by Dr. Nikita Fensham, MBChB (UCT) PGDip (IOPN)
It seems to have become a badge of honour among endurance athletes to be so tired day after day, week after week. If you’re not training “x” number of hours per week, or doing “x” number of interval sessions per sport, or getting up at some ungodly hour for that squad swim, then you’re just “not doing enough”.
Sound familiar? Thought so. But is this really a feeling we should expect, or is it something we need to address?
There are many causes of fatigue – it is such a non-specific symptom that it is often the exam question that medical students detest. But if we pool categories together, it makes it easier to figure out. It’s impossible to cover everything of course, but a few of the more common conditions will be discussed in this article.
(If you have any other emergent and concerning symptoms -- e.g. chest pain, palpitations, shortness of breath, fever, weakness, recent head injury -- then it’s important to seek medical care as soon as possible to rule out more serious diseases.)
Empty and exhausted
Successful training requires periods of intense physical and mental stress coupled with adequate recovery to achieve adaptation. Think of it as a scale: if you increase the load, you need to increase your capacity to deal with it… otherwise you need to decrease the load. But too often we focus on the turning the blocks green or on how the Strava account looks, and neglect the other two components of the “training programme”.
Firstly, the stress response also includes mental/emotional aspects, such as work, family life, relationships, finances. Failing to account for the deadlines you are pushing to meet or the disagreement with your partner in your recovery plan may just be the factor pushing you into the exhausted zone, despite your thinking that you really aren’t training “that hard”. Secondly, the two biggest rocks of recovery are sleep and nutrition, not your compression gear or strange muscle gun. And yet, how many athletes cut an hour or two off sleep to get an extra training session in… or go hours after their session without fuel? Again, this probably sounds familiar. It’s like leaving your car to overheat AND without petrol… not a good look.
What to do? Take a good honest look at your training programme. Are you doing too much volume or intensity? Are you juggling too many balls? Are you sleeping subjectively well for 7-9 hours a night? Are you fueling before, during, and after your training? Are you eating enough to account for your exercise but also for all the organs in your body that need energy to function too? And then put your health first and make the changes, with some advice from a coach or dietitian as well.
Low and slow
As I wrote about previously, iron deficiency is common in athletes, whether from reduced intake, increased requirements, or that silly hormone called hepcidin that rises after exercise and blocks iron absorption. So this is something worth getting tested regularly (~6 monthly), especially if you have been diagnosed with iron deficiency in the past. This might be associated with anemia where your hemoglobin, which carries the oxygen in your blood, also becomes low. Or you might have normal hemoglobin levels but the stores of iron, known as ferritin, drop. In this case, you might need an infusion of iron into the vein or you might be prescribed iron tablets, or you might just need some dietary advice. Either way, test don’t guess.
Down and out
Finally, there may be an underlying medical condition, which is why you should seek out a doctor to get assessed if you are experiencing ongoing fatigue that doesn’t resolve with rest and recovery. Conditions in this category include hypothyroidism, diabetes, viral illnesses such as Epstein-Barr, malabsorption, polycystic ovarian syndrome, and eating disorders, to name a few.
Ongoing fatigue is not normal, not required, and certainly not something to which to aspire in order to “prove” yourself as an athlete. I encourage you to visit your friendly doctor to rule out conditions that require medical treatment, and then get your coach, dietitian, and family involved to make sure your overall energy equation favours surplus rather than deficit.
Medical disclaimer: This content is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Always seek the guidance of your own doctor or other qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard the advice of a medical professional, or delay in seeking it because of something you have read here.