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Dr. Aimée Derbes, LAC

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119 8th Street, Suite 205
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Why you're so tired...and what to do about it

Align Acupuncture Blog. Musings about healing, acupuncture, herbal medicine, breathwork, and more.

At my offices in Brooklyn (serving Gowanus, Park Slope) and Manhattan (Flatiron), I see patients who are dealing with chronic pain (back pain, neck and shoulder pain, knee pain, hip pain, and ankle pain), headaches + migraines, digestive issues (IBS, colitis), infertility, stress, insomnia, PMS, women's health, and autoimmune conditions (Lyme, Hashimoto's, thyroid conditions, and many more).

Why you're so tired...and what to do about it

Aimée Derbes

Take a moment to check in with your energy. Close your eyes, inhale for 4 counts, exhale for 6 counts. A few times. And then...

How are you feeling right now? Totally energized, enlivened, full of vitality? Never been better?

“That sounds real nice, Aimée, but...no way,” you might be thinking. “I’m feeling pretty tired. Like, I’ve been dragging myself through the things I need to do each day. I can’t think, I feel like I could sleep 11 hours per night and still be tired, and I definitely don’t have enough energy to exercise.”

    Over the past few weeks, I’ve heard countless variations on “I’ve been feeling *so* exhausted -- it’s like I’ve lost all my energy.” Fatigue is something I see a lot of in my healing arts practice, but there’s something extra special going on right now, friends: a seasonal transition.


    Your fatigue might be seasonal

    Remember nature? That thing we’re in intimate and inextricable relationship with, even though we may be living in an urban environment and/or we’ve forgotten that the climate and everyday weather affects literally everything in the microcosms of our individual bodies? Seasonal transitions require a lot of energy, so it’s natural to feel tired. Even super tired, because they require our bodies to recalibrate to a new set of environmental influences.

    The late summer to fall transition is especially challenging, because our bodies have been cruising along in warm temperatures and moist, even damp, air -- but suddenly, the temperature has dropped 20 degrees, chilly winds are kicking up, and the air is crazy dry. In New York, it’s 80 one day, 60 the next, and 80 again.

    It doesn’t help that we’re still remembering how to dress for the new weather, so we may not be warm enough or wearing much-needed scarves. Our systems are working hard to adjust, and we (temporarily) have no extra energy left over for things like...exercising. Working. Thinking. 


    So I mentioned that fatigue can be seasonal. But what if you were already tired? Maybe you have been feeling exhausted, or tired and wired, for a while now. Or you were already dealing with chronic fatigue, digestive issues, or insomnia — whether or not you’ve received a diagnosis for CFS or an autoimmune disease, or are in something like postpartum or post-illness recovery. 

    Read on for the East Asian medicine understanding for why you’ve been so fatigued, and what you can do to support your energy. 

    The deal with fatigue in the modern era

    If you happen to have read any classical medical texts (...Bueller? Anyone?), it’s apparent that fatigue has always been a common health issue. Most people in agrarian societies used to work hard, with no breaks, doing challenging manual labor year round to survive. When most of the foundational textbooks I use were written, 1,000-2,000 years ago, most people living in Asia were tired and overworked, at the least, and possibly dealing with cycles of warfare and famine. Fatigue used to be connected to starvation: not enough food or calories going in means not enough qi is being extracted through digestion to power the body. 

    Nowadays in the U.S., most of us are lucky enough to be free from outright starvation (something I am incredibly grateful for), but, strangely, we’re actually still undernourished. Instead of a lack of food or calories, many of us are accustomed to eating too many (convenience) foods that are tasty and calorie-dense, but light on the nutrition. Our blood sugar is also on a nonstop roller coaster ride, causing unsustainable bursts of energy followed by deep crashes. We may be eating, but we are still not extracting enough or the right kind of qi from our foods, and we’re still really tired.

    I know, the #realtalk can be kind of a bummer -- but there are a couple of other common modern health issues that most of us are dealing with, that also contribute to chronic fatigue.

    Stress

    First, many of us are stuck in a harmful nervous system loop, where we stay too long in fight/flight/freeze mode -- our nervous systems keep thinking we are in an emergency and respond accordingly to try to keep us safe. In an actual emergency, this is, of course, helpful, and helped our ancestors survive. But our bodies don’t understand that things like missing the subway by 10 seconds, or worrying about your job or your bills, are not emergencies -- and facing many of these types of minor stressors each day keeps our nervous systems from relaxing into rest and digest mode.

    Instead, we are in a chronic cyclical chemical cascade that keeps us wired and ready for action, causing us to crave fat, salt, and sugar to power our (actually nonexistent) need to fight/flee, all the while draining us of energy by impacting our blood sugar, digestion, and overall health. We are exhausted and can’t seem to catch up on sleep -- or, eventually, even fall asleep at all because we become too wired. The good news is that we can retrain our nervous systems by supporting ourselves with a few lifestyle changes.

    Digestion weirdness

    Second, our digestive systems may not be operating at optimal function. Remember how I mentioned that we’re eating calorie-dense but nutrient-deficient foods? Some of our common everyday foods can, either alone or altogether, be causing low-level inflammation in our digestive tracts. When our guts are irritated, our food isn’t being broken down or absorbed efficiently, so we’re not extracting enough good qi to power our lives. 

