You sleep seven, eight, or even nine hours each night—but you are still feeling tired or even exhausted. Sound familiar?
Fatigue is an incredibly common reason patients come to Healing Roots Natural Medicine. It may be their main reason for seeking out care or simply one on the list of symptoms they are experiencing along with whatever main symptom or condition led them to seek out our care. While poor sleep is certainly one cause of fatigue, it’s far from the only one. Your energy depends on nutrition, hormones, stress, metabolism, inflammation, digestion, and much more. In this article, we’ll walk through the most common reasons we see patients experience fatigue despite getting enough sleep—and what you can do about it.
At Healing Roots Natural Medicine, our initial visits last up to two hours because understanding our patients and the underlying causes of their symptoms requires more than a quick conversation. We look at your symptoms, nutrition, stress, sleep, exercise, digestion, medications, and daily routines to identify patterns that are often missed during shorter appointments. Sometimes simple changes make a dramatic difference. Other times, targeted lab testing helps uncover underlying issues.
After we’ve covered some of the most common culprits behind fatigues, we’ll share some of the less common causes of fatigue we consider.
Nutrition and Eating Habits
- Skipping breakfast
- Intermittent fasting
- Too little protein, especially at breakfast
- Heavy refined carbohydrates, especially at breakfast
- Nutrient deficiencies
One of the simplest interventions we recommend for fatigue is eating a protein-rich breakfast. In our clinical experience, this is one of the most effective foundational changes you can make to ensure sustained energy throughout the day, especially for women. We find that protein from whole foods rather than powders or fortified processed foods work best. Avoid processed foods like cereals and bagels. Be careful with large portions of heavy carbs at breakfast even from whole foods, like oatmeal. Instead choose things like scrambled eggs with veggies or a skyr bowl with nuts, seeds and fruit. Aim for at least 18g of protein at breakfast; many may benefit by aiming closer to 30g.
Intermittent fasting is often touted as improving energy levels. It does for some but for others, it depletes their energy and stresses their body. If you try intermittent fasting and your energy is low or you are anxious, it probably isn’t for you. It is also important to know that our response to things like intermittent fasting can change over time. If you felt energetic when you first tried it but no longer are, it might be time for a break. While intermittent fasting can benefit some people, it isn’t appropriate for everyone.
Your cells need the right nutrients to produce energy. B vitamins, iron, copper, magnesium and sulfur compounds are among some of the most basic. While some of these, like B vitamins, are hard to overdose on, others can cause toxicities if you overload. This include iron and copper. For this reason, focus on food sources rather than supplements unless you are tested and/or evaluated by an expert, like the naturopathic doctors at Healing Roots Natural Medicine.
Exercise and Recovery
- Overtraining
- Too little movement
While movement is good for you, more exercise isn’t always better. If you’re going through a period of fatigue, this is probably a good time to reduce your training routine and give your body time to recover. The exercise itself could be the issue, or it could be that you have additional stress from another source that is making your usual amount of exercise too much for you at this time. Other stressors could include things like not fueling adequately for your exercise level, not taking adequate rest, or something else, like increased emotional or mental stress. Even if your primary stressor isn’t the exercise, overtraining when you’re already depleted just makes things worse. This can be a hard pill to swallow for those who deal with stress through intense exercise. Look for other stress relievers and choose restorative movement like walking, gentle cycling, stretching and yin yoga.
Conversely, not moving enough can also cause fatigue! If you are sedentary, your body isn’t triggered to make energy. Movement stimulates the production of mitochondria, which are considered the powerhouses of our cells because of their role in energy production. When we are sedentary, we also see a reduction in blood flow to our brain and muscles. Lack of movement often worsens sleep which will contribute to fatigue overtime. Start out slowly with more walking and a gentle exercise routine. This will likely improve your energy levels and you’ll often see a quick, gratifying improvement.
Caffeine and Hydration
There is much controversy surrounding caffeine, and coffee in particular, in the holistic health world. We see more and more articles on the benefits of caffeine containing drinks like coffee and tea. It is true that they can be high in antioxidants and gut friendly compounds. However, regardless of what the benefits might be on paper, there are pros can cons that need to be evaluated for each individual. We find that most people just need to do a little experimentation and be honest with themselves about how caffeine, and coffee in particular, impacts them.
If you are drinking caffeine in the morning and crashing in the afternoon (or needing more caffeine midday), caffeine is likely working against you. This can be tough to hear when you’re really fatigued and feel like it is the only thing that keeps you going. We recommend tapering down or completely off caffeine for a couple of weeks to see how your body responds. In general, we find that limiting yourself to one 8oz cup AFTER or with breakfast is usually best for sustained energy.
