One of the most common, and often challenging concerns I see in my office is fatigue. When we are young, most of us have seemingly limitless energy: we may keep crazy hours, seem to perform well on little sleep, and bounce back from stressors with relative ease.

As we age, energy becomes more of an issue, and as an integrative and functional physician, I have to cast a broad net to think through why someone might not have the energy they want.

Here are 7 of the top things I think about that can cause low energy:

01. Poor nutrition.

I am amazed by how unique my patients are in their micronutrient needs. When we test for nutrient levels, we see many people even when taking supplements, may be significantly deficient in key nutrients. Some of the most common ones I see are magnesium and B vitamins- both critical for energy production. Under this same heading is the notion of poor sugar balance. Many of us today ingest an unreasonable amount of (mostly refined) carbohydrates putting our blood sugar, which ideally remains rather stable through meals, through a roller coaster ride. These fluctuations will often result in our feeling tired. We prefer an approach that emphasizes whole healthy food, majority of them plants and addressing specific micronutrient deficiencies only when we can measure them.

02. Hormonal deficiencies.

In our clinic, the frequency of an underperforming thyroid gland- the organ that controls metabolic rate, is surprising and seems to be increasing. There are many reasons for this, and the root causes for any one patient must be identified, but rarely is this picked even up in the labs that are typically performed in conventional medicine. In addition, low testosterone is also on the rise and this can affect women as well as men.

03. Low grade infection or inflammation.

Even in the absence of gut symptoms, many of my patients suffer from inflammation within the digestive tract because of food sensitivities, small intestinal bacterial overgrowth, overgrowth of yeast, insufficient digestive capacity, medications like acid-blockers, to name a few. This chronic low-level inflammation exhausts the system. Improvement in these issues can result in a significant boost of energy. Chronic sinusitis, a condition many of my patients live with, has the same depleting effect. Skin rashes, brain fog, or joint achiness can point us in this direction.

04. Lack of movement:

Exercise begets energy and our sedentary lifestyles, with long commute times, sitting in front of the computer for most of the day, is an absolute drag on our energy. While an hour work-out is terrific, it does not make up for 8+ hours of sitting. Building up movement throughout the day can be a significant energy boost.

05. Poor sleep:

This is a condition of epidemic proportions in our culture and most of the medications prescribed to treat only compound the problem. During deep sleep, we are restoring enzymes, hormones, neurotransmitters and essentially restocking the shelves. When we are gipped out of restorative sleep, no amount of coffee truly makes up for this.

06. Toxic exposures.

Alcohol, mold, mercury, pesticides and other chemicals, medications, sugar and nasty relationships all fall under this category. Many of us live with these exposures for so long, we do not think to associate them with poor energy. But by directly interfering with our capacity to produce energy, they can be a slow and steady drain on our resources. Addressing each of these issues requires a unique approach.

07. Thoughts.

Self-deprecating, shaming, ruminating, judgmental thoughts are a true energy sump. By binding and constricting us, they prevent free flow of energy through the system.

I hope this list is helpful for you to think about with your own health. The good news is, with some thoughtful investigation, each of these issues can be addressed. So, in this New Year, if feeling vital to do the things you love has importance to you, make it a point to have different aspects of your life assessed by a Functional Medicine physician and know that great energy is possible.

By Karen Koffler, MD, IMFCP