    Our gut flora is also affected by lack of fermented vegetables in the diet, and antibiotic use. (For the record, antibiotics can be lifesaving, but even when being used in necessary situations, they still disrupt gut microflora for up to 6 months.) While everyone’s digestive systems are unique, some of the more common inflammatory foods are gluten, corn, soy, and cow dairy. Also, sugar. Aka, the foundations of the American diet.

    Lurkers

    Finally, though these are not modern problems per se, we may be walking around with what East Asian medicine refers to as “lurking pathogens.” These can include parasites, viruses, bacteria, or toxins, causing anything from low-level inefficiency to full blown debilitating health issues. They are referred to as “lurking” because they hide, evading both detection and, often, attempts at treating them with medicine. These pathogens hang around in the background for a long time, slowly stealing our qi and disrupting our immune systems over the long term, causing (you guessed it) chronic fatigue, among many other things.

    Given all of this, it makes sense that you’re so tired. Next, I’m going to break down some of the possible roots of our fatigue in acupuncture-speak, but you’re welcome to scroll on down to the end of this article for things you can do for yourself, to support your energy!


    The roots of fatigue, according to East Asian medicine

    There’s a concept that acupuncturists keep in mind, which is that the same root imbalance can show up as many different branch symptoms, and a single branch symptom can be caused by many root imbalances. Two people suffering with fatigue can have completely different constitutions and root causes of the fatigue, so we treat them with different points, herbs, and strategies. We treat the whole person, not the disease. Like my fellow practitioners of East Asian medicine, I don't put together a treatment plan without thoroughly investigating my patient’s health history, experience, and current presentation.

    I'm going to do my absolute best to keep this as simple and accessible as possible; here goes!

    In the tradition I trained in, fatigue is usually associated with a deficiency of some vital substance, such as qi (vital energy), blood (as well as the substances that it transmits), or yang (primal metabolic fire and the spark of action in the body). That substance may even be further pinpointed to a particular organ or location in the body: for example, many of my patients who had received acupuncture before arrive at their first appointment and tell me that they were previously being treated for “spleen qi deficiency,” which is one presentation of fatigue and digestive issues and diagnosis that acupuncturists in the U.S. see a whole lot of.

    The cornerstones of overall qi deficiency include: fatigue, slight shortness of breath, pale complexion, lack of appetite, and tendency to catch colds easily. People who are kind of always "just under the weather" often have qi deficiency.

    • The spleen-pancreas (more commonly shortened to just spleen, but I'm including pancreas to highlight its importance) is the organ in charge of digestion and determines how much qi we make from the food we take in. If your spleen-pancreas qi is weak, you might also notice feeling full or bloated after eating only a little food, depression, a weak feeling in your body, tendency toward loose stools or diarrhea, or bruising easily. Habits that can impair spleen-pancreas qi are irregular or inconsistent eating habits, eating too much or too little, or going overboard on the sweets. A lot of worrying (aka "ruminating," a literal link between overthinking and digestive processing) can also tax spleen-pancreas qi. As you're gathering, many/most of us (and our friends, coworkers, neighbors, and their mothers) go through phases of spleen-panceras deficiency.
    • The lungs are in charge of taking in and extracting qi from the air; you can think of this type of qi as including not only oxygen, but also ions, moisture, and environmental energetics. When your lung qi is deficient, you might also notice having a weak or low voice, some random sweating, catching more colds, and maybe a slight cough. Teachers and people who talk a lot can become lung qi deficient if they don't take breaks to rest, eat well, and stay hydrated. The emotions of grief and sadness are associated with the lungs, which is why people dealing with loss often get concurrent respiratory issues.

    Blood deficiency can look a lot like qi deficiency, and they often go hand and hand. Blood deficiency shows up as pale or dull complexion, fatigue, dizziness, poor memory, dry hair/skin/nails, and maybe some depression/anxiety or insomnia. Many vegetarians and vegans, and people with anemia, may be blood deficient.

    • The heart has an intimate relationship with blood, for obvious reasons, but also because, in East Asian medical theory, our spirits reside in our hearts. When there isn’t enough blood to nourish our hearts, our spirits don’t want to hang out at home, and they get restless. When your heart blood is deficient, you might feel more anxiety, heart palpitations, dream disturbed sleep, and insomnia. Students can easily become both qi and heart blood deficient, due to the mental energy, stress, and irregular schedules involved in constant studying.
    • The liver is also particularly rich in blood, and it’s in charge of storing blood and making sure that qi, blood, and emotions are flowing smoothly. When liver blood is deficient, you might also notice issues with your eyes or vision, tight sinews, menstrual issues, numbness or tingling sensations, or depression. The liver is associated with anger, and unexpressed anger (the most common kind! eep) can tax the blood, which is why it's important to stay present and tend to your emotions in real time.

