Dear doctor. I eat healthy and exercise. Why am I tired all the time, no matter how much sleep I get?

The internet is alight with people looking for answers to one simple question: why am I always so tired?

A quick google search turns up countless responses like this one on Reddit the forum ‘productivity’.

It reads: ‘I eat a healthy diet, I exercise, take vitamins and get enough sleep yet I’m always constantly tired and low on energy, I feel like I could fall asleep at any point of the day, even during my workouts. Is there a way to figure this out?’

You might look to common culprits — diet, exercise or food. But even people with a perfect routine can be bogged down by seemingly bottomless fatigue. 

If this describes you, there are a number of other factors that you might not be considering that could be to blame, Dr Stuart Fischer, a New York based physician told DailyMail.com. 

These range from the familiar, like stress, to the more dramatic, like hormone imbalances and sleep disorders. 

There’s also the chance you could be suffering from a rare condition such as chronic fatigue syndrome, which involves sustained and extreme exhaustion. The illness is a lifelong disease that affects an estimated 836,000 and 3.3 million people.

It can’t be solved by rest, coffee or medication, and can sometimes get in the way of leading a normal life. 

It’s difficult to determine what might be causing your fatigue, since it’s a symptom in so many different conditions, Dr Neha Vyas, a family medicine physician at the Cleveland Clinic, told DailyMail.com.

However, both Dr Fischer and Vyas said that a thorough doctors visit should be able to determine what’s causing your unique brand of exhaustion. 

Sometimes, the problem can be solved by making simple changes to your lifestyle. 

The NIH recommends between seven and nine hours of sleep per night, eating a well rounded diet full of fruits and vegetables and making sure to exercise for 3 hours a week. Doing all these things could solve your fatigue. 

If the problem still persists, here are six things that might be to blame for your sluggishness despite getting plenty of sleep, nutritious food and exercise.

YOU COULD HAVE A COMMON DEFICIENCY

One potential reason you may be feeling sluggish could be that your don’t have enough healthy red blood cells running around your system. This is called anemia. 

Your blood cells carry oxygen around your body – key in making all the tissues run in your body. 

When they’re not working properly, you don’t get all the oxygen you need, which can make you feel tired, Dr Neha Vyas, a family medicine physician at the Cleveland Clinic, told the DailyMail.com. 

About 3 million people in the United States have anemia, according to the NIH. 

Anemia is popularly known as having low-iron, and many people choose to bulk up on red meat and spinach in order to get more of the essential nutrient, thinking that might be the cure to their energy fix. 

But anemia can be caused by more than a low-iron diet Dr. Fischer said. There are a few different disorders that cause you to lose red blood cells. 

One example is called thalassemia, which is a genetic disorder that is known to affect people in the Mediterranean. 

In this disease, the body doesn’t produce enough hemoglobin, which is the molecule that carries oxygen around the body. 

 Boston Children’s hospital estimates this form of the disease affects 1 million people. 

Another example is that sometimes people develop anemia temporarily after they lose blood in surgery. 

Anemia can also affect women each month when they’re on their period, especially if they bleed particularly heavily. This compounds with other energy drains during the menstrual cycle, like hormonal changes, which can bog someone down. 

Regardless of what kind of anemia you may have, doctors can usually discover it in the lab with a simple blood test. Then, treatment usually involves taking a regular iron supplement. 

But, Dr Fischer said, don’t start taking iron pills on the superstition that you may be anemics, because they can come with unpleasant side effects, like constipation. Wait until you get a diagnosis to act on this hunch. 

‘As a doctor, I’m supposed to know how to wade through someone’s symptom complex to figure out if there are fatigue is psychological, sociological, philosophical, medical or endocrinological,’ he said.

MAYBE IT’S YOUR THYROID 

This small, butterfly shaped organ that lives in the front of the nix, right near the Adams apple helps dictate how your body spends its energy. 

It produces hormones that regulate your metabolism – or the rate that your body uses energy. Sometimes, people’s thyroids produce too much or too little of these hormones – which can make them feel tired. 

Dr Fischer said this may lead to, ‘severe fatigue that nothing will make better. Red Bull, coffee, nicotine, nothing will make it better.’

Like anemia, thyroid disorders can only really be determined by a doctor, he said. 

