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Immortal Musings

Top 5 Answers to “Why am I so tired?” and What To Do About It.

Fatigue has become so familiar; it’s almost stopped being noteworthy. In fact, “Why am I so tired?” was the #4 most frequently asked health question on Google in 2017.

The press has had a lot to say about Chronic Fatigue Syndrome. But, while CFS is a serious condition, it is not one of the most common reasons for feeling consistently tired.

So, before you post Dr. Google’s latest diagnosis on Facebook, check out these far more likely reasons you feel so tired.

Reason #1 you are so tired – Dehydration

Remember when you were a kid and had boundless energy? You’d run home and hit the fridge for a tall glass of something because you were thirsty and tired. Good instincts! What happened to that kid?

There is a reason tired and thirsty so often go together.

Dehydration thickens the blood and increases blood pressure. This, in turn, reduces blood flow to the entire body (including the brain) and reduces oxygen delivered to the individual cells. Oxygen is essential for cells to create energy.

A surprising percentage of people walk around chronically mildly dehydrated. A British study found that 1 in 5 patients visiting their General Practitioner had a complaint that could be traced to moderate to severe dehydration.

How to know if you’re tired due to dehydration?

By the time you feel thirsty, you are already dehydrated. Waiting to “feel” thirsty is probably not the best strategy.

Common symptoms of dehydration include;

  • fatigue (check, or you wouldn’t be reading this article)
  • muscle cramps
  • craving for sweets
  • headaches
  • brain fog
  • chills
  • constipation.

If you can say “yes” to 3 or more of these symptoms, then testing whether increasing your water consumption helps is well worth the effort.

An even simpler test? Check your urine. The color should be clear to pale yellow, and it should be odorless. If the color is any darker or if you can smell it, congratulations, you’re dehydrated. Now go celebrate with a big glass of water!

How to stop being dehydrated?

How much water to consume, ought to be a simple question. But, it turns out to be somewhat controversial. This is commonly the case when talking about human biology because we are not all created equal (physically speaking of course.)

Race, gender, body type, climate, and activity level are all significant variables. The standard advice for years was eight glasses a day. That guideline was not based on science but simply because it was easy to remember. But one size definitely doesn’t fit all here. The general “rule of thumb” according to the Institute of Medicine is roughly 13 cups per day for the average man and 9 cups per day for the average woman. But all the variables above should be taken into account. For a quick, personalized recommendation check out the hydration calculator at the Healthy Hydration Initiative.

Your dehydration action plan.

✅ Use the calculator above to figure out your recommended daily consumption.

✅ There are many apps available for your phone that will help you track your water consumption.

But unless you just really want a perky motivational quote to go with your trip to the water fountain, your phone probably already has the only app you need. It’s called an alarm. Just set regular reminders throughout the day and then repeat daily.

(Pro tip for iphone people: Siri make this process a lot faster.)

✅ At first you are going to want to tinkle…a lot. That’s perfectly normal. Your body will adjust to the new hydration level in 2-3 days and you’ll be more or less back on your routine bathroom break schedule.

✅ Remember, contrary to popular myth, all liquid non-alcoholic beverages count. So, if you are an early morning coffee or tea drinker, that does count as one of your daily glasses.

✅ Personally, I often under hydrate because I’m busy and don’t want to stop what I’m doing. First, that’s a bad attitude. Your body and mind need a break at least as often as you need a drink of water. But if, like me, you still struggle with that, invest in a large water bottle and keep it handy to sip on so you don’t have to stop to hydrate.

✅ As with any new habit, it helps to have an association that you use as a trigger to remind you to drink. It could be anything that happens regularly throughout the day.

What works for me? I use going to the bathroom as my trigger to drink more. As soon as I return from a bathrrom break, I drink another glass of water.

Reason #2 you are so tired – Poor Quality Sleep

It’s pretty obvious that if you were out partying all night or the kids kept you awake with the latest round of flu, you are going to be tired. But this is usually not a chronic situation.
(My wife and I just had our 2nd child. And, “yes”sleep deprivation feels pretty darn chronic to both my wife and I right now. If you are in this boat, I feel you!)

