Causes of Fatigue

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Tired all the time? There can be many causes of fatigue, and obviously, if the fatigue persists you should see a doctor. But your doctor may not know the answer…

Meanwhile, you need to work, function, and live.

So let me share some of the causes of fatigue that repeatedly came up during my decades of treating patients, and which might not be so obvious. You might find the answer to your fatigue among them, and also what you need to do to erase that fatigue.

Let’s get right to it, but be sure to read down to the bottom, where I share several ways to beat fatigue, which may spare you some detective work.

# 1: Stress

Most people equate stress with a bit of caffeinated edginess. But day-in-and-day-out stress, whatever is worrying or aggravating you on a continual basis, can definitely drain your body of energy and natural hormones, and your ability to stay healthy. People usually don’t connect fatigue to financial, job, or relationship issues, to a loss of a loved one, or to the daily grind often encountered by women, of caring for children and aging parents. These are big causes of fatigue: they zap your energy, and, even more than that, threaten your very health. Learn more about stress and what you can do to reduce it.

 # 2: Insomnia

The body works on a cycle of rest and activity. If you don’t get enough rest, you can’t perform well. In other words, your battery needs recharging to keep you running. Sleep deprivation shortchanges your body of the necessary rest it needs to recover from daily activities. A third of adults have sleep problems, and it often stems from worry and anxiety stoked by reason # 1. If insomnia is a problem, check this article for some practical solutions that have worked for my patients. One overlooked cause of insomnia is the excess amount of electrical gadgets in the bedroom which produce potentially disturbing “electrosmog,” that is, electromagnetic fields that have been documented to interfere with melatonin, the body’s sleep hormone. Clear out your bedroom of electronics as much as possible. You can learn more by visiting the EMF section, here at HMDI.

# 3: Refined Carbohydrates and Sweets

Are you an aficionado of sweets and refined carbohydrates like cakes, cookies, and sodas? I didn’t say addict, just an aficionado. C’mon, admit it. It’s well known among nutritionally-oriented doctors like me that eating too many carbs and sweets will send your energy level on a roller coaster ride. The body breaks down refined carbs and sugar into glucose. The pancreas then overproduces insulin to bring down the level of glucose. So first you get a bit of an energy spike, then an energy plunge, right down into the pits. You want your energy level nice and steady. To do so you must reduce your intake of refined carbs and sweets. That means generally avoiding the so-called high glycemic foods, such as simple and highly processed carbohydrates, that create the energy ups-and-downs. To stabilize your energy level and get more nutrition out of your diet, favor low glycemic foods like fruits and vegetables, healthy fats like olive oil, organic butter, and coconut oil for cooking, as well as healthy proteins from wild fish (such as salmon), free-range poultry and meats, and raw nuts.

For Weight Loss and Health, Know Your Carbs

# 4: Low Thyroid

You may not have heard about it, but there is an epidemic of underactive thyroid. Low thyroid can affect your metabolism and how your body processes nutrients to generate energy. Ask your doctor to check your thyroid and your iodine level. You may need to see a holistic doctor/naturopath who can check that for you. Many people are deficient in iodine, and not enough iodine in the diet can undermine thyroid function. I recommend reading this article at HDMI written by women’s health expert Christiane Northrop, M.D.

# 5: Sedentary Lifestyle

People don’t get it. They say, “I’m too tired to exercise.” Often, that’s the reason why they are so fatigued, because they are de-conditioned. I always nagged my patients to exercise because I knew it could make a big difference in their quality of life. Usually, they wanted a prescription drug and instead I gave them a prescription to get moving. This is why cardiac rehabilitation emphasizes exercise after a heart attack, because it is critical and people improve significantly. My prescription isn’t running a marathon or even going to the gym. Just go out and walk for 20 minutes a day, or 10 minutes twice a day, or go dancing. You’ll be surprised how little it takes to jump-start your energy level. Researchers have even found that women who are sedentary in general have less fatigue, and more vigor and vitality, when they meet basic physical activity recommendations.