    Yang is not a tangible thing, per se, but there is evidence of it in the body, where it shows up as heat, movement, action, metabolic fire. While yang naturally declines as we age, we can be temporarily low in it anytime in life, or we can have a “yang deficient” constitution. A deficiency of yang looks like...well, not enough heat: fatigue, weakness, cold limbs, aversion to cold, depression, loose stools, perhaps a low libido or fertility challenges, maybe aching lower back or knees. Spleen-pancreas yang deficiency looks a lot like the above, plus those qi deficiency I mentioned earlier, plus undigested food in your poop. Kidney yang deficiency looks like the above plus more reproductive challenges, such as impotence, frequent or excessive urination, and apathy. Yang deficiency tends to be more constitutional than qi or blood deficiency, which are often temporary.


    How to turn around your fatigue

    It doesn't matter if you have a diagnosed health condition or not -- there are plenty of small things you can do that add up to big improvements in your energy level. If the idea of change is overwhelming, start incorporating just one new habit; then, next week, add in another. The turtle method of taking it slow and steady works!

    Sleep like it’s your job
    Sleep is the much-needed magical time when our bodies repair themselves. There’s so much research on this that I’m not even going to bother reiterating it here, but, pretty much, get 7+ hours of sleep per night, preferably starting by 10pm. The more sleep before midnight you get, the better the quality, and the more positive health outcomes. More on insomnia and sleep hygiene here, but a few things you can do to improve sleep are cutting out the caffeine; turning off all electrical devices and screens 1 hour before sleep time; and doing a writing exercise 30 minutes before bedtime where you simply write down everything that's on your mind.

    Exercise anyway
    Something I hear pretty frequently is “I’m too tired to exercise,” and I totally get it. *Of course* you feel too tired to exercise, given all the above-mentioned conditions conspiring to keep you from having enough energy. But, what if you did it anyway? What if it wasn’t a choice you made each day, but an integral part of your life, whether you feel like it or not? It doesn't have to be a big production: moderate low-impact exercise lowers cortisol, helping your blood sugar, sleep quality, and overall ability to handle stress. It's key, my friend.

    Learn to overdress
    Not, like, be fancy, just dress for the weather, or more. This is some grandma-style common sense. Keep your body warm and protected from the elements by wearing a scarf and appropriate layers, so it doesn’t have to do extra work to keep you warm. Better to have an extra jacket that you need to take off, than leave the house for the day slightly chilly and end up bone cold and exhausted by the end of the day....and wake up aching and sniffling with a cold the next morning.

    Ritualize eating
    There's a reason that the relaxed, parasympathetic nervous system state is called "rest and digest." Our bodies need to be calm and chill in order to fully digest the food we eat. Everyday habits that get in the way of that process? Having stressful or emotional conversations during mealtimes. Eating at different times of day every day. Multitasking while eating. Eating standing up. Not chewing fully. If any of these sound like things you tend to do, pick one to focus on, and notice what happens in your body when you stop doing it. Do you feel more relaxed? Are the flavors and textures of your food more intense? Are you able to connect to more gratitude for the food you're eating (and maybe also the life you have?)? For more info on the East Asian medicine take on eating to support your digestive system and over all energy, click here.

    Mind your blood sugar
    This might be the single most important thing you can do to support your energy level and overall health. Irregular and distracted eating habits can have a significant effect on our blood sugar regulation, which then affects our energy level, stress, and mood, as we all know by the fact that "hangry" is a word. To support steady blood sugar

    • Eat a protein and healthy fat rich breakfast within an hour of waking
      • Protein ideas: cage-free eggs, fish (such as sardines or salmon), brown rice protein powder
      • Fat ideas: avocado, coconut yogurt, coconut oil, olive oil, almonds or almond butter
    • Eat a meal or snack every 3-4 hours, so that you are not able to get to the point of being hangry
    • Make sure you have ample time (3-4 hours) between eating so that your body can fully digest and then rest

    Take a few supplements
    Especially if you're vegan /vegetarian, or menstruating, a few supplements can close important nutrient gaps:

    • B vitamins: Bs are often referred to as "stress vitamins" because they are needed to produce chemicals that regulate our mood and sleep. Different B vitamins are needed to protect and repair our nervous systems; produce energy from food; and support brain function. B6 and B12 are especially likely to be low in both vegetarians/vegans, and in menstruating people who take hormonal birth control pills.
    • Vitamin D: if your vitamin D level was under the 40-50 range the last time it was checked, you might consider adding this into your routine. Clinical trials have shown that fatigue symptoms decrease when vitamin D levels increase. Try the drops, which tend to be absorbed more quickly and easily.
    • Iron: anemia is commonly associated with fatigue, and menstruating people are more likely to be low in iron. Make sure to take iron with vitamin C to improve absorption.
    • Probiotics: while the research on this is in the early stages, some people see a lot of improvement to their energy level after starting probiotics, which can enhance your digestive system's functions by altering the makeup of your gut bacteria.

     

    This is just the tip of the iceberg, as things like changing your breathing patterns, meditation, customized herbal support, and treatments like acupuncture can also expand and enhance your energy level by addressing underlying issues. Need more support? Leave a comment or email me at aimee @ alignnewyork.com anytime. You can also make an appointment for an acupuncture treatment, Healing Touch session, or Breathwork here.