woman feeling tired, exhausted, fatigue
Always tired? We can help

What causes fatigue?

Fatigue can be due to many different things and is very common in our society. The causes of fatigue can range from having a simple cold or flu to hypothyroidism, iron deficiency, stress, lack of sleep quantity or quality, or nutrient insufficiency problems. Our Naturopathic Doctor can help you determine what the source of your fatigue is and correct that to help you feel better!

Signs that your level of fatigue is unusual and would benefit from treatment if you:

  1. Rely on coffee to get going in the morning
  2. Rely on nicotine to keep you going
  3. Work more than 8 hours per day, 5 days per week
  4. Need to sleep more than 8 hours per night on the weekend
  5. Don’t socialize with your friends/family because of the effort that entails
  6. Need a nap when you get home from work
  7. Find it difficult to get up in the morning after at least 7 hours of sleep

What is the underlying cause of fatigue?

Fatigue can be caused by improper diet, poor sleep, stress, food sensitivities, low iron, HPA axis dysfunction, depression, and allergies. Our naturopathic doctor often helps people with fatigue by investigating and correcting a few key areas such as:


As the saying goes, “you are what you eat”, so your diet plays a role in fatigue. Perhaps you have a food allergy or you may not be absorbing nutrients properly due to problems in your stomach or your bowels.  Most people have mild food allergies or sensitivities that are not obvious to them but can create ongoing chronic fatigue. How can you find out?  There is a blood test for mild food allergies, also called food intolerances or sensitivities, that can be done by our naturopathic doctor. Information about that test is listed here.


Are you getting enough sleep and are you waking feeling refreshed?  If you don’t feel refreshed after at least 7 hours of good quality sleep, there is another problem that needs to be fixed. That may include food sensitivities, HPA axis dysfunction, low iron, or low thyroid.


Physical or emotional stress can be exhausting, particularly if it goes on for an extended period of time. Our naturopathic doctor helps by supporting your brain, your nervous system, and your adrenal glands to help mitigate the effects of stress. This helps you to regain your energy and prevent chronic disease due to stress.


Allergies are a hypersensitivity of your immune system to substances that should not be considered an immune threat: dust, pollen, dander, foods, etc. If your immune system is on high alert against something commonly encountered like dust or foods, then it is working overtime all the time, which can be exhausting. While most of us don’t have serious IgE-mediated food allergies, like a peanut or shellfish allergy, we often do have milder, non-life-threatening food sensitivities that we may not be aware of. Even though these may not be severe, they do consume a fair bit of your energy day in and day out. Dairy is a common food sensitivity along with gluten, pineapple, almonds, beans, and eggs. Sometimes a 3-week strict elimination of these common sensitivities will unearth the source of your fatigue. If not, there is food sensitivity blood testing that can be done to determine what your exact food sensitivities are.

Underactive thyroid

Your thyroid may not be working well, but not yet bad enough to warrant medication from your doctor.  This is a prime opportunity to correct it.  Knowing exact thyroid levels (TSH) is necessary to determine if your thyroid is mildly underactive.  Optimal TSH is less than 2.00, while your doctor will still consider your TSH normal until it is greater than 5.00.

Low iron

Iron deficiency is a common cause of fatigue and hair loss. This is easily checked via a blood test as well, but whether your ferritin level is considered normal or deficient will depend on which lab you go to. We use Dynacare for our conventional lab tests, the other two commonly used medical labs are CML and Life Labs.
According to Dynacare, a normal ferritin level is 5-272. According to CML and Life Labs, it’s about 11-190. Quite a difference right? If you went to Dynacare to have your ferritin done and it was 6 you would be told that it is normal, if you go to Lifelabs, you would be told it was low. I find patients don’t feel normal if their ferritin is less than 40 and optimal is above 60.

To properly address low iron, you need to assess why it’s low in the first place and fix that. Here are common causes of low iron:

  • If you’re female perhaps your periods are excessively heavy and you lose too much each month
  • your iron absorption may be poor because your gut is unhealthy
  • maybe you just don’t consume enough iron-rich foods or
  • maybe you do consume foods with iron but there are so many foods in your diet like dairy products and whole grains that inhibit iron absorption that you just don’t take in what you are consuming.

Most iron supplements from a drug store are a high dose of poorly absorbed iron. This causes GI side effects like nausea or constipation, so patients find it hard to stick with them long enough to get their iron level up. I tend to prescribe a much lower dose of much better-absorbed iron.

HPA axis dysfunction (Adrenal fatigue)

If your thyroid tests are normal, i.e. your TSH is between 1.00 and 2.00 (check this number!), and ferritin is ok, i.e. over 40, then the next place to look if your energy is low is your adrenal glands. Your adrenals are two little glands that sit atop your kidneys and perform several jobs for you including:

  • Giving you energy, drive, and motivation
  • They help regulate your blood pressure, water and salt balance
  • Stabilizing blood sugar
  • Balancing hormones, and
  • Managing inflammation.

If your fatigue set in after a bout of intense stress or after a period of more chronic stress and thyroid and iron are normal, then I would suspect HPA axis dysfunction that is affecting your adrenal glands.

There are blood tests that can help assess the adrenals and HPA axis, although it’s not as straightforward as TSH and ferritin. Cortisol is a stress hormone produced by your adrenal glands that should peak in the morning and taper off in the evening. To determine whether your cortisol is being produced in a healthy fashion, it is best to measure a morning level and an evening level. DHEAs and testosterone are also produced by your adrenal glands. Low levels indicate under-functioning adrenals. The adrenal glands need Vitamin C, vitamin B5, and B6, magnesium, zinc, and potassium to function normally. Due to stress, the demand often exceeds the supply for these vitamins, leading to weak HPA axis function.


Depression can manifest as an inability or lack of desire to get out of bed in the morning that is similar to fatigue. If you are really struggling with this and experiencing periods of sadness or despair, see your medical doctor to be assessed for depression. Supporting your HPA axis and adrenal glands and enhancing your brain’s ability to produce a healthy balance of neurotransmitters such as dopamine, GABA and serotonin help to increase your sense of well-being and manage depression.

Which natural therapies help fatigue?

  • Diet modifications
  • Acupuncture
  • Vitamins, minerals
  • Herbal medicine
  • Exercise
  • Good quality sleep

Naturopathic Medicine is highly effective for fatigue. Our Naturopathic Doctor will work with you to help you manage your symptoms and help you treat the cause of your fatigue.

Authored by Dr. Pamela Frank, Naturopathic Doctor, updated Feb. 9, 2022

Some Natural Medicine & Fatigue Research:


Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome.
Cochrane Database Syst Rev . 2017; 4:CD003200. doi: 10.1002/14651858.CD003200.
● A systematic review of 8 RCTs with 1518 participants, undergoing exercise therapy for 12-26
weeks (eg. Swimming, walking, cycling, dancing, anaerobic exercise) compared to control
(passive relaxation, CBT, pacing, supportive listening, pharmacological treatment). 7 studies
showed a reduction in fatigue following exercise therapy at end of treatment – overall findings suggest exercise therapy had a positive effect on sleep, physical function, and self-perceived general health.

Stress Reduction Techniques:

Reduce emotional stress levels by exercising, deep breathing, and meditating.
–Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012


Holy basil (Ocimum tenuiflorum), an aromatic plant native to the Eastern World tropics, was found to strengthen the body against stress.
–Source: Complementary Prescriptions Journal, Vol.26, Issue 12, Dec. 2012

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