For several weeks I’ve been experiencing extreme fatigue and need to take naps every day. I’ve been to the GP and had blood tests done, but nothing worrying came up. I began taking Mounjaro four months ago to lose weight, but the fatigue only began two months ago. What could be the cause? 

Dr Ellie Cannon replies: Sudden tiredness is always a reason to consult a doctor as it can sometimes be a sign of life-threatening illnesses like cancer.

A GP can carry out a blood test to look for signs of tumours, as well as ruling out other causes like anaemia – a blood disorder that occurs when there are not enough healthy red blood cells.

Another possible cause of fatigue is a thyroid problem.

An under-active thyroid gland – a butterfly-shaped gland in the neck that produces crucial hormones – can leave people tired as well as trigger constipation, hair loss and weight gain. Again, a blood test can spot this problem.

Mounjaro is a weight-loss drug that works by suppressing hunger hormones in the body. This means patients on the weekly injection eat significantly less food than they would otherwise. It is highly effective, with many obese patients losing up to a quarter of their body weight as a result.

However, it has a number of side effects and tiredness – or lethargy as it is also known – is listed as very common.

Since the drug is given in gradually increasing doses over a number of months, it is possible that patients may begin to experience symptoms several months after they start.

However, another concern about these weight-loss drugs is that patients do not get enough vital nutrients because they eat such small amounts of food.

This may mean that some patients do not get enough iron, B12 or vitamin D.

A lack of these nutrients can result in severe tiredness.

To assess whether Mounjaro is triggering side effects, it might be worth returning to a smaller dose to see if the problem eases.

A few years ago I tripped and hit my shins on some stone steps. The bruising eventually faded but, since then, I’ve suffered with shooting, burning pains in the front of my shins whenever I kneel or put pressure on the area. What can I do to end the agony?

Pain that continues long after an injury and is triggered by physical contact is often due to nerve damage.

Nerves are fibres that criss-cross the entire body and are responsible for the sensations we feel. If the nerves are damaged, these feelings can go awry. This can lead to debilitating symptoms such as shooting, burning or prickling pain. It’s not uncommon for the area to become hyper-sensitive, meaning the lightest physical contact can lead to severe pain.

GPs can refer patients for a nerve damage test – known as a nerve conduction study. Yet when the symptoms clearly match those of a nerve issue, there is often no need to do so.

Doctors prescribe specific drugs for nerve pain, as painkillers such as codeine do not work. Typically, doctors might prescribe amitriptyline, gabapentin and duloxetine.

Amitriptyline may be helpful to anyone whose nerve pain is leading to a loss of sleep, as it improves deep sleep. When the pain is in a localised area, doctors might offer a cream called capsaicin. This is made with chilli-peppers and can cancel out nerve pain.

Sadly, none of these treatments are 100 per cent effective and many patients find it can take some time for pain to subside.

I was given statins by my GP after a blood test revealed my cholesterol was high. However, after only a few months I had to come off them as I had a bad reaction. I’ve heard that plant sterols are a safe and natural alternative to statins. Should I take these instead?

Dr Ellie replies: High cholesterol is one of the main risk factors for heart disease and strokes.

Over time, heightened cholesterol levels mean that fatty deposits can build in the blood vessels.

This can eventually block the arteries, leading to life-threatening consequences.

A healthy diet and regular exercise can bring down cholesterol levels. But the most effective treatment is statins – daily pills which limit the amount of cholesterol created.

For most, statins are safe and effective. However, some struggle with side effects such as muscle aches. Plant sterols are a plant-based supplement, which are shown to help combat cholesterol. The nutrient is found in most fruits, vegetables and legumes.

Studies show that eating a diet rich in plant sterols can lower LDL – the bad type of cholesterol – by as much as a tenth. Yet statins can lower LDL levels by as much as half.

If someone cannot take statins, then there are other effective medicines GPs can offer. It’s crucial that anyone who stops taking statins talks with their GP as soon as possible.

• WRITE TO DR ELLIE: Do you have a question for Dr Ellie Cannon? Email [email protected]
• Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context.

Over 40... did you know you can get health MOT? 

Have you had your NHS health check? It turns out most people don’t turn up for their appointment.

Often referred to as the mid-life MOT, it’s offered to over 40s and can be done up to the age of 74.

During the appointment your GP will check your blood pressure, weight, cholesterol and diabetes risk. These measurements can give a good indication of whether someone is at risk of developing life-threatening conditions such as heart attacks and strokes.

But according to new NHS data, less than half of those invited show up. I find this astounding as it’s such an easy thing to do.

Have you received an invitation for the NHS health check? Did you attend? And if you didn’t, what was your reasoning? Please write and let me know.