Though she was rocking vintage heels and the latest Gucci bag, Fiona just couldn't seem to make fatigue look fashionable.

Picture this: You work a regular 9-to-5, prepare home-cooked meals daily, manage the house, kids, and a partner to boot, and find time for a spot of tennis with your friends on the weekend. To the rest of the world, you're probably Super Mum (or Super Dad), and if you complain about being tired, it's in all likelihood justified. But what if you're not engaged in a constant whirlwind of activity and still find it difficult to get out of bed, let alone muster up the energy to change your socks? Unexplained, unrelenting fatigue hints at a plethora of possible health complications, and can point to hormonal imbalance, nutrient deficiencies, stress, and other acute or chronic issues.

These are 10 questions worth asking yourself for all those times when you feel like you need a break but a Kit-Kat just won't cut it.

1. Am I Eating Enough?

Glucose may equal energy, but that's no reason to go on an M&Ms binge!

It may seem like a no-brainer to equate food with energy, but research suggests that a large number of nutrient deficiencies stem from inadequate dietary intake rather than health-driven complications – and affect more people worldwide than might be expected. Carbohydrate-based foods are the human body's main source of energy as carbs are catabolised into glucose in the digestive tract and used to fuel cells. However, low-carbohydrate diets deprive our bodies of much-needed energy and tilt metabolism towards a hypoglycaemic state, which is characterised by mental irritability, depression, and fatigue (Mergenthaler, Lindauer, Dienel & Meisel, 2013).

Because the human brain uses twice as much glucose as other organs and tissues to support mood, learning and arousal, low-carbohydrate diets are associated with higher rates of anxiety and depression alongside reduced cognitive function (Gómez-Pinilla, 2008). This heightened need for glucose is compounded by the fact that brain cells are in a constant state of metabolic activity, even during sleep (Banjari, Vukoje & Mandíc, 2014). So bear that in mind the next time you're on a calorie-restrictive diet or can't find the time to squeeze in lunch between appointments!

2. Should I Be Drinking More Water?

Fruits such as watermelon and canteloupe are 95 percent water and make delightful, refreshing inclusions to help meet your daily water intake.

If you're drinking less than eight to 10 glasses of H2O a day, the answer is a resounding 'yes' – regardless of whether you're tired or not! Water is a crucial intermediary in cellular homeostasis and various physiological processes, and among its many functions, helps filter toxins via urination, maintain electrolyte and hormonal balance, lubricate the gastrointestinal tract for regular bowel movements, regulate body temperature, and keep skin clear and radiant (Popkin, D'Anci & Rosenberg, 2010).

The impact of water on mood and energy levels is so profound that even mild levels of dehydration can provoke significant changes in psychological wellbeing and cognitive function such as attention and short-term memory (Popkin et al., 2010). Headaches often co-occur with fatigue due to dehydration's effects on reduced intracranial plasma volume (Popkin et al., 2010), so consider reaching for a glass of water instead of an aspirin the next time you feel an exhaustion-driven migraine coming on.

3. Could My Diet Benefit From More Iron?

Red meat such as lean beef and lamb contain haem, which is a superior and more bioavailable form of dietary iron and is better absorbed compared to non-haem vegetarian sources.

Iron deficiency anaemia (IDA) remains one of the foremost nutrient deficiencies worldwide, and most commonly affects reproductive-aged women due to iron loss sustained through menstruation (Gropper & Smith, 2013). Iron is required for the synthesis of haemoglobin, which is a protein used by red blood cells to transport oxygen to various body cells and tissues. A deficit in iron (and therefore haemoglobin) then leads to reduced oxygenation on a systemic level and corresponding symptoms such as fatigue.

In addition to menstrual losses, iron deficiency is caused by poor intake of iron-rich foods such as liver, red meat and spinach. Low stomach acid is also common, as gastric acid is required for iron catabolism in the digestive tract (Gropper & Smith, 2013). Other causes include pregnancy due to increased foetal requirements as well as to negate blood-loss sustained during childbirth (Pasricha et al., 2010); intestinal diseases such as coeliac's disease and Crohn's (Burke, Leon & Suchdev, 2014); and parasitic or bacterial infections which deplete the body's natural stores of iron (Gropper & Smith, 2013).