Hydration is about more than just drinking water. Plain water doesn’t always hydrate adequately. Most caffeinated, sugary or alcoholic drinks don’t hydrate well either. In our experience, many patients hydrate better when they include mineral-rich fluids rather than relying solely on plain water. Adding electrolytes, mineral water, herbal teas, or a squeeze of citrus can improve hydration. Shoot for about half your body weight in ounces of hydrating liquids each day. Drink more if it is very hot, very dry or you are sweating more than usual from exercise, sauna or work.
Food Sensitivities
Fatigue can also be an indication that you have a food sensitivity. An elimination diet can be a great way to figure out whether you have a food sensitivity or not and if it is contributing to low energy. You are probably wondering if you can just skip the whole elimination diet and find a test that gives you the answer. Food sensitivity testing can be expensive and of dubious quality depending on the lab. An elimination diet remains the gold standard for identifying food sensitivities. Among our patients, gluten and eggs are two of the more common foods that appear to contribute to fatigue, although triggers vary considerably from person to person.
Medical Causes of Fatigue
- Thyroid Issues
- Hormonal dysregulation (nonthyroidal)
- Sleep apnea
- Inflammation
- Digestive dysfunction
- Blood sugar dysregulation and metabolic issues
- Autoimmune conditions
- Medications
If thyroid imbalances are part of the picture, you may also experience classic hypothyroid symptoms like weight gain, hair loss, dry skin and/or general puffiness. It is important to remember thyroids don’t spontaneously stop working. Thyroid dysfunction often develops gradually and may be influenced by autoimmune disease, nutrient deficiencies, chronic stress, or other underlying factors. Identifying the root cause is an important part of treatment. If your thyroid is out of balance, work with an expert to discover why. We have an extensive series on thyroid health for you to learn more.
A key indicator that fatigue is hormone related is fatigue that changes with your menstrual cycle phases. Track your energy levels along with your cycles.
If you wake feeling unrefreshed, you snore or certain red blood cell markers are high on your blood work, these may all indicate sleep apnea.
Generalized inflammation can cause a general stress on the body and compromise the ability of your cells to produce energy. Inflammation can be seen on blood work (see below) but can also be identified by a variety of symptoms including brain fog, joint pain and stiffness, digestive issues, puffiness, swelling and weight fluctuations.
Digestive disorders characterized by bloating, changes in bowel movement, discomfort or even pain can lead to some of the nutrient deficiencies that are associated with fatigue. They can also be a source of inflammation and pain leading to fatigue. Even properly functioning digestion is an energy heavy process. When digestion goes awry, it can become even more taxing leading to systemic fatigue.
Both high blood sugar and low blood sugar can cause fatigue. See below for information on how to evaluate this.
Autoimmune conditions including thyroid (Hashimoto’s and Grave’s), rheumatoid arthritis, scleroderma, and lupus, can all feature fatigue as a prominent symptom when they are not well controlled. Fatigue is often one of the first symptoms our patients with autoimmunity see resolve when we help them to balance their immune systems and reduce inflammation naturally.
Certain medications can also cause fatigue. These include beta-blockers, benzodiazepines, antidepressants, antihistamines and statins. Do not stop any medications suddenly without the support of your medical provider.
Basic Lab Testing for Fatigue
While a thorough intake and physical exam can reveal many causes of fatigue, labs can sometimes give us additional insight and help to refine treatment targets.
The following are common labs we use to help our patients investigate causes of fatigue:
- Full-thyroid panel
- Nutrients: iron panel, B12, possibly a comprehensive micronutrients assessment
- Hormones: testosterone, progesterone, estrogen and morning cortisol
- Inflammatory markers: homocysteine, hs-CRP, ESR
- Metabolic markers: fasting glucose, fasting insulin, hemoglobin A1c
While TSH is a useful screening test, it doesn’t provide the complete picture of thyroid function. We recommend a full panel including T4, T3, Free T4, Free T3 and Reverse T3. You can learn more about why here.
In addition to the metabolic markers listed above, continuous glucose monitors can also be useful in evaluating blood sugar in relationship to fatigue.
Less Common Causes of Persistent Fatigue:
The factors listed above account for most cases of fatigue. However, if you’ve explored these and are still not feeling as energetic as you’d like to, there may be other issues at play.
Here are 6 less common causes of fatigue:
- Mold
- Heavy metals
- Environmental toxins
- Gastrointestinal yeast overload
- Chronic infections: EBV and other viruses
- Post-covid
These can be explored through history, specialty labs and questionnaires. We at Healing Roots have successfully helped patients navigate each of these.
The Bottom Line
If you’re sleeping enough but still waking up tired or experiencing fatigue throughout the day, your body is trying to tell you something. Fatigue is a symptom—not a diagnosis—and it often has multiple contributing factors.
If you’ve been struggling with persistent fatigue, we’d love to help you uncover what’s driving it and develop a personalized plan to help you feel like yourself again.
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