Tired All The Time?
Dr Harpal Bains
MBBS DFSRH PGCAestMed (Dist)
December 15, 2021
Dr Harpal Bains
MBBS DFSRH PGCAestMed (Dist)
December 15, 2021
Have you ever wondered: Why am I tired all the time? You’re certainly not alone. It’s not unusual to feel temporarily exhausted after a heavy night out, a stressful week at work or a particularly busy weekend. But, when you’re feeling tired all the time (TATT) even when you’re sleeping and eating right and it’s impacting your daily life, this is a sign that your body is stressed and there’s always an underlying reason.
In our busy, nose-to-the-grindstone modern lives it’s no surprise that we spend a lot of time either feeling stressed or trying to alleviate it.
Generally, we tend to think of stress as an external thing that happens to us; examples of this include major life changes, what’s happening at work or in our personal lives, and even the stress of our daily commute. Whilst these external stressors certainly don’t help, if you’re feeling tired all the time, this is usually linked to the body’s internal stressors which can include issues with nutrition, emotional stress and hormones. Everything in the body is connected, and whilst internal stressors aren’t widely acknowledged, they can have a significant impact on the body and how we feel.
The body’s stress response is a survival mechanism. We see something we perceive as a threat, our adrenal glands kick in and releases cortisol, the stress hormone. This puts the body into fight or flight mode to help us survive. Our heart rate quickens, blood pressure rises, senses sharpen, and our muscles tighten. Once the threat is gone, our cortisol levels revert back to normal. This was just what we needed back when we were cavemen and our survival depended on escaping a tiger or lion. But in today’s modern world we’re more likely to be running away from our morning alarm clock. These days, when we feel stressed for a long time our cortisol levels stay elevated, which in turn can wreak havoc on the body.
When cortisol levels stay elevated for a prolonged period of time, this causes a huge drain on the body’s other resources. Why? The body will always prioritise the stress hormone because it saves your life. The adrenal glands, which release cortisol, are incredibly nutrient-hungry and so every time something causes us stress, the majority of nutrients in the body are redirected to the adrenal glands in order to keep you alive: Nutrients that were once going to your skin are diverted (which is why you may notice dull, dry crepey skin or acne); nutrients that were going to your hair aren’t important (stress puts hair follicles into a resting phase which is why you may notice it falls out more easily); nutrients that were going to your cells aren’t important and they start to become sluggish. If they stay sluggish for a really long time you then have a build-up of toxins within the cells and aren’t able to get them out, giving rise to very tired cells, and in turn, a very tired person.
Over time the demand on the adrenal glands can lead to them becoming fatigued. Also known as adrenal fatigue, this is often associated with chronic illnesses. At this point, instead of over producing cortisol, the body under-produces it – which during caveman days, is dangerous as it may mean that you do not have enough resources to run away from danger – commonly known today as burn out.
There are many reasons you may be tired all the time, including:
Chronic fatigue syndrome and fibromyalgia
Hormone imbalance – oestrogen, progesterone, testosterone and precursor hormones
Hypothyroidism
Autoimmune disease – the body constantly attacking itself uses up tons of resources
Nutritional deficiencies – due to poor nutrition, absorption issues or genetic predisposition
Problems with nutrient absorption (common in gut dysbiosis like IBS, Crohn’s, Ulcerative Colitis and celiac disease)
High stress lifestyle with poor sleep
Large environmental toxin burden like mould, mercury, traffic fumes, and pesticides
Chronic infections including history of childhood infections which still lie dormant like glandular fever (EBV) and frequent tonsillitis or ENT infections; parasites and other infestations, especially after trips abroad
“Stress is intrinsically linked to the adrenal glands so it doesn’t make sense to try to resolve TATT without addressing your adrenal glands. We don’t just stick a band-aid on the problem, we treat the root cause and look at lifelong management where necessary. Based on the history of a patient I will usually have a good idea of what’s going on internally – especially as our consultations are so thorough – but blood tests can really help to pinpoint and confirm any issues. In my experience, when a patient is tired all the time they frequently have some level of hormonal and nutritional distress. For example, in female patients, they may have also noticed an increase in spots around the chin area. This is a classic sign of a hormonal imbalance and suggests to me that there may be an underlying condition like PCOS – especially if accompanied by extra weight gain, bad PMS and hair growth. In men, symptoms of low testosterone is key with raised anxiety levels and poor ability to handle stress. This is usually more obvious than libido and poor muscle gain which tend to appear later.”
