I am 23-year-old housewife. I got married recently. Though I eat well and make sure my diet is well balanced, I feel very tired and lethargic. What do you think is the reason and how do I get over it?

The primary cause of fatigue in women in India is low levels of hemoglobin which may occur due to poor nutrition during pregnancy and childbirth, excessive menstruation or intestinal worms. Other causes of fatigue include electrolyte disturbances, low function of thyroid, diabetes, low fluid intake, diarrhea and vomiting, vitamin deficiencies, stress, inadequate sleep, post infection fatigue and a disorder know as ‘chronic fatigue syndrome’. You could be suffering from any of the above causes and you need to consult your physician. A physician or a metabolic specialist should, on the basis of history, thorough examination and appropriate investigations, be able to pin point cause of fatigue. A correct diagnosis is a must for appropriate therapy.

What is Chronic Fatigue Syndrome (CFS)?

It is a highly debilitating disorder of uncertain cause. While fatigue is a common symptom in many illnesses, CFS is a multi-symptom disorder. It causes severe mental and physical exhaustion which is unrelieved by rest and may be worsened by even trivial exertion. CFS occurs more often, but not exclusively, in women. Recent studies have shown that oxidative stress and metabolic dysregulation may play a role in the development of CFS.

How do I get over this feeling of tiredness. What diet and lifestyle modifications can I start to combat CFS?

Besides treatment of anemia, thyroid disorders etc., keep the below points in mind:

• Any excess and low salt intake should be avoided. Excess salt could increase blood pressure and low salt (especially in summer months) would cause exhaustion.
• Avoid excessive sugar and sweets, which may cause dramatic fluctuations in blood-glucose levels. Any high or low blood sugar levels may cause fatigue.
• Small meals at frequent intervals should be preferred.
• Good intake of potassium must be maintained by taking wholesome citrus fruits and lime.
• Flaxseed oil (available in liquid and capsule form) is an essential fatty acid that may help people with CFS.
• Despite feeling of fatigue, it is important, however, not to avoid activity and exercise altogether. Such avoidance leads to serious deconditioning and can actually worsen other symptoms. A portfolio of activity -- stretching, aerobic and resistance (with small weights) would help recondition muscles and help in combating fatigue.

 I am 35 years of age and working as a creative director in an advertising agency. In the last few months, I have put on about six kgs and am beginning to feel horrible about myself. Besides weight, I am also noticing some swelling on my upper arms. What do you think could be the reason?

Sudden increase in weight and swelling in arms could be due to hypothyroidism.

What exactly is hypothyroidism?

Thyroid disorders may present with high and low function. Hypothyroidism refers to a state in which thyroid hormones (which regulate functions of many organs of the body), produced by the thyroid gland (located in the lower part of the neck), are below normal levels. This is a common disorder and mainly occurs in women.

What are the features of thyroid hypofunction?

Thyroid hypofunction may occur slowly with vague symptoms and often missed. Any female with recent onset of weight gain, excessive lethargy, sleepiness and menstrual irregularity, feeling tired and weak, fall of hair, coarse and thinning hair, dry skin, puffy face, and swelling of the arms, hands, legs and feet, hoarseness in voice and increased frequency of miscarriages may have hypothyroidism.

How is hypothyroidism diagnosed?

Along with the characteristic signs and symptoms, additional tests are required to confirm hypothyroidism; an increased level of TSH (thyroid stimulating hormone) is the most accurate indicator. Other tests: T3, T4, thyroid auto-antibodies and thyroid scan may be done as advised.

What will happen if it is not treated?

If left untreated, serious consequences may occur. Thinking process and brain activity declines, heart becomes enlarged and fails, and patient may become comatosed.

How is it treated?

With an early treatment with thyroid tablets, the condition can be completely controlled but the medication must be continued even after the symptoms subside. You must see your doctor 3-4 times a year.

Remember

After the treatment has begun, one should be cautious of overdosing which may lead to restlessness, rapid weight loss, palpitations, heat intolerance, and sweating. Such treatment should always be carried out under supervision of experts.