Fatigue: Where to Start When You’re Tired All the Time
Feeling tired occasionally is normal. Feeling tired all the time is worth paying attention to.
We all have periods when life is busy, sleep isn't great and our energy takes a hit.
But there's a difference between feeling tired after a long week and feeling persistently exhausted, flat or as though you're dragging yourself through the day.
Fatigue can show up in different ways. You might wake feeling unrefreshed, struggle to get through the afternoon, find exercise harder than it used to be, or notice that your concentration, motivation and mood aren't quite what they were.
And often, there's more than one thing contributing.
So rather than immediately reaching for another supplement or assuming you just need more sleep, I like to start by looking at the bigger picture.
Start with the foundations
Before looking for complicated explanations, start with what your body is receiving every day.
Are you eating enough?
Are you eating regularly?
Are your meals providing adequate protein?
Are you eating a varied diet with plenty of whole foods?
Are you drinking enough water?
These questions sound simple, but they're easy to overlook — particularly when you're busy.
Skipping meals, relying on coffee to get through the morning or eating very lightly during the day and then having most of your food at night may not be helping your energy.
Sometimes getting the foundations right can make a meaningful difference.
Look at what is actually on your plate
When someone comes to see me with fatigue, nutrition is one of the areas I want to understand.
Iron is an obvious consideration, particularly for women who menstruate or have experienced heavy periods. Iron deficiency and anaemia can cause fatigue, weakness and reduced exercise tolerance.
Vitamin B12 and folate may also be relevant, depending on your diet, health history and individual circumstances.
But rather than assuming that fatigue means you need iron, B12 or another supplement, it's important to establish whether there is actually a deficiency and why it may be occurring.
Sometimes the issue isn't simply what you're eating. Digestion, absorption, blood loss, medications and other health conditions can also influence nutrient status.
Don't overlook sleep quality
You can spend eight hours in bed and still not necessarily get restorative sleep.
Think about how you actually feel when you wake.
Do you feel refreshed?
Are you waking frequently?
Do you snore heavily?
Are you relying on caffeine to function?
Are you scrolling or working late into the evening?
Sleep disorders such as insomnia and obstructive sleep apnoea can contribute to fatigue, and persistent poor-quality sleep deserves attention rather than simply being accepted as part of a busy life.
Stress and recovery matter too
Not all fatigue is caused by a nutrient deficiency or abnormal blood result.
Periods of prolonged stress, high workloads, caring responsibilities, emotional strain and simply trying to do too much without enough recovery can all affect how we feel.
This is where I come back to some very basic questions.
Are there any genuine pauses in your day?
Are you getting outside?
Are you moving your body regularly without pushing yourself into exhaustion?
Is there a point where the phone, work and constant stimulation actually stop?
Sometimes supporting energy isn't about adding another health strategy.
It's about creating enough space for recovery.
What about hormones and midlife?
For women in their 40s and 50s, it's also worth considering the wider context.
Changes through perimenopause and menopause can affect sleep, mood and wellbeing, and poor sleep alone can have a significant impact on daytime energy.
That doesn't mean every episode of fatigue in midlife is “hormonal”.
It means hormonal changes are one part of the picture that may be worth considering alongside nutrition, sleep, stress, medical history and other symptoms.
When blood tests may be useful
If fatigue is persistent, unexplained or affecting your ability to function normally, it is worth discussing it with your GP.
Depending on your symptoms and history, medical assessment may include blood tests or other investigations. Iron deficiency and anaemia, thyroid disorders, diabetes, sleep disorders, infections, medications and a range of other health conditions can all contribute to fatigue.
This is also why I don't think the answer is simply to test everything.
Testing should have a purpose.
The useful question is:
What are we trying to understand — and will this test help us answer it?
When “normal” results don't explain how you feel
Sometimes routine investigations don't reveal an obvious cause, yet you still don't feel well.
That's when it can be helpful to step back and look at your results alongside your symptoms, diet, health history, sleep, stress and lifestyle rather than looking at individual numbers in isolation.
It may be that further investigation is appropriate.
Or it may be that there are areas in your nutrition and daily routine that need attention first.
Often, the most useful approach is not choosing one or the other, but working out what makes sense for the individual.
When should you seek medical advice?
Fatigue shouldn't simply be written off as being busy or getting older.
Healthdirect recommends seeing your doctor if fatigue has lasted for more than two weeks and isn't improving, and sooner if it is worrying you, stopping you from doing your usual activities or occurring alongside other symptoms such as unexplained weight loss.
If something feels significantly different for you, it's worth having it assessed.
Tired all the time and not sure where to start?
You don't necessarily need more supplements, more testing or another complicated health routine.
You need to understand what's contributing to your fatigue.
If you'd like help looking at your nutrition, symptoms, lifestyle and existing pathology together, we can work through the bigger picture and determine what may be worth addressing or investigating further.