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“I just don’t feel like I have enough energy to get through my day”

“It doesn’t matter how much sleep I get, I am ALWAYS tired”

“If I didn’t have coffee in my life, my engine wouldn’t run”

Sound familiar? I often have patients come into the office with a concern of feeling tired or a lack of energy.  But what do these statements mean? People manifest feeling a tired in many different ways, for example, they could physically feel weak or have reduced muscle strength. They can feel sluggish, like they are dragging a bag of sand all day long. Or they can mentally feel foggy, have a lack of concentration, or feel mentally “drained”.  All of these symptoms are messages that something is not quite right and having a better understand of how the lack of energy affects you is key.

Key questions to ask yourself are:

How long have I felt this way?

How is my energy affecting me physically? Mentally?

If I were a battery, what power level would I be at? 0=drained completely, 10=fully charged.

Do I have a reasonable explanation for my lack of energy that seems logical?

I ask all my patients these questions. It helps get a better understanding of what could be causing their lack of energy.

Low energy and feeling tired can be a symptom of many things, ranging from poor lifestyle to more serious and complicated disease states.  Doing a proper clinical investigation is a crucial part of my practice as it helps me cross conditions off my list that are less likely and allows me to get to the ROOT CAUSE of why my patients feel tired.

Since this complaint is so common in my daily practice, I decided to write a short blog post to outline the most common causes of why someone may have a daily struggle with feeling tired or have low energy.

1. Poor dietary habits.

Sometimes patients jump straight to “there must be something seriously wrong we me” as the explanation for why there are noticing a dip in their energy levels, however a much simpler reason like eating the wrong foods can be the culprit.  Consuming a diet that is riddled with processed foods and refined sugars and low in protein, fruits and vegetables will cause people to feel run down and not their best. This is simply because processed foods are filled with “empty carbohydrates” that provide essentially no nutritional value. Foods like fresh fruits and vegetables are packed full of complex carbohydrates that are body needs for energy, not to mention the wonderful array of vitamins and minerals that are critical to optimal energy production and proper organ function.

Simply changing your diet to include more fresh produce, adequate protein which are the building blocks for every cell in our body, and eliminated the packaged, and processed refined sugars can make all the difference in your energy levels. Making these dietary changes also helps reduce your risk of cardiovascular disease, cancer, neurodegenerative disease, diabetes, stroke and many more. With all these health benefits, why wouldn’t you try optimizing your diet to improve your energy levels and over health?

2. Nutrient Deficiencies

The 3 most common nutritional deficiencies that can lead to you feeling tired are:


Vitamin B12


Iron deficiency anemia is the most common nutritional deficiency in women, especially women of reproductive age. A type of anemia, a condition in our red blood cells have a reduce oxygen carry capacity because the main component, hemoglobin, is not formed properly. As women, we are at a disadvantage as we are constantly losing blood due to having a regular menstrual cycle each month. This makes it hard to keep our iron stores, known as ferritin, at an adequate level. Additionally, people who eat very little foods that contain good amounts of iron including meat, are vegetarian or vegan, are at higher risk of developing iron deficiency anemia simply because their iron intake is low. Other symptoms of iron deficiency anemia include poor exercise tolerance, shortness of breath on exertion, joint pain, paleness of skin, irregular menstrual cycles, palpitations, colds hand and feet, dizziness, and weakness.

Increasing the amount of iron rich foods in the diet and/or a trial of iron supplementation for a period of time can improve energy levels within 3 months.

Vitamin B12

These has been advertised of as the main “energy optimizing” vitamin in health food stores and they are not wrong to do so. Vitamin B12 is used in many energy producing processes including muscle function and nervous system pathways.  It also helps make your DNA and red blood cells. Since your body doesn’t make Vitamin B12, we need to get it through our diet or from supplements.  Much like iron deficiency, eat a diet low in animal products or being a strict vegetarian or vegan increases your risk of having low stores of this particular nutrient. Vitamin B12 deficiency can also develop if you have certain conditions like gastritis, pernicious anemia, inflammatory bowel disorders (Crohn’s and Celiac disease), long-term antacid use or certain blood-sugar lower drugs, heavy drinking, immune system disorders (Lupus or Grave’s disease) or if you have had abdominal surgeries to your stomach or small intestine lining which interferes with vitamin B12 absorption.  In addition to feeling tired all the time, severe vitamin B12 deficiency can manifest as numbness or tingling in arms, legs, feet and hands, muscle weakness and coordination problems, mental symptoms like depression, memory loss or behavioural changes, digestive disturbances, vision changes, heart palpitations and shortness of breath.

