Why are you so tired?

exercise fatigue micronutrients nutrition sleep Feb 06, 2024

“I’m just so tired. I talked with my PCP about it, and they prescribed an antidepressant. But I don’t feel depressed - I just feel so...tired”.

I can’t tell you how many times I’ve heard that statement from my patients. Fatigue is one of the most common reasons people come to see me, especially women. Often she’s already met with her primary care doctor, but she was dismissed, or told that fatigue is normal “at this age”. 

Um, no. No it is not normal. It might be common, but that’s not the same thing as “normal”. 

So why do so many women over the age of 35 complain about being tired all the time? There are four main reasons: poor or inadequate sleep, imbalanced nutrition, inadequate or improper movement patterns, and micronutrient deficiencies. 

In 90% of the patients I’ve seen in clinical practice, addressing one or more of these factors dramatically improved their energy levels. Read on for more, or sign up for my self-paced “Ignite Your Energy” course to rise above the drag. 

Poor or inadequate sleep

We all know we need to sleep. Adults need 7-9 hours nightly to feel rested and recharged, even if you think you function just fine on 5-6 hours. The American Academy of Sleep Medicine and Sleep Research Society both agree

“Sleeping less than 7 hours per night on a regular basis is associated with adverse health outcomes, including weight gain and obesity, diabetes, hypertension, heart disease and stroke, depression, and increased risk of death. Sleeping less than 7 hours per night is also associated with impaired immune function, increased pain, impaired performance, increased errors, and greater risk of accidents.”

If you’re not getting at least 7 hours nightly, start here. Make it a priority. Schedule it. Treat it like an appointment you cannot cancel. Charge yourself a late fee if you miss your bedtime. Do whatever it takes to get to bed on time. 

However, if you already get to bed on time, but struggle to fall or stay asleep, you may need to work on your environment or your personal sleep habits (together called “sleep hygiene”). Factors such as light, temperature, the time you last ate, your hydration status, and how much alcohol you drank can profoundly affect your sleep quality and quantity. 

Imbalanced nutrition

The foods you eat can either set you up for a day of sustained energy that results in productivity and a balanced mood - or not. And I’m not talking about so-called “superfoods” or “energy powerhouses”, or other claims made about kale and quinoa. 

For energy, it’s the balance of macronutrients - carbohydrates, proteins, and fats - that really matters. This is especially true of carbohydrates, which when eaten in excess or isolation, can result in the dreaded “carb coma”. This is when you bonk an hour or two after eating and all you can do to save yourself is grab a coffee and/or a donut. 

I swear I’m not the carb police, but when it comes to beating fatigue, the timing, quantity, and form of the carbs you eat really do matter. 

Other food factors that can sharply improve your energy include eating more protein (most women don’t eat enough), and laying off the alcohol, due to the impact on sleep quality. 

Inadequate or improper movement patterns

If you do not get enough exercise, or you do too much of the wrong kinds of exercise, you’re certainly going to feel the effects of fatigue. 

Movement in general is ridiculously beneficial. It helps balance blood sugar so you don’t feel the “carb coma” so sharply, and exercise during the day increases sleep pressure at night to help you sleep. Muscles also contain the mitochondria that are the energy powerhouses in your body, so more mitochondria from trained muscles = more energy.

The one type of exercise I recommend to every single patient (especially women), is resistance training. With barbells, dumbbells, bands, or machines - the point is to push your muscles to fatigue. If you’re not sure where to start, one free resource is darebee.com, which has tons of downloadable and printable routines. Generally, the weight you choose should be enough that you can do at least 8 repetitions, but not much more than 12, for at least 3 sets. 

One caution: if you’re like I was several years ago, your only exercise is a lot of cardio in the form of long bike rides or long runs. It was a great stress reliever, but it totally burned me out. Women need resistance training to build up our muscles and power our hobbies and hormones. I discuss this much more in depth in my programs, but know that if you are hitting the pavement hard, and you’re too tired to do the rest of your life, you may want to shift a little bit to incorporate some resistance training. 

Micronutrient deficiencies

When a patient tells me she is fatigued, there are some blood tests I always run, such as a Complete Blood Count (CBC). In addition, I always check the status of three micronutrients: iron, B12, and Vitamin D. Together, they make up the most common micronutrient deficiencies I see in clinical practice. 

Iron and B12 are necessary to carry oxygen in your blood, and if they’re deficient, you’ll have symptoms such as fatigue (duh), but also poor motivation, breathlessness walking up stairs or exercising, restless legs, numbness or tingling, and even heart palpitations and hair loss. So ask your doctor to check your iron and B12 levels. Ferritin (the storage form of iron) should be 70-90 ng/mL for women, and B12 should be around 500 pg/dL. If they’re low, consider talking with your doctor about a supplement. 

Vitamin D has many functions, including improving your immune system and helping you sleep. It may also relieve symptoms of depression in people who are deficient. My goal for Vitamin D in the blood is about 50-80 ng/mL. 

Talk with your doctor before supplementing these micronutrients, as too much can be toxic, and they may interfere with medications or other supplements you may be taking. 

Want more?

Join the self-paced course, Ignite Your Energy for an in-depth discussion about each of these issues, and tons of helpful tips and tricks to get your energy back on track.

Need more help?

We offer programs for those who want to diver deeper into any health-related topics, from mental health to fatigue to perimenopause.