By: Christophe Doré Le Figaro Santé
We've all experienced a certain feeling of exhaustion, of burnout. A phase of life more burdened with work and worries, a cold or flu, or a period of insomnia can explain the causes of these disturbances when they are temporary. But sometimes fatigue sets in and remains for many weeks, months, without letting up. What does this represent? How to find a solution? Le igaro Santé interviewed Dr. Jean-Dominique de Korwin, a gastroenterologist in Nancy and specialist in chronic fatigue syndrome, about this.
The Figaro Health – A disturbing fact: In France, and practically in all other Western countries, 20% of people who consult a doctor report feeling fatigued. Has tiredness become the new ailment of the century?
Jean-Dominique de Korwin – These figures need to be put into perspective. It's true that people who seek medical help for fatigue problems represent only 1 to 3%. Conversely, the concept of fatigue, or symptoms related to fatigue, appears in 10 to 25% of those seeking medical attention. Let's not forget that we live in an era that seeks performance at any cost. Therapists receive many patients who say: "I can't take it anymore, I can't do what I used to do!" Of course, age and pathologies are often the cause of this discomfort. But with relatively simple hygiene and dietary measures, things will improve in most cases.
Should we be concerned when we feel tired almost all the time?
It's necessary to make a distinction related to the duration of fatigue. We speak of chronic fatigue when the symptoms last for more than six months. Fatigue felt after an infection (a cold or flu, for example) or related to surgical or medical procedures should be ruled out because, theoretically, it shouldn't last more than 4 to 5 months. We can also distinguish fatigue due to a particular effort, an unusual or temporary workload. Or, even more simply, if you've just run a half marathon, it's normal for your body to be fatigued and need a little more time to recover.
What are the different types of fatigue?
To begin with, there is physiological fatigue. It is linked to excessive expenditure and insufficient recovery. Next, there is toxicological fatigue, which results, for example, from the use of certain medications, and fatigue linked to addiction, dependence on substances such as alcohol and drugs, and also to activities such as video games. These types of fatigue have causes that are relatively easy to detect.
Fatigue linked to purely medical causes is less evident. We will define it in terms of organic, functional, or psychological causes. Psychological causes can stem from generalized anxiety, certain psychoses such as schizophrenia (an illness capable, at times, of draining all of a person's vital energy), obsessive-compulsive disorders, depression, etc. Fatigue of organic origin (diabetes, tumors, infections, etc.) can now be resolved in 90% of cases after a thorough interview, a clinical examination, and some complementary analyses. Emotional fatigue, on the other hand, linked to a malfunction of an organ or system, is somewhat more complicated to detect. Different causes may overlap.
Can fatigue have a genetic origin?
Science has not yet been able to identify and isolate a gene responsible for fatigue. However, some family groups are more prone to fatigue than others. The cause often lies in a functional context with poorly identified genetic factors, plus environmental and psychological elements. We can include in these categories functional somatic syndromes, such as irritable bowel syndrome, fibromyalgia, etc. In short, all those syndromes for which medicine has not yet found explanations, but whose cause is essentially psychological, as many now believe. If the feeling of being exhausted, of a real lack of energy, lasts more than 3 weeks, it's time to sound the alarm.
What are the warning signs?
First of all, use common sense. The feeling of being exhausted, of a real lack of energy, a sensation of inner emptiness should alert a person when it lasts at least 3 weeks to a month. It is necessary to distinguish this from more significant complications such as malaise and drowsiness. We have made enormous progress in understanding sleep disorders.
We have realized, for example, that sleep apnea is much more frequent than previously thought, and it doesn't only affect certain population groups like the obese, those with hypertension, etc. We find it in patients who don't fit these patterns at all. Doctors now have very simple tests to diagnose these syndromes. The Epworth Sleepiness Scale, for example, is very effective in detecting abnormal daytime sleepiness.
If you had to develop a medical definition of fatigue as a disease, what would you say?
A simple definition: it is a persistent fatigue that does not improve with rest, as opposed to purely psychological fatigue that disappears when the person recovers.
Experts tend to say that fatigue is one of the most specific symptoms in medicine. Do you agree with that opinion?
Yes. This is complicated, as fatigue is a psychophysical sensation. The doctor's job is to accurately characterize what is happening, particularly by analyzing the patient's complaints and descriptions. It is necessary to distinguish between tiredness due to exertion and simply the fact that the patient can no longer do what they naturally did before. This could mean some difficulty walking, in which case the origin of the "fatigue" would be neuromuscular, or it could be a sudden and rapid loss of breath, the cause of which could be cardiac and/or respiratory. Therefore, the causes are diverse and very disparate. Added to all this are sensations that can be different for each patient. Someone very active, upon noticing a decline in their performance, will feel fatigued, even though their activity level is still far superior to that of most people.
Should we accept fatigue and try to adapt to it?
Yes, if it's explainable. If I do too many things, if I get stressed, if I draw strength from my reserves, if I eat poorly or in insufficient quantities, if I'm sleep-deprived, it's logical that I'll feel fatigued. Most of the time, lack of sleep is the main factor in this spiral. We don't sleep enough. This ends up becoming a handicap.
If a person is experiencing a period of high professional demands, or is dealing with children, sometimes both at the same time, are there simple steps they can take to avoid a state of fatigue that diminishes their capabilities?
In life situations where individuals are under significant stress, it's crucial to pay close attention to the messages sent by their own bodies. First, it's essential to eat correctly. Next, pay particular attention to the need for good and sufficient sleep. This doesn't mean sleeping excessively, but rather ensuring that sleep is of good quality. For most people, this means sleeping between 6 and 8 hours a day. We can have shorter nights, provided we allow ourselves recovery time during the day.
Relaxation is essential in our modern lives, where we are constantly on the verge of stress. And finally, it's necessary to take care of the body. Physical exercise can be tiring, but it certainly tones the body. Above the age of 50, physical exercise is indispensable.
A word of advice: pay attention to and analyze your state upon waking. If you feel fatigued, with cramps or muscle and joint pain, you are almost certainly in a stressful situation, the extreme stage of which can be burnout, what English speakers call... In that case, be extra careful. And seek medical help.