# 6: Vitamin B-12 Deficiency in Vegans and the Elderly

If you fit into these categories, and have constant fatigue, it’s a good idea to think about a deficiency of vitamin B12, an essential nutrient that helps keep the body’s nerve and blood cells healthy. Not enough vitamin B12 can cause tiredness, weakness, loss of appetite, and anemia. It is found naturally in many animal foods: fish, meat, poultry, eggs, and dairy products. That’s why vegans often are deficient. Seniors may become deficient because their body doesn’t produce enough hydrochloric acid to break down the animal protein and permit absorption of B12. One easy solution is to take a B12 supplement and look for breakfast cereals and other food products fortified with B12. Pernicious anemia is a condition in which your stomach can’t make intrinsic factor, a protein that is also critical for B12 absorption. Your doctor can check you out for anemia. You may require vitamin B12 shots. In my practice, I found deficiencies among many elderly patients and often was able to resolve their fatigue problem with a monthly B12 shot.

Reason # 7: Medication

Medications are another cause of fatigue, led by sleeping pills, blood pressure medicines, steroids, diuretics, and antibiotics. Many people, particularly the elderly, take multiple drugs, and thus increase the chance of developing side effects, including fatigue. Every drug, in fact, has side effects, including one big one that doctors rarely ever consider: depletion of nutrients. That, in itself, can cause fatigue, among many other problems. In my own field of cardiology, I’ve seen fatigue result from cholesterol-lowering statin drugs, beta blockers, blood pressure pills, and diuretics. Drugs, moreover, erode the function of mitochondria, the structures within cells where cellular energy is produced. This kind of mitochondrial “toxicity” is a major problem, but an unfamiliar one, to most doctors. If fatigue comes on unexpectedly after you start a new prescription, be sure to speak to your doctor about it. Listen to your body.

# 8: Antibiotics

Even though antibiotics fall under the category of medication, I want to make a big deal out of them for a couple of reasons. One is that people run to their doctors at the first sign of a cough, sneeze, or cold, and demand an antibiotic. As a result, these drugs are highly overprescribed and often don’t effect the length or intensity of a cold or flu, which are caused by a virus. Antibiotics combat bacteria but they don’t take out viruses. One common side effect is fatigue which results from the antibiotic killing not only harmful bacteria but also killing the absolutely essential benign bacteria that reside in your gut and that are intimately involved in immune and digestive functions. When depleted, your digestion and resistance suffer, and fatigue and diarrhea can develop. The solution is to take a probiotic supplement that replaces the good bacteria. You’ve likely heard of them: acidophilus and bifidabacteria, are two common strains. You can find probiotics in a health food store. Take them for a month or so after an antibiotic course, or better yet, take them routinely.

# 9: Chronic Illness

Any disease can drain the body of energy simply because it’s running abnormally and using resources to try and repair what’s gone wrong. I’ve seen fatigue thousands of times in connection with heart disease, where a heart isn’t pumping enough blood through the system to keep the body adequately nourished and oxygenated (See reason # 10 below). The term chronic fatigue is often used – way overused, I would say – when doctors don’t know why a patient is constantly tired. There could be many reasons that conventional doctors overlook or are not aware of, such as multiple chemical sensitivities, electromagnetic field sensitivity (“electro-sensitivity”), undiagnosed Lyme disease, mold, and food or environmental allergies. If a regular medical doctor can’t find the cause of your chronic fatigue, see a naturopath or an environmental medicine doctor (see solution #3 below) who may be better able to find the problem and make individualized recommendations. Meanwhile, check out the general solutions below.

# 10: Undiagnosed Heart Disease

I’ve seen many new patients complaining mostly about fatigue. Their primary doctors suspected some kind of heart disease and referred them to me. Upon examination and testing, many such patients indeed had silent ischemia (not enough blood to the heart muscle because of arterial blockage), undiagnosed heart failure, and/or cardiomyopathy. The heart’s pumping capacity was suffering and the body wasn’t getting enough blood resulting in fatigue. Many women were suffering with diastolic dysfunction (DD), a progressive stiffening of the heart muscle that weakens the left ventricle so that it can’t relax sufficiently after contraction. DD causes shortness of breath and fatigue, leads to heart failure, and is frequently overlooked by doctors. The “Awesome Foursome” supplements I describe below often work very well, either by themselves or along with other treatments, for the fatigue generated by these conditions.

