Fatigue is an extreme lack of energy that drives many to seek medical care. While fatigue can be a normal response to many physical activities and events, unrelenting fatigue warrants a medical workup.

   Fatigue is a sense of severe tiredness, exhaustion or lack of energy. It can be classified as secondary, physiologic or chronic. Secondary fatigue is caused by an underlying medical condition, generally lasting six months. An imbalance in daily lifestyle routines causes physiologic fatigue. It usually resolves with rest and has minimal impact on the ability to perform activities of daily living. Chronic fatigue lasts longer than six months and does not improve with rest.

   While most people feel being sleepy, lacking motivation or concentration or decreased endurance is fatigue, there are other symptoms. They include changes in mood (depression, anxiety, nervousness and irritability), trouble concentrating, low motivation, muscle weakness and muscle and joint pain. Red flag symptoms that are more serious include unexplained weight loss, chronic fever, night sweats, enlarged and tender lymph nodes, difficulty breathing, confusion and coughing or throwing up blood.

   Fatigue may be caused by the following.

   Illness and health conditions: These can include hypothyroidism, Lyme disease, asthma, diabetes, obstructive sleep apnoea, rheumatoid arthritis, fibromyalgia and heart disease.

   Chronic infections: Studies have shown that patients complaining of chronic fatigue have lab markers consistent with active pathogen activity and infection. These infections may be either viral or bacterial. Viruses cause nervous system fatigue, which can be the deepest and most persistent type of chronic fatigue.

   Diet imbalances and micronutrient deficiencies: Not eating enough or eating foods that are not nutritious can cause fatigue. Foods can also cause spikes in your blood sugar and when it drops you feel fatigued. Eating a healthy, well-balanced diet is the best way to combat this. Taking supplements that promise to reduce fatigue will usually not produce any results. That’s because so many different vitamins are absorbed differently.

   Lifestyle factors: These include physical exertion, lack of physical activity, lack of sleep, being overweight or obese, periods of emotional stress, boredom, grief, using alcohol on a regular basis and using illicit drugs, such as cocaine.

   Impaired methylation: Genetic mutations which affect the methylation pathway are associated with chronic fatigue.

   Adrenal fatigue: This is also known as HPA (hypothalamic – pituitary – adrenal) axis dysregulation. Stress, whether emotional or physical, is defined as a real or perceived threat to our homeostasis. When our body is in fight or flight mode, the body releases hormones that cause the heart to beat faster, increases blood sugar to fuel muscles and increases the rate of breathing. When the system is activated too often and doesn’t have time to rest, it leads to adrenal fatigue.

   Gut dysfunction: There are a number of these including small intestinal bacterial overgrowth (SIBO), chronic infections (bacterial, viral, parasitic), dysbiosis and fungal overgrowth, intestinal permeability and food intolerances.

   Hormones: Several hormones can contribute to fatigue. The thyroid and adrenal gland are two that can be affected by hormones.

   Mitochondrial Fatigue: Our mitochondria are the engines of our cells, producing energy. If they get damaged, they can not do their job. The body can repair these “engines” but if the onslaught is so persistent, the body is unable to repair your mitochondria fast enough. If you suffer from this, you feel like you are in a fog all of the time. Heart failure is a severe form of mitochondrial damage.

   Sleep Disorders: Undiagnosed or unmanaged sleep disorders disrupt healthy sleep and contribute to pathological fatigue. Examples include insomnia, sleep apnea and narcolepsy.

   Medications: Many commonly prescribed medications cause sleepiness as a common side effect. The most common culprits of medication-induced fatigue include antihistamines, muscle relaxants, antidepressants, topiramate to treat seizures, beta-blockers, opioids, benzodiazepines, antibiotics and chemotherapy.

   Environmental exposures: Some of the main ones are lead, mercury and carbon monoxide.

   There are natural solutions that can help. There are plenty of things you can do to help boost energy and ensure you’re eating a healthy, well-balanced diet. Try an anti-inflammatory diet or adding anti-inflammatory foods. Limit inflammatory foods like sugar, fried foods and processed meat. Stay hydrated. Limit your caffeine intake. If you feel too tired or don’t feel hungry, try smaller meals more frequently. Decrease your sugar consumption. Fill up on non-starchy vegetables. Limit processed foods. Include healthy fats.

   There are some good supplements to consider taking. They include vitamin D, zinc and B complex.

   Chronic stress and fatigue are signs that your adrenals are overworked. Supporting the adrenal glands and resetting the body’s stress pathways can be important in treating fatigue. Along with eating a nutrient-dense diet focusing on foods rich in B vitamins, vitamins C and E and magnesium, adaptogenic herbs like Asthwagandha, Schisandra and Rhodiola effectively reduce feelings of stress and support adrenal function.

   Often we can not change our external stressors but we do have control over two factors that make all the difference.They are our mindset and our internal biochemistry.

   Supporting the thyroid is very important. Vitamins A, Bs and D, selenium, magnesium, iron and zinc can be maximized through diet and supplements.

   Balancing the sex hormones is also important. Ensuring that each hormone is within optimal range and in a healthy ratio compared to one another can support mood and energy. Eating microbiome- and liver-friendly foods like garlic, artichokes, beans, dark leafy greens and cruciferous vegetables support the elimination of excess estrogen. Reducing alcohol and caffeine intake can also help estrogen metabolism. Stress management and exercise, especially strength training, can optimize testosterone levels.

   Chronic stress, dysbiosis and inflammatory foods can increase the permeability of the gut lining causing leaky gut syndrome. Avoiding food sensitivities, probiotics, L-glutamine and anti-inflammatory herbs like ginger and curcumin can aid in the restoration of the gut lining and intestinal microbiome.