But many people are unaware that it’s not just quantity of sleep but also quality. Many of us are unknowingly experiencing poor quality of sleep. Common causes of poor quality sleep include stress, lack of exercise, depression, alcohol consumption, environmental factors (like that neighbor with the “awesome” stereo, you know the one I mean), and a host of possible physical causes including sleep apnea.

How to know if your problem is poor quality sleep?

  • Do you hit the snooze on your alarm clock routinely?
  • Do you sleep late on weekends?
  • Are you irritable and moody, especially upon waking?
  • Do you consume 2 or more caffeinated beverages daily?
  • Do you get more than you share of colds or flus?
  • Do you have trouble remembering things or focusing?
  • Is your blood sugar or blood pressure slowly creeping upwards?

If you answered “yes” to 3 or more of these questions, you may be experiencing poor quality sleep.

How to improve the quality of your sleep?

Cut caffeine consumption, especially in the afternoon or evening. Your body takes longer than most people realize to process caffeine. Caffeine from a cup of coffee consumed with dinner, we’ll still be in your system at midnight and beyond.

Limit alcohol consumption. Many people say alcohol makes them sleepy and, indeed in the immediate short term this is true for many people. But, as your body processes the alcohol, your blood sugar drops which can adversely affect the quality of your sleep.

Eat less before bed. Not only is this good for maintaining healthy weight. Research shows it’s also good for your sleep. A heavy meal before bed disrupts sleep patterns.

Need a jump start on getting a full night's sleep?

This little-known Chinese herb may be the answer.

✅  Establish a sleep schedule and routine. Your body needs a sleep schedule. Force yourself to get up at the same time everyday regardless of how tired you may feel and force yourself to go to bed at the same time every evening.

✅  Get a workout. Again, it turns out that the behavior that is just in general good for your health is also beneficial for quality of sleep. Exercise makes you tired. A tired body sleeps better.

Turn off the electronics. It so tempting to catch up on Facebook or Twitter once you’re comfy in your bed. Or, maybe just idly scroll through Instagram to help turn off your brain. But, the blue light from most electronic devices disrupts the production of melatonin, a hormone essential to sleep.

Lower the thermostat. Again, our intuition is that a warm cozy bed is conducive to sleep. But sleep research shows that the ideal temperature for sleep is a chilly 66° F.

Reason #3 You are so tired – Poor Circulation

Poor circulation, whether due to clogged arteries, poor heart function, thick blood or PAD, does relate to persistent fatigue. The first and most important connection is that blood deliver oxygen to the brain. When your brain is deprived of oxygen you feel tired.
Muscles throughout the body will also feel sluggish and weak, again due to lack of oxygen which is required in order to convert dietary calories into energy.

How to know if you’re tired due to poor circulation?

  • Are your hands and feet constantly cold, even during the summer months? As mentioned, blood delivers oxygen to every cell of the body. It also carries heat from your body core to the extremities. When that blood flow is lacking, hands and feet may feel cold.
  • Do you get tingles or numbness in your hands and feet? Ever fall sleep laying on one of your hands? That cramped position cuts off blood flow to your hand and you wake up with pins and needles. People with poor circulation often feel that same sensation without any obvious cause.
  • Do you often get dizzy spells or struggle poor focus and memory? Yes, this symptom is a sign of BOTH poor quality sleep and poor circulation. Your brain needs oxygen to function well, in fact, no oxygen for more than 6 minutes and brain damage is likely. Brain fog is a very common sign of poor circulation.
  • Is your skin dry despite all the hand cream in the world? Your skin needs water inside to stay moist and fresh. When you have poor circulation your body diverts water from the skin to thin the blood.
  • Is your love life in the dumps? You know that little blue pill? It works its magic simply by increasing blood flow to the genitals. Poor circulation has the opposite effect. ‘nuff said.
  • Are you just not hungry much of the time? Your brain has to be informed when you stomach is hungry. As hunger sets in, you stomach muscles generate a hormone called ghrelin. Your blood system delivers ghrelin to your brain. One side effect of poor circulation is this key hormone does not get delivered and you r brain doesn’t receive the message.
  • Do people keep telling you, you look tired? People notice visual signs of fatigue like dark circles under the eyes. While there are many causes of dark circles, including plain old genetics, poor circulation is on of the most common.

