Exhausted all the time but normal blood results, what now?

[GenericName123]

I’m hoping for some advice on what to do about feeling so exhausted and run down all the time. I’m usually in bed and asleep by 9-9.30pm, up around 6.30am so around 9 hours of sleep despite which I am constantly knackered. I don’t sleep particularly soundly and wake regularly but I’ve always been like that and have managed fine. My DD is 3 so life is pretty full on and she/we do pick up a lot of bugs from nursery but other people with young kids still have enough energy to watch TV until 10pm or later which just seems impossible for me right now!

I saw my GP who tested me for a variety of things - thyroid, diabetes, celiac, hormone levels (I’m 40 so may be peri menopausal) along with FBC and electrolyte levels. All came back normal. She didn’t check vitamin levels so I did a private test through Superdrug which was 47 so not too bad. I’m assuming any anaemia issues would have shown up in the FBC.

So I guess that’s all very reassuring but I don’t know where to go now. Is it worth going back to the GP? I take a general multivitamin but should I try other supplements? Any advice appreciated!

Can you find out your actual results? Sometimes the NHS will say your result is “normal” because your iron is 16 and the cutoff is 15. But 16 is still super low, it should ideally be 80+.

That’s a good point, I didn’t get the actual numbers. I don’t think they tested my actual iron levels though. The tests I had were:
Full Blood Count
Electrolytes
Calcium profile
Liver Function
CRP
Thyroid Function
Gonadotrophin
HBA1C
Anti-tissue transgluonase

Should I ask for iron levels too? Or is that covered in the full blood count?

Of course it’s worth getting medically checked out, but have you considered your lifestyle/diet etc and any impact that could be having?

For example how much water do you drink, how much caffeine do you consume, how many portions of fruit/veg/protein/carbs do you consume a day, how many minutes of exercise or fresh air do you get per day? What does your “day” look like? There may be a medical reason that you are feeling so run down and exhausted but it could equally just be your diet/lifestyle, it is crazy the difference that looking after yourself properly can make to your energy levels.

If you have the NHS app you can usually access any of your test results with numbers and what the normal ranges are. 10 mins accessing that and cross checking with Google can be very enlightening!

Which vitamins did the private test check? A figure of 47 is meaningless without that. And different vitamins require different levels.

I'm the same. I have a lot of stress so I'm guessing I have a bit of adrenal fatigue. I probably rely a bit much on caffeine but the one thing I suspect is my diet. I'm really slim and exercise most days (proper exercise) but my diet is really carb heavy. I think I need more protein and fats and maybe more complex carbs. I think I maybe also need more calories in general. I have a massive slump after lunchtime and will nap if working at home. For me I'd say diet is the main culprit.

I don't understand why a 40 year old woman complaining of exhaustion didn't have tests for vitamin D and iron. That is completely bizarre as these are two highly common factors. Your Gp is, I'm afraid, a bit shit.

Agree with a PP - sign up to the NHS app and double check that if they did in fact do iron and vitamin D. As others have said, often they'll say it's fine because it's on the line rather than under the line, but actually, boosting those can make a huge difference.

Oh and ferratin levels are possibly more important than whether you are anaemic.

You absolutely need your haemoglobin and ferritin.l levels tested. The NHS are dreadful at saying normal when you're only a point above 'their' normal. You will still be feeling awful, also yes to Vit D and B12 levels.

I do wonder if it is lifestyle issues. I don’t have caffeine and I eat a fairly varied diet - not much meat and plenty of veg, whole grains etc. But sometimes lunch is just my daughter’s leftovers and three chocolate biscuits so that could be improved.

I do drink alcohol but not loads, just about the 14 units per week. I did Dry Jan and didn’t notice a huge difference in energy levels but I could try cutting that down and see if that makes a difference.

In terms of exercise I don’t do anything formal and I struggle to find the time to fit anything in, but I get about 7,000 steps a day and am often outside with my DD.

As I said in my OP I don’t sleep that well and my DD does still wake in the night about once a week. She’s also going to sleep really late at the moment as she’s resisting going to bed so it can be a bit of a battle. She doesn’t need a lot of sleep and she does go through these phases so I know it’ll settle down a bit soon. But plenty of people have young kids and they don’t seem as knackered as I am! But maybe I just need to accept this is a very tiring stage of life

It’s not showing for me but I can request the results from the surgery so will have a good google when they come through!

Oh sorry, the 47 was Vit D which they said was insufficiency but close to the normal level of 50

Thanks for all the advice, it’s really useful. The PP who mentioned about carbs, I do think I probably rely a bit too much on carbs and sugar for an energy boost so I will try to get a bit more protein in my diet.

