Fatigue is one of the most common complaints heard in a doctor’s office today, with 5-7% of patients listing fatigue as their chief complaint, and nearly everybody else mentioning it as a big factor in the way they feel. I feel these numbers are grossly underestimated. Many people don’t realize that fatigue is a clinical problem, so they under-report it to their medical doctor. In my clinic I have done health histories on 1000s of patients, and I very rarely get any (adult) patients who DON’T have fatigue, and it’s becoming more and more prevalent to see people in their teens and 20’s with fatigue as a primary or secondary health complaint. 

Fatigue has a broad spectrum of severity. You could feel a little sluggish or you could feel like you have been hit by a truck. You could feel down for a day, a week, or you could feel down every day for years. I have had so many patients who struggle to get out of bed to go to work or parent their children. I’ve had patients who’ve said that their kids would come to their bedside when they needed something because they knew that’s where mom could be found. This is a highly debilitating problem for millions of Americans every single day!


Poor Sleep

Sleep is the most obvious cause of fatigue. If you sleep poorly you are going to be tired, and we have likely all felt that mental and physical fatigue. If you chronically experience poor sleep, you will be chronically fatigued and your health will deteriorate. Many important functions of the body are performed while sleeping, like healing and regenerating tissues, rebuilding energy stores, detoxification - and many important functions are related to proper circadian rhythm, or sleep cycles. These critically important functions include hormone secretion (hypothalamic-pituitary axis), immune system function, metabolism, cellular function, and gene expression. For this reason, altered circadian rhythm and poor sleep is associated with most of our modern diseases, including diabetes, cardiovascular risks, obesity, mood disorders, diseases of metabolism and energy, and even cancer. 

While you are asleep your body cycles through stages of sleep - stage 1, 2, 3, REM, and back through again. Stage 3 is what’s known as “deep sleep”. As you cycle through the stages you spend less time in deep sleep and longer time in REM, which is why you are more likely to have more vivid dreams closer to waking up. Many people can sleep 8-10 hours and still wake up and not feel rested, and this is often a sign they are not getting enough deep, restorative sleep. 

We have a webinar on “Resetting Your Sleep Cycles”, which gives some good habit suggestions to improve your sleep hygiene, and In our recent podcast episode “3 Ways to Control Light Exposure For Better Sleep” we discuss sleep cycles, circadian rhythms, and melatonin in detail and give you simple action steps to control light exposure to enhance your sleep. 


Stress and Poor Adrenal Function

If you google search “fatigue” and are researching why the heck you are so tired, you are likely to come across many articles talking about adrenal fatigue, which is more properly termed HPA axis dysfunction. 

Stress has become a normal part of life in today’s society. Chemical, Physical, and Mental or Emotional stressors create a physiological stress response that leads to inflammation of your cells and disrupt your hormone balance, specifically affecting your HPA Axis, or Hypothalamic-Pituitary-Adrenal axis. This hormone communication system (along with your thyroid) is largely responsible for your body’s energy production and regulation, and the workhorses of this system are called your adrenal glands. These walnut-sized glands, which sit on top of your kidneys, produce your body’s stress hormones including cortisol, DHEA, norepinephrine and epinephrine (or the name we are more familiar with - adrenaline).  Cortisol specifically is your body’s main stress hormone.

When your adrenals are being overworked, they fatigue. At first they produce MORE stress hormones, but eventually they wear out and begin producing less stress hormones. The first step is to reduce mental or emotional stress through methods like meditation, prayer, exercise, grounding, mindfulness, or the best one - taking a vacation. Listen to our past podcast episodes on Allostatic Load and Adrenal Fatigue, or watch our webinar Reduce Stress (Hormones) for more suggestions and hacks to minimize your stress response. In today’s world, if you are not actively reducing stress, it will catch up to you!

Supporting the adrenals with supplements can be magical for fatigue - IF THE CAUSE IS NORMAL, DAILY STRESS and you just need some stress support. This can be done with certain herbs like ashwaganda, rhodiola, adrenal cortex supports, vitamin C, and B vitamins. We often see amazing results with fatigue by simply supporting the adrenal glands and adding in a high-quality full-spectrum B vitamin complex. If someone is suffering from extreme adrenal issues there is almost ALWAYS an underlying cause like a leaky gut, chronic toxicity, a hidden infection (see below), or something that is providing a constant, low-grade stressor to your body at all times without you knowing it. 