If you can answer ‘yes” to at least 3 of the above, poor circulation may be your culprit.

How to improve your circulation?

Relax – Stress can cause tightening of muscles which in turn constricts blood vessels. Conversely, relaxation improves blood flow. Look for moving meditation exercises like yoga or tai chi. Massage is another relaxing way to improve circulation.

Get moving – Too much sitting either in the office or at home constricts blood flow and atrophies muscles. There is a strong body of emerging science that shows skeletal muscles are as responsible for blood circulation as the pumping of your heart. Even light exercise like walking has been shown to significantly improve blood flow. I personally also use a standing desk in my office and try not to sit more than 2 hours per day.

Reach…for your toes. Or any other kind of stretching. Again, tight muscle are the enemy of ciculation. Flexibility is key. Daily 15 minutes spent stretching was shown in one study to increase blood flow an average of 14%.

Try Gynostemma – Gynostemma is a little known Chinese herb, usually consumed as a tea. Locally, it’s known as the “Immortality Herb”. One of its many benefits is increasing your body’s production of Nitric oxide. Nitric oxide is a natural vasodilator.

✅  Reduce cholesterol - Most of the information out there about cholesterol is misleading and misinformed. Our bodies need cholesterol. In fact, the walls of every cell of your body are constructed of cholesterol. But, cholesterol in the blood is a problem. The cholesterol catches on the turns and branches of blood vessels and builds up plaque which restricts blood flow.

Statin drugs are beneficial in this regard but may mask the root cause of the problem which are often related to chronic inflammation or high blood sugar.

Do you have poor circulation?

The herb Gynostemma can help, often in just days.

Chill Out – Fitness guru Wim Hoff has been the subject of dozens of scientific studies due to his ability to withstand extreme cold for extended times without any adverse effects. Researcher studying Mr Hoff and his training method have found that practitioners have significantly better circulation.

The exact mechanism is not well understood but Mr. Hoff suggests that repeated cold exposure tightens the circulatory system causing it to function more efficiently.
Fortunately, you do not have to follow such an extreme routine to benefit. Try gradually turning down your home thermometer until you reach a temperature of around 60° F. Or, try cold showers, working up from 30 seconds at a time until the entire shower is taken cold.

Reason #4 you are so tired – Poor Diet or Poor Nutrient Absorption

Ok, so back to high school physics for a moment, specifically, the law of conservation of energy. In order for you to express energy you have to be taking in energy, aka food!
With the rates of obesity in America, you’d think this was hardly a problem. But, your body is particular about what kinds of food it can use effectively and has nutrient requirements to convert food to energy, after all, it is a chemical process.

Finally, just because you are eating food, that does not mean that food is being absorbed into your body.

How to know if you’re tired due to poor diet or nutrients?

If you are not getting proper nutrition or a experiencing malabsorption of nutrients, in addition to consistent fatigue you may notice the following;

  • Every day is a bad hair day – You can learn a lot about someone by looking at their hair. Beautiful, healthy hair is a sure sign you’re getting plenty of nutrition. Your body knows that, in terms of health, hair is a low priority. If there are insufficient nutrients, it won’t be wasted on hair.
  • Provided there is no chemical damage to be considered, a pretty clear sign of inadequate nutrition is dry, dull or easily broken hair.
  • Are you aging faster than you friends? Wrinkles, they seem inevitable. But poor diet accelerates the process. One of the key factors in aging is oxidants that slowly break down the skin and gradually overwhelm your body’s innate repair mechanism. A proper diet, especially one rich in anti-oxidants, ensure the boy does not have to work so hard at self-repair and thus slow the process.
  • Do you dread the dentist? Poor nutrient absorption is also closely associated with poor dental health. Of course, you know that sugar can lead to cavities. But poor diet also impairs you body’s ability to resist a wide range of gum disease.
  • Do you heal slowly, even from minor injuries? Your body needs nutrients to repair itself. When the necessary nutrients are lacking the repair process takes longer as your body gathers the resources. It also impairs your ability to resist infection while you are healing.
  • Do you feel fuzzy headed? Brain function is also clearly linked to quality of nutrition, especially omega 3 fatty acids. While brain function keeps coming up as a symptom here, poor cognition from nutritional issues can usually be spotted if you are particularly fuzzy when you first wake up and feel clearer after meals.
  • Do you feel bloated? Excess gassiness or bloating is also a common sign of poor nutrition. If nutrients are not absorbed normally while passing through the stomach and upper intestine and thus make their way to the lower intestine, they are far more likely to cause serious gas or bloating.

