“Why am I so tired?” 5 biological causes of your constant fatigue

“Why am I so tired”

“Gosh why am I so tired all the time”? Is that a question you are often asking yourself?

Are you experiencing lack of energy, feeling constantly tired and sluggish? Struggling to focus at work and have a decent social life without feeling totally wiped out?

You’re not alone

Tiredness and fatigue are in fact one of the most common complaints clients present to their GP with and I have seen a lot of clients who suffer from this in my own practice.

A 10-year-long study conducted in the UK reported a 1.5% annual increase in new tiredness/fatigue (NICE).

Lifestyle for sure can impact our energy and cause fatigue. Sleep deprivation, prolonged screen time, not having boundaries are known causes of fatigue. 

But sometimes we need to dig a little deeper. Especially when the fatigue has been ongoing with no apparent cause. 

In this blog post we discuss 5 common biological causes of fatigue including signs and symptoms to look out for.

5 biological causes of fatigue

1. Nutrient deficiencies

In most cases having low or insufficient levels of macronutrients, vitamins and minerals is the result of inadequate intake due to poor dietary choices.

Majority of people’s diet is mostly made up of convenient, refined products that have been stripped of essential nutrients.

Another factor that can have an impact on our nutritional status is low absorption of nutrients. This is usually the result of digestive issues and enzyme insufficiencies, like low stomach acid, leaky gut, chronic diarrhoea and so on. 

Minerals and vitamins work in synergy to provide us with energy so keeping a balanced diet is key. 

Micronutrients that are essential for energy production include B vitamins, especially B12 and Folate, Vitamin C, Iron, Zinc and Magnesium (source). 

    Magnesium is needed as a cofactor for more than 300 enzymatic processes in the body, one of the most important being the production of energy in the form of ATP (source). Magnesium is quickly depleted with stress and so it comes with no surprise that in our overworked and stressed society Magnesium Insufficiency is rather common.

    You can check your serum Magnesium level with a blood test, however Red Cell Magnesium seems to be a better indicator of Magnesium status.

    Iron and B12 are involved in red blood cell formation and energy metabolism respectively. Low levels of these two can sometimes cause anaemia, which manifests with profound fatigue, pale and dull skin, hair thinning and in more severe cases palpitations, dizziness and shortness of breath. In this instance it’s important to discuss your symptoms with your GP and get a blood test done to assess your serum levels.

    Tips  —  Improving our diet is the first step in ruling out other possible causes of fatigue. Focus on whole foods and limit refined products such as white flour, pasta and baked goods. Include pumpkin seed and green leafy veggies for magnesium and good quality meat for B12. If you follow a plant based diet learn how to pick the best B12 supplement for you. 

    Run blood tests yearly, especially if you experience chronic or recurrent fatigue

    2. Poor detoxification pathways

    The liver is the main organ responsible for detoxifying our systems, filtering the blood, eliminate spent hormones and converting toxins so they can be excreted from our bodies without building up.

    High alcohol and processed food intake, drugs (pharmaceutical and recreational), genetic predispositions and low nutrient status can all put an extra load on the liver and impair its functions. And ultimately this leads to fatigue and sluggishness.

    Another thing to add is  that we store some glucose in the liver, so when it isn’t functioning optimally, it will struggle to regulate glucose storage and use for energy.

    The Skin and Gut are two other important systems in the detoxification process and it’s where we might expect to see signs and symptoms related to a sluggish liver.

    Itchy, irritated skin, breakouts and acne, changes in bowel movements (constipation or diarrhoea) may mean your liver needs some support (source).

    Tips — Supporting the liver can help if this is the main cause of your constant fatigue. Start by cleaning up your diet, increase your fibre intake to ensure regular bowel movement, ensure adequate water intake, increase protein intake, try warm water and lemon in the morning, bitter foods, grapefruit juice, milk thistle, eat more beetroots. 

    Support the lymphatic system to eliminate toxins by sweating regularly (whether that’s through exercise or in a sauna), try dry brushing or lymphatic massage done by a professional.

    It is possible to check liver function through conventional and functional blood testing.


    3. Chronic stress (HPA axis imbalance)

    We hear about stress more and more often these days and yes, you’ve guessed it, there is a correlation between stress and constant fatigue.

