Why does every woman I know say she’s exhausted?

In a few short years, it seems like every woman I know, and many of the ones I treat, have gone from saying, “I’m so busy” to “I’m so tired.” And it’s not the type of exhaustion a good eight hours of sleep on a Saturday can knock out either.

So what do you do when no amount of sleep is enough?

Too many doctors write patient fatigue off as just being tired.

Understanding the root cause of exhaustion can be complicated, and it often requires making simple but steady life changes over time. Too many doctors write patient fatigue off as just being tired. They tell you to get more sleep, to take a vacation. They don’t look under the hood to figure out what’s really going on. When someone is chronically exhausted, there are a few possible causes.

What’s the real reason you’re so tired? Here are 5 possibilities.

You have adrenal fatigue

This is characterized by imbalances in cortisol production. Cortisol should be high in the morning and low by the evening. If it’s high all day, or what I refer to as “flat-lined,” meaning low all day, it indicates disruption in the adrenal cycle that requires intervention.

You’re producing less energy, at the cellular level

When we eat too much sugar and refined processed foods, we create more free radicals in the body (AKA atoms or molecules that are unstable because they have an unpaired electron, so they bounce around and do damage to cells and DNA). This creates an environment where it’s harder for our cells to make energy.

You’re depressed or anxious

Often my patients will say they’re “tired,” but what they really mean is they’re sad or fearful. It’s more socially acceptable to be tired than sad, and a lot of people hide uncomfortable emotions behind an energy deficit.

You need a nutrition boost

We’re eating too much and not getting enough nutrients. Our high-calorie, low-nutrient food system is depleting people. The foods we eat usually don’t give us enough of the folate and B12 that power our nervous systems or magnesium, nature’s natural anti-anxiety medication.

Add alcohol and coffee, two staples that further deplete nutrients and body water through the kidneys; chronic high stress, which makes us pee out magnesium faster; and medications like blood-pressure drugs and stomach-acid blockers that reduce absorption of nutrients or increase our excretion of them, and you have a recipe for an overfed but nutritionally deprived population.

You’ve got gut issues

Our bacteria, the trillions of them that live in our gut and regulate our immune systems, also regulate our brains. They do a lot of work. These bacteria make neurotransmitters that get through the gut wall. They also trigger the nervous system to make neurotransmitters like serotonin and gamma-aminobutyric acid (or GABA) in the brain and manage a process of inflammation in the immune system that can make people feel foggy.

One of my patients came in with symptoms of brain fog and fatigue. Stool tests found that she had an overgrowth of yeast in the gut. We helped her resolve this through a low-sugar diet, antifungal medications, and antifungal herbs. Her brain fog lifted.

No one should be tired all the time. It isn’t normal, and your doctor should never just tell you that you need to get more sleep.

Originally posted April 26, 2017. Updated June 30, 2018. 

Robin Berzin, MD, is the founder and CEO of Parsley Health, an innovative primary care practice with offices in New York, Los Angeles, and San Francisco. Dr. Berzin attended medical school at Columbia University and is also a certified yoga instructor and meditation teacher.

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