Iron, Vitamin B12, Magnesium deficiencies are diagnosed through specific blood tests through your primary health care provider. This is usually my starting point with patients, especially young healthy females as nutritional deficiencies can be easily corrected through dietary modifications and supplementation.


Magnesium, a mineral like iron, is used in many biological pathways in the body. This mineral often can get overlooked as a cause for low energy and fatigue, so it is important to know the signs and symptoms. Often, this mineral can slowly become deficient over time which makes it tricky to spot. It is often not a part of common routine blood panels, so this may explain why it is often classified as an invisible nutrient deficiency.  Signs and symptoms of magnesium deficiency are very general and benign but when looked at as a collection of symptoms can clue myself into thinking that a patient may be deficient. These signs and symptoms include but are not limited to chronic headaches, muscle spasms/leg cramps, weakness, fatigue, low bone density, anxiety, low blood pressure, insomnia just to name a few.  The population that are most at risk for developing this mineral deficiency are those with a diagnosis of chronic health conditions including diabetes, osteopenia/osteoporosis, hypertension and coronary artery disease.

3. Metabolic Conditions

Conditions like undiagnosed or uncontrolled Diabetes Mellitus, Fibromyalgia, Chronic Fatigue Syndrome and Fibromyalgia are just a few metabolic/neuroendocrine disorders that elicit the symptom of chronic and debilitating fatigue at the cornerstone of the disease presentation.  They also contain other symptoms that lead practitioners to rule in or out these conditions including increased thirst, urination and hunger in Diabetes; chronic pain, insomnia and reduced function in both Fibromyalgia and Chronic Fatigue Syndrome.  It is important to consider and rule out these conditions because they can truly effect the quality of life of persons who are affected.

Thyroid disorders

The thyroid gland itself has an important role in regulating the body’s metabolism and directly impacts how many organ systems.  It helps us regulate our body temperature, maintain a healthy weight, promotes a healthy digestive system, ensures adequate health of our hair, skin texture and hydration just to name a few.  The most common thyroid disorder in Canada is Hashimoto’s disease, a form of auto-immune underactive thyroid function or “hypothyroidism”.  Fatigue, always feeling cold with cold hands and feet, weight gain, thinning, dull/dry hair, brittle nails and constipation are just a few of the most common presentation signs and symptoms.  Women who are perimenopausal or postmenopausal are commonly affected.

The opposite side to an underactive thyroid disease is a over active thyroid, known as “hyperthyroidism”.  Although less common than underactive thyroid disorders, the symptom of fatigue is still present despite the thyroid gland over producing its hormones to push metabolism into overdrive.  Weight loss, diarrhea, heart palpitations, greasy hair, increase in perspiration with activity and flushing even at rest are signs to look out for that can lead one to suspect their thyroid is functioning in overdrive.

So, how do we know if our thyroid is “out of whack” as many of my patients suspect? The first is to note any increase in side or growth on the neck termed a goiter.  This can happen with both hypothyroidism and hyperthyroidism conditions, with tenderness of the throat or difficulty swallowing alerting to more severe cases.  The second way to determine the health of our thyroid is to look for fluctuations of specific thyroid hormones within the blood.  These include Thyroid Stimulating Hormone (TSH) produced by the pituitary gland within the brain, the prohormone Thyroxine (T4) and triiodothyronine (T3) which is the most biologically active and sensitive hormone of the three.  T4 and T3 are known as peripheral circulating thyroid hormones meaning these are the hormones that exert the metabolic effects we often associate with the thyroid gland, while TSH is a centrally acting hormone that acts directly on the gland itself to facilitate the production of T3 an T4.

TSH is often used as “screening” blood test that most adults have checked during their routine physicals with their primary health care provider.  If there is an elevation or decrease outside the typically reference ranges, this often leads practitioners to test free, unbound T3 and T4, to have a more complete picture of thyroid function, however these two other hormones are often not routinely performed unless a strong suspicion of a thyroid disorder is occurring based on the TSH laboratory evaluation.