    Acute stress is fastly resolved and usually has little to no health consequences.

    But when we are in a state of chronic stress our adrenal glands (two little glands that sit on top of your kidneys and regulate the release of cortisol) can go into overdrive, resulting in constant high levels of cortisol and other stress hormones.

    Chronic stress can also affect our energy and cause fatigue by affecting our sleep.

    It is in fact quite common for us to experience insomnia or other sleep disturbances when we’re confronted with a stressful period at work, or in our private lives (source).

    If prolonged, chronic stress could potentially lead to adrenal fatigue, a condition characterised by loss of response from the adrenal glands and a chronically low release of cortisol, which will manifest with low moods, cravings, brain fog and ultimately, chronic fatigue.

    Tips Finding ways to manage your stress is more realistic than avoiding stress altogether. Experiment with exercise, yoga, breathwork, meditation, long walks, painting and anything else that can help you relax.

    It is possible to assess your adrenal health through saliva or urine cortisol and DHEA tests.

    4. Hormonal imbalance

    In women, fatigue can also be the result of fluctuations in hormones.

    Although it is normal for our hormones to fluctuate and change in concentration throughout the menstrual cycle, what we don’t want is ending up with having too much oestrogen or progesterone.

    On one hand, oestrogen build up will put an extra load on the liver, on the other hand excess progesterone will increase GABA (the relaxing neurotransmitter).

    Both of these can increase our chances of experiencing fatigue.

    Look out for other signs and symptoms of hormonal imbalances such as Premenstrual Syndrome (PMS) and Premenstrual Tension (PMT), breakout around ovulation or before your cycle, mood changes, irregular cycles, heavy bleeding, period cramps, cravings.

    Another hormone which could cause fatigue and lethargy is testosterone.

    Although commonly associated exclusively with males, women too produce testosterone in the ovaries and adrenal glands.

    Low testosterone will also manifest with low libido, low mood and may affect fertility.

    Another hormonal imbalance commonly associated with fatigue is low thyroid function, also known as underactive thyroid or hypothyroidism.

    In this condition the thyroid gland (a butterfly shaped endocrine gland located in the front of the neck) does not produce enough thyroid hormones, which is needed for the regulation of the body’s metabolism amongst other functions.

    Constipation, difficulty in losing weight, poor memory and concentration, cold extremities and chronic digestive issues can all be signs of low thyroid function.

    Tips — Optimal hormonal balance can be hard to achieve without testing or help from a qualified professional, but here are some tips to promote sexual hormone balance. Ensure regular bowel movements, support the liver detoxification (see above), experiment with seed cycling, reduce exposure to endocrine disruptors found in your most immediate environment, eat and exercise to support each phase of your menstrual cycle.

    It is possible to assess your hormonal status throughout different stages of your cycle as well as running a thyroid panel through your GP or functional testing labs.

    5. Unstable blood sugar levels

    If you’ve been here before you might know I talk about the importance of balancing blood sugar levels all the time and I have shared tips and tricks on how to build meals that support blood sugar balance in the past (shall we link to this https://isawelly.com/what-is-a-healthy-balanced-diet/?).

    Essentially, glucose in the blood is transported by insulin into the cell, where it can be used for energy production. Carb heavy foods such as pastries, white bread and other baked goods, sugary drink, white rice and pasta (especially if consumed alone) will cause a bigger spike in blood glucose followed by a drop. And so we enter the carb-induced blood sugar rollercoaster.

    But there are other lifestyle factors that can have a negative impact on blood sugar levels, such as high and chronic stress, meal timing, lack or excess movements, impared sleep and gut health.

    Fatigue is more often associated with low blood sugar, which can also manifest with dizziness, sudden hunger, irritability and cravings.

    But it can also be related to high blood sugar levels, like in the case of unmanaged diabetes.

    Tips — General tips include sticking to three meals a day and avoid snacking, choosing complex over whie carbohydrates, building balanced meals that contain all three macronutrients (protein, complex carbs, healthy fats) and fibre. Some  supplements can also help to optimise insulin response. Adequate sleep and stress management are also important pillars in blood sugar management.

    I hope this has shed some light on some of the most common biological cause of fatigue and that it might have helped you in getting closer to the root cause of your own symptoms.

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