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I just don’t feel right — again.

I can’t pinpoint exactly why, nor can I quite explain the feeling. But it’s not an unfamiliar one. It’s a cross between having the flu and a hangover, and it’s often accompanied by unwanted fatigue. I can feel queasy, dizzy, and warm from a mild fever. Sometimes smells that once brought me pleasure bring me nausea.

This feeling of unwellness pops up often and unexpectedly, usually at awkward times. Some days it isn’t a huge annoyance, and I can move about my day fine. Other days, it stops me in my tracks. Occasionally, it’s a warning sign of a bigger issue.

What is causing this uneasy sensation I can’t quite seem to shake off?

The culprit is called “malaise” — by way of my rheumatoid arthritis (RA).

When I was diagnosed with this chronic illness at 29, I was expecting joint pain and stiffness. After all, those are common RA symptoms. I didn’t expect to feel like I was hit by an 18-wheeler … after drinking all night … after running a marathon. (Doesn’t sound too pleasant when I paint that picture, does it?) This feeling of general unwellness is known as malaise, and it’s one of the lesser-discussed symptoms of chronic illnesses like RA.

What Does Malaise Feel Like

Some people describe malaise as feeling like a minor flu, or the low-grade crappy feeling you get when you know you’re getting sick but not sure what’s wrong. The definition of malaise is a general feeling of unwellness that can include the following symptoms, according to Medline Plus:

  • Weakness
  • Unease/discomfort
  • Mild nausea
  • Fatigue
  • Lack of appetite
  • Sensitivity to smells

Malaise can be caused by a number of illnesses, medications, and lifestyle habits. In my case, malaise is a result of my rheumatoid arthritis, which occurs when your immune system turns against your body’s tissues, causing inflammation, swelling, and pain that impacts the lining of your joints. Because your immune system is constantly in attack mode (against your own body, no less), it’s not uncommon to run a low-grade fever as an autoimmune response.

What Triggers My Malaise

After living with chronic pain for a decade, I’ve been able to figure out a few things that make malaise worse, as well as things to help me cope with it. Keep in mind that what triggers and eases malaise for me may not be the same for you. It is important to track your own reactions and speak to a health care provider to come up with a treatment that works for you. This will probably involve a lot of trial and error, so be patient.

Medications: Taking multiple medications can contribute to malaise symptoms like nausea, dizziness, fatigue, and appetite changes. It is important to bring this up to your doctor if it is getting in the way of your life and too frequent.

Some vitamins and supplements: Two that many people take to help manage rheumatoid arthritis — but happen to make me feel uneasy — are turmeric and vitamin B12.

Hunger: Once my blood sugar drops, I feel hangry and nauseous.

Coffee:  Too much of my favorite energy-booster brings about some uneasy sensations. If I drink water and eat before or after my coffee, I find the malaise is less likely to occur.

Dehydration: Not drinking enough water throughout the day can be a major trigger for malaise.

Lack of physical activity: If I am sedentary for too long, the malaise arrives.

Too much physical activity: On the other hand, sometimes I experience post-exertional malaise. According to the U.S. Centers for Disease Control and Prevention (CDC), this is when symptoms worsen after physical activity and can persist for days or even weeks.

Fatigue: Maybe I’ve overexerted myself or just had a bad night’s sleep. Whatever the reason, the more tired I am, the more likely I am to deal with malaise.

Alcohol: I cannot drink a lot without experiencing pain, fatigue and poor sleep. Gone are the days I drink much more than a glass or two of wine. I really only drink on special occasions, always with some food and plenty of water.

Certain foods: For me, foods that are high in sugar, overly processed, fried in fat, or high in salt can not only make my pain worse, but also make me feel unwell. I try to limit my consumption of these foods, which is a lot easier than cutting them out completely.

Not getting enough fresh air: Spending too much time inside with the windows closed can make me feel worse.

Face masks: This has become a recent trigger due to the COID-19 pandemic. When I wear a mask for too long, it makes me feel physically uneasy. Of course, I still wear my mask when out in public or around others, because doing so has been shown to contain the spread of coronavirus. But if I need to take a breather, I find a private area where I am not putting anyone else at risk.

Menstruation: Right before and at the start of my period, I can run mild fever, which triggers the malaise.

Fever: If you have RA, you have to be very cautious when you feel like you’re running a fever. It could be garden-variety malaise or it could be a sign of an infection, which needs to be addressed right away.

Deficiencies and malnutrition: One of the worst episodes of malaise I ever experienced happened when I was diagnosed with a copper deficiency. When your body is being deprived of the nutrients it needs to thrive, it may lash out.

Anxiety and depression: Your mental health can also have a significant impact on how you physically feel. I find that whenever my anxiety or depression have spiked, so does the malaise.

How I Treat My Malaise

Although each of my malaise triggers requires different solutions, I do have a few go-to ways that I find generally help me feel better.

Sparkling water: I always have some cold carbonated water on hand. For me, this stuff can be a lifesaver when dealing with malaise. The carbonation works like magic when nausea hits and I prefer sparkling water vs ginger ale as there is far less sugar involved! Plus it’s a tasty way to stay hydrated.

Herbal teas: I have quite the collection of herbal teas for different ailments. When I feel nauseous or sluggish, I turn to tea with ginger, chamomile, lemon, fennel, peppermint, or licorice. If I’m feeling lethargic, I steep some matcha or green tea.

Rest: Sometimes malaise is a sign I am doing too much and need to take a moment to rest. But I need to be careful to not rest too much, which can backfire and make the malaise worse. When I rest, I set a timer for 20-40 minutes.

Crackers or toast: This is the dynamic duo on the days I just can’t stomach food but need to eat.

Smoothies: This is another food I can tolerate when I’m feeling queasy. I also find it easier to swallow my medication when I take it with a smoothie.

Fruit and nuts: They are an easy and tolerable source of nutrients when malaise hits.

Anti-nausea medicine: I always keep Tums on hand, as well as a big bag of mints.

Fresh air: This is one of the cheapest and most efficient ways to feel a little better; I find some sunshine helps me feel more energized.

Regulating my temperature: Being overheated can exacerbate malaise, so I try to cool myself down whenever possible. This may involve going outside, opening a window, removing layers, using a fan, or drinking cold water.

Meditation: Simply focusing on my breathing helps to calm the storm brewing inside of me.

Cannabis: Research has found that two compounds in cannabis, THC and CBD, may help prevent or ease nausea. In my experience, cannabis has also helped relieve joint pain and increase my appetite on days when I can’t stomach food. Keep in mind that cannabis may not be legal where you live and can cause various side effects or interact with medications. Talk to your doctor if you have questions about using it safely.

What to Do If You Have Malaise

Malaise can be a warning sign of a larger medical issue, or an unpleasant side effect of living with chronic illness. Either way, it is important to let your health care provider know when you’re experiencing this unpleasant feeling. They will be able to run tests and offer treatments to help you through.

Track Your Symptoms with ArthritisPower

Join CreakyJoints’ patient-centered research registry and track symptoms like fatigue and pain. Sign up here.

Malaise. Medline Plus. February 2019. https://medlineplus.gov/ency/article/003089.htm.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Centers for Disease Control and Prevention. November 19, 2019. https://www.cdc.gov/me-cfs/healthcare-providers/clinical-care-patients-mecfs/treating-most-disruptive-symptoms.html.

Parker LA, et al. Regulation of nausea and vomiting by cannabinoids. British Journal of Pharmacology. December 2010. doi: https://doi.org/10.1111/j.1476-5381.2010.01176.x.