If you find yourself tired all the time and you can say yes to 3 or more of the above. Poor nutrition or leaky gut syndrome are possible candidates.

How to improve your nutritional absorption?

Here, we’ll assume that the problem is not as simple as making better food choices. You are eating your veggies, right?

There are serious health conditions that cause malabsorption. If you think this may be your issue, a trip to a physician specializing in integrative health may be in order.

But, the most common malabsorption issues can be resolved with some simple changes in how you eat.

Cut back on liquids before or with meals – As discussed, dehydration is one of the major causes of persistent fatigue. You should make sure you are getting enough liquids. But timing can be an issue.

Food is broken down in your digestive track by enzymes and stomach acids. Too many liquids just before or during a meal dilutes the enzymes and acids making the chemical process less effective.

If you feel poor absorption of nutrients is one of your issues, then do not drink for 30 minutes before or after your meals. This ensures the concentration of digestive enzymes is at peak when the food arrives and for the crucial 30 minute window following.

You can also consider making that beverage 30 minutes before a bitter tea like Gynostemma (aka jiaogulan) or simply over brewing regular green tea. The bitterness stimulates production of digestive enzymes.

The Old Standby – Apple Cider Vinegar - Over half of Americans struggle with too low stomach acid. For decades we believed that indigestion was caused by excess stomach acid. We now understand that the exact opposite is true.

Most acid reflux and indigestion is caused by a bacteria called Helicobacter pylori. This bacteria is present in almost everyone but is controlled by stomach acid. When your stomach acid is too low, this bacertia growas uncontrolled and is responsible for many of the symptoms of acid reflux. Including a relaxation of the lower esophageal sphincter (LES).

When the LES relaxes inappropriately, stomach acid is allowed to flow backwards into the esophagus. This acid burns and this is the reason doctors once thought the disease was an excess of acid. Many doctors are still prescribing dangerous drugs that lower stomach acid to combat this illness. It is the exact opposite of what you need.

You can help stimulate increased stomach acid by drinking one or two tablespoons of apple cider vinegar before meals.

Fermented foods like sauerkraut, kimchi or kefir will also help lower the pH of your stomach and improve digestion.

Put your tummy on a schedule – Our bodies are remarkably dependent on a schedule. Largely governed by circadian rythms. We are just beginning to understand all the mechanisms in our body that are on a clock.

Digestion is one of those functions. When we eat (and eliminate) on a regular schedule our bodies fall into a rhythm and produce the necessary digestive enzymes right on cue.

Irregular eating is likely to blindside our digestive system.


Skip Breakfast – I know mom always said breakfast is the most important meal of the day. I agree. But let’s take a look at the word for a minute. Breakfast is the meal that “breaks” your “fast”. That can happen anytime after an extended period of time without eating.

It’s only in relatively modern times that we’ve begun to presume that breakfast means a morning meal.

Postponing that important first meal of the day to noon or later is called Time Restricted Eating and it is one of the most popular methods of intermittent Fasting (IF).

IF has tremendous overall health benefits. One the most important is it gives your body time to achieve a state of true physical hunger vs. hedonistic hunger.

True physical hunger is accompanied by a host of chemical signals that prepares your body to process food properly.


