Understanding the common drivers of fatigue

It feels like more and more patients are coming in complaining of fatigue.

Fatigue can be described as “a lack of energy, feeling of exhaustion or overwhelming sense of tiredness (either physical or mental), that is not relieved by rest".(1)

It is almost overwhelming the amount of potential contributing factors there are as to why you might be feeling fatigued. For the sake of keeping it simple, I am going to talk about the most common fundamental factors that I see contributing to my patients’ fatigue.

Poor sleep

With the prevalence of devices and streaming services, there certainly has been a demise of sleep after the last few years. With the mindset of, “just one more episode” and endless scrolling on social media, it is easier than ever to be entertained until all hours of the night or early morning. I have seen far too many patients who come in and stay up until 1-2am binging shows, but then sleep in to 8-9am thinking this is fine because they are still technically getting their 7-8 hours of sleep.

What many people don’t know is that the sleep you get from roughly 9.30 until 1am is most important. This is when our bodies make human growth hormone, which is important for metabolism, immune function, cellular and DNA repair, and more. It is during this time frame that we get the most quality and important sleep in the night. So if you are going to bed past 9:30-10pm each night, you are missing out on these important benefits.

Some strategies for improving sleep quality and onset:

• Aim to be in bed and sleeping by 10pm most nights.
• Have a consistent relaxing bedtime routine. For instance, have a warm shower, drink a sleepy tea, do your skincare routine, read a book and keep the lights low.
• Avoid screen time an hour before bed, as the blue light from devices stimulates cortisol production and blunts melatonin.
• Instead of scrolling the night away, read a paper book, have conversations with those you live with, do a meditation or journal.

Nutritional deficiencies

There are a whole host of nutrients involved in energy production in the body. Sub-optimal levels of any of these nutrients can negatively impact your energy levels. If you are struggling with low energy, speak to your doctor about testing these vital nutrients before supplementing (2):

• Iron
• B12
• Vitamin D
• Iodine
• Zinc
• Magnesium

Unstable blood sugar levels

The brain and body rely on a steady supply of blood sugar levels to keep our cells fueled. The body requires a lot of energy to just keep you alive each day. Then, adding on extra requirements such as exercise, using your brain, or just performing daily tasks puts an extra demand on energy. The brain in particular relies 100% on what is in your bloodstream for its energy, and so if blood sugars are up and down all day, especially when the blood sugars are low, your brain is not going to be able to function optimally because it is not adequately fueled. If you skip meals regularly or eat erratically, you are likely experiencing unstable blood sugar levels. Here are a few ways to help your blood sugars remain stable:

• Ensure each meal contains protein to anchor and stabilise your blood sugar levels. Protein can come from animals or plants including nuts, legumes, grains and seeds.
• Ensure each meal contains healthy fat to keep you full and satisfied. Good sources include avocado, olive oil, oily fish, nuts and seeds.
• Ensure each meal has lots of fibre from veggies and fruit.
• Eat three filling meals each day.
• Start your day with a nourishing breakfast and steer clear of long fasting periods.
• If you feel like you need a snack, choose options that have protein such as hummus and veggies sticks, nuts and seeds, a boiled egg, or a homemade protein ball.
• Avoid refined carbs and sugars. These send your blood sugars through the roof and ultimately end in a sugar crash.

Insulin issues

Insulin is the hormone responsible for getting glucose into your cells so they can burn it to make adenosine triphosphate (ATP). If insulin levels are too high for too long of a period of time, the cells eventually become “resistant” to the effects of insulin.(3) Instead of your glucose being utilised by your cells, a large portion of it is being stored away as adipose tissue (fat tissue). Ideally, you want your fasting insulin levels to be 5 nmol/L but certainly well under 10 nmol/L.

Some signs of high fasting insulin include:

• Struggling to lose weight
• Easily gaining weight, particularly in the mid-section
• Feel exhausted after eating

Stress

Long-term stress can lead to fatigue.(4) Patients in both high and low cortisol states can end up feeling exhausted because there is a dysregulated hypothalamic-pituitary-adrenal axis. High cortisol can also lead to blood sugar dysregulation and insulin issues long-term.

