Why do I feel tired all the time? Is your nutrition the missing piece in the puzzle?

If you feel like an exhausted zombie most of the day, and you are fed up with feeling tired all the time, despite going to bed early and resting, then the answer might be focusing more on your nutrition, which I can certainly vouch for.

For me in my early 20s, it was changing my diet and taking a few focused supplements that pulled me out of a seven-year state of chronic fatigue. Within only 10 days of making these changes I went from napping several times a day to having all the energy to maintain a full-time job, study, exercise and have a social life. That rapid and positive change in my energy level was so profound, and it was that transformation that motivated me to study nutrition and build my career as a naturopath over the past 30 years.

Horrible feelings of tiredness and fatigue are one of the main reasons for visits to the GP, and there are many underlying reasons that could be causing it. The good news is that often just a few simple diet upgrades, some basic food supplements or lifestyle changes can make a massive difference in reducing that lingering tiredness so you can get your va-va-voom back again.

Micronutrient shortfalls

Often chronic tiredness can be due to micronutrient deficiencies that you may not be aware of unless you have a blood test. These are shortfalls in certain vitamins and minerals that are vital for keeping your cells energised, and can usually be tested by your GP through a blood draw if you are tired all the time.

The difference is that your GP will only treat marked deficiencies such as anaemia, and they will leave it up to you to support any more minor shortfalls in your blood markers. So many of the people we work with at NatureDoc fall into this in-between place where their micronutrient blood levels don’t warrant a prescription, but they still feel lousy. That is where working one to one with a nutrition specialist is so valuable, as it is hard to know how to get this right on your own.

Iron

One of the most prevalent micronutrient deficiencies worldwide is iron. Iron is a powerful mineral that helps your red blood cells carry oxygen around your body, and is core to your vitality. Iron deficiency affects around 2 billion people worldwide and is a leading contributor to chronic tiredness and fatigue.

Anaemia and iron shortfalls are much more common in women who menstruate. This is because the level of iron lost through a woman’s monthly bleed can be more than their dietary intake. Since a menstruating woman needs around 18mg of iron daily and a juicy steak only contains around 6mg, you can see how it is easy for women to run low on iron. Women have a much higher need for iron-rich foods overall and you can also read my blog dedicated to iron deficiency in women for more information.

Dietary iron comes in two forms: Haem iron and non-haem iron. Haem sources include meat, such as liver and kidney, beef, lamb, venison, poultry, egg yolks and fish. Non-haem sources of iron include legumes such as lentils and chickpeas, leafy green vegetables, nuts, seeds, and dried fruits such as apricots and prunes. Non-haem sources should be consumed with a source of vitamin C, to aid the iron absorption.

Do get your iron levels tested as well as your ferritin levels (which are your iron stores and help you understand more about your iron ‘bank account’) before supplementing at high doses, as too much iron can cause its own problems too! You need your ferritin level to be at least 30 µg/L and ideally this is more like 70-100 µg/L to feel fully energised with your tank full (the maximum should be 400 µg/L).

Vitamin B12

A common symptom of a vitamin B12 deficiency is fatigue and all-day tiredness. Vitamin B12 is vital for supporting your nervous system and energy levels. If your diet is low in animal produce and you follow a mainly plant-based diet, you are at a higher risk of developing a vitamin B12 deficiency. This is another vitamin worth testing in a blood test to rule out as a cause of your tiredness.

B12 is only found in foods that come from animals, so great dietary sources are liver, beef, lamb, venison, dairy products, eggs and chicken. If you are vegetarian or vegan, it can be tricky to reach your vitamin B12 requirements, and it may be worth supplementing daily with vitamin B12.

A normal serum vitamin B12 level is generally between 180 and 914 ng/L and we like it to be over 600 ng/L for you to feel the most benefit from vitamin B12.

Folate

Another micronutrient deficiency that can cause tiredness and fatigue is folate deficiency and this goes hand in hand with iron and vitamin B12 to build healthy red blood cells. Folate deficiency can also be a result of vitamin B12 deficiency, so it is important to get both checked in a blood test at the same time.

Folate occurs naturally in foods such as leafy green vegetables, legumes such as chickpeas and lentils and citrus fruits, as well as avocados and eggs.

A normal serum folate level is typically between 3.0 µg/L and 20.0 µg/L; and for optimal vitality and energy we like it to be around 14-16 µg/L.

Vitamin D

Vitamin D is often referred to as the ‘sunshine’ vitamin, because our body can produce it within our skin on contact from specific sun rays. Unfortunately, for countries that do not see the sun a lot during the year (UK, I’m looking at you!), it can be quite easy to become deficient. Vitamin D is essential for musculoskeletal health, and deficiency can lead to fatigue as well as a low mood.

