Are you feeling tired, exhausted and haggard? Can’t seem to get your energy back and, in the words of Bilbo Baggins, you’re feeling like “not enough butter scraped over too much bread”.


Fatigue is one of the most common symptoms people want my help with because of the significant impact on their enjoyment of life and ability to get things done.


To improve your energy and vitality, it is essential to get to the underlying cause of fatigue and treat it. Many things can contribute to fatigue and here are 11 underlying reasons you might want to consider when tracking down the source of your fatigue.


1. Inadequate energy intake/poor diet

One of the first places to start when looking at fatigue is what you put in your mouth. Food provides the building blocks for your body’s energy currency, adenosine triphosphate (ATP). If you’re not putting the right fuel in the tank, so to speak, it will be difficult to get the output you need.

Be cautious with diets that restrict specific food groups (unless you have a diagnosed condition such as coeliac disease). I’ve had clients who have noticed fatigue developing after 2-3 months of going on a Paleo eating plan. This is often due to the removal of grains and legumes, which are a significant source of B vitamins (a fundamental group of vitamins required for energy production) and not increasing the consumption of other foods to compensate for this. Now, I’m not hating on Paleo here. It can be a healthy way of eating.

Just remember if you’re going to remove a food group you’ve got to make sure you’re replacing those lost nutrients or problems will arise. Similar issues may occur when people switch to a vegetarian or vegan diet.


Other things that can sabotage an otherwise healthy diet and lead to fatigue are excess consumption of alcohol and refined sugar. Amongst other things, these two substances deplete the B vitamins, zinc and magnesium essential for energy production.


2. Chronic mild dehydration

A mild loss of between 1-2% of your body’s fluid is not sufficient to cause the classic symptoms of more severe dehydration such as thirst, dry mouth, dizziness and confusion. However, it can cause fatigue, reduced concentration and poorer exercise recovery1,2.

Mild dehydration is reasonably common and can occur due to not taking in fluid regularly throughout the day. Small regulate intakes will reduce fatigue more than not drinking and downing a litre of water in one go.


3. Iron deficiency anemia

Iron is an essential component of haemoglobin in red blood cells and myoglobin in the muscle. Haemoglobin and myoglobin are responsible for the delivery of oxygen to the cells and the removal of carbon dioxide. Iron also has a role in energy production in your mitochondria. Fatigue is a key symptom of iron deficiency along with paleness of skin, conjunctiva and nail beds. It may also be accompanied by shortness of breath on exertion, dizziness, headaches, dry, scaly skin and hair loss3.


People most at risk are pregnant women (increased needs), vegetarians and vegans (reduced dietary intake), women with heavy menstrual bleeding, people with gastrointestinal diseases and people taking proton pump inhibitors long-term (Nexium, Somac) or corticosteroids4.

Supplementation with iron is not recommended without having a test (as too much iron is also not healthy). It’s also essential to determine the underlying cause of the deficiency, so this can be corrected.


4. Hypothyroidism

The thyroid is a butterfly-shaped gland located in your throat and the hormones it produces act on every cell in your body to control your basal metabolic rate, energy production, neurotransmitters, cholesterol excretion and a whole lot more. Symptoms of an underactive thyroid include low energy, fatigue, unexplained weight gain and difficulty losing weight, cold intolerance, tender and stiff muscles, constipation, brain fog, irritability depression and reduced libido.


The standard medical investigation for hypothyroidism, thyroid, thyroid stimulating hormone (TSH) does not always reveal the full picture. If your TSH is in range, but you have a lot of the symptoms you may need an entire thyroid panel (T4, T3, reverse T3 and thyroid antibodies) to get a complete picture.


5. Adrenal hormones

The adrenals produce adrenaline, noradrenaline, cortisol and a hormone DHEA-S which is a precursor to testosterone as well as small amounts of estrogen in postmenopausal women. Things that reduce the amount of cortisol and DHEA-S available to cells can also produce fatigue and similar symptoms of hypothyroidism. If you’re being treated for hypothyroidism and it’s had little effect you might want to investigate the adrenal hormones.


Cortisol levels change throughout the day and are highest in the morning and reduce in the evening. Signs that cortisol may be an issue for you include difficulty getting going in the morning before 10 am, a big slump in energy around 3-4pm, feeling better around 6 pm and if not in bed by 9-9:30 pm energy picking up again around 11 pm and being able to work through the early hours of the morning. Other indicators are constant respiratory infections, increase in allergies to foods, feeling sleepy after a high carbohydrate meal, trouble maintaining sleep (waking up every 2 hours) and dizziness when standing quickly.

