How often do you hear yourself say, “I am so tired”? You are not alone. From not be able to sleep through the night to needing a 3pm pick-me-up to crippling issues like chronic fatigue syndrome or fibromyalgia, fatigue is really taking a toll.

Over 50% of us are tired sometime during the day, with half of us reporting fatigue lasting weeks, months or even years. So why are we so darn tired? Turns out fatigue can be due to more than just lack of sleep. Issues with diet, anemia, mitochondria, thyroid, adrenals, detoxification, digestion, brain, immune system dysfunction can have a huge impact. 

What are some of the causes of fatigue?

Adrenals  and  Thyroid

Our total stress load can really take a toll on the body. If you think about it, it makes sense. Basically, there are only so many resources to go around. You need them to keep you safe and alive. So if the body gets too overwhelmed, the adrenals direct the thyroid to go into hibernation mode.

How does hibernation work? In order to get ready for their deep winter sleep, bears eat tons of salmon and whatever else they can catch. Salmon runs are short-lived, though, so bears turn to berries and other plants to fill their metabolic needs. But what happens in late fall, when all of their food sources are gone? The abrupt reduction food supply leads to an increase in their manufacture of reverse T3 (rT3), an inactive thyroid hormone that slows down metabolism. Since the bear tucked away lots of body fat when there was plenty of food, it can sleep through the winter and not starve

It is no different for us. If our body senses that it is has been too low on its necessary resources for too long, in order to sustain energy, the adrenals block the thyroid from producing and activating hormones. In addition, the process of creating energy from stored sources to meet our basics needs costs even more energy from our already limited supply.

Without intervention, over time cortisol and thyroid hormones remain low leading to lowered resilience and fatigue.

What is Cortisol Awakening Response?

Chronic stress dampens the morning release of cortisol or something called the Cortisol Awakening Response (CAR). If you wake extremely fatigued or need caffeine or other stimulants to get you going in the am, CAR might be an issue for you.

As you get closer to waking up and light enter your eyes, the adrenals are supposed to “wake up” and release cortisol. It is so vital that almost 50% is released within the first 30 minutes. Why so important?

• First, cortisol reduces inflammation so we can react quickly for our survival.
• Second, blood sugar quickly rises to allow us to function after the long night’s fast.
• Third and most important, cortisol also allows thymus glands to check/remove any unhealthy immune cells so as not to help induce an autoimmune condition.

For some of us, cortisol is not released as expected and symptoms such as inflammation and fatigue may be especially worse in the am (and at night when cortisol is naturally low). In addition to chronic stressors, a SAD diet, medications such as steroids, brain trauma, etc. can also be contributing factors.

How to Support a CAR?

You might want to employ the strategies listed below to help bring up early morning cortisol levels (while working on the underlying cause) to help benefit sleep and alleviate fatigue.

• Use a sun clock or try to exposure yourself to outdoor sunlight as soon as possible upon waking. Outdoor grey overcast light can still provide some healthy light. This will help reset circadian rhythm.
• Partake in gentle exercise upon waking
• Improve blood flow to brain (exercises,supplements, etc)
• Activate your vagus nerve through exercise
• Avoid fluorescent light as it suppresses cortisol. If you look at its pattern, much of the spectrum is missing. Please consider using full spectrum lights or a light box to naturally raise am cortisol levels.

Mitochondria

The body has other “fail-safes” to protect us from harm. According to Dr. Naviaux MD, over time long periods of stress may create a “cell danger response”. This is a defense mode at the cellular level that shuts down mitochondrial function to conserve resources. This affects function throughout the body (since they are on a rationed fuel supply) while at the same time creates damaging free radicals that weaken/sicken us and accelerate the aging process.

How? Our mitochondria are our metabolic braking system. Too much stress and they shift from an energy mode into crisis management. If you are healthily, no worries, only the least-damaged mitochondria tend to replicate so there is usually no obvious sign of mitochondrial dysfunction. But over time, the mitochondria become smaller, weaker, and more dysfunctional. They generate less energy and more free radicals, causing us to “rust” or age. As we lose our resilience, stressors easily overwhelm our mitochondrial capacity and we start to notice fatigue, lowered ability to recover from illness, memory issues, etc.

Rebuilding our mitochondria is fundamental. So what can we do? Like muscles, what you don’t use, you lose. Activities that promote “hormesis” or temporary mitochondrial stress, “exercises” them. Why? Too little stress is just as unhealthy to your body as is way too much stress. Without some type of stress, there is little drive for transformation and growth.

Hormetic stress

Hormetic stress creates a transient burst of reactive oxygen species that stimulates our cellular antioxidant defense systems to grow stronger. This in turn stimulates the cells to repair the damaged and dysfunctional parts and to rebuild more robust parts capable of handling greater stress loads. This leads to the production of greater numbers of stronger, healthier mitochondria.

Keep in mind, aging can also causes us to lose mitochondria. Between the age of 40-70, people typically lose 1/2 of our mitochondrial capacity, so another great reason to consider the activities below.

Some hormetic activities include:

• Exercise
• Intermittent Hypoxic Training or controlled oxygen “stress”. Breathing exercises such as Alternate Nostril Breathing, Breath of Fire, or breath holding exercise.
• Sauna: Both FIR and NIR are great for mitochondria, brain function, detox, etc.
• Intermittent fasting
• Cold therapy
• UV light

You can learn more about mitochondria health here.

Vagus Nerve

The mitochondria are not alone in their quest for preservation. Dr. Stephen Porges introduced a stress model known as the Polyvagal Theory. Until recently, we believed that the autonomic nervous system was divided into two branches: the sympathetic and parasympathetic systems. The sympathetic system is our fight/flight response and the parasympathetic system our rest/digest function.