I was surprised that my GP didn’t check vit d and ferritin but she definitely didn’t. I may try a private ferritin test as the vitamin d one I did was pretty straightforward. Then if that’s normal too I can focus on the lifestyle factors

Do you have a health tracker watch or anything like that ? The quality of sleep matters as much if not more than quantity.
I find that eating early eg 3 hrs before bed and no alcohol means my sleep quality is vastly improved.
Maybe just take a multi vit as well, it's low cost and low risk and may address any minor deficiency you could have.
If you think you may be peri then I'd get testosterone levels tested, that's what made me exhausted despite doing everything else right

I know my sleep quality isn’t great. I’m a light sleeper and am easily disturbed, plus my natural sleep pattern is ‘biphasic’ so I am often awake in the night for a while. I’ve been like that my whole life though and can’t remember ever sleeping through the whole night so that’s not a new factor. I’ve had so many colds this winter and I’ve started snoring which I don’t think helps. Not sure what to do about that though.

I can definitely try cutting out alcohol and eating earlier. We have our main meal at 6pm to eat with DD but I do sometimes have a snack a bit later on. I’m willing to try anything at the moment!

I believe snoring could be a sign of sleep apnea which can lead to feeling very tired. Perhaps ask your GP about that. Do you have a Fitbit? You can track how much time you spend in deep, rem and restorative sleep. I have a Fitbit and sometimes a longer sleep is counted as less restorative because I've actually had less quality sleep.

FWIW having a glass of wine early seems to less impactful so at weekends I will have a glass of wine with dinner.
Sadly late night snacks do seem to affect me. It's worth a shot ... Worst case it doesn't work and you can try something else

Hi OP,
If blood levels of vit D are adequate at 50 and above then at 47 they are not adequate.

I expect you will be on the low side of vit D, Iron and B12 among others purely because of your low vit D and the fact you are not prioritising yourself if your lunch is your daughters leftovers with biscuits.

I would say take a good balanced multivitamin but make your own nutrition a priority. Eggs/meat/red meat (iron, B12), yogurt, fruit, veg. Your body is a machine and you can't expect it to run on half a fish finger and biscuits.

Make yourself a priority for a few months and see how you get on.

Thanks everyone, I really appreciate the suggestions. I don’t have a Fitbit but I could look into getting on, although I wonder if I’d just be tracking my poor quality sleep without the ability to change it. I will try cutting out alcohol and no late night snacking - has anyone got any other tips for improving sleep quality?

@Winter2020 I think you’re right that I don’t prioritise myself enough. I can definitely work on my diet and try not to cut corners. I know it’s silly as my DD eats much better than I do some days! I take a multivitamin already (the Well Woman one) but I might try an extra vitamin D one too.

A sleep tracker might help you work out what changes are working although feeling less tired might do the same job! I think you've had lots of good advice on here. Ideally you'd set aside some time every morning to exercise outdoors. Morning daylight is important for setting your body clock and some physical exercise (a brisk walk or run) would also help.

47 Vit D is fairly low, just not low enough that the NHS will recommended an infusion. Mine was 50 when I first had it tested last year which is literally the cut off for "normal" and I felt like absolute poop. Got it up to 60 over the next 4 months and felt a bit better, but normal in an active person is anywhere 50-200 - it's a massive window and what is normal on the overall human scale is not necessarily normal for you, depending on how active you are, how much time you spend outside, your skin tone etc.

Did they check iron, ferritin and B12 as well?

Just keep going back to your GP - if they don't know you are struggling still, they can't necessarily help. I kept being fobbed off by GP, about ongoing fatigue and illnesses. I have kept going back and blood tests are clear, so trying various things but with limited impact. Still no solutions, but at least being monitored......

I used to manage on not much sleep at all, but found as I've got older, poor sleep has a much bigger impact on how I feel the next day.

Perhaps try some yoga/ mediation and cut out screen time and caffeine before bed. Magnesium is reportedly good for sleep in perimenopause.

I also feel much more energised when I'm sticking to intermittent fasting and not eating loads of carbs/ sugar and also when I exercise regularly.

Definitely get the ferritin levels done. I have to have an iron infusion for low ferritin every year. Yet my FBC is normal.

I will say though when my ferritin is getting g low there are signs, shortness of breath eve up a flight of stairs, heart palpitations, and when really really low the itching starts.

Is it possible to significantly boost your iron levels without injections?