Warning: This is super long one, so make a pot of tea, find a quiet spot to curl up, and get ready to change everything you thought you knew about your body’s energy.

The reason this post is so long is because fatigue as a symptom can be caused by so many things. Honestly, if it’s been going on for a while, your tiredness is probably influenced by several factors that have added up over time.

The first thing you’ll want to consider is whether your fatigue is more mental or more physical. I know it probably feels like both, but which is the prime mover? Is your problem largely one of low motivation, lack of focus, and just not getting excited about things? If so, you may be dealing more with mental fatigue, to which the solution will be more esoteric and personal. Maybe you have too many responsibilities and not enough joy in your life? Or you could be unappreciated at work or home. Really an infinite number of things could have you languishing right now – but that’s not really what this article is about.

Today we’re getting more into root causes for physical tiredness, when your fuel tank feels like it’s never quite full, and empties a whole lot faster than it used to. We’ll start with the more well known, obvious causes, then wander our way through some things that may be new to you.

Mr. Sandman, Bring Me A Dream

No discussion on fatigue would be complete without addressing sleep. Plain and simple, if you’re not getting 7-8 hours of good quality sleep a night, preferably around the same time every night, you’re going to start feeling it eventually. Even if you used to get away with 5 or 6 hours when you were younger, that may no longer be the case. If this is a struggle for you, I’ve got a whole article devoted to getting good quality sleep by resetting your circadian rhythm. Regardless of your root causes, you’ll benefit by getting your sleep game on point.

Fuel for the Fire

Another low-hanging fruit on the tree of fatigue is nutrient deficiencies. Obviously, if your body is not getting the building blocks it needs function efficiently, you’ll run out of fuel much faster. Some common deficiencies include Vitamin B12, Vitamin D (which is actually a hormone), and Ferritin (a blood protein that stores iron). It’s also possible to have amino acid deficiencies from not eating enough protein, which can be an issue for people on a plant-based diet.

Ask your doctor to run blood tests for B12, D and Ferritin, then make sure you get copies of your labs. Your Vitamin B12 should be between 450-800 pg/ml – if it has dropped below that use a high quality B12 in the form of methylcobalamin to raise your levels.

Optimal Vitamin D levels are 50-80 ng/ml. I recommend 5000 IU’s of a liquid, oil based D3 supplement for a few months, or until your levels return to normal. 1000-2000 IU’s daily can be used ongoing to make sure they stay there.

Anemia is a common cause of fatigue, and most practitioners will check for it via a CBC blood test. However, many docs won’t think of an iron deficiency independent of anemia, so they rarely check ferritin without you asking for it. So be sure to mention it specifically if you think this could be an issue for you. If your Ferritin is below 50, you’ll want to supplement with iron bisglycinate, a gentle, bioavailable form of iron that’s easy to absorb and doesn’t upset your digestion. 

Baby, It’s Cold Outside

Surely by now you’re aware that hypothyroidism can be a cause of fatigue, but getting a diagnosis and treatment unfortunately isn’t always straightforward. If low thyroid is a main cause of your tiredness, you’ll probably have a few other symptoms as well. Weight gain, hair loss, constipation, depression, feeling cold, heavy or irregular cycles, infertility, high cholesterol and brain fog are all on the table here.

If you suspect your fatigue could be due to a thyroid issue, ask your doctor to run some tests. You’ll probably have to directly ask for each of these tests, and you may even want to write them down so your doc is clear. To assess for hypothyroidism, you’ll want to check your TSH, free T4, free T3 and autoimmune antibodies. Stay tuned for an entire post on this topic – it’s a big one!

I’m So Tired, I Haven’t Slept a Wink

HPA axis dysregulation, colloquially called “adrenal fatigue”, can also be a cause of ongoing tiredness. This happens when we continue to ask more from our bodies (and minds, and lives) than we have resources for. When we push and challenge ourselves occasionally it creates resilience, but when we do this continually, and don’t have time to recover, we burn out.

This overworked, overstressed, and overwhelmed world that we currently find ourselves in is a recipe for HPA axis dysregulation. And it’s compounded by watching others who *seem to be* doing it all and not suffering. Basically, everyone is stressed and working too hard, so it becomes normalized and we forget that this is not the way we evolved to live.

Another big cause of HPA axis dysregulation is trauma. This can be a big, life changing kind of trauma, or it can be all the “small t traumas” that build up through our lives and highjack our nervous systems.

All this trauma, anxiety, stress, and overwhelm effects our stress hormones: cortisol and adrenaline. Ideally, we want our cortisol levels to spike in the morning to give us the energy we need to get through the day. As we go through our day, cortisol levels naturally decline, reaching their lowest levels at bedtime. This is the time we want to be tired, so we can sleep! In HPA axis dysregulation, this cortisol curve is off in some way. Sometimes the levels are reversed, starting low in the morning and then going up in the evening. Other times they stay low throughout the day.