Thyroid Imbalances

The thyroid gland regulates your body’s metabolism and energy and is closely related to the adrenal glands. In fact, the same hypothalamus-pituitary control tower has an HPT Axis - Hypothalamic-Pituitary-Thyroid axis. The thyroid can be either hyperthyroid - which means it is producing too many thyroid hormones, or hypothyroid, in which it is producing too little thyroid hormone. HyPOthyroidism is more commonly a cause of fatigue, lethargy, weight-gain, thinning hair, body temperature imbalances, and general poor feeling of well-being. 

The thyroid gland can be altered by many factors, shown in the image below. 

As you can see, there are a lot of factors that can affect your sensitive thyroid!

Approximately 80% of hypothyroidism is what’s called Hashimoto’s Thyroiditis. This is an autoimmune condition in which your immune system actually begins attacking your thyroid tissues, causing further inflammation and poor thyroid function. Sometimes the key to proper thyroid function isn’t the thyroid gland at all, but other causes such as leaky gut or intestinal dysbiosis. IT IS CRUCIAL TO HAVE PROPER THYROID TESTING TO DETERMINE WHERE THE REAL PROBLEM IS!  

Conventional medicine will determine thyroid diagnosis based on very limited testing of what is called Thyroid Stimulating Hormone, or TSH. This is horribly inadequate! A proper thyroid panel will (at least) include markers like T4 (free), T3 (free), Reverse T3 (rT3), T3 Uptake, and antibodies TPO and ATA to determine whether the immune system is attacking the thyroid. Watch my Thyroid Disease Webinar to learn about the thyroid, its pathways, what testing you need to have, and how you can support it. I have a lab result sitting in front of me right now that a conventional endocrinologist would likely say “your thyroid is fine”, but with further testing we discovered severe inflammation and antibody levels (meaning that the immune system is attacking the thyroid) that are 7x the upper limit! Synthroid is one of the top-selling drugs in America, and millions are told they need a medication without truly knowing where the problem lies. It’s crucial to get the right testing to know so you can address the underlying functional issue. 


Gut Dysbiosis

Your gut is populated by hundreds of trillions of microorganisms (bacteria, viruses, fungi, etc) which make up the environment known as your gut microbiome. These bacteria are responsible for an incredible array of important functions in your body including digestion, hormone balance (including conversion of thyroid hormone (T4) into the active form T3), neurotransmitter metabolism, brain function, detoxification, and keeps the delicate gut lining intact and healthy. When this microbiome becomes imbalanced or disrupted massive problems arise, including fatigue, brain fog, allergies, skin problems and many different autoimmune conditions. 

Good bacteria are known as probiotics, which are all the rage today as a supplement. Your gut really needs a healthy balance of good and bad bacteria, about 80% good to 20% bad. Your gut microbiome can become dysbiotic, or imbalanced, from many things in our 21st century lifestyle like a Standard American Diet (see our podcast on 7 Food Additives Causing Leaky Gut and Autoimmune Disease), stress, medications, toxins, and probably the worst offender - antibiotics. Think about an anti-biotic - it is specifically designed to kill bacteria. Which bacteria? It is not specific. It kills ALL bacteria (anti = no; biotic = life). One round of antibiotics can disrupt your microbiome for life! Another common cause of dysbiosis comes from day 1 of life, a C-section birth. When a baby passes through the vaginal canal he or she receives their first and most important dosage of probiotics. If the baby misses this probiotic dosage, a slew of health symptoms can arise in a very short time. It is even suggested that during a C-section birth a mother keep a sponge in her vagina to transfer the probiotics to the infant after birth!

Like the adrenal glands and stress, I have seen fantastic results by simply supporting a healthy microbiome with probiotics - for some people. At the same time (and more often than not), THIS ALONE IS OFTEN NOT THE ANSWER! Many people have had severe gut dysbiosis and leaky gut for years and need further work - cycling supplements, leaky gut support, drinking bone broth, and much, much more. Dr. David Perlmutter, a neurologist and NY Times best-selling author who specializes in the gut-brain connection, has said “the way to know if you have leaky gut is if you have a vowel in your name.” This is a joke, but the point is that in today’s society we all have intestinal permeability and gut dysbiosis and we all need to address the root cause of the problem. This is highly personal and you need to work with a physician or coach to help guide you! Watch my Gut Health Webinar to learn more details about your gut health and what you can do to support it.

 

Toxicity - Heavy Metals, Mold

Constant exposure to various toxins, which creates chronic toxicity, is a huge problem in today’s society. We live in a toxic, chemical soup. We have cancer-causing toxins in our kids toys, heavy metals in our food, additives in our vaccines, pollution in our air, antibiotics in our water - they are everywhere. Toxicity can cause hormone imbalance, gut dysbiosis, and can cause very severe fatigue. These toxins store in the cells of our body and affect our cellular membranes causing inflammation, including brain inflammation of the cellular membrane and the very delicate mitochondrial membrane. If you are suffering from fatigue, you have a mitochondrial problem! 

