Common Causes of Fatigue and How to Beat Them

According to the National Institutes of Health (NIH), fatigue affects a staggering 42% of the population (1). This pervasive condition manifests in various forms, ranging from a low level of grogginess upon waking to sudden bouts of drowsiness after meals, often accompanied by an overwhelming urge to sleep at inconvenient moments. Despite its prevalence and diverse manifestations, fatigue is often overlooked or even completely dismissed as a valid standalone health concern. Its subjective nature further complicates recognition and treatment, with underlying conditions such as depression and sleep apnea frequently intertwined. In this blog post, we dive deeper into the complexities of fatigue, exploring its common causes, impacts, and strategies for effective healing.

In naturopathic medicine, the physician is looking for the cause of the fatigue, not simply giving a natural energy pill or tincture. This thorough investigation to find the cause(s) varies person to person. It can be simple and quick or it may take time to unlock the mystery of all the reasons one has fatigue. 

The Top 6 Common Causes of Fatigue and How to Beat Them. 

Iron Anemia

Iron anemia can be seen in the blood way before it becomes a problem in which your red blood cells go below the normal range which classifies ‘iron anemia’. You can see the beginnings of this when your red blood cells become smaller and this is seen in the complete blood count you have Mean Cell Volume (MCV) of less than 90.  another way to see it in the blood if you run serum ferritin and you see it below 40.  Iron may not be low but may be on the low side. If you choose to take iron, take a form that’s chelated such as the bisglycinate form. Avoid iron sulfate as it is the form that causes gastrointestinal issues. Commonly menstruating women and men who work out often, or people who are vegetarian or vegan will have some level of iron anemia.

B12 Anemia

B12 anemia is very common and it’s difficult to find in the bloodwork. However, if you use again the MCV and it is trending high, as in higher than 75% of the normal range, your blood cells are enlarged and this is most commonly caused by B12 deficiency. The truth is B12 is very difficult to absorb for many reasons. Even if you eat many B12 containing foods, sometimes you cannot increase your levels. This brings up another issue which is the serum B12 testing. Blood testing is not the best as there are many forms of cobalamin, and only two are active forms.  So the value that you see in the bloodwork represents the inactive forms as well as the active forms. So I trust the number in serum testing if it’s low, but I never trust it if it’s high.  Proper testing involves a urine test measuring MMA or methylmalonic acid. MMA represents the breakdown of the active forms.  If you choose to take B12 supplementation, it may be helpful, but you need to take it in high amounts and the forms that need to be taken are methylcobalamin or hydroxycobalamin.  Many times B12 injections are also needed to get this anemia under control. 

Adrenal Fatigue

The world seems to be on edge with wars and crime and political disruptions and rising prices. There seems to be quite a bit of stress in our worlds in our lives. Our adrenal glands produce cortisol and help us handle stress.  After a period of chronic intense stress during which our cortisol levels soar and we exist in a state of fight or flight, the adrenal gland can reach its maximum and begin to get fatigued.  This is called adrenal fatigue syndrome. It is nature’s way to tell you that you have had too much stress and not enough rest.  When cortisol is low, it’s difficult to get up in the morning, we can get sleepy after meals, sometimes we get a late night surge of energy.  The testing for cortisol deficiency is a saliva or spit test, testing morning, noon, late afternoon, and bedtime levels.  blood levels are rarely accurate as they represent total cortisol rather than free cortisol.  

To help modulate stress, you can take botanical medicines such as ashwagandha, holy basil, rhodiola, and ginseng (2).  You can take these in the forms of a tea, tincture, or capsules.  If you have a deeper level deficiency, you may want to explore using adrenal glandulars. These are usually sourced from bovine.  Note that if the cortisol deficiency is severe, you may need to be prescribed hydrocortisone for a short period of time.  A licensed naturopath with years of experience may save you time and money by giving you a unique treatment plan based on testing.  

Dr Wendy Wells Common Causes of Fatigue and How to Beat Them with Chronic Infections

Dr Wendy Wells Common Causes of Fatigue and How to Beat Them with Chronic Infections

Chronic Infections

Chronic infections are infections that the body continues to fight long after the initial acute infection.  I see these present in patients who have autoimmune conditions such as Hashimotos, Chronic Fatigue syndrome and Fibromyalgia but also in those who have general fatigue, joint pain, and muscle soreness. 

People with chronic infections are ones that often say,

“I’ve never felt well since I got sick.” 

