The Top 10 Most Overlooked Causes of Fatigue

November 16, 2021

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“Why am I always so tired?”

Today, I wanted to take some time share the most common (and overlooked) causes of fatigue that I see among my clients. Because truthfully, fatigue isn’t always a matter of getting enough sleep. And I’m sure that since many of you in here are very active, it can be overwhelming, perplexing, and dang frustrating when you DO get those 8-9 hours and you’re still very tired.

1. Chronic constipation: This is #1 because it’s by far the most common thing I see. And before you rule this one out right away, make sure you do a transit test first (record the time between ingestion and elimination after eating a cup of corn). YOU CAN BE GOING EVERY DAY AND STILL BE BACKED UP. If you eliminate 80% of the waste products from Monday on Tuesday, but 20% is still backed up, and then you repeat this cycle for 10 days, that TWO full days of waste just hanging out in your colon.

The reason fatigue increases exponentially with chronic constipation is because your body is overburdened with excess toxins, waste and hormones that normally and easily get excreted with the stool on a daily basis. If you don’t take out the trash 3 days in a row, it starts to really add up and weigh you down!

You have to CLEAR the back up first and then keep rhythm going with dietary and lifestyle changes conducive to healthy, daily BMs.

2. Low iron: Very common amongst women. Most of us don’t check our levels enough. No, you don’t need a ferritin level of 75 or 100 to be healthy, BUT if your levels drop below 20, you’re at risk of deficiency. I always recommend trying a whole food based supplement first to see if that bumps levels (it’s just a powder with a few whole foods that are rich in iron). Once your levels are too low, it can be really hard to raise them back up.

3. Low thyroid: Hypothyroidism is very common amongst women as well—your thyroid gland is like your body’s thermostat. If it’s low, everything slows down and fatigue sets in. Problem is, most doctors’ idea of optimal TSH is way to high of a range. I have a very different perspective on what optimal TSH levels look like, so I always ask my clients to pass them along—then, you have to look further into T4/T3, etc. to further investigate.

4. Parasites: If you have chronic GI issues such as loose stools, bloating, brain fog, and you’re also experiencing fatigue, it’s probably time to look further into the possibility of parasites—they’re much more common than you think, especially with the huge increase in prescription medication for stomach acid suppression (PPI’s and antacids—stomach acid is your body’s first line of defence against these kinds of things).

5. SIBO: Again, this is a condition that is seen with more than one chronic GI symptom, BUT it can lead to fatigue as well. Small intestine bacteria overgrowth is when large amounts of bacteria live in the small intestine (most of them are suppose to live in your colon or large intestine where they make up your gut microbiota) due to poor motility, poor digestion and overall poor gut health. When those bacteria come in contact with food in the small intestine, they ferment those foods and create substantial amounts of gas. This can be really draining over time and lead to fatigue amongst other symptoms. SIBO needs to be addressed properly with anti-microbial treatment and motility support.

6. Chronic diarrhea: Diarrhea is when food is moving too fast through the GI tract. As a result, many nutrients aren’t absorbed properly, leading to nutrient deficiencies and fatigue. It’s important in this case to discover what the cause of the diarrhea is in the first place (could be celiac disease (below), SIBO or parasites (above), IBS, IBD or something else).

7. Undiagnosed celiac disease or non-celiac gluten sensitivity with extra-intestinal symptoms: Celiac disease can often go undiagnosed because lower grades of the disease are often missed on blood work. Celiac disease is when the body attacks the intestines upon the consumption of gluten. Common symptoms include loose stools, bloating and gas, but chronic fatigue, migraines, brain fog, and night terrors can also occur (among other symptoms). NCGS is similar in that it’s not celiac disease, but the sensitivity the person has to gluten presents with non-digestive symptoms such as brain fog and fatigue. However, this isn’t as common as people think and cannot be mistaken for classic gluten sensitivity that presents with digestive symptoms—this is often just a sensitivity to fructans, the high FODMAP carbohydrate found in wheat.

8. Low Vitamin D3: Vitamin D is an incredibly important nutrient that so many of us are low in due to lack of sun exposure (mostly applies to folks who are north of the equator) and low intake from the diet. Low Vitamin D can lead to fatigue among other symptoms—I highly recommend that anyone who lives north of the equator should supplement with this vital nutrient (that some scientists are trying to re-classify as a hormone, instead of a vitamin).

9. Low Vitamin B12: This isn’t just a vegan population problem anymore! B12 is very important for the nervous system and can greatly impact energy levels. Since B12 is created by micro-organisms/bacteria in the gut of mammals and in soil, it’s no wonder both vegans and meat eaters alike are commonly low in this nutrient these days. Our microbiome can produce some, but it’s not enough for what we need, plus, many of us have poor gut health which would naturally equate to lower levels of B12 being produced. Livestock such as cows are also being injected with B12 because their guts are also incredibly damaged from antibiotics administered during “growth” in feedlots. Soil conditions are so sterile compared to 100 years ago, so vegans are also out of luck. I always recommend a B12 supplements to all vegans or plant eaters, but am often inclined to recommend one to meat eaters too.

10. Allostatic load/adrenal fatigue: When the body is under a chronic state of stress for too long, and cortisol and adrenaline are on high output, the body eventually down-regulates this process and suppresses adrenal gland function to protect itself. This is when allostatic load or adrenal fatigue set in. Chronic fatigue that isn’t alleviated no matter how much you sleep. I don’t like calling it adrenal fatigue because the adrenal glands aren’t actually getting tired, the body is simply protecting itself. High cortisol/adrenaline output can be very detrimental to health over time since the role of cortisol/adrenaline is to increase blood sugar, shut down digestion, and raise BP/HR.

I’ve definitely missed quite a few but these are the top ten that come to mind! What stands out the most to you?

– Ros

NOTE: Please get your blood levels checked for any nutrients recommended above and then seek out the help of a professional to supplement, if applicable.

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 I help ambitious women struggling with chronic gut health imbalances overcome their symptoms.