The 7 Hidden Causes of Fatigue

From the Cleveland Clinic

Fatigue can signal anemia, diabetes, hypothyroidism or hepatitis C. But once your doctor rules out major medical causes of fatigue, it’s time to consider hidden ones. "We look for the less obvious roots of fatigue — that’s our job,” says Tanya Edwards, MD, Medical Director of Cleveland Clinic’s Center for Integrative Medicine.

Hidden causes include:

1. A junk food diet

Diets that are high in trans fats, saturated fats, processed foods and added sugars can sap your energy. Edwards recommends switching to a diet high in good sources of protein — mainly fish, nuts, seeds and beans — with eight to 10 servings of fruits and vegetables per day.

Watch out for grains, though. These complex carbs affect insulin. “Insulin is the storage hormone that makes us heavier. The heavier we are, the higher our blood sugar becomes, and the more insulin resistance (prediabetes) we develop,” she says.

2. Lost nutrients

Today’s industrial farming practices rob the soil of key fatigue-fighting minerals, says Edwards, who recommends taking a multivitamin and mineral supplement. Supplements contain minerals rarely found in food, such as:·Selenium, important for thyroid function and metabolism, and  Iodine, present in the iodized salt that many people with heart disease and high blood pressure avoid. “Low iodine states can result in fatigue,” she says.

3. Not enough omega-3 Fish are rich in omega-3 fatty acids — but most of us don’t eat enough. “I recommend about 1,000 mg of an omega-3 supplement,” says Edwards. “My preference is fish oil because it is the long-chain form that our body needs.”

4. Vitamin D deficiency Vitamin D gives us energy. Low levels of this vitamin can cause low energy and depression. “Vitamin D and omega-3 are necessary for every single cell in the body — including brain cells — to work properly,” says Edwards. If blood tests reveal low vitamin D levels, she recommends supplements.

5. Low magnesium We are born with a finite amount of magnesium — also needed for energy production — in our bones and muscles. The vast majority of Americans get less than half the required amount of this mineral from their diet.

“Magnesium is still leaching out of our bones and muscles in our 40s and 50s,” says Dr. Edwards. She recommends magnesium replacement for those with symptoms of a total body deficit: insomnia, fatigue, constipation, muscle cramps and pain, joint pain, anxiety and elevated blood pressure.

6. Poor sleep When it comes to sleep difficulties, “we’ve got the perfect storm happening in our 40s and 50s,” says Dr. Edwards. Reasons for lost sleep include increased work responsibilities, living with teens, aging parents and falling magnesium levels. For women, menopause and perimenopause are also factors. Falling levels of progesterone (a female hormone that helps with sleep) and hot flashes can cause insomnia. A change in caffeine metabolism doesn’t help.

“Women who have had two cups of coffee a day since age 20 suddenly can’t metabolize it as fast at age 50,” says Dr. Edwards. Caffeine can take eight to 10 instead of five hours to clear the system. For these women, she recommends scaling back to one cup of coffee before 10 a.m.

7. A sedentary life Ironically, not getting enough exercise can make you feel tired, says Dr. Edwards. Regular exercise will boost your energy as well as your mood and fitness level. If healthy changes in diet, sleep and exercise don’t improve fatigue after a couple of months, she often recommends: B complex vitamins — these help our bodies make energy, especially in times of stress, and Coenzyme Q10 — this cofactor, which helps enzymes produce energy in our cells, is often blocked by statins (common heart disease drugs). In addition, “acupuncture can be huge for fatigue, sleep, pain and hot flashes,” says Dr. Edwards. 

Reprinted with permission from For more information, visit



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