Why am I so tired?

A psychologist, endocrinologist and integrative physician explain common sources of fatigue and offer healthy ways to get your engine running again.


What a psychologist says

Doctors used to call fatigue the “yuppie disease,” thinking that it most commonly affected people of high socioeconomic status. We know that it’s actually more common in people with fewer resources for several reasons, including higher stress and a compromised diet. Some people with severe mental fatigue may have memory loss; those with severe physical fatigue can feel like every muscle is drained, leaving no strength or energy to do the simplest tasks. If fatigue lasts for a month or longer, you might want to go to a physician. But if there isn’t a medical cause, you should assess your nutrition, sleep, and “energy envelope,” the amount of energy you possess for daily activities.

People suffering from fatigue might consume too many stimulants such as caffeine or eat a diet high in fat, sugar, and salt. Exercising, eating chocolate, drinking alcohol, and obsessing over what you have yet to accomplish before bed might interfere with sleep patterns. These things stimulate the brain’s amygdala, keeping you awake and making it difficult to organize, remember, and process information.

For people with less severe fatigue, a gentle-exercise program, such as a short walk, and proper nutrition—complex carbohydrates from whole grains and good fats such as omega-3s from salmon—minimize fatigue. In terms of the energy envelope, the goal is to not extend beyond this level. Some fatigued people can’t complete essential duties; when responsibilities pile up, they try to do them all, which can result in overextension and collapse. To strengthen your energy reserves, it is important to not overexert yourself and keep expended energy close to available energy.

Leonard A. Jason, PhD, Center for Community Research, DePaul University, Chicago


What an endocrinologist says

Fatigue is one of the most poorly diagnosed and treated medical conditions. People become more irritable and depressed the longer fatigue lasts. To figure out if you’re fatigued and not just drowsy, look at your sleep patterns. If you constantly feel tired but don’t get relief from sleep, you’re probably fatigued. Mental fatigue, caused by such things as stress or working on a computer for a long time, can lead to physical fatigue, a feeling that makes you want to lie down. Physical fatigue also can be directly caused by activities such as exercise.

Low thyroid-hormone levels is one of the most underdiagnosed causes of fatigue. Signs of low thyroid include depression, fatigue, weight gain, cold hands or feet, brittle hair or nails, and dry skin. Any extra stress on the body, from physiological and emotional stress to chronic illness, will significantly reduce thyroid levels. It is important to get your hormone levels tested to figure out if this is the problem. Adrenal glands secreting low levels of hormones is another cause of fatigue, often accompanied by anxiety and a low stress tolerance.

Receiving adequate amounts of nutrients is important but difficult considering how depleted many foods are of vitamins and nutrients. A good energizing supplement that targets the mitochondria, the energy makers of the body, can be beneficial. Mitochondrial boosters include D-ribose, magnesium, malic acid, and all the B vitamins. To get higher doses of daily vitamins, you can use powders rather than bottles of pills. One scoop can equal 30 to 40 capsules.

–Kent Holtorf, MD, Holtorf Medical Group, Los Angeles

What an integrative medical physician says

It’s normal to be tired after mental or physical exertion, but not being able to meet your usual activity amount—for example, only being able to run two miles at a time when you used to run five miles—is a sign of fatigue. Fatigue means that you can’t reset yourself by taking a break from exertion, such as by getting off the computer and taking a long walk, and that minimal activity leaves you feeling exhausted.

There are two types of fatigue: local and general. Local occurs in certain areas of the body such as the limbs or chest and often results from an individual using a specific body part excessively (for example, hands for a hair stylist). General fatigue is on a larger, constitutional level, from stress, poor sleep, or poor diet.

Work with your health care provider to assess the pattern of fatigue from a variety of perspectives; then build a Multifaceted treatment plan, which may include herbal formulas, lifestyle stress-management tips, and acupuncture. If stress is the cause, prescription drugs, vitamins, or herbs alone will not truly heal your condition. Instead, find a mental therapy that you’re comfortable with, such as qigong, psychiatric therapy, counseling, or meditation. Diet is especially important. To maintain energy levels, eat nutrient-dense foods like berries and foods such as salmon and walnuts that are rich in essential fatty acids.

–Kamau Kokayi, MD, Integrative Medical Physician, Patients Medical, New York

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