Take Probiotics – The typical adult has roughly 3 pounds of symbiotic bacteria living in their gut. This bacteria is absolutely essential to properly processing our foods, especially fruits and vegetables.

Our internally produced enzymes are relatively efficient at breaking down simple carbohydrates and proteins. But extracting many of the more complex nutrients present in fruits and vegetables requires help from our little buddies, bacteria.

Unfortunately, too many of us are casually treating simple infections with antibiotics. While these antibiotics are great for killing infections, they also go to town on our beneficial bacteria in our guts, severely impairing our ability to process foods.

Natural sources of probiotics include, yogurt, kefir, saurkraut, pickles and farmer’s cheese.

You can also buy live probiotic supplements at most health food stores and many grocery stores. Probiotics is one of those things where you don’t want to skimp. Low quality probiotics are next to useless. You want live, high quality probiotics.

Reason #5 you are so tired – Hormone Imbalances

The human neuro-endocrine system is one of the most complex and least understood systems in the human body. In a healthy person, an exquisitely choreographed ballet is constantly in motion between the various hormone organs in our bodies.

The major endocrine glands are your brain (hypothalamus and pineal and pituitary glands), adrenals, pancreas, reproductive glands (ovaries and testes), thyroid, parathyroid, and gastrointestinal tract.

Their job, in some sense, is to maintain the status quo. Through a complex series of feedback loops, hormones regulate metabolism, mood, sex drive, appetite, energy levels and more.

When they get out of balance with each other, it can be quite challenging to reestablish equilibrium. External interventions like hormone replacement therapy or gland removal, often backfire making the system irreparably out of balance.

One of the most common manifestations of a neuro-endocrine system that has lost its groove is chronic fatigue.


The two primary hormones secreted by the adrenal gland are adrenaline (of course) and cortisol. In the presence of constant mental or emotional stress the adrenal gland can become “fatigued.”

In reality, research shows the name ‘adrenal fatigue” is a misnomer. The adrenal gland is, in fact, usually working just fine. The problem is caused by a communication dysfunction between the brain and the adrenal gland.

The brain thinks it’s sending one set of signals and the adrenal gland is hearing another. The results can be widely varying, too much cortisol, too little, or just bad timing of its secretion.

Top signs your fatigue is caused by a cortisol problem?

In addition to fatigue,

  • You’re especially slow to start in the morning.
  • Low sex drive
  • You crave sweets
  • You crash in the afternoon but are wide awake by evening
  • You get to sleep but can’t stay asleep.

What to do about a cortisol problem?

Confirm cortisol is the problem with a 24 hours adrenal stress index. This is a simple saliva based series of tests that tracks your cortisol levels over a 24hour period.

✅  Reduce stress (meditation, massage, plain old downtime, stop trying to do and have it all)

Exercise regularly. It’s a strange thought when you’re exhausted, go to the gym. But research shows that regular aerobic exercise may be just what the doctor ordered. The mechanism is not entirely clear but it seems to have something to do with convincing your body that you have responded appropriately to the stress signals and now it’s safe to relax.

✅  Whole adaptogenic herbs are famous for putting the neuroendocrine system back in balance. Tea or capsules will work but steer clear of extracts which are not as effective and may be too concentrated for regular use. My favorites are gynostemma (aka jiaogulan) and tulsi.

✅  Get more sleep. See the above section on sleep for tips on how to do this (even if it feels impossible at the moment.)


Readers of my blog will know that I personally have suffered with Grave’s Disease, an autoimmune condition that overstimulates the thyroid. Grave’s is just one of many potential thyroid issues including Hashimoto’s Syndrome, thyroid resistance and thyroid conversion problems.

Top signs your fatigue is caused by a thyroid problem?

In addition to fatigue,

  • Your hands and feet are cold
  • You have problems either maintaining your weight (hyperactive thyroid) or trouble losing weight (hypoactive thyroid)
  • Depression, lack of motivation or constant unexplained anxiety
  • Constipation or infrequent bowel movements
  • Thinning hair and/or dry skin.

What to do about a thyroid problem?

​​ ✅  Confirm it’s a thyroid problem with a full thyroid panel (not the standard one which will miss many thyroid issues).