4. Does My Gut's Health Need Tweaking?

Though liver is something of an acquired taste, there's no greater source of folate, B12 and iron to boost your status of all three nutrients while staving off the risk of anaemia!

The digestive system has long been revered as the seat of all health and disease across myriad healing traditions. The human gut plays host to billions of microbiota which normally co-exist in symbiotic harmony to ensure optimal nutrient absorption while supporting regular bowel movements. However, bacterial disequilibrium, poor gastric acid production and disrupted liver function often lead to inflammation within the digestive tract, and results in diffuse aches and pains, fatigue and general malaise caused by nutrient malabsorption.

Small intestine bacterial overgrowth (SIBO) is associated with the aforementioned symptoms, and often causes fatigue due to depletion of vitamin B12 vis-a-vis damage to the small intestine's ileum (James, 2013). Alongside its sister B-vitamin folate, vitamin B12 is important for the production of red blood cells. A deficit of both these nutrients leads to megaloblastic anaemia, a condition characterised by a reduced total red blood cell count and larger-than-normal cells (Chandra, 2010). These atypically large red blood cells have a significantly shorter life span and reduced organelle integrity, making them incapable of efficiently transporting oxygen to body cells and tissues (Chandra, 2010). The result? You guessed it...fatigue.

5. Do I Have Chronic Fatigue Syndrome?

A noted superfood for restoring depleted kidney qi, spirulina's high iron content makes it a potent blood-building tonic to boost oxygenation, circulation and mental alertness.

So you're tired...but just how difficult is it to get out of bed, really? If your experience of fatigue spans a period of six months or more, is persistent and unremitting in nature, and is accompanied by symptoms such as lowered concentration, diffuse muscle weakness or pain, sleep disturbances, and mood changes such as anxiety and depression, chances are high that you may suffer from chronic fatigue syndrome (CFS) (Dreher & Murray, 2013). The causes of CFS are widespread, and may include pre-existing medical conditions such as multiple sclerosis, heart disease and rheumatoid arthritis (Dreher & Murray, 2013); stress and impaired adrenal function (Yancey & Thomas, 2012); nutritional deficiencies (Joustra et al., 2017); and viral infections such as Epstein-Barr (Jason et al., 2014).

In traditional Chinese medicine, CFS is thought to stem from spleen and liver qi deficiencies, which cause reduced appetite, tiredness, skin pallor and depression (Chen, Moriya, Yamakawa, Takahashi & Kanda, 2010). Other notable issues include weak kidney qi, which gives rise to insomnia, forgetfulness, and reduced mental focus (Chen et al., 2010). Foods that nourish all three organs are essential in CFS treatment, and include sweet foods such as sweet potato and pumpkin for replenishing spleen qi, bitter and sour foods to nourish a stagnant liver, and salty foods such as miso and seaweed to rejuvenate weakened kidney energy.

6. Am I Depressed?

"The bravest thing I have ever done was continuing to live when I wanted to die." ~ Juliette Lewis, American actress and singer.

While there are many theories surrounding the causes of depression, the disorder's neurobiological basis is believed to lie in dysfunction of brain areas mediating arousal and mood such as the orbitofrontal cortex and the anterior cingulate cortex (Demyttenaere, De Fruyt & Stahl, 2005). Additionally, suppressed activity in the striatum and cerebellum may account for physical fatigue due to regulation of physical motor function by these brain regions (Demyttenaere et al., 2005).

This diminishing of physical function often occurs in tandem with symptoms of mental fatigue such as poor concentration, reduced memory and loss of decision-making skills. What's more, depressed individuals tend to lose their desire for social interaction and pleasurable activities, and is the result of neurotransmitter deficiencies affecting serotonin, dopamine and acetylcholine activity - all of which are common in clinical depression (Demyttenaere et al., 2005).

7. Are My Adrenals Overtaxed?

Depleted adrenals thrive on vitamin C, so chow down on citrus fruits for a power-packed rejuvenative boost to your body's hardworking stress-fighters!

Stress is synonymous with 21st century lifestyles, and is a normal physiological response to our environment. Your body's response to stress is coordinated by the adrenal glands, which are situated on top of the kidneys and release a glucocorticoid hormone called cortisol as part of the fight-or-flight response (Head & Kelly, 2009). Cortisol serves an important short-term function as an insulin antagonist to ensure adequate circulating glucose in the bloodstream (Wilcox, 2005). This is an essential part of the stress response because glucose functions as cells' key energy substrate, and is utilised by cells and muscles to counteract the demands of the stressor.