You can take steps to stop feeling tired all the time by seeking the help of a hormone doctor who deals with these kinds of problems on a daily basis. At Harpal Clinic our doctors are specialists in hormones, functional medicine and nutritional medicine and are ideally placed to help you back to optimal health.
At home, you can make sure that you take good quality supplements, eat well 80% of the time and ensure you get enough sleep as this is hugely important. We say eat well 80% of the time as, in our experience, people who try to control every aspect of their life don’t fare as well due to the high stress levels that perfectionism causes. When it comes to exercise, more is not necessarily better – especially for those where you feel worse after or where it takes days to recover. We also encourage you to take pleasure in the little things in life, remember to laugh, and have a good social network of friends you can count on.
When it comes to TATT we do what we can to help the body heal itself so it can do its job better, because if the adrenal glands are burnt out, they aren’t much use. This could involve a combination of good quality supplements, and Bioidentical Hormone Replacement Therapy (BHRT) tailored to the patient in order to optimise their hormones and help them feel better. We don’t just optimise the end hormones (oestrogen, progesterone and testosterone), but also the precursor hormones (pregnenolone and DHEA). This reduces the pressure on the body having to make those hormones, and allows the adrenal glands time to recover. We would provide this for as long as necessary until the patient is in a better place and feeling more optimal.
Dr Bains comments: “We have a fantastic success rate with this – when we follow-up with our patients they have more energy and feel so much better – it really is life-changing for them. During the pandemic I have noticed that a lot of our younger patients need less management and some are finding they don’t need anything any more because there is less stress. The pandemic has really highlighted the significance that stress has on one’s body.”
We would also take a look at any gut issues as we do find that a lot of patients who are tired all the time also experience these. Occasional gas, bloating, burping, acid reflux aren’t unheard of, but to experience this on a regular basis or after every meal is NOT normal. Similarly, passing stools once or twice a day is normal for the majority of people; if you’re doing so 4-6 times a day or only once every 2-3 days, it’s a sign of a gut issue and it’s very likely that your body isn’t absorbing nutrients correctly. We do find that gut issues are more prevalent in vegans and vegetarians as they have less nutrients coming into the body. If your body is already struggling with resources due to hungry adrenal glands, and it’s also not absorbing nutrients as it should, you may want to consider IV nutrient therapy. IV drips can be tailored to your body’s specific needs and are administered straight into the bloodstream. This enables the nutrients to bypass the gut and go directly where they are needed.
As with any medical treatment, there will be a small number of patients that don’t respond. In those cases, we go on to look at other environmental factors that could be causing their symptoms. Environmental factors like mould, damp in the home, and moving into a new house with new carpets and fresh paint have been known to cause chronic fatigue symptoms. Something else that we may consider at this stage is whether there is a long-term low-lying chronic infection (for example, a history of multiple bouts of tonsillitis or glandular fever) as this is known to give rise to chronic fatigue.
Hormones, nutrition, immunity, absorption – it’s all connected. And so for effective, life-long management of TATT and any underlying conditions, it’s vitally important to manage all these areas.
If you’re tired all the time and what we’ve discussed above sounds similar to what you’re experiencing, please don’t hesitate to seek help. If you’d like to speak with one of our specialist doctors via telephone or video consultation we can arrange this for you. Simply call 020 7096 5475, email help@harpalclinic.co.uk or fill in our Book An Appointment form.
