When Jo Chambers started to feel tired all the time, she initially put it down to the pressures of everyday life. A single mother to son Sam, now 16, and working part time in primary care for the NHS, Jo suffered in silence for two years.
“I was working three days a week and I’d spend much of my days off sleeping because I had no energy,” says the 47-year-old from Market Harborough. “My social life suffered. All I wanted to do was go to bed.
“I started to get other symptoms too, such as feeling breathless even when I was barely doing anything strenuous. On one food shopping trip, I had to stop to get my breath back after walking from the car to the door of the supermarket.”
Blood tests ordered by her GP in 2017 and again in 2018 resulted in no follow-up call, so assuming that there was nothing physically wrong, Jo soldiered on, putting her fatigue down to work and being a single mum. But then she started to feel anxious and noticed that her hair was thinning and her eyelashes were beginning to fall out, leaving a bald patch on her upper eyelid.
“It may sound vain but losing my eyelashes was what upset me most. I knew there must be a reason for what was happening so I made another GP appointment.”
This time Jo’s blood results revealed very low levels of iron and haemoglobin, indicating anaemia. Iron is an important mineral present in haemoglobin (a protein found in red blood cells), which carries oxygen to the muscles and brain and is crucial for mental and physical performance.
Jo immediately started on a prescribed course of iron pills. Further tests were made to rule out Coeliac disease and thyroid issues, which can have an effect on iron stores, but these came back clear.
Feeling constantly tired is a common complaint among Britons. One in eight of us feels tired all the time, according to a 2022 YouGov survey. And three in five women (61 per cent) say they feel tired when they wake up, even when they get plenty of sleep.
“Fatigue for no obvious reason is one of the most common reasons for people to see their doctor,” says GP Dr Hana Patel. “Low iron levels can often be the cause. If other symptoms are present, such as dizziness, chest pains, shortness of breath, restless legs and finding it difficult to concentrate, this may mean your iron stores are so low it’s likely to be anaemia.
“A GP would usually order a blood test to check ferritin and haemoglobin levels. Ferritin is a protein that can be picked up in a blood test and reflects overall iron stores. Women are most often affected either because of heavy menstrual periods or during pregnancy when the baby uses up their iron stores.”
If anaemia is indicated, a course of iron pills is prescribed. A blood test can also screen for other deficiencies that affect energy levels, such as low stores of vitamin D and B12.
In Jo’s case, the iron pills didn’t agree with her. “I tried several different types, but they all gave me horrible side effects, including stomach pain and diarrhoea. I even gave up 30 years of being vegetarian because the doctor said eating red meat would help.
“But my iron levels stayed low so I did my own research online and ended up using my savings to pay £880 for an iron infusion at a private clinic, where iron is infused via a vein straight into the bloodstream.
“Gradually I started to feel better and after around eight weeks I felt back to my old self. It was such a relief for my hair and eyelashes to grow back. I now have six-monthly blood tests and had to pay for another infusion last year when my iron levels dipped again. I can ill afford it but there’s no way I’d have got an infusion on the NHS.”
To this day, Jo has no idea why she developed anaemia despite further investigative tests to check for auto-immune conditions, which can cause poor absorption of nutrients such as iron.
“I have a good diet, take vitamin D all year round as blood tests showed I was deficient, and I also take a multivitamin. But at least now I feel back to my old self.”
What’s making you tired for no reason
Check your iron levels
Low iron is the most common deficiency worldwide and affects 30 per cent of women aged 15 to 49, according to the World Health Organisation. In the UK, the National Diet and Nutrition Survey found that 54 per cent of girls and 27 per cent of women had inadequate iron intake.
“It usually affects women because they have periods, and while it is a real problem in young women, iron deficiency can affect any age group,” says consultant haematologist Dr Noémi Roy. “Vegetarians and vegans are also at risk because they don’t eat red meat, which is the best way to absorb iron. The iron in green vegetables and pulses is not as absorbable as the iron from red meat.”
If you experience symptoms of iron deficiency anaemia, such as tiredness, shortness of breath and heart palpitations, ask your GP for a blood test, and depending on the results, you may be prescribed iron tablets. If you buy over-the-counter supplements, avoid relying on a multivitamin containing iron because these usually also contain calcium, which prevents iron being absorbed.
“You should take iron every other day with some orange juice, which contains vitamin C to charge up the iron,” says Roy. It takes three months of taking iron tablets to build up your red blood cell stores, but you can feel better much sooner than that.
Meanwhile, it’s important to identify the underlying cause of anaemia, which you should discuss with your doctor. “Certain intestinal conditions including Crohn’s disease can cause bleeding in the digestive tract, affecting iron levels, while others such as Coeliac disease can mean your body’s not absorbing nutrients properly,” says Roy.
If you’re over 60 and found to be anaemic, your GP should send you for a colonoscopy to check for bowel cancer. “This is because tumours in the colon can leak blood.”
Lifestyle factors
“Fatigue can be caused by many factors, including poor diet and lifestyle, stress and digestive issues,” says Dr Anna Forbes, a medical doctor and founder of The Forbes Clinic of Integrative Medicine.
“The gut is the central hub of our health and our classic Western diet with all its beige foods, sweets and carbs causes gut inflammation and toxicity, meaning we can’t absorb the nutrients we need for energy.”
Changing to a gut-friendly diet is crucial, Forbes says. “Follow a nutrient-dense diet with plenty of vegetables, fruit, nuts [and] good sources of proteins, such as red meat and fish.”
