Fatigue is a surprisingly common problem — as a doctor, I seem many people with this complaint. For some, the fatigue is severe, relentless, and debilitating. For others, it is mild, but ever present or occasional and severe. Almost always, fatigue limits our ability to do what we want and to enjoy life.

Low thyroid function
Low adrenal function
Low estrogen, progesterone
Low testosterone, dhea
High insulin
High cortisol
Neurotransmitter imbalance
Low digestive enzymes
Low vitamin levels
Low amino acids
Low essential minerals
Low antioxidants
Impaired detoxification
Impaired circulation

Food allergies
Environmental exposures/sensitivities
Mold reactivity
Heavy metal toxicity
Chronic low grade infections
Active systemic infections
Gastrointestinal infections
Poor sleep


LOW THYROID FUNCTION: Along with fatigue those with low thyroid are often cold, have hair loss and dry skin and are overweight even with low caloric intake. One can be low thyroid with normal thyroid tests. Some people need a special form of thyroid called T-3, or liothyronine in the form of cytomel, armour or naturthroid, in addition  to T-4, levothyroxine to maintain normal healthy energy.

LOW ADRENAL FUNCTION: In addition to fatigue other frequent symptoms are low blood pressure, dizziness or lightheadedness, cold hands and feet and salt craving. Chronic stress or severe short term stress can lead to adrenal fatigue.

LOW ESTROGEN, PROGESTERONE: Estrogen is energizing both physically and mentally so when low women can feel depleted. When estrogen is very low or unstable it results in hot flashes and night sweats leading to poor sleep and hence fatigue.     Progesterone is calming and helps put us to sleep so when very low it can result in sleep deprivation. See the MENOPAUSE section for much more on these hormones.

LOW TESTOSTERONE, DHEA: Testosterone and DHEA are muscle and tissue building hormone and help with physical and mental energy as well as sense of well being. See the MENOPAUSE section for much more on these hormones. Many men and women benefit from testosterone replacement as a skin cream. It can help with libido, exercise endurance, mood, motivation and mental focus.

HIGH INSULIN: High insulin can result from excess body weight, excess sugar or refined carbohydrate intake, and lack of exercise. High insulin causes metabolic syndrome: increased inflammation in the body which in turn leads to an increased risk of cardiovascular disease, cancer, dementia, and arthritis.

HIGH CORTISOL: High cortisol symptoms include being tense and anxious, difficulty sleeping, being overweight, especially excess truncal weight with thin arms and legs and depression.

NEUROTRANSMITTER IMBALANCE: Low Brain levels of Norepinephrine or Dopamine can result in mental or physical fatigue.  Low neurochemicals: melatonin, GABA or serotonin can result in poor sleep and tiredness.

LOW DIGESTIVE ENZYMES: deficient stomach HCL (hydrochloric) acid, pepsin and intrinsic factors, inadequate pancreatic digestive enzymes, and insufficient bile salts all will impair digestion and this will result in diminished nutrients for absorption.

LOW VITAMIN LEVELS: B-6, B-12, folic acid, and all the Bs along with Vitamin D and many more: These can be due to poor absorption by the gastrointestinal system or due to poor dietary intake. For low D consider low sun exposure or low fish intake as possible causes.

LOW AMINO ACIDS: Poor protein intake or incomplete digestion due to insufficient Hydrochloric acid (stomach acid) or low pancreatic enzymes, or poor absorption due to damage to the absorptive surface of the intestinal wall are all important considerations in this correctable cause of fatigue.

LOW ESSENTIAL MINERALS: Iron, magnesium, calcium, zinc, selenium and others, if low result in poor cellular function and low energy. Poor diet or poor absorption are common causes of these mineral deficiencies.

LOW ANTIOXIDANTS: Low levels of glutathione, selenium, vitamin C, vitamin E, coenzyme Q 10, lipoic acid, SAMe, result in higher free radical damage when energy is made in our cells. Damage to the mitochondria, where most cellular energy is made inside our cells, results in diminished energy.

IMPAIRED DETOXIFICATION: In the liver and all cells poor detoxification can be due to chemical or other toxic exposures or low nutrient levels. We can also inherit poor detoxification enzyme function due to common genetic polymorphisms (inherited mutations) and any of these can cause fatigue. This is correctable in most cases with targeted nutrients.

IMPAIRED CIRCULATION: Poor blood flow to the brain or any major organs can lead to fatigue. “Hypercoaguable” State or “Thick  Blood” can be inherited or can develop over time in some. This can be associated with blood abnormalities like high platelets, high fibrinogen, high PAI 1, high Lp(a) Factor II, and Factor 5. This is generally correctable with tailored nutritional treatments.


FOOD ALLERGIES: Gluten, Dairy, Corn, Soy Eggs, Peanuts, Citrus, Nightshades and many other foods cause multi-system disease which varies from person to person, including, but not limited to: arthritis, headaches, depression, chronic sinusitis, fatigue, ulcers. Elimination diets, blood testing and stool testing are tools used for diagnosis and can profoundly impact health in both the short and the long term.

ENVIRONMENTAL EXPOSURES/SENSITIVITIES: Formaldehyde, toluene, benzene, perfumes, pesticides, carbon monoxide and electromagnetic radiation are a few of the common hazards we are exposed to daily that can compromise our health. There are many thousands of chemicals in our air, water and food and we need to be aware of their health consequences.

MOLD REACTIVITY: Mold spores and biotoxins produced by molds can produce illness. Unseen leaks in roofs or under housing can be sources of toxicity. Food industrial standards, for example, allow ketchup to contain 20% mold by volume. Mold is a hidden toxicity that impacts many people.

INHALANTS and other air-borne allergens: grasses, trees, dust mites and many more cause a multitude of symptoms and can be relieved by many non pharmaceutical solutions.

HEAVY METAL TOXICITY: Lead, mercury, cadmium, arsenic, aluminum and many other metals can accumulate in organs, cause chronic symptoms and impair health. Toxic metal levels can be addressed in several ways.

CHRONIC LOW GRADE INFECTIONS:  Dental abscess, gingivitis, mandibular osteomyelitis, sinusitis and skin or nail fungal infestations can be long lasting irritants and may have major consequences when not addressed.

ACTIVE SYSTEMIC INFECTIONS:  Viral infections such as CMV, Epstein Barr, Herpes 2, HHV 6 and bacterial infections like Lyme, chlamydia, mycoplasma, bartonella, babesia and many more can cause pain, weaken us and cause many debilitating symptoms.

GASTROINTESTINAL INFECTIONS: Yeast or bacterial overgrowth or parasitic infestations with amoebas or worms  in the gut can significantly impact  gastrointestinal digestive and absorptive function and thus overall health.

STRESS: Chronic long term stress or severe short term stress can be related to work, family, friends, financial or health issues. This can have a damaging effect on immune function, can profoundly impact  hormonal health and damage the nervous system.

MEDICATIONS: Severe fatigue is a common side effect of Beta Blockers, Blood pressure meds, Statins, sleeping pills, antidepressants, medroxyprogesterone (provera) and many other prescription medications.

POOR SLEEP: Inability to fall asleep or to stay asleep has many causes, for example: sleep apnea,( can be obstructive or central), low melatonin, high cortisol or high adrenalin all can be significant contributors to this debilitating problem.