Does Your Teenager Have Chronic Fatigue?

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As I continue to ask every patient and their caretakers what their child’s eating and drinking habits are, specifically, what goes in the mouth and what time, I have found a serious crisis amongst American teenagers. As adults, most people are not surprised and even expect that teenagers like junk food, drink soda, and most likely don’t eat their veggies. Perhaps it’s more tolerated or even accepted as a part of the teenage year behavior along with not listening to parents. While many may look “healthy” on the outside, especially if they are skinny and not obese, teenagers are often in my clinic or those of my Infectious Disease or Allergy/Immunology Clinics.  They come because they may have “Chronic Fatigue Syndrome.”

Parents will come with a relatively quiet teenager who sits there looking bored, and tell me that their child is very tired all the time, often needing to take a nap as soon as they get home from school. They don’t have the energy to do much, and seem to be sleeping more than they should. Some patients have had to miss many days of school because they are “too sick” to go to school. I even met one 16 year old who failed home-schooling due to her chronic “illness.” It is not unusual that by the time I meet these families, their pediatrician or family doctors have already checked their thyroid hormones, basic blood work to show that they don’t have low thyroid hormone or anemia as a cause of their symptoms.

This is the eye-opener. I have learned over the years to really focus on the patient and their families “story.” You see, the story is very much the same. Mysterious illness that doctors can’t seem to figure out, yet something has to be done, we can’t go on like this, there has to be something wrong. The parental and caretaker frustrations are very palpable during those visits with me. As I shift gears, after asking about past surgeries, medications used, and questions about their “medical” history, I ask exactly what their eating/drinking habits are.

“What does he/she eat for breakfast?” This is usually followed by a pause, then, “He doesn’t eat breakfast.” Sometimes the teenagers will volunteer that information themselves. “What does he/she eat for lunch?” the answer is typically, “I don’t eat lunch,” the teenager will interject. Yesterday, a mother stated immediately after that question, “But she eats as soon as she gets home from school before going to sleep.” But the daughter interjects, “No I don’t Mom,” and then a few seconds of disagreement while they look at each other as mother expresses her surprise to hear this.

“What do you drink all day? Let’s start with the morning from the time you wake up.” These are my questions, to every patient, every day. If you ask, they will tell you. It’s not medically complicated.

“Gatorade,” “soda”, “juice,” “sweet tea,” “lemonade,” oh, “water.” There is always pride when either child or mother state “Gatorade,” as if they are waiting for me to commend such a healthy choice.

After what is typically a very normal ENT exam, I explain the following: the body likes to maintain at all times a constant environment, including blood sugar. When we don’t eat, the blood sugar is too low, so it’s thinks it’s in “crisis” and will go into survival mode, breaking down glycogen (stored energy) from muscle mass and liver first, and always saving “fat” for last in case we are really stranded on an island.  Then we are so very hungry and likely overeat when we do eat, and then too much sugar in the bloodstream overwhelm our insulin and ability to absorb sugar, as the body tries to maintain the same level all the time. So that extra sugar goes into fat for in case we’re stranded on an island.

Drinking sugary drinks can make you feel less tired, but as the body quickly gets that sugar out of the blood stream, one will lose that “spike” in energy. These teenagers do not really have a medical illness, MANY, have simply a dysfunctional and unhealthy eating and life habit.

What follows then is a conversation and more questions so that I can help the patient understand “WHY” they are choosing not to eat regular meals, and drink water. Even more importantly, I explain to patients and parents WHY this is not acceptable and hurt them. Have I mentioned these patients often may not be future valedictorians and are doing average to poor at school? But often times the expectation to perform academically has been reduced as they have already told themselves and believe the story that their child is “sick,” so  how can anyone expect that they would do well in school?

Health is not possible without the basics of how to take care of one’s body, and no single human body can function at its best without proper care. After over 5000 years of evolutionary miracle, the human body does an incredible job of keeping us alive and allowing us to do extraordinary things. None of which involves not eating, not drinking water but lots of sugary beverages, and then expecting extraordinary feelings of health and great performance in school.

If there is a teenager in your life or lives of those you love and know, please, ask today, “What are you drinking all day?” and “Did you eat breakfast and lunch?”

Diet Sleep Well-Being

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