Why are we so tired?

The last column focused on the debate about weather changes and joint pain. From the feedback, it is obvious many people share this experience.

However, I suspect the subject of feeling tired all the time' will strike a chord with even more readers.

There are so many patients consulting their GPs complaining of being tired all the time, that it now has the universal acronym of TATT. There are many causes of feeling TATT and to the relief of many sufferers, the most common causes are benign and once diagnosed, can be treated successfully.

So why are we so tired? Many cases of TATT have a psychological reason, such as stress, depression or anxiety due to problems like pressure at work, financial issues or divorce.

If there are no apparent causes psychologically, the next step would be to look for a medical cause.

Usually the first tests undertaken would be blood tests. These would be trying to detect anaemia, thyroid problems and diabetes among others. Another common cause, which is not routinely screened for, is coeliac disease.

Coeliac disease is a condition caused by an intolerance to gluten. In Britain there are an amazing 250,000 diagnosed cases, but even more incredible is that research suggests that up to 90 per cent of sufferers don't know they have it.

The symptoms are usually chronic diarrhoea, anaemia and severe weight loss associated with feeling TATT. This set of symptoms understandably has most patients worried about a malignant disease.

The intolerance to gluten causes inflammation and damage to the small intestine, therefore reducing the area for absorption. This is an important role required by people to obtain essential nutrition from the food we eat.

This causes patients to have diarrhoea, but they can also suffer chronic unexplained fatigue, anaemia or other complications of the disease.

Osteoporosis is another problem associated with coeliac disease. One study showed that half of sufferers have osteoporosis, compared to one in three women and one in 12 men in the overall population. For these people it is essential to make up the calcium shortfall by eating foods like tinned fish, dried fruit, spinach and tofu - or dairy products.

I would suggest expert nutritional advice is sought. It is likely that poor absorption of essential vitamins and minerals contributes to the fatigue.

With coeliac disease the fatigue experienced can be so severe that many patients spend a lot of time in bed, either at weekend or after work.

It used to be the case that patients would be diagnosed as babies, after they were introduced to solids. However, now it is more common to be diagnosed in their 20s and 30s with another peak in the 50s. Once people have been diagnosed with coeliac disease, the basis for treatment is incredibly simple.

They must go on what is known as a gluten free diet, which excludes food containing wheat, rye, barley as well as oats, which is suggested by Dr Paul Ciclatera, who is a professor of gastroenterology at Kings College London.

In his experience, positive results can be observed in patients as soon as five days into the new regime. Sometimes these people have been ill for decades so the improvement can be amazing.

Professor Ciclatera states how sensitive certain people can be to gluten.

He estimates that each year he has to advise at least one sufferer to buy a separate toaster to that which the family uses, as the crumbs transferred from regular bread can be enough to cause symptoms. Mercifully, there is now a specific blood test that can be carried out to confirm the diagnosis of coeliac disease, so it is no longer a diagnosis of exclusion.

Thankfully most of us are now familiar with gluten free ranges available at our local supermarkets. It is now more straightforward to avoid gluten than it was. Also there are cookery books available specifically for gluten free recipes.

Researchers are currently developing varieties of wheat without the protein to which sufferers are intolerant, so it may only be a matter of time before there will be a real alternative for sufferers.

Another condition that is associated with the symptom of being TATT is chronic fatigue syndrome. In the next column we will look at the onset of the condition, the variations in presentation and will look at two cases. Remember, most of us who feel tired need either something to eat or need to get more exercise.

You can email me on ilkleychiro@tiscali.co.uk with suggestions or questions or telephone 605060.