To complicate matters even more, sometimes patients can have normal TSH laboratory values but demonstrate all the signs and symptoms of a thyroid disorder which can stump many practitioners.   I often test the remaining peripheral thyroid hormones with the addition of the enzyme of reverse T3, as well as thyroid auto-antibodies that can depict an underlying auto-immune cause of both hyperthyroidism and hypothyroidism.  This helps me create an overall picture of the current state of health of the thyroid and focus my treatments accordingly.

Many of my patients ask the question what are the causes of thyroid dysfunction?  In truth, there are many including the hormonal fluctuations of pregnancy and post-natal environment, acute viral infections can attack the thyroid gland and push an individual in an overactive state that over time causes the gland to shift into a sluggish, hypothyroid state known as thyrotoxicosis.  Direct radiation exposure to the neck/chest whether through occupational or as a result of chemotherapy can also create a dysfunction.  The mineral deficiency of iodine, although not as common as in developing nations due to the addition of fortifying foods in developed countries, is the most common nutritional deficiency to cause thyroid disease due to its critical role in the formation of these hormones.  Chronic stress, as we will look at in more detail in another post, can suppress the function of the thyroid gland and slow the body’s metabolic rate in order to conserve energy.  Conditions that promote an unhealthy stress response in the body liked Chronic Fatigue Syndrome, Fibromyalgia, and Adrenal Fatigue can contribute to the worsening mental and physical fatigue of thyroid disorders.

Heart failure

Heart failure can occur at any age due to significant trauma or congenital defect of the heart, but most often affects those with previous heart attack or underlying cardiovascular disease.  There are different grades of heart failure from mild with little effect on quality of life, to severe that can be devastating to a person’s ability to engage with people and their environment.  Because in heart failure the heart cannot pump blood out of its chambers with adequate force, this deprives the body over time of blood rich in oxygen, and less oxygen rich blood promotes fatigue and muscle weakness with poor exercise tolerance.  Cough and shortness of breath are often additional signs of congestive heart failure that should be adequately investigated if a cough lingers on for 6 months or more without any other known cause.

4. Poor Immune status

How can one tell if their immune system is struggling to function at its maximum capacity?  Questions you should ask yourself are

  1. How often do I get sick during the year?
  2. How quickly do I bounce back from an illness?
  3. Do I catch frequent colds, sinus infections and/or GI infections back to back of each other?

If the answer is more than 2-3 times per year, with each infection lingering on or difficult to get rid of OR having consecutive infections back to back; these are all signs that your immune system is struggling to shift to body back to a state of health.  Having one infection alone, requires a significant amount of energy to mobilize the white blood cells and inflammatory mediators to help your body fight and repair from an infection.  This redirecting of energy towards the immune system is a good thing during times of illness, however, when we do not allow ourselves to stop, rest and take care of our bodies during times of illness, we can prolong illness because energy is no longer being directed to heal but instead to keep us focused at work, school, or is being used for other activities that take away our energy stores.

Chronic fatigue can also develop with repeated infections as this contributes to an energy deficit in our bodies.  We can never really recover to our ideal state of health because we are trying to fight off one infection after another.  We can feel run down for months on end, which propels a vicious cycle of putting us at risk of “catching” whatever infection may be going around in our communities.

To ensure that we support a healthy immune system, we have to practice two basic lifestyle activities that are at the cornerstone of good health status:

  1. Adequate rest and practicing proper sleep habits including establishing a bedtime routine, ensure we get enough sleep to recharge our batteries, and not pushing ourselves beyond our limits.
  2. Eating the colours of the rainbow! Consuming foods with a variety of colours ensure that you are achieving a wide variety of vitamins and minerals that are crucial for ensure our immune system stays in tip top shape. I always tell my patients to ask themselves, “Have I eaten the colours of the rainbow today?”  It acts as a quick reference to boost their fruit and vegetable content in their diet as well as challenges them to step out of their comfort zone and try different produce they normally wouldn’t think to eat.

Lastly, if you have a family history or you yourself have been diagnosed with an auto-immune disease, the above two lifestyle habits MUST be followed.  Individuals who have been diagnosed with an auto-immune disease are also at risk of developing a second auto-immune condition elsewhere in the body.  Regardless of the organ/tissue that is targeted, when your body essentially starts to attach its own tissue, this is known as auto-immunity where your body has lost the ability to distinguish between self and non-self.  Once this happens, patients can have bouts of “flare-ups” that they will have to overcome throughout their life, however patients can maintain their remission status as long as they identify their triggers, eat well, practice healthy lifestyle habits and follow the recommendations of the team of specialists that are monitoring their cases.