Your mitochondria produce all of your body’s energy, and you have between 400-4000 mitochondria in every single cell. Each neuron in your brain has over 3000 mitochondria, so if these powerhouses of energy are disrupted you will experience brain fog and fatigue. This brain inflammation can especially affect the hypothalamus and pituitary (see #’s 2 and 3 above) and disrupt the downstream hormone pathways (thyroid, adrenal, reproductive hormones) and create chaos in your body. 

Heavy metals are some of the worst toxins because of their ability to store in our cells and affect the brain - mercury, lead, and aluminum being the biggest culprits. These toxins are very hard to detect, because if they are stored in our cells then they will not be present in a conventional  blood, urine, or hair test. If you suspect heavy metal toxicity you absolutely have to work with a knowledgeable practitioner to determine if toxins are present and how to safely and effectively detoxify them. 

Another toxin that can absolutely rob your energy is mold. There are several types of dangerous molds, not just ‘black mold’, and there is a certain percentage of the population who are genetically susceptible to mold toxicity (approximately 24% of the population carry the HLA-DR gene). Severe mold toxicity can present as something called Chronic Inflammatory Response Syndrome (CIRS). This inflammation can and will absolutely affect the brain and cause severe fatigue along with many other debilitating symptoms. If you suspect mold toxicity it’s incredibly important to have the right home testing, the right body testing, and the right treatment. 

Dave Asprey, founder of the Bulletproof brand, has created an incredible film which is available for free on Youtube called Moldy Movie. If you or a loved one suspect mold toxicity, I would highly recommend watching the documentary to learn more. 


Hidden Infections

If someone is experiencing severe fatigue and they feel like they have “tried everything” mentioned above, there is often an underlying hidden infection that is stressing their body. Some of the most common hidden infections include: 

Lyme Disease (Borrelia bergdorferi) - the most common and fastest growing vector-borne infectious illness, this biotoxic disease is famous for being transmitted by ticks and presents with similar symptoms as mold toxicity - with debilitating fatigue being at the top of the list! Over 300,000 people are infected with Lyme disease each year according to the CDC, and roughly 40% of those infected will suffer long-term health problems. Like many causes of fatigue, there really isn’t a good solution in the medical model, and testing and treatment are often inadequate and leave the patient confused and with very little positive results.
Epstein-Barr Virus - the virus that causes ‘mono’, it’s estimated that 90% of people are carriers of EBV, but the infection can be ‘active’ or ‘inactive’. EBV is strongly associated with Chronic Fatigue Syndrome. 
Helicobacter pylori - this bacteria is also carried by many people worldwide (approximately 50%), and can be easily spread by sharing cups, silverware, etc. H. pylori can burrow into the stomach lining and causes low stomach acid, and is the most common cause of ulcers. It can also cause a myriad of other symptoms including nutrient deficiencies (especially iron and B12), small intestinal bacterial overgrowth (SIBO), gastritis, leaky gut, and chronic fatigue. 
Candida - There are 17 different strains of Candida, the most common being Candida albicans. This fungal overgrowth is one of the most common bloodstream infections in the United States. Although Candida can be present in many tissues (mouth, vagina) it is especially disruptive in the gut, disrupting normal flora and causing extreme fatigue and brain fog.

These infections are incredibly hard to deal with for several reasons. For one, many people carry the infections, and in some people they cause no problems at all. Second, the infections are hard to test for and find. Third, and probably most important, the infections can hide under something called “biofilms”, which allows them to hide from conventional antibiotics. 

Biofilms
Infections, especially bacterial and fungal infections, live and thrive in colonies. These colonies of bugs can produce a protective layer that they can hide under called a biofilm. This slimy layer of biofilm protects the colony and allows it to grow, move, and exist while being protected from the immune system, stomach acid, and even the most powerful antibiotics. Biofilms can contain one or more strains of bacteria, and can even contain viruses that are sharing the biofilm for protection. 

In my experience, if an underlying infection is not clearing with anti-microbial/anti-fungal herbs, it is important that you address the biofilms! When working with a practitioner it is important that they understand biofilms and how to dissolve them. 


Conclusion

These are not the only causes of fatigue, but clinically I believe they are the Top 6 Causes that need to be considered. Fatigue is very multi-factorial, so it is crucial that you work with a coach or practitioner who understands these causes, understands the proper testing to perform, and understands how to address these causes in the right order. If you get to the root cause, you can absolutely regain your energy and get your life back!