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By Dr. Ellen Albertson, PhD, RDN, NBC-HWC
Why am I so tired all the time? It’s a question I hear constantly, alongside “How do I lose weight?”—especially from midlife women. While many lifestyle and medical issues can cause fatigue, you can fix problems and find solutions to feel vital and energized again.
The solution to reverse fatigue and go from exhausted to supercharged is two-fold. First, determine what may be causing your fatigue. Second, take action to address what’s making you tired. You may need to talk with your doctor, improve sleep, lower anxiety, manage stress, exercise more, stay hydrated, drink less alcohol, eat better, or switch up your supplement regime.
In our get-it-done-yesterday hustle culture, where action and accomplishment are prioritized over rest, fatigue is a common issue for many people. According to a study published in BMJ Public Health, over 20% of people between 45 and 86 have fatigue. Other researchers estimate that about 25% of adults experience fatigue lasting two weeks or more. To complicate matters, about 60% of patients who complain they’re tired lack a recognizable medical cause for the fatigue.
Like menopausal weight gain and depression, fatigue is particularly common in midlife. One study found that nearly one-third of adults aged 51 or older experience fatigue. According to research published in the Journal of Psychosomatic Obstetrics & Gynecology, fatigue is the most common symptom during menopause, followed by insomnia, irritability, palpitations, and depression.
While better diagnostic tools are needed, it’s estimated that about 1% of the world’s population has chronic fatigue syndrome (CFS). A confusing, debilitating disease much more common in women than men, CFS is characterized by fatigue that lasts for over six months and doesn’t go away with rest. The syndrome can also be accompanied by numerous other symptoms, ranging from brain fog and headaches to muscle and joint pain.
Tiredness has physical, mental, and emotional dimensions. Several medical conditions can cause fatigue, including sleep disorders, thyroid problems, anemia, heart disease, diabetes, and poor mental health. Poor sleep, a sedentary lifestyle, an unhealthy diet or too few calories can also be at the root of tiredness.
Adults between 18 and 64 need seven to nine hours of sleep each night. Disturbingly, over 35% of Americans say they get less than the required amount, and half report feeling sleepy three to seven times a week during the day. Not only does insufficient sleep make you feel tired, it also increases the risk of having an accident, gaining weight, and developing a chronic disease like diabetes or cardiovascular disease.
Below are some of the many things you can do to improve sleep quality and quantity:
Having trouble sleeping? Certain supplements may help you relax and fall or stay asleep. Good choices include melatonin, magnesium, and valerian root.
A hormone made by your body in response to darkness, research suggests melatonin may help you fall asleep. Studies show that not getting enough magnesium, the fourth most abundant mineral in the body, can contribute to several medical conditions, including insomnia, PMS, and hypertension. A systematic review and meta-analysis on valerian for sleep concluded that the root might improve sleep quality without producing side effects.
Placing a few drops of lavender essential oil on your pillow may also help you get a good night’s rest. One study of college students with insomnia found that good sleep hygiene combined with inhaling lavender essential oil improved sleep quality more than sleep hygiene alone.
If you are still having trouble sleeping, consult your doctor to rule out sleep disorders like sleep apnea and restless leg syndrome (RLS). Sleep apnea is a dangerous, common condition where breathing stops briefly throughout the night. RLS is a neurological disorder that causes unpleasant sensations in your legs, especially at night, making sleep difficult.
If you are tired all the time and it doesn’t go away with adequate sleep and rest, you may want to get your thyroid checked to make sure it’s working properly.
Hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can cause fatigue. With hypothyroidism, metabolism slows down, making you feel lethargic. Other common symptoms of hypothyroidism include trouble losing weight, muscle aches, and sensitivity to cold. In contrast, with hyperthyroidism, your body speeds up, which can also make you tired and interfere with sleep. Symptoms of hyperthyroidism include mood swings, anxiety or nervousness, and sensitivity to heat.
Thyroid conditions are typically treated with medications. Dietary changes, especially going on a whole-foods, gluten-free diet, may also help with both hypothyroidism and hyperthyroidism. This type of diet can reduce inflammation. It may also slow the production of thyroid antibodies that attack the thyroid gland, as happens with the autoimmune disease Hashimoto’s thyroiditis.
Gluten-free eating is easy. Simply substitute regular products made with wheat for gluten-free ones. There are gluten-free pastas, gluten-free crackers, and even gluten-free flour and bread.
If you are diagnosed with an overactive thyroid, talk with your physician about taking supplements. The amino acid L-carnitine and the mineral selenium have been shown to reduce symptoms associated with Graves’ disease, the most common cause of hyperthyroidism.