5. Pregnancy

If you’re a woman and have ever experiences the joys of being pregnant, you are well aware of the fatigue, both mental often referred to as “baby brain” and the physical fatigue that goes along with nourishing a growing baby.  The fatigue and sensation of being tired all day long can occur early on in the pregnancy during the first trimester, generally tends to lessen in the second, and due to discomforts with sleeping can worsen later in pregnancy as a woman’s due date draws near.

In any woman of reproductive age who is sexually active, this is a state of wellness that needs to be properly assessed before any other treatment or condition is considered.

6. Sleep disturbances

It’s no secret that if you don’t get a good night sleep, you will pay for it the next day.  According to Stats Canada, more than 3 million Canadians over the age of 15 or about one in every seven Canadians, struggling with either falling asleep or maintaining sleep, otherwise known as insomnia.

The key to correcting insomnia is getting to the reason why someone is struggling with delay sleep onset or maintain sleep to begin with.  Distrupted sleep can be caused by benign factors like eating too close to bedtime, drinking excessive amounts of caffeine and alcohol with disrupts REM sleep, or can be caused by other health conditions where insomnia is one symptom.

Daytime sleepiness, loud snoring that often wakes a partner, and gasping for air while sleeping are signs of sleep apnea where the body is lacking adequate oxygen supply to the body and causing periods short respiratory arrest that startles the brain causing a reflex reacting of gasping for air during sleep.  Often times, partners can attest to this behaviour, however for many who live alone, many can have daytime drowsiness related to a condition they are not aware of having.  Referral to a sleep clinic can result in a diagnosis of sleep apnea as well as other sleep disturbances that can be the reason why you may be feeling tired, especially late in the afternoon.

Another common cause of interrupted sleep affecting are the vasomotor hot flashes and night sweats related to menopause.  Menopause is a natural occurrence in all females that occurs most commonly during the 5th decade of life.  The number and intensity of symptoms varies from woman to woman, however insomnia tends to be a more common complaint.  The key to improving daytime fatigue related to vasomotor symptoms at night is balancing the hormone fluctuations that occur during periods of rest/sleep and identifying triggers that can promote these symptoms from occurring more frequently.

It is important to track variations in your sleep patterns by keeping a sleep diary to log changes in sleep patterns, as this can reveal possible triggers whether dietary or lifestyle, as well as timing issues, differentiation of weekday versus weekend patterns and other possible symptoms that can lead to discovering the root of sleep related dysfunction causing decreases in energy and daytime fatigue.

7. Chronic Stress & Adrenal Gland Dysfunction

When it comes to stress we may be familiar with the physical responses that can take over during periods when we define our stress level to be “high”, these including increase in our heart rate, elevation in our blood pressure, changes in appetite, headaches, changes in energy levels etc.  These physical changes are common during the “fight or flight” response to stress that our body pushes to help us survive the curve balls that life may throw at us.

But what happens when our bodies have to constantly deal with a high-stress situation like a demanding job, troubles in our marriage, or caring for a loved one who is ill.  Our bodies are designed to deal with stress for the short term and not for lengthy periods of time.  The energy required to keep us going during short periods of chronic stress simply becomes a heavy task to bare by the body, and can pull energy away from other body functions that we need to maintain health.  What organs are responsible for promoting our resistance to the negative effects of stress like lack of energy, immune dysfunction, digestive upset, and blood pressure regulation? That would be the Adrenal Glands, small triangular shaped organs that sit above our kidneys.

If you have ever heard of the tern adrenal fatigue but have not quite understood what that means, here is a short and sweet definition: adrenal fatigue is essentially your body’s inability to regulate a proper productive stress response within the body because of chronic long-standing stress.

As an analogy, let’s  think of the grass growing on your front lawn or garden.  If we think of the hot summer weather as a source of stress, periods of dry weather will cause your grass to dry out and die due to lack of water. But in reality, this doesn’t happen overnight.  Your grass will be able to survive and stay green because of its stores it has within the ground, even during times of draught.  If there is however no rain and the weather continues to stay dry, your grass will begin to suffer as it will use up all its stores to the point where it can no longer adjust to its environment, even if it decides to suddenly rain hard, your grass has reached a point where no matter how much water or fertilizer you use it will resistance to regrow because there is nutrients left to rebuild.

If we extrapolate this to your own body, years of chronic, high stress environments whether it is work, personal or financial can cause a significant strain to your adrenal glands.