The Energy Guide

Before assuming something complex is wrong, check the basics. The most common causes of fatigue are remarkably simple: • **Sleep:** You need 7-9 hours. Quality matters as much as quantity. Screen time, alcohol, and irregular schedules all hurt. • **Hydration:** Even mild dehydration causes fatigue and brain fog. • **Blood sugar:** Roller-coaster blood sugar from processed carbs leads to energy crashes. • **Movement:** Paradoxically, exercise gives you more energy over time. • **Stress:** Chronic stress exhausts your adrenals and nervous system. This isn't sexy advice, but it's where most improvement happens. Optimize these before spending money on testing or supplements.

If lifestyle optimization doesn't work after 2-4 weeks, it's time to dig deeper. Many causes of fatigue show up in labs—if you know what to look for. The problem is that standard lab panels often miss things. A thyroid "in range" might still be suboptimal. Iron can be low-normal but still cause symptoms. You need a doctor who looks at the full picture, not just whether values are flagged as abnormal. Common findings in chronically fatigued people: • Suboptimal thyroid function (especially low T3) • Iron deficiency (ferritin often low before anemia develops) • Vitamin D insufficiency • B12 deficiency (especially in vegetarians/vegans) • Chronic infections (EBV reactivation, etc.) • Sleep disorders (like undiagnosed sleep apnea)

Once you know what's wrong, you can fix it. This looks different for everyone: **If it's thyroid:** Work with a doctor who optimizes, not just normalizes. Some people feel better with Free T3 in the upper half of the range. **If it's iron:** Ferritin below 50-70 causes symptoms in many people, even though labs won't flag it. Oral iron or IV iron can be transformative. **If it's vitamin D:** Get to 40-60 ng/mL. This often requires 4,000-5,000 IU daily, not the 400 IU in a multivitamin. **If it's sleep quality:** Treat the underlying disorder. CPAP for apnea, CBT-I for insomnia, addressing anxiety or restless legs if present. **If it's mitochondrial:** This is where supplements like CoQ10, B vitamins, and NAD precursors might actually help—but only if mitochondrial function is the bottleneck.

Once you've fixed obvious deficiencies and medical issues, there's a second tier of interventions that may help optimize energy further. These are more experimental but have some evidence: **NAD+ precursors (NMN, NR):** NAD declines with age and supports mitochondrial function. Some people notice more energy; others notice nothing. The research is still developing. **CoQ10:** Essential for electron transport in mitochondria. Especially relevant if you're on statins (which deplete CoQ10) or have known mitochondrial issues. **Creatine:** Not just for muscles. Your brain uses it too. May improve energy and cognitive function, especially in vegetarians. **Cold exposure:** Builds mitochondria and brown fat. Some people find it energizing; it's also free. **Peptides:** Some peptides (like Epitalon) claim longevity and energy benefits, but human evidence is extremely limited. Experimental territory.