Cut out both coffee and sugar…completely! Sugar should basically be on everyone’s list to reduce or completely eliminate. There is strong evidence linking sugar to a host of health conditions including, chronic inflammation, diabetes and, yes, thyroid problems.

In the case of thyroid, coffee has also been linked to both overactive and underactive thyroid.

✅  Eliminate most dairy. Many dairy product contain a protein called A1Casein. A1 Casein, a mutated protein chain found in the majority of commercial cow’s milk and milk products is a detrimental biochemical known to cause autoimmune disorders like Grave’s Disease or Hashimoto’s Syndrome. (Butter is ok and in fact beneficial.)

✅  Do a heavy metal detox. When I was in gradschool I needed a vacuum system for an experiment I wanted to do.

My advisor showed me storeroom with an unused vacuum chamber, “Someone set the valves backwards and sucked mercury into all the pipes in this one. But if you clean all that out, you should be good to go.”

So, like an idiot, I got some brushes and a pair of rubber gloves and got busy. There’s no knowing how much mercury a managed to expose myself to.

But you don’t need a disastrous science experiment to have a heavy metals problem. Heavy metal exposure is growing steadily throughout our food supply including especially seafood.

✅ Again, load up on adaptogens like gynostemma. That will be our recommendation for virtually any hormone issue.


The human body produces three forms of estrogen. The ratio amongst three forms of estrogen is crucial and falls easily out of balance. It normally self-corrects. But in severe cases the ratios can get so out of whack the natural feedback system fails.

Abnormal estrogen levels are linked to chronic fatigue, cancer and heart disease.

Top signs your fatigue is caused by an estrogen problem?

In addition to fatigue,

  • Get a full hormone panel done including detailed estrogen levels,
  • Too little estrogen; vaginal dryness, urinary infections, impaired mentation, depression, lack of energy, hot flashes
  • Too much estrogen; rapid weight gain, moodiness, migraines, anxiety or insomnia.

What to do about an estrogen problem?

To reduce estrogen -

Get more sun, or at least more of the sunshine vitamin, E. Studies show that vitamin can help to lower estrogen levels. Vitamin D also reduces inflammation at the cellular level and may also help to lower the risk of endometriosis.

Cut down on the foods with high glycemic index (GI). High GI foods not only effect your insulin levels, they may also cause a surge in the circulating estrogen levels. Thus, you should avoid the high GI foods as much as possible.

✅ Increase your daily fiber with consuming fresh fruits and vegetable, whole grains and beans. A highfiber diet promotes the excretion of excess estrogen from the digestive track and may decrease risk of breast cancer.

Get more exercise. More exercise is usually a good idea. In this specific case, exercise helps your body metabolize circulating blood estrogen into other healthy compounds.

Reduce Stress. Stress keeps coming up in this article. So no surprise here. High stress levels are also linked to excess estrogen production.

To increase estrogen -

Drink coffee. While reducing caffeine is best for most hormone issues, low estrogen is an exception. 23 cups of coffee per day are associated with increased levels of estrogen production.

Don’t over exercise. Many female athletes experience a severe drop in estrogen production. But you don’t have to be a world class athlete to have this problem. Yes, to moderate exercise but don’t overdo it.

Add soy product to you diet. Soy milk, miso and tofu are all soy bean derived. Soy beans are known to increase estrogen production.

✅ And, as always, consider adding adaptogenic herbs to your routine.

More energy and the end of chronic fatigue may be just weeks or even days away!

Slightly more than 93% of the time, one of the above causes of fatigue is the reason people are feeling chronic fatigue, often more than one simultaneously.

Before you start looking for more exotic (and post-worthy) reasons, be sure you check out these basic causes of fatigue.

The chances are very good that with just a few basic lifestyle changes, like better sleep, better hydration, more exercise and less stress will give your body a reboot to a happier, more energetic (and let’s face it, more fun to be with) you!

While you make those lifestyle changes or if you just want a little extra help, our top herbal recommendation for chasing away chronic fatigue is Gynostemma.

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