Dr. Rachel Stricker Blog

Why You’re Tired All the Time — And What Your Body May Be Asking For

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Fatigue is one of the most common concerns I hear as a naturopathic physician. Many patients arrive saying, “I sleep well, I eat well, my labs are normal — so why am I still exhausted?” The answer is often more complex than a single diagnosis. True fatigue is rarely just about sleep. It is often the body’s way of communicating that something is out of balance — physiologically, neurologically, immunologically, or even emotionally.

Fatigue as a Signal, Not a Failure

In modern life, our nervous systems are under near-constant demand. We move quickly from task to task, absorb endless information, and rarely give ourselves time to fully rest and reset. Over time, this sustained pace can keep the body in a state of low-grade stress physiology. Even when we stop, the body may not know how to shift into restoration.

Fatigue is increasingly understood in the medical literature as a complex, systems-based condition rather than a single diagnosis. Recent research highlights how biological, psychological, and environmental factors converge to influence energy, resilience, and recovery.

From a clinical perspective, fatigue often emerges when multiple systems are strained simultaneously:

• The nervous system
• The endocrine (hormonal) system
• Immune function
• Digestive health and nutrient absorption
• Emotional and psychological reserves

Fatigue, in this context, is not simply depletion — it is often a protective adaptation.

Understanding Stress Physiology and “Adrenal Fatigue”

The term “adrenal fatigue” is commonly used in integrative and naturopathic medicine to describe dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis — the system that governs our stress response.

While not recognized as a formal diagnosis in conventional medicine, HPA axis dysregulation is well described in current research and is associated with altered cortisol rhythms, impaired stress tolerance, and persistent fatigue. A growing body of evidence shows that chronic stress can disrupt HPA axis signaling while also promoting immune imbalance and low-grade inflammation. Rather than a simple “burnout” of the adrenal glands, this reflects a complex shift in how the brain and body regulate stress over time. Patients may experience this as feeling “wired but tired,” difficulty waking in the morning, difficulty falling asleep or staying asleep, or energy crashes throughout the day.

Nervous System Dysregulation

Fatigue is also deeply tied to the autonomic nervous system. When the body remains in a sympathetic (“fight-or-flight”) state for extended periods, restorative parasympathetic (“rest-and-digest”) activity becomes impaired. Over time, this can lead to:

• Poor sleep quality despite adequate hours
• Reduced cellular energy production (i.e. mitochondrial function)
• Heightened sensitivity to stress
• Difficulty recovering from exertion

Recent research has expanded our understanding of fatigue beyond hormones alone, highlighting the interconnected roles of the nervous system, immune signaling, and the gut-brain axis. Disruptions in this network can contribute to persistent fatigue, particularly in conditions involving chronic stress or inflammation.

Supporting fatigue, in many cases, requires not just more rest — but restoring the body’s ability to access rest.

Immune Dysregulation and Chronic Illness

One of the most important clinical considerations in persistent fatigue is underlying immune activation. There is increasing recognition that fatigue is often driven by low-grade, chronic inflammation, particularly in the context of infections, environmental exposures, or post-viral syndromes.

In my practice, when a patient presents with ongoing fatigue, I often investigate for contributors such as:

• Chronic infections (e.g., Lyme disease, Epstein-Barr virus, other herpes viruses)
• Mold exposure and biotoxin illness
• Long COVID or post-viral syndromes
• Food sensitivities and immune reactivity
• Gut dysfunction and microbiome imbalance

These conditions can shift the body into a state of ongoing immune vigilance. Energy is diverted away from daily function and toward defense and repair. Fatigue, in this context, is not simply “low energy” — it is energy being reallocated.

Metabolic and Nutritional Considerations

Energy production is fundamentally a metabolic process. Even subtle imbalances can contribute to fatigue:

• Blood sugar instability
• Iron deficiency (with or without anemia)
• B vitamin insufficiency
• Mitochondrial dysfunction
• Thyroid imbalances, even within “normal” lab ranges

Standard lab work may not always capture these nuances, which is why a more comprehensive and individualized evaluation is often necessary.

