"Why Am I So Tired?": Hidden Causes of Fatigue and How to Fix It

Fatigue is one of the most common complaints I hear from patients, yet standard medical tests often don't identify the cause. If you feel exhausted despite getting enough sleep, it may be a sign to look deeper. Many factors, including diet, lifestyle, and hidden health conditions can drain your energy. Here are some of the most overlooked causes of fatigue and suggestions on steps you can take to reclaim your vitality.

Hormone Imbalances:

Thyroid Dysfunction: Even mild hypothyroidism can cause sluggishness and brain fog. Standard TSH tests may not always capture early thyroid dysfunction, so comprehensive testing, including Free T3, Free T4, and in certain situations, Reverse T3, can be valuable.

Adrenal Fatigue: Chronic stress can lead to dysregulated cortisol levels, causing energy crashes, difficulty waking up, and sleep disturbances. This can be due to personal stresses (work, relationships, etc), physical stress (too much HIIT, illness, post viral syndromes, lack of quality sleep), and other stressors.

Insulin Resistance: Blood sugar fluctuations and insulin resistance can lead to fatigue, especially after meals (that "post lunch crash").

Nutrient Deficiencies:

Low Iron: Even in the absence of anemia on your routine bloodwork, low ferritin (iron stores) can cause exhaustion.

Vitamin B12 Deficiency: Essential for energy production, B12 deficiency is common in vegetarians and those with poor digestion. Those with certain genetic mutations (MTHFR) may need supplementation with a specific type of B12 supplement.

Magnesium and Vitamin D Deficiencies: These play a crucial role in energy production and immune health.

Gut Health Issues:

Leaky Gut and Dysbiosis: Poor gut health, imbalance of gut bacteria, increased intestinal permeability, all can lead to inflammation and reduced absorption of vital nutrients.

Food Sensitivities: Undiagnosed food sensitivities (such as gluten or dairy intolerance) can cause chronic inflammation, leading to fatigue.

Chronic Inflammation:

Autoimmune conditions: untreated autoimmune conditions can lead to fatigue

Poor diet: intake of ultra-processed foods, simple sugars (any sweet drink), artificial sweeteners, and inflammatory/overheated oils.

Environmental Toxins: Heavy metals, mold exposure, polluted water, and endocrine disruptors can impair energy metabolism.

Poor Sleep Quality:

Sleep Apnea: A commonly overlooked cause of fatigue, especially in individuals with snoring or weight gain, but is also increasingly more common in the age group of 30-50 years.

Disrupted Circadian Rhythms: Late-night screen use and irregular sleep patterns can reduce sleep quality.

How to Fix It:

Balance Blood Sugar: Avoid refined carbs and simple sugars, prioritize healthy fats and proteins, and eat balanced meals.

Optimize Gut Health: Incorporate probiotic-rich foods, eliminate processed foods (if getting packaged food, under 5 ingredients total, with ingredients you can pronounce), and consider a gut-healing protocol.

Movement: Don't be a couch potato or an exercising couch potato--move throughout the day and aim for at least 30 minutes/day of structured exercise including functional strength training. Improves blood flow/oxygen to muscles and tissues, releases endorphins which will help with fatigue and mood, improves sleep quality, and increases stamina/endurance.

Prioritize Restorative Sleep: Establish a calming bedtime routine, reduce blue light exposure, complete your last meal at least 2 hours before bed, and consider magnesium supplementation.

Manage Stress: Identifying and removing stressful triggers if possible, breathwork and meditation to enhance the mind body connection, and in some cases adaptogenic herbs like ashwagandha can help regulate cortisol.

Consider Comprehensive Lab Testing: Functional medicine testing can uncover hidden causes of fatigue.