How to Beat Fatigue

As promised, here are three ways to beat fatigue.

# 1: The Awesome Fatigue Fix

Just take four nutritional supplements that have worked for me and my patients over many years to boost lagging energy levels. I call them my “Awesome Foursome” because they are, well…awesome. The four are:

  • CoQ10 – Take 100 milligrams in the soft gel form (not capsule) with breakfast.
  • Magnesium – Take 200 milligrams once or twice a day, also with food. I like magnesium citrate or magnesium glycinate, different forms that this important mineral comes in.
  • Carnitine – Take 1 gram (1,000 mg) on an empty stomach.
  • D-ribose – Take 5,000 milligrams, either in the powder form with water or juice, or as capsules.

What each of these supplements has in common is that they provide nutritional support for the mitochondria, the “power plants” inside the trillions of cells in the body where energy is produced. These supplements increase energy in tired cells just like wood giving new life to the flame of a fire when it is burning out.

What I have learned from treating patients is that they are typically energy-deprived. Whether they have fibromyalgia, adrenal exhaustion, a heart condition, or are struggling with the challenges of a stressful, demanding life, their mitochondria are lacking the raw materials with which to optimally function and produce energy. The awesome foursome can usually remedy such deficits and in quick order. Once mitochondria are replenished, you typically experience more energy which can help you function better and address other underlying causes of life and health problems.

# 2: Reconnect with Mother Earth – Earth/Ground

Earthing, in case you haven’t heard about it, is creating a buzz throughout the health world as a simple and natural way to restore and maintain optimum health. It simply means living in contact with the Earth’s natural surface charge – being grounded − which naturally discharges and prevents chronic inflammation in the body. This effect has massive health implications because of the strong link between chronic inflammation and virtually all chronic disease, including the diseases of aging, and the aging process itself. Among many other significant benefits, people sleep better and have more energy.

# 3: See the Right Doctor

Conventional doctors, as skilled and knowledgeable as they are, often overlook nutritional, environmental, and stress-related causes of unwellness and disease, or they just don’t have the time or the training to dig for the cause. Instead, they may prescribe some medication to deal with a particular symptom. That, of course, leaves the cause of the problem still unaddressed and, even if you get some symptomatic relief, you may then develop side effects. Whenever people ask me about health issues their medical doctors haven’t been able to resolve, I usually advise them to consult with a naturopath – a highly-trained physician who uses homeopathy, herbs, nutrition, acupuncture, and other holistic, non-invasive treatments and generally avoids medication. You can find a naturopath near you through this organization. Another option is an environmental medicine doctor when chemical sensitivities or food allergies are suspected.

References and Additional Resources:

© 2014 HeartMD Institute. All rights reserved.

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2 Comments

  1. Judy B.

    on November 7, 2014 at 1:51 am

    Soy also causes you problems unfermented Soy is bad and it is in everything ,go shopping you would be shocked its in vitamins, bread, tuna ,horshradish, it affects your thyroid ,and mimiks Estrogen and that could be the cause of breast cancer . People are getting bigger and bigger ,with Soy ! hyfruitose corn syrup ! Vitamin A palmitate ,hormons injected in our cattle and GMO foods we are for sure an unhealthy country !!!!! Check out the Soy ! Judy

  2. David R.

    on November 13, 2014 at 3:18 am

    Also worth mentioning is the insidious usage of seed and vegetable oils, especially canola (rapeseed) oil. Canola oil is in everything from baked goods to trail mix to salad dressing. I know Dr. Sinatra recommends avoidance of these oils. I started reading labels and was surprised to find canola oil in my favorite trail mix. I now buy only trail mix with raw nuts. Become an avid label reader.

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