A cortisol saliva or urine test, taken 4 times throughout the day, can reveal a dysfunction with your HPA axis. This can show you, with objective data, that you need to slow down, take time to rest and de-stress, and not push yourself so hard. Unfortunately, while there are supplements you can take to help your body out in this department (namely, adaptogenic herbs and glandular adrenal supplements) they just aren’t enough without lifestyle interventions. Getting 8 hours of sleep, taking time to rest and do things that are enjoyable, and in some cases restructuring your life and priorities to support your health and wellbeing are necessary to fix this issue.

Come On Baby, Light My Fire

Chronic inflammation is another drain on our human energy battery. This can come from so many places – a poor diet, chronic infections, food intolerances, extreme stress, and autoimmunity being some of the most common. 

If you’ve been diagnosed with an autoimmune condition, then you definitely have some inflammation going on, but other signs and symptoms include fatigue and brain fog, joint/muscle/nerve pain, skin rashes, headaches, digestive issues, recurring colds or infections, mental health issues, and weight gain, among many other things.

Inflammation, especially the chronic kind, happens because our immune system becomes activated and starts attacking the wrong things. Immune cells called inflammatory cytokines run amuck, and cause many of these symptoms. Then it’s made worse when your body is unable to break down these cells fast enough and they build up in your system.

Addressing the root cause of your inflammation is obviously the long term solution here, but there is one thing I’ve seen that can help regardless of cause, and that is an anti-inflammatory diet. The AIP (Auto Immune Protocol) diet is the gold standard here. In a nutshell, AIP takes out any food that could possibly cause an inflammatory reaction: grains, legumes, nuts and seeds, eggs, nightshades, dairy, and obviously any kind of processed foods/sugars, alcohol and caffeine. This basically leaves you with meat/seafood, fruits, and vegetables. This is quite a strict diet, and it does remove lots of healthy foods. This is why we use it as a short term medicinal diet. After a few months on the AIP, I encourage patients to experiment by adding foods back in, one at a time, to determine if the food causes inflammation in them. If not, you can continue eating it. If so, leave it out and try again in a few months.

If that seems a little un-doable to you right now, there are other options. The next best anti-inflammatory diet is a short term Whole30, Paleo type diet, which adds back in eggs, nuts, seeds and nightshades. If you have moderate levels of inflammation, this may be enough for you. Again, after a few months, once your inflammation levels decrease, it should be safe to add non-glutenous grains and legumes back as well.

Long term, the best anti-inflammatory diet is a Mediterranean/Ancestral type diet. This is ultimately the diet to strive for, as it is quite diverse, includes all the healthy foods, and only removes added sugars and processed foods. If you struggle with keeping inflammation down on this diet, removing gluten and/or dairy might be a key for you. Also check for hidden sources of sugar in things like nut butters, yogurt, or salad dressings. 

A Gut Feeling

You can have the cleanest, most nutrient dense diet in the world, but if your digestion isn’t working properly, your body can’t actually absorb all those nutrients, leading to fatigue. There are 3 major areas your digestion could be getting stuck, and you could have 1, 2, or all 3 of these happening simultaneously.

1. Food isn’t being broken down sufficiently. Food you eat needs to be well chewed and mixed with saliva, shuttled to the stomach where hydrochloric acid breaks it down, then moved through the first part of the small intestine, where pancreatic enzymes and bile salts are added to the mix. Each of these substances: saliva, hydrochloric acid, enzymes, and bile salts, play a role in breaking down what you eat into something that your body can use as fuel.

Nausea, bloating, reflux, clay colored stool, and/or undigested food in your stool are all signs that this could be part of your issue. Start by only eating when relaxed, and chewing each bite well before swallowing. If that’s not enough, consider supplementing with Betaine HCl with pepsin, a stomach acid supplement, digestive enzymes, or bitters. If you’re experiencing nausea and clay colored stool, bile salts will be your friend.  

2. Chronic gut infections are stealing your nutrients. Small Intestine Bacterial Overgrowth (SIBO) candida overgrowth, parasites, or other gut infections need nutrition to survive. So if we’re harboring any of these in our intestines, they are getting to our nutrients before we are. Severe bloating, constipation and/or diarrhea are SIBO’s biggest symptoms. But to know for sure, it’s important to do a SIBO breath test which measures the amounts of hydrogen and methane gasses in your breath. If you find out this is a part of your fatigue picture, it’s best to work with a practitioner who can use antimicrobial substances and other supplements to rebalance the bacteria in your small intestine.

 If you have hard core sugar cravings and tend towards yeast and fungal infections, candida could be an issue for you. And if your digestive symptoms wax and wane with the moon or your cycle, and if you’re noticing weight gain or loss, you could be dealing with parasites. Both of these conditions exist as part of a larger health picture, and need to be addressed by a practitioner who knows how to diagnose and treat these.