The test I use in clinic is a diurnal salivary cortisol test, which measures your cortisol levels at four points throughout the day.

Low cortisol is often associated with chronic stress (psychological, physical, environmental toxins and chronic infections) and in rare cases Addison’s Disease, an autoimmune destruction of the adrenal glands.


6. Chronic fatigue syndrome and post viral fatigue

Chronic fatigue syndrome presents after a viral illness sometimes quickly and sometimes years later (often associated with a prior history glandular fever, the Epstein Barr virus or Cytomegalovirus). It has been described as “a body wise energy crisis” 5. There are no specific tests, and the diagnosis is one of exclusion. One of the key differentiator in people with chronic fatigue is they feel much worse after any exercise sometimes being wiped out for days 6.


7. Sleep disorders

Lack of sleep or not enough restorative slow wave sleep can also present with fatigue. This could be due to poor sleep hygiene, circadian rhythm disorders, sleep apnoea or chronic sinus infections.


8. Liver disease

Fatigue is a common symptom of liver disease and although the mechanisms are not entirely understood it is thought that it may be due to alterations in neurotransmitters due to stress and inflammation7.


9. Blood glucose dysregulation

Glucose is one of the key molecules involved in energy production in the body, and the inability to regulate blood glucose (either too much or not enough) can cause fatigue. For this reason, fatigue is a symptom of both Type 1 and Type 2 diabetes. Other contributing factors to diabetic fatigue include inflammation, insomnia and nutrient deficiencies such as Vitamin D 8.


10. Cancer

Yep, this is a scary one. Cancer can change the way cells use energy and often causes anaemia. Fatigue may be an early warning sign of cancer especially if accompanied by sudden unexplained weight loss 9GP.


11. Coeliac disease

Fatigue accompanied by diarrhoea, abdominal pain, bloating and weight loss can be due to coeliac disease. This auto-immune condition causes a malabsorption of iron, B12 and folate that can lead to anemia10. Coeliac disease does have a genetic link so you might be suspicious of this if there is a family history. Be aware that you will need to be consuming gluten when you are tested otherwise you may return a false negative.


Fatigue is an important symptom to investigate further. If you’d like help tracking down the source of your fatigue, please get in touch.



  1. Ganio MS, Armstrong LE, Casa DJ, et al. Mild dehydration impairs cognitive performance and mood of men. Br J Nutr. 2011;106:1535-1543. doi:10.1017/S0007114511002005.
  2. Maughan RJ. Impact of mild dehydration on wellness and on exercise performance. Eur J Clin Nutr. 2003;57(2):19-23. doi:10.1038/sj.ejcn.1601897.
  3. Lopez A, Cacoub P, Macdougall IC, Peyrin-biroulet L. Iron deficiency anaemia. Lancet. 2015;6736(15):1-10. doi:10.1016/S0140-6736(15)60865-0.
  4. Camaschella C. Iron deficiency anemia. N Engl J Med. 2015;372(19):1832-1843. doi:10.1056/NEJMra1401038.
  5. Teitelbaum J. Effective Treatment of Chronic Fatigue Syndrome. Integr Med. 2012;10(6):24-29. Accessed October 20, 2013.
  6. Brown BI. Chronic Fatigue Syndrome : A Personalized. 2014;20.
  7. Swain MG, Unit L, Centre HS. Fatigue in liver disease : Pathophysiology and clinical management. Can J Gastroenterol. 2006;20(3):181-188.
  8. Lien A, Hwang J, Jiang Y. Diabetes related fatigue sarcopenia , frailty. J Diabetes Investig. 2017:1-2. doi:10.1111/jdi.12752.
  9. Bower JE. Cancer-related fatigue: Mechanisms, risk factors, and treatments. Natl Rev Clin Oncol. 2015;11(10):597-609. doi:10.1038/nrclinonc.2014.127.Cancer-related.
  10. Jackson JR, Eaton WW, Cascella NG, Fasano A, Kelly DL. Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity. 2012:91-102. doi:10.1007/s11126-011-9186-y.



Need help with improving your energy?

Norelle Hentschel is an experienced Naturopath with a clinic in Stones Corner, Brisbane who enjoys supporting her clients to reach their health goals.


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