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Dr. Aimée Derbes, LAC

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13 W 28th St, Suite 5R
New York, NY, 10001
United States

5 health issues that could be behind your fatigue

Not a totally boring blog about acupuncture, breathwork, energy medicine, and self-healing

At my office in Manhattan (Flatiron / Union Square / Chelsea), 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).

5 health issues that could be behind your fatigue

Aimée Derbes

So, everyone is feeling jet-lagged this week due to the time change. Ok ok, not everyone. Not you lucky people down in Arizona who don’t have to deal with daylight savings nonsense. But, definitely most of the patients I’ve seen in the past few days, and definitely me! It’s totally normal to feel fatigued when our sleep-wake cycle is disturbed and our bodies have to adjust to a new set of daylight signals. 

Beyond situational, temporary causes, though, fatigue is one of the most common concerns that inspires people to explore acupuncture and herbs. “I am exhausted all the time,” they tell me. “I think I’m doing a lot right, and I just feel like I should feel more energized.”

A while back, I wrote a blog post on how fatigue is understood through the lens of East Asian medicine, and what you can do about it. Some of my patients got straight to work putting those suggestions into practice, and they told me they noticed improvements in the quantity and quality of their energy in under a week. Those people just needed some support around their eating habits to steady their blood sugar, or an excuse/permission to protect their sleeping time, for example.

But others found that, while there was some improvement, they still didn’t feel anywhere near 100%. What could be going on there?

Friends, I know the feeling. Fatigue -- in particular, fatigue accompanied with plenty of sleep, a whole foods based diet, and a consistent dose of varied movement, yoga, and exercise practices aka “doing things right” -- was what first brought me into an ND’s office 15 years ago, after my regular MD told me I was physically fine: "You're just a mellow, low energy person." Still, something in me knew that I could feel better, that that wasn’t as good it could get. 

And I was right -- turns out, I had failed to be nourished by an unbalanced vegan diet that I had thought was healthy. My vitamin B12 stores were long gone (though I had been taking supplements), and my vitamin D level barely cracked the double digits (optimal level according to integrative MDs: 50 or higher). Also, I was anemic! No wonder I didn’t feel right. But that was all pretty basic stuff.

After a shot of B12 and a serving of fish, my brain lights switched on for the first time in 3 years. I soon went to my first acupuncture treatment on my ND’s recommendation, and I experienced a similar, but exponentially more powerful, sensation of my entire body being turned on. I sat on the bus my way home, crying as I looked out the window, feeling like I was seeing the sun for the first time at 22, thinking “is this what other people have been feeling like all along? I have missed so much!” 

Simply put, I felt fully alive, maybe for the first time in my life. And so grateful that I had continued to follow my intuition and seek answers, because a simple blood test was all it took to get some actionable information.

In this case, a few everyday nutritional deficiencies were a significant part of why I felt so exhausted, While this isn’t always the case for people, it’s important to do routine blood tests from time to time, just to see if there might really be a straightforward solution. And the nutrition you need will give you the energy and resources you need to manage (and, I hope, transform) any other contributors to fatigue in your life -- such as an unrewarding job, big relationship challenges, life transition, and other stressors. 

It’s time to stop guessing and start testing. Because the state of New York doesn’t allow licensed acupuncturists to order labs (this isn’t the case in every state, though), I often send my patients their doctors to ask for tests. I understand the reluctance to do so; very few people these days seem to like the MD office visit experience, but, please, you still gotta do it! If you don’t have insurance or a doctor you enjoy working with, there are a growing number of direct-to-consumer websites that offer at-home lab testing, such as

Vitamin D levels

Clinical trials have shown that fatigue symptoms decrease when vitamin D levels increase. Low vitamin D is associated with chronic inflammation, digestive dysfunction, depression, and cognitive impairment. If your vitamin D (25OH) level was under the 40-50ng/mL range the last time it was checked, you might consider adding this into your routine. While some MDs say that 20ng/mL is a fine level for most people, integrative MDs like Aviva Romm recommend an optimal range of 40-80. 

All the thyroid tests

The thyroid gland produces hormones that regulate metabolism, among other things; if you’re dealing with fatigue, thyroid health is a smart rock to turn over. TSH (thyroid stimulating hormone) is commonly included in annual blood tests, for example, but it doesn’t tell the whole story of what’s going on with your thyroid. It’s possible to have normal TSH levels while other markers are wildly off, but you’ll never know if you only receive a TSH test.

If your fatigue isn’t shifting through other interventions, consider getting TSH, free T3, free T4, and TPO tested for a more complete thyroid picture, and then compare the results to an integrative MD’s interpretation (like Amy Myers’s suggested levels), which will generally consider much smaller ranges to be optimal.


Most doctors will immediately look into iron, particularly if you menstruate and/or have other symptoms like hair falling out, pale complexion, insomnia, dry or brittle nails, or heart palpitations.

MTHFR gene mutations

Believe it or not, just about every patient I have seen who names fatigue as one of their main concerns has turned out the have one or more MTHFR gene mutations. The MTHFR gene is in charge of producing an enzyme that is key for synthesizing proteins, countering inflammation, and eliminating toxins. Several common mutations are now considered to potentially impair the enzyme’s functioning.

Have one of more MTHFR mutations doesn’t necessarily mean you’ll have associated health issues (lots of complexity here, friends), but these mutations may play a role in why you feel fatigued, have difficulty thinking, and even have depression and psychiatric symptoms. The workaround is to take methylated B9 (folate) and B12 supplements. Since you might not need these supplements, it’s important to check in with your doctor and get tested first. You can also find out if you have any variants (and which ones) if you’ve done at-home genetic tests like AncestryDNA or 23andMe

"Lurking" pathogens

I'm talking about parasites, viruses, bacteria, or environmental toxins, which can be associated with anything from low-level inefficiency to full blown debilitating health issues. They are referred to in East Asian medicine 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 disrupting our immune and digestive systems over the long term, causing (you guessed it) chronic fatigue, among many other things. Many of them show up in stool tests, but some (such as Lyme) are often undetectable, so it's helpful to look for and / or rule out other issues.


These common lab tests can offer specific and actionable information about why you're still so tired. For some people, a B12 supplement is all they need, while for others, regular nutritional support along with customized herbal medicine and treatments like acupuncture are a better fit for healing. Need more support? Leave a comment or email me at aimee @ anytime. You can also make an appointment here for an acupuncture treatment, Healing Touch session, or Breathwork.