, egg yolks and fortified foods, “but it’s hard to get enough from diet alone”, Khan says.
Low iron levels are described by the World Health Organisation as “the most common and widespread nutritional disorder in the world” and is one cause of tiredness.
“Iron is not only vital for energy but also for things such as hair health. If you don’t have enough iron, your body cannot produce the haemoglobin in your blood,” Khan explains.
“The haemoglobin is what binds to oxygen, and the red blood cells in our body help transport this oxygen to cells for growth and repair, and for energy at the cellular mitochondria. Lacking iron simply means less than adequate oxygen is being transported around the body.”
Low iron levels particularly affect women in their fertile years, as well as those adopting a vegan diet. Food sources include leafy greens, meat and poultry, legumes and fortified iron foods.
“Vitamin C can help facilitate the absorption of iron therefore a glass of orange juice alongside iron-rich foods can help boost the absorption,” Khan says.
But it’s not something to guess at; a blood test is the best way to determine iron levels. “If someone is anaemic and needs supplementation, they should discuss with a registered practitioner,” Khan says. “It is important to get tested because having too much iron can also be detrimental.”
Low B12 levels
“B12 is vital for energy production. It draws energy from the foods we consume, helps our nervous system stay healthy, is fundamental for red blood cell formation and helps us use folic acid in the body,” says Clarissa Lenherr, nutritional therapist at the health subscription service, bioniq LIFE.
As B12 is predominantly sourced from animal products, vegans and vegetarians and flexitarians can be at risk of low B12. But even if you’ve had your B12 levels checked and found that they are normal, then you might not be getting the full picture.
“The active B12 [otherwise known as holotranscobalamin] represents 10%-30% of the B12 in our blood, yet it is the only form that can actually be used by our cells,” Lenherr says. So, she says, you need to get tested for the active compound specifically.
Khan says that any supplements, once discussed with a professional, should be taken for a minimum of three months to see any change in deficiencies.
“It’s important to get tested again, and once levels are up to normal, in many instances to try to maintain health through diet,” Khan says.
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