Digestive symptoms include loss of appetite, sore tongue, abdominal pain, heartburn, and diarrhea. In more severe cases, women can suffer from symptoms as varied as headaches, heart palpitations, tingling in the fingers and feet, loss of coordination, and a yellowing of the skin. As you can see, a woman can become quite ill from the physical and mental effects of anemia if her physician does not diagnose her condition properly.

Many cases of anemia are caused by nutritional deficiencies. Without sufficient nutritional factors, the red blood cells cannot grow and mature normally. The most common cause of anemia is iron deficiency. In fact, as many as one-third to one-half of young American women have low or depleted iron stores. The main reason for these low reserves is that women simply don't eat enough iron-rich foods.

Children, adolescents, and women during their reproductive years are at particular risk of iron deficiency anemia. Children and teenage girls need this iron to support growth and development; grown women need it to replace the iron lost in the monthly men-strual period. This increased need for iron persists until meno-pause, when the monthly blood loss finally ceases. Elderly women are still susceptible to developing anemia because they tend to eat less and have a nutrient-poor diet, especially if they live alone or have a limited income.

Pregnancy and the postpartum period are also vulnerable times for women because fetuses and breast-feeding infants take iron from the mother. Women athletes also have an increased need for iron during training because of the metabolic demands of heavy exercise.

Some women develop iron deficiency anemia because their bodies are unable to absorb and assimilate iron properly. Iron absorption may be decreased by chronic diarrhea, laxative abuse, or malabsorption diseases such as celiac disease and sprue, as well as by nutritional deficiencies of vitamins and minerals needed for the health of the digestive tract.

Another common reason for the development of iron deficiency anemia is excessive blood loss. This is commonly seen in women who suffer from menorrhagia (heavy or prolonged menstrual bleeding) caused by hormonal imbalances, fibroid tumors, or uterine cancer. Women who use intrauterine devices for contra-ception are also at higher risk of blood loss, as are women who overuse anti-inflammatory medications such as aspirin or ibuprofen, which can cause blood loss through irritation of the digestive tract.

Besides iron, other nutrients are needed for healthy red blood cell growth and maturation. Deficiencies of vitamin B12, folic acid, and vitamin B6 are also common causes of anemia. Vitamin E is important for red blood cell survival. Medical research done on subjects deficient in vitamin E has shown that this nutrient helps prolong the life span of red blood cells.

For many American women, anemia can complicate a pre-exist-ing health-care condition. For example, anemia often accompanies thyroid disease, rheumatoid arthritis, and chronic kidney disease, as well as recurring or chronic infections. Anemia contributes to the fatigue and lack of energy that affect people suffering from these health problems. Anemia can also be caused by drugs that destroy or interfere with the utilization of the nutrients necessary for the health and maturation of the red blood cells. These drugs include oral contraceptives, alcohol, and anticonvulsive agents such as Dilantin.

In any case, the underlying causes of anemia must be reversed and corrected in order to re-establish healthy, normal red blood cells capable of carrying sufficient oxygen. When the anemia is corrected, the accompanying fatigue and lethargy will also be corrected.

The Nervous System

Depression
Depression is characterized as feeling so down or "blue" that these feelings interfere with daily life. One person in five in this country experiences symptoms of depression at some time. Thirty million people can expect to suffer from depression during their lifetimes, and 1.5 million people are currently undergoing treatment for this condition. Depression is twice as common in women as in men.

Depressed people suffer from a variety of symptoms that cause them to feel lethargic, fatigued, and unable to cope with other people and normal life activities. These symptoms include difficulty in concentrating and making decisions, and lack of self-esteem and self-confidence. Depressed women may suffer from a feeling of worthlessness and self-pity and may want to isolate themselves from other people to avoid social contact. Women with depression also display anxiety and irritability. They often suffer from eating problems (either overeating or undereating), insomnia, fatigue, digestive complaints, loss of sex drive, headaches, and backaches. Most dangerous to the women affected is that severe depression can lead to suicide attempts. Any threat of suicide in a depressed woman should be taken seriously and immediate medical care begun.

Many stressful life events can lead to depression, including death of a loved one, divorce, loss of a job, or even aging. Women who are experiencing low thyroid conditions, PMS, menopause, or the postpartum period are at higher risk of depression. Poor nutritional habits or the use of drugs and hormones (such as birth control pills and estrogen replacement therapy) can add to depression. Some women with depression are sensitive to the change of seasons. The shortness of the days and decreased light during the winter can trigger depression because the endocrine or glandular system may need more daylight to function optimally.

Women with depression may need a combination of antidepressive medication along with psychotherapy to combat the condition. Self help techniques such as exercise, proper nutrition, and stress management can also be very helpful.

In summary, fatigue is an important symptom in many common health problems of women, including chronic fatigue syndrome, candida infections, allergies, PMS, menopause, hypothyroidism, anemia, and depression. Chapter 2 contains a workbook that will help you pinpoint any underlying physical problems that may be compounding your fatigue. It will also help you evaluate how your lifestyle habits may be contributing to increased tiredness.