We’re a country bogged down by extreme exhaustion. Chronic fatigue syndrome affects more than 1 million Americans—more people than multiple sclerosis, lupus, and some forms of cancer. Plus, an estimated 70 million people in the United States currently live with insomnia and sleep disorders, fueling debilitating tiredness. Many more suffer from undiagnosed fatigue disorders.
What is the underlying cause of this epidemic of sleepiness? Here are the 10 causes of chronic fatigue that I see most often:
1. Thyroid problems
Thyroid issues affect around 20 million Americans, and low thyroid function, or hypothyroidism, is one common problem. Every cell of your body needs the thyroid hormone for energy. Sadly, there are many underlying thyroid problems that go undiagnosed.
What to do: If you suspect you have a thyroid problem, the first step is to do complete lab testing to find out for sure. Thyroid conversion dysfunctions, thyroid resistance, and autoimmune attacks on the thyroid, such as Hashimoto’s disease, all require different care.
2. Insulin resistance
Metabolic syndrome and diabetes are two varying forms of the same thing: insulin resistance. When your body is resistant to insulin, glucose cannot get into your cells to create ATP, your body’s gasoline. This can leave you feeling tired and irritable. This problem is also associated with sleep apnea, further fueling fatigue.
What to do: In addition to eating a clean diet consisting of vegetables, fruits, meats, and healthy fats, I also recommend natural medicines such as alpha-lipoic acid, chromium, and cinnamon—some of my favorite blood sugar stabilizers.
3. Adrenal fatigue
Your brain tells your adrenal glands what to do through a complex web of communications called the hypothalamic-pituitary-adrenal axis (HPA axis), or simply the brain-adrenal axis. Adrenal fatigue happens when that brain-adrenal communication isn’t working well, causing cortisol, your stress hormone, to be too high or too low. This leaves you feeling exhausted and cranky and not sleeping well.
What to do: Focus on things that activate your resting, parasympathetic system. I’m a big fan of adaptogenic herbs like ashwagandha, maca, holy basil, and Rhodiola to balance cortisol levels. Consistent mindfulness meditation is also another thing that I did to rehab my own adrenal fatigue.
4. Viral infections
I find that chronic low-grade viral infections are a common cause of fatigue in patients. Herpes viruses such as Epstein-Barr virus (EBV) and human herpes virus 6 (HHV-6) and HHV-7 have been linked in some studies to chronic fatigue.
What to do: I recommend natural antiviral support such as astragalus, olive leaf, larrea tridentata, bee propolis, melissa Officinalis, L-lysine, zinc, and vitamin C. Discuss with your health care practitioner what might be right for you.
The food we eat, the water we drink, and the air we breathe is not what it used to be, thanks to pervasive toxins. And it could be affecting our energy: One study published in the journal Science of the Total Environment showed an association between exposure to environmental toxins and an increase in chronic fatigue.
What to do: Make sure to bring detoxing foods into your daily diet. Garlic, cilantro, parsley, plantain leaf, spirulina, sage, and red clover blossom are some of my favorites. Whether you use them in smoothies, on salads or with your meals, rotating these foods throughout your week is a great way to make meals your detoxing medicine.
6. Nutrient deficiencies
You need the right nutrients for optimal vitality. Deficiencies in vitamin D, iron, and B vitamins can especially leave you feeling groggy and spent.
What to do: Get labs done to check your levels. Supplementing and focusing on foods that contain these nutrients is a great idea.
7. An unbalanced diet
The foods you eat are your medicine and your fuel. I oftentimes see fatigue occur when patients are not eating the right ratio of fat, protein, or carbohydrates that works for their body.
What to do: I recommend starting with a macronutrient ratio of 20 percent carbohydrates (coming from fruits and starchy vegetables) 65 percent fat (coming primarily from coconut products, avocados, olive oil, and grass-fed meats), and 15 percent protein (coming primarily from clean organic meats). Then, adjust over time to see where you feel the best. We are all different, so a diet that works for one person may not be optimal for you.
8. Gut problems
A “leaky gut” is when your intestinal lining is damaged, allowing undigested food proteins and bacteria to pass into the bloodstream, causing an immune response and inflammation throughout the body. One study in the Journal of Affective Disorders linked increased intestinal permeability to chronic fatigue.
Candida overgrowth and undiagnosed food intolerances can also contribute to you feeling drained.
What to do: Healing your gut involves a comprehensive approach. The elimination diet is the gold standard for this. I also typically use natural medicines like L-glutamine, probiotic therapy, and bone broth to heal the gut.
Inflammation is a commonality between most chronic health problems. Systemic inflammation can weaken your body’s ability to handle stress very well and can lead to fatigue and brain fog.
Every pharmaceutical drug has side effects, and fatigue is one of the most common. It amazes me how little people know about the side effects of the drugs they take every day.
What to do: If you’re on any medications, find out if fatigue is one of the side effects. If you believe your medication is causing or adding to your fatigue, discuss with your doctor what other options you might have.
Will Cole, IFMCP, DNM, D.C., is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is the host of the popular The Art Of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian,The Inflammation Spectrum, and the brand new book Gut Feelings: Healing the Shame-Fueled Relationship Between What You Eat and How You Feel.