Being tired in your twenties is normal. Being tired every single day is not. It is one of the most common complaints we hear in general medicine outpatients, and among younger patients it is almost always attributed to screens, late nights and work stress before anyone thinks to test anything.
Sometimes that is exactly right. But fatigue is also the first symptom of several very ordinary, very treatable conditions, and all of them show up on a basic blood panel that most people in their twenties have never had done.
Iron deficiency, especially in women
This is the single most common cause we find. Iron deficiency can leave you exhausted long before it becomes full anaemia, which means a normal haemoglobin reading does not rule it out. Ferritin is the test that matters, and it is not part of a routine blood count unless you ask.
Menstruating women lose iron every month, and a diet low in red meat makes replacing it slower. Vegetarian diets in India are common, and plant iron is absorbed far less efficiently than the iron in meat.
- Ask for ferritin, not just haemoglobin
- Vitamin C with meals improves absorption from plant sources
- Tea and coffee with food reduce it — leave an hour on either side
An underactive thyroid
Hypothyroidism is common in India, and disproportionately so in women. Tiredness, weight gain, feeling cold and low mood arrive gradually enough that people adjust to them rather than reporting them. A TSH test costs a few hundred rupees and settles it.
Fatigue that has lasted more than six weeks deserves a blood test, not a lifestyle lecture.
Vitamin D and B12
Vitamin D deficiency is close to universal among people who work indoors, and it causes tiredness and muscle aching. B12 deficiency is common in vegetarians and causes fatigue along with tingling in the hands and feet, and sometimes difficulty concentrating.
Both are cheap to test and cheap to correct. Neither should be self-supplemented indefinitely without checking the level first, since very high doses of vitamin D cause their own problems.
Blood sugar
Type 2 diabetes is appearing a decade earlier in Indian patients than in Western populations, and prediabetes is more common still. Persistent tiredness, thirst and frequent urination are the classic combination, but tiredness alone is often the only symptom for years.
And yes, sometimes it is sleep
Obstructive sleep apnoea is badly underdiagnosed, and it does not only affect people who are overweight. If you snore, wake with a dry mouth or headache, or feel unrefreshed after eight hours, that is worth investigating properly with a sleep study rather than a phone app.
Depression and anxiety also present as physical exhaustion far more often than as sadness, particularly in men and particularly in cultures where low mood is difficult to name.
What to actually do
- If fatigue has lasted more than six weeks, get a blood panel rather than a supplement
- Ask specifically for ferritin, TSH, vitamin D, B12 and HbA1c
- Take the results to a physician rather than reading them alone
- Mention snoring, low mood and menstrual history — all three are relevant and all three get left out
Most of the time we find something ordinary and fixable. Occasionally we find something that needed catching. Either way, six weeks of unexplained exhaustion is a reason to test, not a reason to buy a multivitamin.