However, when cortisol is released in response to long-term and chronic stress, adrenal exhaustion and metabolic complications such as insulin resistance caused by persistently elevated blood glucose levels may occur (Wilcox, 2005). Deranged cortisol levels are also linked with circadian rhythm disturbances wherein individuals find themselves exhausted upon waking in the morning but have difficulty winding down at night (Wilson, 2014). Other symptoms of overtaxed adrenals include an over-reliance on caffeine for energy, a craving for salty foods in the afternoon, reduced sex drive, and a desire for sugar during periods of stress (Wilson, 2014)...all of which lead to even more fatigue.

8. Do I Need More Sleep?

Both alcohol intoxication and fatigue are associated with reduced alertness, mood changes and poor sleep quality, so think about that before reaching for your customary pre-bedtime glass of wine!

Poor sleep is a leading cause of fatigue, and is often the result of chronic insomnia and sleep disorders such as apnoea and restless leg syndrome. In addition to heightened risk of accidents, lowered sleep quality is associated with symptoms of mental fatigue such as diminished memory function, alertness and problem-solving skills (Kim, Cranor & Ryu, 2009).

Other factors contributing to disturbed sleep include hormonal disequilibrium caused by menopause, medications with a stimulating effect, caffeine, stress, and alcohol. While many people use liquor as a nightcap, research suggests that though alcohol may indeed have a sedative effect in the short-term, that glass of wine or snifter of brandy before bed actually disrupts circadian rhythm function in the long run (Brower, 2001). To quell an endless stream of leaping sheep and to usher in a good night's rest, check out these 10 tips for improving sleep.

9. Am I Low in Ojas?

Dates are considered a 'sattvic' food in Ayurveda, and are believed to promote mental peace while restoring immune function.

In Ayurveda, chronic fatigue is viewed as the depletion of ojas and rasa dhatu, both of which stem from poor nutritional factors (Vinjamury & Singh, 2005). Ojas is the culmination of the body's three elements of Vata (air), Pitta (fire) and Kapha (water), and is created from proper functioning of these elements to drive physical vitality, mental vigour and spiritual well-being.

Rasa dhatu, on the other hand, is one of the body's seven main tissues, and represents plasma and the 'essence of digestion' extracted from food. Supporting digestive function is key to replenishing both ojas and rasa dhatu, and involves the consumption of nourishing foods such as dates, almonds, ghee, and cow's milk. Golden Milk is a time-honoured Ayurvedic recipe for boosting ojas and restoring rasa dhatu, and makes the ideal pre-bedtime beverage for individuals struggling with insomnia.

10. Do I Have a Sluggish Thyroid?

Cruciferous vegetables such as cabbage, cauliflower and broccoli are antioxidant superstars in their own right, but should be avoided in hypothyroidism due to their goitrogen content which prevents iodine uptake by the thyroid gland.

Just like overtaxed adrenals, a sluggish thyroid is associated with a host of metabolic complications. Hypothyroidism, otherwise known as a low-functioning thyroid, is one of the most common endocrine problems worldwide, and is attributed to a range of factors including genetics, poor intake of iodine-rich foods, exposure to toxic substances such as pesticides, mercury and cadmium, pregnancy, intestinal dysbiosis, autoimmune triggers, and stress (Hechtman & Gruner, 2012).

Because the thyroid is indirectly responsible for energy, a deficit of thyroid hormones results in reduced metabolism and corresponding symptoms such as weight-gain, constipation, lethargy and depression (Pizzorno, Murray & Joiner-Bey, 2016). Nutritional management for hypothyroidism involves correcting iodine deficiency by increasing consumption of foods such as kelp, fish and brazil nuts while simultaneously avoiding foods that disrupt thyroid function.

Like low mood and weight gain, various factors may underlie chronic fatigue including hormone imbalance, nutrient deficiencies, sleep deprivation and psychoemotional disturbances. For more physical and emotional vitality, book a consultation with me to discover the right nutrients and lifestyle measures to create more balance and energy in your life. Visit www.applesandunicorns.com for more information or drop me an email at rohini@applesandunicorns.com.

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