Always Tired?

A closer look at the top 3 causes of fatigue in women

If you feel like your energy levels are low, your motivation is zapped and you’d like to crawl under your desk and take a nap mid-day, it’s time to take a close hard look at the top 3 causes of fatigue in fit women.

1) Iron Deficiency Anemia
Iron deficiency occurs in stages. First, your iron intake stops meeting your daily needs. Next, this negative balance takes a toll on your iron stores – the supply your body digs into when you aren’t getting enough from your diet. By the time you hit iron deficiency anemia, your storage iron is low and your blood levels of iron cannot meet your daily needs. Your hemoglobin, the protein in your red blood cells (RBCs) that carries oxygen to your body’s tissues, levels drop, signaling anemia.

Signs and Symptoms:

•    feeling tired and weak
•    headache
•    difficulty sleeping
•    work performance suffers, lack of concentration
•    feeling cold often
•    inflamed tongue (glossitis)
•    shortness of breath during routine activities
•    pica – desire to eat non-food substances such as laundry starch, dirt, clay, ice

Who’s at Risk:

•    Women of childbearing age, teenage girl and pregnant women.
•    Those with a low dietary iron intake
•    Vegetarian athlete
•    Female athlete
•    Distance runner
•    Significant blood loss from menstruation
•    Celiac disease
•    Crohn’s disease
•    Gastric bypass surgery patients and former patients
•    Excessive antacid intake

What You Can Do:
Iron is found in a number of different foods. But, not all of this iron is well absorbed. The two types of iron are heme and non-heme iron. Heme iron is found in animal foods including red meats, fish and poultry. A serving of chicken livers, clams, or roasted beef tenderloin contains all the iron you need for a day. Heme iron is absorbed better than non-heme iron and absorption isn’t affected by anything else you eat. We absorb approximately 15-35% of the heme iron we eat.

Non-heme iron is the form of iron found in all other, non-meat based foods including vegetables, grains and iron-fortified breakfast cereal. Only 2 – 20% of nonheme iron is absorbed. And, there are many components of various foods that decrease the absorption of non-heme iron including tannins (found in tea and wine), calcium (dairy, multivitamins), polyphenols, phytates (legumes, whole grains), some proteins in soy food. You can increase the amount of non-heme iron you absorb by consuming vitamin C rich foods or beverages or heme iron (from meat, turkey, chicken and fish) at the same time.

If your doctor wants you to take an iron supplement, ask for one containing heme iron. You’ll need less to boost your stores, which will also decrease the likelihood of that all too common complaint with iron supplements: constipation. And, you won’t have to worry about when you take your supplement (with or without certain foods). After all, if it isn’t easy and makes you feel worse (by being constipated), you are less likely to continue taking it.

2) Depression
Depression comes in many forms and can sometimes be masked by other life issues. The symptoms of depression may come and go or last for a short period or years making how each person experiences depression different.

Signs & Symptoms:

•    Fatigue
•    Sleep irregularities
•    Feeling sad or empty
•    Changes in weight and eating patterns
•    Chronic, unexplained physical symptoms such as headaches
•    Difficulty focusing
•    Indecisiveness
•    Poor memory
•    Feelings of worthlessness
•    Thoughts of death or suicide

Who’s at Risk:

•    Being female
•    Having a relative with depression
•    Traumatic experiences from childhood
•    Family history of alcoholism
•    Recent birth (postpartum depression)
•    Having a serious or terminal illnesss
•    Drug use
•    Use of certain medications (talk to your physician about this)
•    Life factors including a job you hate, recent traumatic experience, post traumatic stress disorder, recent loss

What You Can Do:
If you think you may be depressed, schedule an evaluation with a psychiatrist as well as cognitive behavioral therapist. While drugs can help treat depression, experts recommend therapy as well to help manage the daily symptoms. In addition, tell your friends and coworkers that are supportive and can help you (and tell them how they can help) when you are feeling down. If you ever feel suicidal, call 911 immediately.

3) Hypothyroidism
Your thyroid gland produces hormones that regulate your metabolism. When it starts slowing down, you may end up with an underactive thyroid and therefore, hypothyroidism.

Signs & Symptoms:

•    Fatigue
•    Weakness
•    Poor concentration
•    Muscle soreness, aches, tenderness
•    Heavy menstrual periods
•    Brittle fingernails and hair
•    Depression
•    Weight gain
•    Feeling cold all the time
•    Constipation
•    Low blood pressure
•    Low body temperature

Who’s at Risk?

•    Women, especially those over 50
•    Those who already have an autoimmune disease
•    Anyone treated with radiation to the head or chest
•    Those who have had a previous thyroid surgery

What You Can Do:
See your doctor to get the necessary blood tests to evaluate your thyroid functioning (TSH and T3).

Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. Washington, DC: National Academy Press, 2001.

Monson ER. Iron and absorption: dietary factors which impact iron bioavailability. J Am Dietet Assoc. 1988;88:786-90.

Tapiero H, Gate L, Tew KD. Iron: deficiencies and requirements. Biomed Pharmacother. 2001;55:324-32

Hypothyroidism. Medline Plus, NIH.

Depression. National Institutes of Mental Health, NIH.