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Why Am I So Tired All The Time?

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“Why am I so tired all the time” is consistently one of the most searched phrases on Google. When I first found out I couldn’t believe it. But after almost 20 years in practice I can tell you that everyone I see suffers from this to some degree. In this post I am going to go beyond “get more rest” and “de-stress” and explain why people are tired and what they can do about it

The Miriam Webster dictionary defines tired as “drained of strength and energy fatigued often to the point of exhaustion”. Or “obviously worn by hard use”. In today’s high-pace, high-stress world it’s not hard to see why so many people feel burnt out and tired.

Let’s dig into it…

Nutrient Deficiencies

Let’s start with the simplest of causes: nutrient deficiencies. All energy is made inside the cells in your body in the Krebs cycle. In the Krebs cycle energy is created by “burning” glucose which then goes on to produce ATP – the universal energy molecule of all living cells. So eating the right foods doesn’t mean much if we are not burning or metabolizing them properly. This is where nutrients come in

B-complex vitamins are family of vitamins that include B1, B2, B3, B5, B6, folate and B12. There are a couple of others like choline and biotin but we’ll leave them out of this discussion. B-complex vitamins are needed to power the Krebs cycle. Think of them like spark plugs that help you to start your engine and burn your fuel better. Without them, energy production (ATP) slows down and you feel tired. If you read the label on most B-complex supplements, they all say “helps to metabolize carbohydrates, proteins and fats”.

B-complex vitamins are fairly abundant in the food supply. The following foods are a good source of B-vitamins and contain an even spread of most of them:

  • Salmon and trout
  • Eggs
  • Leafy greens – kale, spinach, etc.
  • Legumes and pulses – especially chickpeas and lentils
  • Nutritional yeast
  • Avocados
  • Beef, chicken and turkey
  • Whole grains such as brown rice

You can also take a B-complex supplement. Personally I prefer “activated” or methylated b vitamins. Without getting too technical, these are pre-converted and are useful for people with methylation and MTHFR issues. I do also like lower-dose, whole foods B-complexes like those from Innate Response

Iron

Iron is an important component of hemoglobin, the substance in red blood cells that carries oxygen from the lungs to the rest of your body. Hemoglobin represents about two-thirds of the body’s iron. If you don’t have enough iron, your body can’t make enough healthy oxygen-carrying red blood cells.

When iron levels fall significantly, your red blood cells absorb less oxygen. Becoming iron deficient, or anemic, because you don’t consume enough iron in foods can cause fatigue, shortness of breath, low energy levels, poor attention span and irritability.

There are two types of iron. Heme iron can only be found in animal tissue (seafood, poultry, meat), whereas non-heme iron can both be found in animals (meat, eggs, and other dairy products), plants (grains, fruits, vegetables, beans, seeds, and tofu), iron supplements, nutrition bars, and fortified foods. Meat is a great source of both, containing 40% to 45% heme iron and 55% to 60% non-heme iron. Generally-speaking you will find that plant foods have a lower concentration of iron compared to animal foods.

It’s also important to point out that heme iron is better absorbed (25%) vs. non-heme iron (~16%). Other foods also greatly affect the absorption of non-heme iron.

Some common reasons why you might be iron deficient

  • Low intake of iron in the diet
  • Poor absorption due to digestive problems (iron requires sufficient levels of stomach acid/hydrochloric acid/HCL)
  • Infections in the gut such as SIBO (small intestinal bacterial overgrowth) and parasites
  • Leaky gut syndrome
  • Inflammatory bowel diseases (Celiac disease, Crohn’s and Ulcerative colitis)
  • Bleeding disorders
  • Heavy menstruation due to hormone imbalances

Food and Recommended Daily Intake

The recommended daily intake is 18 mg for pre-menopausal woman, 8 mg for men and post-menopausal women. Pregnant and lactating women require higher amounts up to 29 mg/day. And of course, if you are deficient, you might need higher than this. A therapeutic dose of iron is 30-45mg/day

When it comes to iron supplementation I ALWAYS recommend formulas over isolated iron. Red blood cell formation requires synergistic nutrients like folate, B12, Vitamin C and more. My go-to for iron supplements is Blood Builder by Mega Food. 1 a day is all you need and it does not cause any digestive upset, irritation or constipation.

What Times of Day Are You Tired?