His idea is that our vagus nerve is actually made up of two nerves from different areas of the brain that although fused together, serve different roles.

The ventral vagal response is when we feel safe and everything is going along just fine. When things start to get a bit stressful, our classic sympathetic fight-or-flight response is initiated. Finally, when the stress response isn’t working and we just can’t deal with another physical or mental trauma, the dorsal vagal activates which forces us to metabolically “freeze”. This response can be associated with signs and symptoms of giving up, both mentally and physically including ongoing fatigue. Good news, treatment protocols and simple exercises to been developed to help reset the vagal response.

Brain- Overactive neurons

Brain issues can also be a source of fatigue. Neurons communicate via neurotransmitters. To pass messages from neuron to neuron, the message must reach a minimum threshold, or stimulus level, before it can be sent along.

To keep from sending false messages, each neuron has its own “resting potential”. This means in order for a message to be sent, the stimulus must also be greater than the neuron’s resting potential. So, if the neuron’s resting potential is far away from the threshold amount needed, it would require a lot of stimulation. Conversely, if a neuron’s resting membrane potential is too close to threshold, it can fire way too easily. Either case can lead to problems. Too far away and the message is never sent, too close and it may be inadvertently triggered.

Neurons health depends on oxygen, glucose, or stimulation. If they don’t get enough, they get weak. Weak neurons have a resting potential too close to threshold. When this happens, folks can become more sensitive to lights, sounds, smell, taste, and touch– so they end up trying try to avoid these situations. This can further degrade the neuron’s health.

According to Dr Datis Kharrazian DC, PhD,

“Resting membrane potential explains why some chronically ill patients are overly sensitive to certain inputs such as strong scents, bright or flashing lights, or loud sounds. It can also explain intolerance to many foods and supplements. So many of their neurons are so close to threshold that any stimulation at all fatigues them and symptoms of neurodegeneration develop. When the neurons fatigue, so does the body. For many of my patients, getting to the root of brain dysfunction is the key to relieving chronic exhaustion. “

To relieve fatigue, we need to keep the neurons from continually overfiring. So, just like a muscle, neurons need to be exercised to make them stronger. This moves the resting potential farther away from threshold. Dr. Kharrazian recommends slowly exposing yourself to triggers to help reset the neurons. For example, if smells really affect you, start exposing yourself to smells such as essential oil or flower from across the room. Over time, bring the smell closer or increase your exposure time until it no longer affects you. Work slowly so you don’t end up going backwards!

Brain- Mitochondrial uncoupling

As we mentioned, mitochondria provide cellular energy in the form of ATP. One of the byproducts of this process are the formation of free radicals (such as superoxide and reactive oxygen species). If our mitochondria are not working effectively, they can create too many free radicals which can lead to oxidative stress.

Since neurons are easily damaged by oxidative stress, they handle its suppression locally via antioxidant proteins, one of which are mitochondrial uncoupling proteins (UCPs). Their job is to slow the production of ATP and instead use the resources to make heat, which then limits the number of free radicals being produced. Since neurons require a considerable energy for their activities, this can lead to ongoing fatigue and other brain symptoms.

In addition, UCPs are also involved in calcium regulation. If calcium is not effectively cleared, it can lead to the formation of overactive neurons by lowering their resting potential.

Brain- Inflammation

Inflammation in the brain is unfortunately becoming more and more common. Issues with fatigue, mental activities, endurance, mood, increased need for sleep, lack of motivation, loss of appetite, inability to exercise, difficulty speaking, tremors, etc., can all have inflammatory origins. With inflammation present, the brain or any other organ for that matter, can’t effectively do the things it is supposed to do. We talk more about causes and potential solutions in the article covering neuroinflammation.

Diet and digestion

Last but not least in any respect, is how we fuel our body. If we feed it junk or have a system that cannot effectively breakdown our foods, there is no way we can supply all the cofactors required for detox, brain, mitochondria, thyroid, adrenals, etc. which can all lead to fatigue.

Inflammatory foods can set off our immune system and create yet another form of metabolic stress. Gut infections can affect macro and micronutrient assimilation as well as release substances such as LPS that can affect the permeability of the blood brain barrier, effectively opening to highway to neuroinflammation. We cover these issues in our articles on gut health .

Micronutrients are a big deal. For example, lack of B vitamins and minerals are cofactors  involved in the production of ATP, the energy currency of our body.

Issues with iron or oxygen utilization can definitely contribute to fatigue. It turns out there are something like 24 different types of anemia patterns. So if you are low on iron, please don’t just load up on a supplement. Sometimes the body sequesters iron to keep from feeding pathogenic load and you may make it worse. Other types of oxygenation issues can be caused by the inability to effectively use folates or vitamin B6 or B12. Additionally, if you have underlying inflammation, you might have anemic tendencies. Please work with your provider to determine if any of these issues could be affecting you.

What should I do to help my fatigue?

The key to helping fatigue is to try to determine which stressors (infection, inflammation, detoxification, etc.) are affecting your health.

In the meantime, an elimination diet, exercise (to tolerance–you don’t want to make your fatigue worse!), and meditation to reduce stress can be very helpful.

There are also a few supplements that I often use with good results. Broccoli sprouts can gently nudge your mitochondria to wake up, whereas CoQ10 supplies them with an often lacking resource. L-carnitine may help convert fats into energy for those with issues, whereas ribose might be a necessary building block to help recycle energy in those with low oxygen. A good multivitamin or B complex can support energy production, detoxification, immune support, etc..

Bringing down inflammation is vital so consider Vitamin D, EFAs, curcumin, etc. It is best to work with a practitioner to help determine root cause and apply the interventions best suited to your metabolic needs.