3. Gut flora isn’t doing its job. We just talked about the overgrowth of pathogenic bugs in our digestive tract, but we have many more good microbes making a home in our intestines. And these bugs serve some very important purposes. They feed off our waste products in the large intestine and excrete beneficial substances like butyrate that support gut health, immunity and inflammation.

The best treatment for this is to feel your microbiome the foods that support it, namely fibers and resistant starch. Each different plant we consume carries its own unique mix of fibers and starches that feed a particular type of gut microbe. The more variety we have in our diet, the more species of plants that make it to our plate, the more diverse our flora becomes.

Don’t You Know That You’re Toxic?

I apologize in advance for having to go here, but unfortunately toxins are something that we need to address in this fatigue discussion. When I use the word toxins, what I’m referring to is foreign substances that make it into our cells that shouldn’t be there. This could be anything from pesticides, heavy metals, endocrine disruptors, mycotoxins, and so much more.

While it is true that our body has some really great built-in detoxifiers, the toxins in our current environment can overload even the best of us. And to top it off, some of us have genetic markers that make detoxing even harder. This is why some people seem to be more affected than others. Because symptoms of toxicity are so varied they can look a lot like gut imbalances, inflammation, or really any of the other issues on this list. If you want to be sure this is what you’re dealing with, there are some functional tests that look for specific toxins.

While testing for specific toxins is undoubtably helpful, there are a few things you can do to support your detoxification, regardless of what it is you need to detox from. Step 1 is called “Awaken the Waste”, and involves flushing these toxins out of our cells with lots of mineral rich water and fresh vegetable juices, then in Step 2 we “Release the Waste” through sweating, colon cleansing and urination.

One example of what this could look like is adding a saturated sea salt solution to all the water that you drink, drinking 16 oz of fresh squeezed vegetable juice daily (with some fruit for flavor if you need), then doing twice weekly detox baths and enemas to help encourage quick removal of those toxins.

Another important aspect to detoxifying is making sure to reduce your exposure as much as possible. Eat organic, swap out all your cleaning and personal care products to natural versions, avoid plastics, and all those other things you know you should do. Stay tuned for a detox deep dive.

Ain’t No Sunshine

Ok folks, hold on to your hats (are you even wearing a hat?) ‘cause things are about to get weird. The paradigm we learn in school about how our bodies make energy goes something like this: we eat food, food is broken down in by our digestive process, those nutrients are loaded into our cells mitochondria, and the mitochondria spit out ATP – which is the fuel our bodies run on.

This is of course true. It all happens exactly like we learn that it does. But that’s not the whole story. The amount of energy we get from ATP isn’t enough to fuel all our body’s processes, from the beating heart to the ion pumps in each cell. There’s actually another human energy battery that gives us the rest of the energy we need to function.

Things are about to get a little woo-woo, so please bear with me. This extra energy that our bodies make comes from light. Specifically, different frequencies of sunlight. Think about it: our modern office jobs keep many of us inside most of the day, which makes us light deficient. This is more than just Vitamin D. Ultraviolet and infrared light frequencies actually restructure the water in our bodies. These sheets of structured water not only repel toxins and other foreign substances, but create ion chains that, when activated, create a burst of bioelectric energy to power our bodies. In a nutshell, light from the sun (and specific devices using healing light frequencies) creates a literal electric human energy battery.

In the summer, it’s important to get sunlight on bare skin, without clothes or sunscreen, which blocks the UV light from getting to our cells. To protect your skin from the aging and cancerous effects of that light, start getting outside in the Spring, and build up your skin’s tolerance to the sun over time. Very fair skinned people may need to start with only 5-10 minutes a day, but the goal is to get 30-60 minutes of sunlight on a majority of your skin every day.

Lullaby, and Goodnight

I want to swing back around to something I mentioned at the beginning of this article. If you’ve been tired for a long time, it’s very likely that you’ve got a number of these issues going on simultaneously. I know it seems overwhelming to think about, and to try to suss out which of these are the main culprits. This is why working with a good health practitioner that you trust can be invaluable. This person can listen to all your health issues, suggest the most likely testing and treatment, and help you get the most bang for your buck with expensive tests and supplements. 

However, there are a few things that are cheap or free, and that can set up a good foundation for you, so that anything else that you do works better and faster. If you don’t know where to start, work on resetting your circadian rhythm/getting enough high quality sleep, get on the most anti-inflammatory diet you can muster, move regularly, and spend some time outside daily.

Have you tried any of these suggestions? How did they work for you? Is there a cause of fatigue that I forgot to mention? Share your thoughts below in the comments.

Author:

Dr. Elizabeth Williams, DACM, LAc, is an acupuncturist, herbalist, and Doctor of Chinese medicine. She is the founder of Women’s Wellness Movement, an online community of women dedicated to improving their health naturally. Her work includes reproductive health, gut imbalances, mental health, complex chronic illness, and the ways these interact uniquely in each individual.