Looking at energy patterns throughout the day can be a good indicator of some other reasons why you might be tired. For this segment I am going to break it down into two categories: adrenal gland issues and thyroid problems

Adrenal Gland Issues

The adrenal glands are small glands located on top of each kidney. They produce hormones that you cannot live without, including sex hormones (estrogen, progesterone and testosterone), steroid hormones (cortisol, adrenaline, pregnenalone, DHEA, aldosterone) and a number of intermediary hormones. When it comes to energy, we are going to focus on the hormone cortisol

Cortisol is a steroid hormone that helps the body respond to stress. It’s sometimes called the “stress hormone.” As part of the body’s fight-or-flight response, cortisol is released during stressful times to give your body a natural energy boost. This boost is meant to fuel your muscles to respond to a threatening situation. But when cortisol levels are constantly high, due to chronic stress, it can wreak havoc on the body.

Cortisol levels reach their lowest levels late at night — usually around midnight. From there, levels begin to rise. Cortisol reaches its highest level in the body early in the morning, peaking around 9 a.m., before beginning to decline again throughout the later day. This is called a “diurnal cycle”.

Some signs that cortisol and adrenals are unbalanced (for a full list, click here):

  • sluggish in the morning, it could be a sign of low morning cortisol.
  • energy crashes during the day (especially in the afternoons between 3-5 PM)
  • Light-headedness and dizziness upon standing
  • Low blood pressure
  • Blood sugar issues (hypoglycemia) – this will create wild energy fluctuations coupled with cravings, crashes and irritability
  • insomnia

There are MANY things that stress out the adrenal glands. These can include psychological, emotional, chemical, toxin and dietary stressors. Removing these as much as possible is a good first step.

Nutrients, Adaptogens and Supplementation

The key nutrients for adrenal gland function are magnesium, potassium and sodium plus vitamins B5 and C.

Adaptogens

Adaptogens are a select group of herbs (and many medicinal mushrooms) that support the body’s natural ability to deal with stress. They are called adaptogens because of their unique ability to “adapt” their function according to the specific needs of the body. This may be physical, chemical or biological needs. There are dozens of adaptogens. Some are more stimulating, while others are calming and grounding. Others are considered “nervine tonics”. As the name implies, these strengthen and nourish the nervous system. Here are some of my favourite adaptogens:

  • Ashwaghanda
  • Rhodiola
  • Ginseng
  • Eleuthero
  • Schisandra
  • Licorice
  • Maca
  • Shatavari
  • Holy Basil (Tulsi)
  • Reishi
  • Cordyceps
  • Oat straw

If you are not sure what to take, it is usually best to take a formula that contains a mixture. These should include the vitamins and minerals listed above, as well as some adaptogens.

Thyroid Problems

The thyroid gland is a butterfly-shaped organ located in the base of your neck. It releases hormones that control metabolism – the way your body uses energy. It sets what is called your Basal Metabolic Rate or BMR. This is your resting metabolic rate and doubles up as your internal thermostat. The thyroid’s hormones regulate vital body functions, including:

  • Breathing
  • Heart rate
  • Central and peripheral nervous systems
  • Body weight
  • Muscle strength
  • Menstrual cycles
  • Body temperature
  • Cholesterol levels
  • and much more

Symptoms of thyroid imbalance are widespread and relate to many different body functions. When it comes to fatigue and tiredness, we are more concerned with an under-functioning thyroid gland (hypothyroidism) vs. and over-active gland (hyperthyroidism). Some of the hallmark signs and symptoms of hypothyroidism include:

  • Fatigue – not helped by rest or sleep.
  • Feeling tired upon waking
  • Weight gain – regardless of dieting or exercise
  • Cold body temperature
  • Hair loss
  • Dry Skin
  • Drooping eyelids
  • Slow thought/dull thinking (ie. not as sharp as you used to be)
  • Feeling depressed
  • Constipation – not eased by fiber, magnesium or water intake
  • There are many more!
Key Nutrients and Supplementation

Optimal thyroid functioning requires key nutrients. You need adequate amounts of Iodine and the amino acid tyrosine to make thyroid hormone (T4 and T3). You also need the minerals Selenium, Zinc and copper for proper hormone conversion. A piece that is often missed is the role of cortisol. Cortisol can block thyroid hormone conversion. It is vital that the adrenal glands are supported (please see above for more info).

For both adrenals and thyroid you want to make sure you cut down on the carbohydrate intake, especially refined carbs and sugar. You also want to ensure that you are getting adequate amounts of proteins and fats in the diet. These cover a lot of ground when it comes to thyroid and adrenal health including blood sugar balancing and blunting the cortisol response. Animal proteins also provide vital cholesterol which is the backbone of all of your sex hormones.

 

Brett Hawes, CFMP, CNP is a Certified Functional Medicine Practitioner and Clinical Holistic Nutritionist with 16 years of clinical experience – specializing in complex digestive issues, autoimmune disease and hormone health.

He hosts a popular podcast, Holistic Health Masterclass, which delivers valuable health information to 1000’s of listeners around the world

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