Heidi D. is always tired. "I stay at work as long as I can, then come home and go to bed. I slept for 19 hours the other day."

Heidi suffers from lupus, a chronic and sometimes fatal autoimmune disease afflicting one in every 500 people in America. Ninety percent of lupus patients are women and children.

Lupus carries a host of health challenges: headaches, sensitivity to the sun, severe digestive problems, and more. But the most persistent complaint of people with lupus, though not life-threatening, can be the most debilitating and depressing: fatigue.

The cause of this fatigue remains unclear. Several recent studies suggest that the chronic tiredness comes from fibromyalgia, another autoimmune disorder which often afflicts lupus patients concurrently. Anne Rapoza, a health educator for the Lupus Foundation of America, notes that lupus patients also often have anemia, famous for causing fatigue. Linda White, M.D., says that certain deficiencies of B vitamins, vitamin C, magnesium, iron, and zinc can cause or add to fatigue. The inflammation process is energy-draining, as well.

Although people with lupus suffer from fatigue, the disease is quite distinct from Chronic Fatigue Syndrome (CFS). While the two conditions share several symptoms initially, the diagnostic criteria are different. Doctors use a set of eight criteria to determine whether a person has lupus.

Fatigue solutions
The first thing people with lupus can do to lessen fatigue is to get adequate rest. That is difficult to do with the go-go-go lifestyle so popular today, but for lupus sufferers, rest is essential. The Lupus Foundation of America recommends that people modify and reprioritize their schedules to include naps if necessary and cut out energy-sapping extras. Teresa Brady, Ph.D., suggests parceling strenuous tasks throughout the day, resting before doing hard work, and using labor-saving devices like rolling carts.

Ironically, though rest is essential, so is exercise. Regular, gentle aerobics usually help lessen fatigue. Brady recommends swimming, dancing, fast walking, cycling, rollerblading, and cross-country skiing. Water aerobics are also a good choice because water supports the body and puts less strain on the joints. However, lupus patients should avoid strenuous exercise if they have a fever or other signs of a flare (active disease state). They should consult their health care practitioner to determine what exercise is appropriate.

Therapies that connect the body with the mind have proved beneficial as well. Karen Goldinov, executive director of the Arizona chapter of the Lupus Foundation, used self-hypnosis, visualization, and relaxation techniques to help her sleep through the night. Goldinov had trouble sleeping even though she was exhausted because of pain. This is common among lupus sufferers.

Goldinov also recommends that people with lupus keep a food diary, recording both what they eat and how they feel. She discovered that some foods or combinations of foods made her tired because she couldn't digest them well. "If I eat animal protein with carbohydrates, I'm exhausted for three days! she says. Fruits and vegetables, however, energize her."

Supplements to combat fatigue
People with lupus should consider supplements as an added boost to other positive lifestyle changes. Ginseng contains a usable form of ATP to provide muscles with energy. NADH proved helpful for CFS patients in a recent Georgetown study, and Georg Birkmayer, M.D., Ph.D., who co-authored the study, says that while there are no clinical studies yet on NADH and lupus, he suspects that NADH may also prove to be helpful to people with lupus.

Other energy supplements include CoQ10, malic acid, lecithin, essential fatty acids, and L-carnitine. Skullcap and valerian are natural sleep aids. However, people with lupus should avoid certain supplements, like alfalfa, which promotes inflammation, and immune stimulators, like astragalus and echinacea. If you do have lupus, it's best to work with a healthcare practitioner who is knowledgeable about both lupus and supplements.

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Brady, Teresa, Ph.D. "Managing Your Fatigue," Sjogrens Digest, Summer 1997.

Bruce, I.N. et al. "Factors associated with fatigue in patients with systemic lupus erythematosus," Annals of Rheumatic Disease 58(6):379-81, 1999.

Forthsyth, L.M. et al. "Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome," Annals of Allergy, Asthma and Immunology 82(2):185-191, February 1999.

Gladmann, D.D. et al. "Fibromyalgia is a major contributor to quality of life in lupus," Journal of Rhematology 24(11):2145-8, 1997.

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By Heath Davis Havlick

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