Vitamin D is not found in many foods, with the exceptions being oily fish, organic milk and some mushrooms. Most people make enough vitamin D from sunlight during the months of May-August, however in the colder and less sunny months, many people need to supplement.

In the UK, an adequate vitamin D blood level (serum 25-hydroxyvitamin D) is 50 nmol/L and we like to see it at 70-110 nmol/L which seems to provide most benefit from our clinical experience. Avoid a blood level any higher than 200 nmol/L.

Chronic stress

Chronic stress is one of the most common reasons behind feeling tired all the time and is often a vicious cycle; psychological stress can disrupt sleep, but poor sleep can make it harder to cope with stress. Sleep quality is just as important as how many hours you sleep, so finding an evening routine to help you wind down is very important.

Chronic stress and high cortisol can cause something called HPA axis dysregulation. It is thought that after a period of time in this wired state, an adrenal crash can occur, causing cortisol levels to drop too low which can leave you exhausted. You might feel light headed and weak on waking when your adrenal reserves are low. If this sounds like it could be you, you can read more about low adrenal reserve and what you can do about it here.

Creating a wind-down routine to help yourself feel settled before bed is important to ensuring you get quality sleep. Swap your evening drink to a calming herbal tea such as chamomile and aim to have your last coffee before midday or lunch at the latest.

Find a routine that works for you, some people enjoy reading or a bath, or others enjoy gentle yoga or a walk, finding what helps you to wind down is key, and although it may seem tricky, putting screens away an hour before bed is important to aid sleep. You also want to make sure your bedroom is cool enough and dark, to create the optimal sleep environment.

Morning supplements to help you manage your stress better include cordyceps, rhodiola and theanine. And if you are finding the stress hits you later on in the day and you struggle to get to sleep, then think magnesium, ashwagandha and/or saffron.

Thyroid disorders

Thyroid disorders, specifically an underactive thyroid, can be a cause for persistent tiredness. The thyroid helps to regulate your metabolism and balance of energy in the body and produces two main hormones thyroxine (T4) and triiodothyronine (T3), which help fire up energy in your body. An underactive thyroid can leave you feeling weak and low in energy, particularly in the morning.

Hashimoto’s thyroiditis is the most common autoimmune thyroid disease. Autoantibodies destroy your thyroid follicular cells and it’s very common in women, even if their usual thyroid tests look normal. The symptoms can match that of an underactive thyroid, but the nutritional and functional medicine support is more focused on the underlying autoimmunity and takes an anti-inflammatory approach.

Often tiredness isn’t the only symptom of a thyroid problem and is more likely to occur alongside other symptoms such as weight gain, constipation, cold hands and feet, brittle nails and menstrual irregularities. You can read more about how to optimise your thyroid health and Hashimoto’s here.

Post-viral fatigue

Fatigue can get worse or creep up following a viral illness and can affect you long after the initial infection has cleared up. Post-viral fatigue can cause varying degrees of tiredness, with some feeling exhausted after exertion, and others having feelings of constant ongoing tiredness, even when they aren’t having a busy day.

The reason behind this is still unknown, but the more recent research that has been mounting around Epstein Barr Virus (the trigger for glandular fever) and Long-Covid points to factors such as inflammation and oxidative stress from the viral load, as well as changes in the immune system.

It is vital to get adequate rest and good nutrition following a viral infection, to support your body and get back to feeling like yourself. Foods to support the immune system during this time include citrus fruits, berries, leafy green vegetables, nuts, ginger and garlic, which contain essential immune-supporting nutrients like vitamin C and zinc.

Once your recovery allows, exercising can help to reduce feelings of lingering fatigue. The key is starting with something gentle like yoga or walking and finding something you love.

Supplements to support your energy levels during this time include a vitamin B complex, ginkgo biloba, reishi mushroom and shiitake mushrooms which can be taken as supplements or added to your diet.

If your fatigue is not going away after a month of having a viral infection, then you may need to dig deeper, and support from a nutritional specialist can make all the difference.

Round up

Feeling tired all the time can really hold you back from doing the things you love to do. This was me in my early 20s when I spent much of my time napping and missing out on the fun stuff. Without the changes in my nutrition then, I dread to think where I would be right now and I why I try and educate people on the power of nutrition and why it is so important to learn what works for you.

If you would like more individual support, my clinical team at NatureDoc would love to help. Please share this blog with your friends and family who always complain of feeling exhausted, as these tips can really help.

Ask me what supplements can help… or anything else!