Anemia occurs when you don’t have enough healthy red blood cells. Red blood cells bring oxygen to your tissues and release carbon dioxide to your lungs. So, a lack of healthy red blood cells can make you feel tired and rundown. Often undiagnosed, anemia can cause fatigue along with other symptoms like headaches, dizziness, frequently feeling cold, and shortness of breath.
The most common blood disorder impacting nearly 6% of Americans, anemia, can be due to excessive bleeding, certain medications, and low levels of iron, vitamin B12, or folic acid. Anemia is more common in menstruating or pregnant people, young children, and people with certain medical conditions, such as kidney disease.
Think anemia is causing your tiredness? Talk with your doctor and get a Complete Blood Count (CBC) done. If you are diagnosed with anemia, he or she can do more testing to determine the cause and treatment.
Fatigue is one of the most common side effects of prescription and nonprescription medications. Some medications for high blood pressure, depression (especially tricyclics), anxiety, allergies (especially antihistamines), epilepsy, and anxiety can all make you feel tired. Muscle relaxants and some pain medications can also be problematic.
Don’t stop taking your medications if you suspect they are causing your tiredness. Instead, talk with your doctor. They may adjust the dose, suggest you take a medication before bed or recommend a different one.
Your body makes energy from the foods you eat—so what, how much, when, and how often you eat can greatly impact how tired you feel.
One of the leading nutritional causes of fatigue is eating fewer calories than your body needs. This is a big issue with low-calorie diets. While you may believe you are doing the right thing by severely limiting calories to lose weight, your body thinks you are in danger of starvation. Your body ramps up appetite and slows your metabolism to keep you alive, leaving you feeling tired and hungry.
Without adequate calories, blood glucose levels dip, resulting in fatigue and cravings for sweets and caffeine. While you may feel energized temporarily after having a coffee and some cookies, the lift and blood sugar spike are generally followed by another dip that leaves you feeling tired again.
Consuming a healthy diet is the best long-term strategy for losing weight and feeling energized. This means eating a high-fiber, whole foods plant-based diet and avoiding overly processed foods. Eat several small meals throughout the day to stay fueled and stabilize blood sugar levels. Aim for at least five servings of fruits and vegetables, plenty of lean proteins, slow-digesting complex carbohydrates, small amounts of nuts and seeds, and healthy fats.
Start your day with a healthy, high-protein smoothie made with greens, berries, and a scoop of protein powder, a bowl of oatmeal with skim milk topped with an ounce of walnuts, or eggs, whole grain toast, and fruit.
For lunch, have a large salad topped with canned chickpeas or salmon. Or have a tuna or turkey whole wheat wrap with sprouts and avocado.
Enjoy an ounce of almonds with some dried fruit, sliced apples with nut butter, or plain Greek yogurt with raisins for a snack. The combination of complex carbohydrates, protein, and fat will keep you satisfied, so you won’t be tempted to visit the vending machine or breakroom for a sugary treat.
For dinner, fill half your plate with veggies and the other two-quarters with lean protein and complex carbs. For example, have a tofu-veggie stir-fry over quinoa or pesto chicken and veggies with whole wheat or chickpea rotini.
Don’t forget to drink plenty of water. Dehydration can make it difficult for your body to produce enough energy. Aim to consume about half your body weight in pounds in ounces of water. For example, if you weigh 150 pounds, shoot for about 75 ounces of water a day. Buy a colorful water bottle and set a timer every hour to remind you to drink water throughout the day.
A sedentary lifestyle can also contribute to tiredness, so exercise regularly and incorporate more movement into your day. Regular exercise triggers cellular changes, including the creation of more mitochondria—small cellular structures that produce energy from food and oxygen. Exercise can help reduce stress and improve sleep.
You also may want to use a standing desk and take short walking breaks. One study found that people who used a standing desk experienced less sleepiness and back discomfort. Another study published in BMJ Public Health concluded that light-intensity walking breaks throughout the workday may effectively reduce fatigue.
Although not a substitute for a healthy diet, certain supplements may help reduce fatigue. A good multivitamin mineral complex helps ensure you have all your body needs to transform the food you eat into energy. If physical or mental exhaustion contributes to your fatigue, adaptogens such as Rhodiola rosea and ashwagandha may help you cope with stress and anxiety. You may also benefit from coenzyme Q10, which all your cells need to produce energy.
Fatigue is common. But you can address your fatigue and feel more energized by identifying the causes of your fatigue and making dietary and lifestyle changes.
Once you’ve ruled out medical conditions that can cause fatigue and work on diet, movement, and sleep, examine your work-life balance. Do more of what lights you up and energizes you and less of what drains you.
Finally, be patient. It takes time to determine what’s making you tired and take steps to address the issues.
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