Fatigue That Won't Lift Has a Reason
You sleep, you eat pretty well, you've cut back on plans, and you still wake up worn out. Dr. Spiegel and Jennifer look for why your body is running low, starting with a long conversation and the right labs.
Not ready to book? Start with a free 15-minute call
What Causes Constant Fatigue?
At the Osteopathic Center for Healing in Rockville, MD, Dr. Neil Spiegel, DO, MBA and Jennifer Gularson, PA-C, IFMCP treat long-term fatigue by finding what's causing it. That can be thyroid or hormone changes, low iron or nutrients, blood sugar swings, gut problems, inflammation, infections or environmental exposures. Care starts with a long first visit and targeted labs, then a plan built around your results.
What Can Fatigue Feel Like?
Fatigue doesn't look the same for everyone. Most people we see have a few of these at once.
Fine at 9am, done by 2pm, and coffee doesn't touch it.
You lose words, reread emails and walk into rooms forgetting why.
Exhausted all day, then your mind won't shut off at night.
Stairs feel steeper and your arms and legs feel like sandbags.
Small things set you off because you have nothing left in the tank.
A workout, a cold or a long week takes days to recover from.
Why Is Fatigue Usually a Symptom?
Fatigue shows up in a lot of conditions, which is why it gets brushed off so easily. It can come from thyroid changes, perimenopause and menopause, low testosterone, gut problems, Lyme, mold exposure and autoimmune conditions. Finding the cause behind it is what changes how you feel.
Where Does Your Energy Come From?
Every cell in your body has mitochondria, small engines that turn food and oxygen into energy. They need iron, B vitamins, magnesium, CoQ10 and steady blood sugar to run. Inflammation, toxins, infections and hormone shifts slow them down.
When enough of your cells are running low, you feel it as fatigue, so we look at what's feeding those engines and what's getting in the way.
What Fuels Them
- Iron
- B vitamins
- Magnesium
- CoQ10
- Steady blood sugar
- Good sleep
What Slows Them
- Inflammation
- Toxins and mold
- Infections
- Hormone shifts
- Poor absorption
- Ongoing stress
Where Do We Look?
Fatigue rarely has one cause. These are the areas we check, and most people have more than one going on.
Thyroid
A TSH test alone can miss problems. We also check free T3, free T4, reverse T3 and thyroid antibodies, because you can have a normal TSH and still have a thyroid that isn't keeping up.
Stress Hormones
Cortisol should be high in the morning and low at night. When that rhythm flips, you drag all day and lie awake at night.
Sex Hormones
Dropping estrogen, progesterone or testosterone affects sleep, mood and stamina, in women and in men.
Iron
Your ferritin can be low enough to wipe you out without showing up as anemia. This is one of the most common things we find.
Nutrient Gaps
B12, folate, vitamin D and magnesium all play a part in energy, and stress, medications and gut problems use them up.
Blood Sugar
Spikes and drops cause the crash, the cravings and the 3pm slump. Fasting insulin often shows a problem years before A1c does.
Inflammation
Ongoing low-grade inflammation tells your body to slow down and conserve energy.
Gut Health
If you aren't digesting and absorbing well, it doesn't matter how well you eat. Learn about gut health.
Environmental Exposures
Mold, chemicals and heavy metals build up and can keep your immune system on alert.
Lingering Infections
Lyme, Epstein-Barr and other viruses can keep you exhausted long after the first illness.
Autoimmune Activity
Your immune system working against your own tissue takes a lot of energy.
Food Sensitivities
Reactions to foods you eat every day can leave you foggy and drained.
Sleep Quality
Eight hours doesn't help if your sleep is broken. If we suspect sleep apnea, we'll refer you for a sleep study.
Genetics
Some people process B vitamins or clear toxins differently, and that changes which supplements will work for you.
What If Your Labs Came Back Normal?
A lot of our patients come in with a folder of normal results and still feel awful.
Standard panels check a short list of markers, and the reference ranges are wide, so you can land inside the range and still be off for you. We run a broader set of labs and read them against how you feel. If you've been told to just get more sleep, we hear that a lot, and we start somewhere else.
The Labs We May Run
We choose the labs based on your symptoms, and they may include:
- Full thyroid panel with antibodies
- Ferritin and iron studies
- B12, folate, vitamin D and magnesium
- Fasting insulin, glucose and A1c
- Inflammation markers
- Sex hormones
- Cortisol rhythm testing
- Gut testing (GI-MAP or Genova GI Effects)
- Food sensitivity testing
- Testing for Lyme, mold or viral exposure when your history points there
How Do We Figure It Out?
A Long First Visit
We go through your history, your days, your sleep, your diet, your stress and when the tiredness started.
Targeted Labs
Testing is picked for your symptoms, which may include hormones, thyroid, nutrients, inflammation and gut markers.
A Plan Built for You
Nutrition, supplements, hormone support, gut repair, IV therapy or a mix, depending on what we find.
Follow-Ups That Adjust
We check in, recheck labs when needed and change the plan as your energy comes back.
What Might Your Plan Include?
What Does Getting Better Look Like?
Energy usually comes back in layers. How long that takes depends on the cause, and we'll tell you what to expect once we have your results.
The crashes get smaller.
Mornings get easier.
You make it through a full day with something left for dinner with friends.
Who Looks at the Whole Picture With You?
Dr. Neil Spiegel, DO, MBA is an osteopathic physician who looks at how your whole body works together. Jennifer Gularson, PA-C, IFMCP is certified in functional medicine and has helped thousands of patients with hormones, gut health and energy.
They work as a team, so your labs, history and plan get two sets of eyes.
What Do People Ask About Fatigue?
Is This the Same as Chronic Fatigue Syndrome?
No. Chronic fatigue syndrome (ME/CFS) is a specific diagnosis. We see people with long-term fatigue from many causes, including people who have already been diagnosed with ME/CFS.
What Labs Will I Need?
It depends on your symptoms. We go through your history at your first visit and decide on testing together, which may include a full thyroid panel, iron and ferritin, nutrients, blood sugar, hormones and gut testing.
Does Insurance Cover Fatigue Care?
We're out of network. We give you a claim form to submit to your plan, and many of the labs we use bill your insurance directly for testing.
Can IV Therapy Help With Fatigue?
It can be part of the plan for some patients. We decide after a consult and your first visit, based on what your labs show.
How Soon Will I Feel Better?
Some people notice changes in a few weeks. Others take longer, depending on what's driving the fatigue. We'll tell you what to expect once we have your results.
Do I Need a Referral?
No. You can book a consult directly with our office in Rockville, MD.
I Drink Coffee All Day to Function. Is That a Problem?
Coffee can cover up fatigue and throw off your cortisol and sleep. We don't make you quit, but we'll talk about how much you drink and when.
Could My Medications Be Making Me Tired?
Some can, including blood pressure medications, antihistamines, acid blockers and antidepressants. Bring your list to your first visit and we'll review it. Please don't stop a prescribed medication without talking to us first.
You Deserve to Feel Like Yourself Again
Book a consult with Dr. Spiegel and Jennifer in Rockville, MD.
Not ready to book? Start with a free 15-minute call