Fatigue

Feeling tired can have many causes, from not enough quality sleep, overwork, poor nutrition, or dehydration, to underlying medical issues like infections, chronic disease, or even normal life stress. Sometimes the cause is simple—like burning the candle at both ends—but sometimes it’s more complex and needs a doctor’s input.

Feeling “tired” is a normal, short-term response to things like a late night, a busy day, or physical exertion—usually, a good night’s sleep or some rest will leave you refreshed again. Fatigue, on the other hand, is much more than just needing a nap—it’s a lasting sense of weariness, heaviness, or low energy that doesn’t get better with sleep or rest. Fatigue often hangs around for weeks or months, making it hard to concentrate, get through your day, or enjoy activities. It can affect both your body and your mind, and is more likely to signal an underlying medical, mental health, or lifestyle issue when it becomes persistent or starts limiting what you can do.

Yes! These are some of the most common medical causes of persistent fatigue:

Low iron (anemia): When your body doesn't have enough iron, it can't make sufficient healthy red blood cells to carry oxygen throughout your body. This leaves you feeling exhausted, weak, and short of breath, even with normal activities. You might also notice pale skin, cold hands and feet, headaches, or strange cravings for ice or starch. 

Thyroid disorders: Your thyroid acts like your body's "energy thermostat." An underactive thyroid (hypothyroidism) slows down your metabolism, causing extreme fatigue that doesn't improve with rest, weight gain, feeling cold, depression, and brain fog. An overactive thyroid (hyperthyroidism) can also cause fatigue through insomnia, anxiety, rapid heart rate, and the stress it puts on your body. 

Hormonal changes: Diabetes and insulin resistance can cause fatigue through blood sugar swings—both high and low blood sugar leave you feeling drained. Menopause brings declining estrogen levels that can disrupt sleep, affect blood sugar, and contribute to fatigue. Low testosterone in men, adrenal hormone imbalances, and other hormonal shifts can all sap your energy. 

The good news is that these conditions are usually diagnosed with simple blood tests and often respond well to treatment, which can dramatically improve your energy levels.

Stress, anxiety, depression, and grief are well-recognized medical causes of chronic fatigue and low energy. Effective treatments—supported by clinical research—include seeing a mental health professional for structured therapies such as cognitive-behavioral therapy (CBT), which has strong evidence for reducing both fatigue and psychological symptoms.

Other evidence-based treatment options include regular physical activity, mindfulness-based strategies (like meditation or yoga), and in some cases, medication. Selective serotonin reuptake inhibitors (SSRIs) are a first-line, well-studied class of antidepressants shown to improve both mood and energy in patients with depression and anxiety. Additionally, the natural supplement saffron has emerging evidence from clinical trials suggesting it may help mild to moderate depression.

A comprehensive care plan—tailored to your needs—can substantially improve energy and overall wellbeing.

Keep an eye out for “red flag” symptoms that could mean something more serious is going on: unexpected weight loss, fevers you can't explain, soaking night sweats, new or worsening pain, sudden shortness of breath, or fatigue that hits like a truck out of nowhere. If any of these symptoms pop up, don’t wait—schedule a checkup to rule out anything urgent and get you the right care.

Here’s how we typically approach fatigue in the clinic:

Step 1: Start with a conversation and a checkup
First, we’ll take a deep dive into your health story—your symptoms, lifestyle, stress, and sleep habits—and perform a physical exam. This helps us look for common clues and focus on likely causes.

Step 2: Run basic, evidence-based labs
The first round of bloodwork checks for the most frequent medical causes of fatigue and will usually include:

• Complete blood count (CBC), to rule out anemia or infection

• Thyroid function, for checking under- or overactive thyroid

• Blood sugar and metabolic panel, to assess for diabetes and check liver and kidney health

• Ferritin and iron studies, to catch hidden iron deficiency

• Vitamin B12 and sometimes vitamin D, for nutritional causes

Step 3: Respond to red flags or unusual findings
If your symptoms suggest something specific (unexplained weight loss, new pain, shortness of breath, or a history of cancer), we’ll investigate further with more targeted testing.

Step 4: Explore less common causes
If initial tests don’t turn up the answer and fatigue persists, we dive deeper—checking for rarer conditions like sleep apnea (usually with a sleep study), chronic fatigue syndrome (CFS/ME), fibromyalgia, persistent post-viral syndromes (like long COVID), or even autoimmune or rheumatologic diseases.

Step 5: Build your personalized plan
No online list replaces a hands-on medical assessment. If fatigue is dragging you down, book an appointment with us so we can get you feeling energized again, safely and efficiently. Tailored testing and follow-up are how we find answers together.

Treatment starts with finding and fixing the root cause. If bloodwork reveals something like low iron (anemia), thyroid disease, diabetes, or a vitamin deficiency, we’ll treat that specifically—such as with iron infusions, levothyroxine for hypothyroidism, or adjusting diabetes medications.

When fatigue is tied to chronic conditions like fibromyalgia or chronic fatigue syndrome (CFS/ME), a multi-pronged approach works best. This might include sleep optimization, gentle graded exercise (pacing, physical therapy, or yoga), CBT, medications for symptom control (such as low-dose naltrexone, low-dose amitriptyline or duloxetine for pain and sleep), and sometimes stimulant medications (like modafinil) when appropriate for you.

Evidenced natural treatments that can help include addressing sleep hygiene, ensuring balanced nutrition, and supplementing with vitamin D, B12, or magnesium if you’re deficient.

Above all, treatment is individualized. We build a personalized plan that targets medical, mental, and lifestyle factors—combining prescription options, lifestyle tweaks, and proven natural therapies so that you can get your energy (and your life) back.

If fatigue is wearing you down, book a visit so we can design the best strategy for you—no guesswork required.