High stress levels are so prevalent in modern times. Global pandemics, lockdowns, financial stress and personal stress are just a few of the many contributing factors. Stress is problematic in a myriad of ways, but most obviously it can impact sleep quality, food choices and overall nutritional status, as the body burns through essential nutrients like magnesium and B vitamins when stressed.

Thyroid problems

The thyroid is responsible for regulating the energy and metabolism of all cells in the body.(5) Its importance cannot be summarised in one paragraph. However, in cases of fatigue, it is paramount that all the thyroid hormones are checked comprehensively. This includes thyroid stimulating hormone (TSH), free thyroxine (T4), and triiodothyronine (T3). It is often not enough to just check TSH levels in standard blood tests because I see very often how it can sit “within normal range” yet there can be issues with both T4 and T3. Many cases of sub-clinical hypothyroidism are missed because the thyroid is not fully assessed.

Sedentary lifestyles

I am sure you have heard the saying “sitting is the new smoking”. So many modern-day jobs involve sitting in front of a computer all day. Having a more active lifestyle has been shown to reduce feelings of fatigue.(6) This means doing the obvious and exercising in whichever way makes you feel best, daily. But it also means adding in extra movement in your day on top of this, with examples such as:

• Going for a walk on your lunch break
• Walk to the shops instead of driving
• Ride your bike instead of driving where possible
• Take regular breaks from your desk to walk around or stretch
• Get a stand-up desk if your workplace allows it (or if working/studying from home)

It is important to have a health practitioner on your side to help you investigate all the possible drivers that could be contributing to fatigue. In most instances, it isn't just one thing and so a holistic approach is necessary to help get to the root cause of the issue.

References

1. Hulme K, Safari R, Thomas S, Mercer T, White C, Linden M Van der, et al. Fatigue interventions in long term, physical health conditions: A scoping review of systematic reviews. PLoS One [Internet]. 2018 Oct 1 [cited 2021 Aug 4];13(10). Available from: /pmc/articles/PMC6193578/
2. Tardy A-L, Pouteau E, Marquez D, Yilmaz C, Scholey A. Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence. Nutrients [Internet]. 2020 Jan 1 [cited 2021 Aug 4];12(1). Available from: /pmc/articles/PMC7019700/
3. Kaltsas G, Vgontzas A, Chrousos G. Fatigue, Endocrinopathies, and Metabolic Disorders. PM R. 2010;2(5):393–8.
4. Gruner T, Sarris J. Stress and Fatigue. In: Clinical Naturopathy 2e. 2nd ed. Chatswood: Elsevier; 2016. p. 352–4.
5. Gruner T. Thyroid Abnormalities. In: Clinical Naturopathy 2e. 2nd ed. Chatswood: Churchill Livingstone; 2016. p. 399–422.
6. Ellingson L, Kuffel A, Vack N, Cook D. Active and sedentary behaviors influence feelings of energy and fatigue in women. Med Sci Sports Exerc [Internet]. 2014 Jan [cited 2021 Aug 4];46(1):192–200. Available from: https://pubmed.ncbi.nlm.nih.gov/23783259/

Chelsey is an Endeavour College Alumni and qualified naturopath practicing at Perth Health & Fertility in City Beach, Perth. She is passionate about all things women’s health and specialises in, among general naturopathic medicine, treating hormonal conditions such as PCOS, cycle irregularities, endometriosis, PMS and acne.
In Chelsey’s graduating year, she graduated with the Naturopathy Academic Excellence Award and Dux Medal Award. Her goals are to continue her studies alongside clinical practice with hopes to one day complete a PhD and help contribute to the naturopathic research field.

She is one half of @peppermintandsage_ on Instagram and has interests in health education and regularly conducts public based health education talks in the community.

Read more by Chelsey Costa