If you have a tendency to de-stress with a G&T or a glass of wine, it’s time to stop. “Alcohol depletes essential nutrients, including the B vitamins needed for energy. It affects sleep quality and is a known depressant, which can negatively impact mood,” Forbes says. “And low mood leads to fatigue.”
If stress is an issue, you need to find ways to reduce it. “High levels of stress can cause adrenal fatigue and burnout,” Forbes says. “The primary role of your adrenal glands is to produce and regulate the stress hormone cortisol. We deplete certain micronutrients through chronic stress, especially vitamin C, magnesium and B vitamins and antioxidants, which are all needed to deal with stress hormones.”
The best way to reduce stress is through regular exercise, which bumps up the production of endorphins, your brain’s feel-good neurotransmitters. “What’s more, exercise helps with circulation and blood oxygenation, as well as more subtle processes essential for energy production.”
The best supplements to take for fatigue
Vitamin D
“Vitamin D is important for energy, the immune system and bone strength, and most of the UK population is deficient,” says Dr Roy.
We top up our supplies from the sun - which is tricky during the winter months - but it’s only present in a few foods, including egg yolks and oily fish. “Take Vitamin D supplements all year round to improve energy levels,” Roy advises.
Vitamin B12 and folate
Low levels of vitamin B12 can cause fatigue. Good sources of it include meat, fish, milk, cheese and eggs. If you’re a carnivore, you’re probably getting enough. “If you stopped eating anything that contains B12 today, you would probably have enough in your body to last two years,” says Roy.
Perhaps controversially, Dr Forbes believes a lack of meat can be problematic, and has tried to persuade many patients to eat meat again. “The bottom line is that for good health, most of us need some meat in our diets,” she says. “If you’re born into a meat-eating culture from a meat-eating mother, your genetics expect meat to be a key source of nutrients. Recent studies, including one published earlier this year, have shown a decline in health and energy levels among vegans and vegetarians. There’s a link to depression, low energy and poor immune health.”
Folate (otherwise known as vitamin B9) is needed for the production of red blood cells, and a lack of it can mean the body cannot generate enough energy to perform daily activities. “To get enough folate, eat green leafy veg such as kale, spinach, pulses and fortified grains,” says Forbes.
Do I need vitamin C?
Vitamin C is found in most fruit and veg, and some studies suggest it can help with fatigue. A 2021 German review of studies into vitamin C and fatigue concluded that high-strength vitamin C could help reduce fatigue in long-term medical conditions, including long Covid.
“Vitamin C is very important for energy production,” says Forbes. “Taking vitamin C alongside magnesium is good for cleansing the bowel of toxicity and inflammation from unhelpful pathogens and microbes. These can affect brain function, joints and skin, and impact on our energy.”
Magnesium and calcium
Magnesium is an essential mineral relied on by every organ in the body. It’s known to reduce tiredness. So should we be taking a supplement?
“I would definitely take magnesium alongside vitamin C and D,” says Forbes. “Their combined actions are significant for maintaining cellular vitality, immune health and overall physiological well-being.”
Calcium also plays a part. “Low levels of calcium can be implicated in fatigue but not in isolation, so it depends what’s causing it,” says Forbes. “I would only suggest supplements if indicated by a blood test. If you have too much, you can get calcium build up in the arteries, so I’d recommend working with a practitioner before taking a supplement. But good food sources of calcium include dairy, almonds (especially pre-soaked and roasted for better digestion), sardines and dark green leafy veg.”
Other supplements that can help
Some people take the Ayurvedic herb ashawangha to relieve stress and increase energy and stamina, while creatine, a molecule used for muscle strength, is popular with gym-goers hoping to improve sporting performance. Both are available in supplement form (synthetically, in the case of creatine).
“Ashwagandha is a good adaptogen which helps with adrenal fatigue by regulating stress response,” says Forbes. “I often include it in a regimen along with other supplements and have seen good results.” One 2021 study found that 120–1000mg of ashwagandha per day reduces fatigue and optimises recovery in healthy individuals.
Meanwhile, creatine helps to make ATP (adenosine triphosphate), which provides the energy for muscle contractions throughout the body. “There is evidence that post-viral fatigue syndrome could be caused by irregularities in creatine metabolism. As with many supplements, the studies into ashwagandha and creatine are often inconclusive and further studies are needed,” Forbes says.
Coenzyme Q10, which is believed to help with energy production and immune system regulation, and L-arginine, an amino acid that helps the body build protein, can both be supportive of our flagging energy levels. A 2022 study showed that L-arginine plus vitamin C supplementation improved walking performance, muscle strength and fatigue in adults with long Covid. L-carnitine, meanwhile, helps the body metabolise fat to produce energy, which may be useful if you’re following a low-carb diet.
What about chronic fatigue and long Covid?
“If your lifestyle’s not great, you’re not getting enough sleep, you’re a bit stressed with a poor diet and perhaps a low mood, this can just point to tiredness, which can be improved with lifestyle changes,” Forbes says.
However, if your fatigue persists and you’ve ruled out other likely factors, you need to get diagnosed.
Both chronic fatigue syndrome and long Covid can have a wide range of symptoms, including debilitating tiredness.
“Chronic fatigue syndrome is a disease of exclusion, which means you need to undergo medical tests to rule out serious illnesses that could be causing the chronic fatigue, such as cancers, auto-immune and degenerative conditions,” Forbes says.
“Long Covid is easier to diagnose. If symptoms persist for four or more weeks following a Covid infection, this indicates it’s long Covid. It usually presents as similar to chronic fatigue syndrome and seems to improve on its own over time, albeit slowly in most cases.”