Emotional and Existential Fatigue

Not all fatigue originates in physiology alone. Emotional strain, chronic stress, unprocessed grief, and a sense of misalignment with one’s life or purpose can all manifest as physical exhaustion. This is not “just psychological.” The body and mind are deeply interconnected, and emotional burden can influence hormonal signaling, nervous system tone, immune function, and sleep architecture.

In some cases, fatigue is the body’s way of creating a pause — an invitation to reassess, recalibrate, and realign.

How I Approach Fatigue Clinically

When working with patients experiencing fatigue, I consider multiple layers simultaneously:

Foundations

• Sleep quality and circadian rhythm
• Nutrition, hydration, and mineral balance
• Blood sugar stability

Substances and Medications

• Caffeine and other stimulants
• Alcohol and other depressants 
• Current medications
• Timing and patterns of use

Nervous System

• Signs of chronic stress or dysregulation
• History of trauma
• Current stress load
• Capacity for rest and recovery

Hormonal Patterns

• Cortisol rhythm
• Thyroid function
• Sex hormone balance

Immune and Inflammatory Drivers

• Chronic infections
• Mold and toxin exposure
• Autoimmune or inflammatory patterns

Digestive Health

• Gut integrity
• Microbiome balance
• Food sensitivities
• Eating habits

Inner Landscape

• Overall happiness and satisfaction with life
• Life alignment, meaning, and purpose
• How one feels about past, present, and future/hopefulness
• Relationship with self

Fatigue rarely has a single cause. More often, it reflects the cumulative effect of multiple small imbalances over time.

A Different Question

Instead of asking, “How do I push through this?” a more helpful question may be: “What is my body asking for right now?”

Sometimes the answer is deeper rest — not just sleep, but true restoration. Sometimes it is nourishment, rhythm, or nervous system support. Sometimes it requires investigating underlying illness that has gone unrecognized. And sometimes, it asks for a change in how we are living. Fatigue is not the body failing you. It is the body communicating — often wisely, and often early. Healing begins when we slow down enough to listen.

Final Thoughts

At Mederi, we approach fatigue not as a symptom to suppress, but as a signal to understand. This means taking the time to look more deeply — at patterns, physiology, environment, and lived experience — and supporting the body in a way that is both individualized and comprehensive. For many patients, this process brings clarity to symptoms that previously felt confusing or unexplained.

If you are experiencing ongoing fatigue, you do not have to navigate it alone. With the right support and investigation, it is often possible to uncover the underlying contributors and begin restoring energy in a sustainable way.

References

1. Nunez, S. G., et al. (2025). Chronic stress, HPA axis dysregulation, and immune function. International Journal of Molecular Sciences, 26(20).
2. Bertollo, A. G., et al. (2025). Interactions between the HPA axis and the gut-brain axis in stress-related conditions. Frontiers in Psychiatry, 16.
3. Tonini, E., et al. (2025). Multidimensional outcomes associated with fatigue in young populations. Journal of Affective Disorders, 350, 105–114.
4. Proal, A. D., & VanElzakker, M. B. (2021). Long COVID and post-viral fatigue syndromes: Emerging pathophysiology and treatment considerations. Frontiers in Microbiology, 12.
5. McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179.
6. National Academies of Sciences, Engineering, and Medicine. (2015). Beyond myalgic encephalomyelitis/chronic fatigue syndrome: Redefining an illness. The National Academies Press.
7. Wyller, V. B. (2017). The chronic fatigue syndrome—an update. Acta Neurologica Scandinavica, 135(Suppl 212), 7–14.

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Meet Dr. Rachel Stricker

Rachel Stricker, ND, is a licensed naturopathic doctor who is passionate about helping people feel their best by blending natural therapies with compassionate, personalized care. With over a decade of experience, including eight years in private practice, she specializes in GI health, autoimmune disease, Lyme disease and chronic infections (Epstein Barr, Long COVID, etc.), hormonal balance, and detoxification (mold toxicity, environmental toxicity, etc.). Dr. Stricker integrates her background as a yoga instructor and plant-based chef to help patients reduce stress, nourish their bodies, and build lasting vitality. She was drawn to the Mederi Care model for its deep focus on botanical medicine, clinical nutrition, and whole-systems healing, and loves working alongside patients to create integrative treatment plans that support long-term health and resilience. Learn more about Dr. Stricker here.

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