Organisms that tend to cause chronic infections are Epstein barr virus/mono, Strep, mycoplasma, the herpes family of viruses, cytomegalovirus, mycoplasma, candida, lyme, and the covid virus.  You can test for most of these in blood, stool or urine tests.

Once the infections are identified, we can support the body to eradicate the infections and support the immune system to fully recover using natural medicine.  Treatments typically involve high dose vitamin C IV’s, herbal medicines, or even pharmaceuticals.  The treatment varies depending on the individual. 

To support the immune system I often recommend plant medicines such as astragalus, arabinogalactans, and Maitake mushroom.  Vitamin A is very important as it is antiviral and supports the immune system within our mucus membranes. Vitamin D3 is also very important as it is a potent immune stimulator.


It’s well established that environmental toxins buildup in the body and cause disease. However, I find the most important one is called glyphosate.  Glyphosate is an herbicide also known as N-Phosphomethylglycine, that is sprayed on our food.  Glyphosate blocks a pathway in our gut bacteria that produce amino acids such as phenylalanine, tyrosine and tryptophan.  These amino acids are key for our energizing neurotransmitters such as dopamine, norepinephrine and epinephrine which support energy and mood.  This chemical also is a binder of metals and minerals. In our body, glyphosate binds up very important minerals such as iron, cobalt, zinc and manganese.  Zinc deficiency is associated with a decreased immunity, hair loss, attention issues, and low sex hormone production. Iron deficiency is associated with fatigue and anemia. Cobalt deficiency is associated with B12 (cobalamin) deficiency which can then cause fatigue.  Glyphosate also interferes with our detoxification pathways so in general when we have more toxins, our liver is more stressed and that can also cause fatigue.

The most effective method to minimize exposure to toxins is by purchasing organic foods rather than non-organic foods.  Organic foods prohibit the use of glyphosate. Avoiding exposure altogether is crucial in safeguarding health and well-being.  Again, avoidance is key.

To help eliminate toxins from the body, you can take a supplement called liposomal glutathione, which is one of the most important molecules in the body for detox. You can also purchase or use a far infrared sauna to help get the toxins out.  You may not realize that sweat has been shown to contain environmental toxins, including heavy metals.  It is important to shower with soap directly after the sauna and not let the sweat dry on your skin as you will reabsorb the toxins.  Make sure your bowels are moving daily, if not, you will be accumulating toxins by the process of bile recirculation.  You can include the following in your daily routine to help pull out toxins: binding fiber such as psyllium hulls, bentonite clay, zeolite binder, and activated charcoal.

Hormone Imbalance

Low hormone levels typically cause fatigue. The underlying cause of low hormones can be due to gut dysbiosis, electromagnetic radiation, endocrine disrupting toxins such as pesticides, parabens, BPA, phthalates, and poor diet including processed foods. Adrenal fatigue can also cause sex hormone imbalance as the adrenal makes DHEA which is a precursor to estrogen and testosterone. 

In conclusion, the common causes of fatigue can stem from many factors, either singularly or in combination. Understanding the unique interplay of these elements is crucial in effectively addressing fatigue. Seeking guidance from a naturopathic physician may prove invaluable, as they dedicate the necessary time and expertise to deciphering the individual nuances of one’s fatigue. By identifying and addressing the specific underlying causes, individuals can embark on a path towards renewed energy and vitality, reclaiming their quality of life.


  1. Yoon JH, Park NH, Kang YE, Ahn YC, Lee EJ, Son CG. The demographic features of fatigue in the general population worldwide: a systematic review and meta-analysis. Front Public Health. 2023 Jul 28;11:1192121. doi: 10.3389/fpubh.2023.1192121. PMID: 37575103; PMCID: PMC10416797.
  2. Stansbury, Jill & Saunders, Paul & Winston, David. (2012). Supporting Adrenal Function with Adaptogenic Herbs. Journal of Restorative Medicine. 1. 76-82. 10.14200/jrm.2012.1.1007.

Hi I’m Dr. Wendy Wells, a licensed Naturopathic Physician in Arizona in the United States.  I was awarded a Doctorate of Naturopathic Medicine from Southwest College of Naturopathic Medicine, now called Sonoran University. I’m a member of the American Association of Naturopathic Physicians and the Arizona Board of Naturopathic Medical Association.  I enjoy helping patients with a variety of acute and chronic issues such as thyroid issues, hormone balancing, chronic fatigue, food sensitivities, gut health, mental health, autoimmune and skin issues. My passion is finding the source beneath any health concerns, getting the body back in balance, educating patients and their communities about how the body heals itself, and setting a course for continued wellness going forward.

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