But if you are diagnosed with a thyroid disorder, there are hormone therapies that you can take that should help your body re-balance its energy.

Thyroid dysfunction is one of the more common fatigue diagnoses, Dr Nyas said.  

Approximately 12 percent of the US population will develop thyroid problems at some point in their life, according to Weill Cornell medicine. Women are five to eight times more likely to develop a condition than men. 

HAVE YOU BEEN STRESSED RECENTLY? 

Our body uses stress to prepare us for something challenging – whether that’s competing in the Olympics, going on a job interview or testifying in court.  

When we enter this state of stress, our body gets flooded with chemicals like cortisol and adrenaline – which spike your heart rate, send more blood to your muscles and help you feel alert. 

This is a biologically challenging state for our body to be in, and after our system has been bombarded with stress signals, it nosedives into a crash, Dr Fischer explained, which can make us feel exhausted. 

In small doses, stress can be helpful. But these days, many people are stuck in daily stress cycles – which can affect our energy levels, sleep quality and mood, Dr Fischer said. 

This is of particular concern for people who work long hours in stressful jobs, he said. 

Dr Fischer tells people to do their best to worry less in day to day life and make sure that when you’re not working, you’re taking the time to relax, recharge and rest. 

ARE YOU SUFFERING A MENTAL HEALTH PROBLEM? 

Though hearing that fatigue might be in your head may sound dismissive, Dr Fischer said there are a host of psychological affects that could be causing serious drain on your body. 

This includes depression, anxiety, PTSD and more, Dr Vyas said. 

In all these conditions, fatigue may be the first sign that you’re struggling, or it could be a cause behind the disorder in the first place. 

Depending on your particular psychological condition, physicians will recommend different treatments that might help alleviate your tiredness.  

For example, depression is sometimes caused by a chemical imbalance in your brain, Dr Fischer said.

In the case that you’re dealing with a chemical imbalance – taking mood drugs that add more neurotransmitters back into your system could help bring your energy back.  

YOU MAY HAVE PREDIABETES 

The NIH has warned about a silent health epidemic of adults suffering from pre-diabetes – representing an estimated 97.6 million Americans. 

Before you are diagnosed with Type 2 diabetes, the body slowly begins falling into dysfunction in ways you might not notice. 

Insulin is a hormone that your body produces naturally to tell you when to use the sugar circulating in your body that  you get from food. It helps control how your body uses energy.

When someone gains a lot of weight or doesn’t eat enough food, their bodies natural levels of insulin might fall out of whack Dr Fischer said. 

For example, in someone that gains a lot of weight rapidly, their body might begin producing way more insulin than they need to accommodate. 

Overtime, a body that’s bombarded with insulin can become resistant to the hormone’s effects – meaning your body has a harder time knowing when to use the sugar that’s in the blood stream.

This is a similar to what happens when someone has diabetes – and insulin resistance is often a precursor to the chronic condition.

This, Dr Fischer said, can make someone feel fatigued. 

Diabetes can also cause someone to feel tired, but if it’s managed properly, shouldn’t be debilitating. 

…OR A LITTLE-KNOWN SLEEP CONDITION 

Sometimes, you might go to bed early, wake up late and still get a bad nights rest, Dr Fischer said. 

There are a number of sleep disorders that might be lurking under your closed eyes that trick you into thinking you’re getting better rest than you are. 

One example is sleep apnea. 

This disorder causes someone to stop breathing while they’re asleep. When you don’t get enough oxygen in your body, you feel tired. 

Also, when you stop breathing, you tend to wake up frequently, which makes you get less sleep overall, and can make you fatigued, Dr Vyas said.

Another example is parasomnia, otherwise known as sleepwalking. When your body is moving around at night, you’re not getting the same quality of sleep that you would if you were lying still. 

Then there are plenty of other conditions – like narcolepsy, sleep paralysis, and restless leg syndrome, which can all make the sleep you are getting less restorative.  

If you have a sneaking suspicion that any of these could be plaguing you, it’s best not to jump to conclusions, she added. 

Sometimes, these are caused by medical conditions, but other times, it’s just a passing fad. 

‘There’s a lot of weird reasons for fatigue and that’s why this topic is somewhat challenging,’ she said, adding, ‘check with your doctor if you’re concerned.’