Why am I always tired? The many causes of fatigue
Fatigue is one of the most common symptoms I see in my practice. The tricky thing about low energy is that it can be caused by so many different root causes. Luckily, there are lab tests that can be ordered and a targeted history taking can help get to the bottom of your tiredness.
Without further ado, here are some causes of low energy!
Poor sleep
Ok this one may seem like a no brainer but sleep is so crucial to so many pieces of our health, especially for my athletes who are reading this. While we sleep, hormones are regulated, the immune system is busy at work and cell recovery and tissue repair occur. And of course, if you’re not sleeping long enough (at least 8 hours for most folks) or having restful sleep, you will wake up in the morning feeling tired.
However, there may also be a chance that you might be waking up throughout the night and you’re not actually aware of it. Sleep apnea, for example, is when you stop breathing for short periods while you sleep. Some individuals who have sleep apnea might not even know that this happens to them before they get this diagnosis. Check out the STOP-BANG questionnaire to decide if you should ask your doctor to assess you for sleep apnea.
There are a few lifestyle habits you can modify to reduce the chance of you waking through the night and improve your sleep quality. These include no alcohol before bed, no caffeine after 12pm and having a high protein snack before bed to reduce a drop in blood sugar levels which may wake you through the night.
Thyroid function
Whether you have been given a diagnosis of a thyroid condition (more likely hypothyroidism for low energy) or your thyroid isn’t functioning optimally, both can impact your energy levels. I see lots of patients who have a “normal” Thyroid Stimulating Hormone (TSH) level but are on the higher end of normal and this can impact their energy levels. This brings me to an important point. Blood work results can be normal but this doesn’t mean that they are optimal!
I see a lot of thyroid dysfunction in my athletes but also non-athletes as well. If you’re feeling like you’re dragging your feet, having your thyroid function tested through blood work is a good idea!
Low iron, anemia and/or low vitamin B12
Iron is an essential mineral found in foods such as red meat, fish and poultry (“heme” iron) as well as plant sources (“non-heme” iron) such as spinach, tomatoes and oats. Heme iron is more readily absorbed than non-heme iron.
Iron is important for our health because it helps our red blood cells carry oxygen to all over our body. This is extremely important in aerobic exercise such as running but generally for energy levels as well. There are certain populations that are more susceptible to low iron than others. These include menstruating women especially those with heavy periods, vegan and vegetarians. Some individuals generally have a hard time absorbing iron as well, this can be helped through combining sources of vitamin C with iron and trying different forms of iron. Also, dairy, high fiber foods and caffeine all reduce the absorption of iron so eating iron rich food away from these foods is best. If you’re feeling tired despite getting 8 hours of good quality sleep, you should have your iron levels tested.
Also, iron levels can get too high and can cause negative health outcomes if they get excessive. So I HIGHLY recommend having your levels tested before supplementing with an iron supplement to avoid any negative health impacts.
Anemia is when the number of red blood cells and hemoglobin in the blood are too low. This can be present WITHOUT iron deficiency. So having a complete blood count (CBC) run is important in the investigation of low energy as well. Finally, vitamin B12 also plays a key role in red blood cell formation and feelings of energy. Vitamin B12 is only found in animal products so folks who eat vegan diets are more susceptible to having low B12. Therefore, B12 is another key marker to test on your blood work to distinguish the root cause of your fatigue. And again, you may fall into the normal range for iron (ferritin - storage form of iron), red blood cell count, hemoglobin and vitamin B12 but are you optimal in each of these?
Pregnancy
Is your period late? Fatigue can be one of the early signs of pregnancy! If there is any chance that you might be pregnant, you can take a urine pregnancy test at home to assess this. If it comes up positive, book an appointment with your doctor to discuss future steps!
Overtraining
Overtraining is when your exercise volume isn’t matched with enough recovery time or isn’t met with enough fuelling, chronically. Signs and symptoms of overtraining are fatigue, increased perceived effort, decreased performance, chronic injuries and more.
Things to improve your recovery include fuelling properly for your activity level and specific sport, taking rest days and getting good quality sleep. Having a qualified and knowledgeable practitioner assess if overtraining is causing your fatigue could make a huge difference in your energy and performance.
There are several other causes of fatigue including mental health conditions, autoimmune conditions and even serious things like cancer. Fatigue is not a symptom to ignore, but can be improved in most cases if the root cause is found!
