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Fatigue and Autoimmune Disease: Restoring Your Energy Levels

Fatigue is one of the most common complaints among those individuals living with an autoimmune disease. It can be one of the most frustrating symptoms associated with autoimmunity, mostly because others don’t understand why you are so fatigued, even after you had a decent night sleep.

In fact, fatigue is not well understood in the medical community and effective treatment options are limited. When you dig deeper there are several possible root causes that may be contributing to fatigue when you have an autoimmune condition. Knowing a potential cause, may lead to some potential solutions. This article will lay out some possible areas to explore to find an underlying cause of fatigue and offer some tips on how to manage or improve your energy levels.

In general, fatigue is defined by debilitating periods of exhaustion accompanied by the inability to perform activities to an expected capacity. Fatigue in autoimmunity means symptoms of tiredness and exhaustion that do not improve with rest. Fatigue can be composed of both physical fatigue and mental fatigue. For many, fatigue affects their daily activities including ability to work and do everyday tasks such as house chores, cooking, grocery shopping and even taking care of one’s own personal hygiene. It can affect social life and ability to gather with friends and family as well as participate in recreational activities.

Possible Root Causes of Fatigue

Chronic Inflammation

One of the main underlying causes of fatigue in autoimmunity is chronic inflammation. Autoimmune diseases are characterized by enhanced inflammation in the body. This inflammation is created by the body’s release of cytokines, which are cells responsible for coordinating an attack against foreign pathogens.

In autoimmune disease, the body’s immune system is overactive and it releases an elevated level of cytokines. This increase of cytokines, leads to additional inflammation which leads to an increase in fatigue. Your body is devoting much of its resources to constantly mounting an immune response, which can be an exhausting process for your body.

One way to decrease overall body inflammation levels is to make changes to your nutrition to focus on consuming anti-inflammatory foods. When we consume foods that have processed, artificial, inflammatory ingredients, our body won’t recognize them and will increase the immune system’s response to try to fight them, leading to increased inflammation.

Instead, choose quality whole foods. Aim to have the majority of your daily diet be foods that do not have an ingredient list. Fill up your shopping cart with colorful foods from the produce section. Fruits and vegetables contain important phytonutrients that are full of antioxidants which are disease fighting properties. A simple change in your diet can have a profound impact on your energy levels. Your body won’t have to expend more energy fighting with so many unknown invaders in the form of unhealthy ingredients.

One consideration is having blood work done to check for systemic inflammation levels. Specifically, the CRP (C-Reactive Protein) and the ESR (Erythrocyte Sedimentation Rate) are two common blood tests that check for systemic inflammation.


When our digestion is compromised due to systemic inflammation, chronic illness and medication use, we may lack certain nutrients due to poor absorption in our gut. An inflamed gut lacks the ability to absorb all the essential micronutrients from our food. Most of them will just pass through our digestive tract and exit our body as stool. This lack of essential nutrients will lead to fatigue because our body does not have the building blocks it needs to repair and heal itself.

It is similar to trying to build a house without a solid foundation. Without that solid base, the walls will fall down and the house will collapse. By focusing on improving nutrition and consuming anti-inflammatory whole foods, systemic inflammation levels will decrease and our gut will be able to better absorb nutrients. Your body will have the proper foundation of essential nutrients it needs, leading to stronger walls and increased energy levels.


Anemia is defined as a reduction in the quality and/or quantity of red blood cells. There are many different kinds of anemia, the most common type being iron-deficiency anemia. Iron is one of the most common nutrients that individuals with autoimmunity are deficient in. Ferritin is the storage form of iron and a simple blood test will show if you are deficient.

Without enough iron, your body can’t produce enough hemoglobin. Hemoglobin is a protein in red blood cells that enables them to carry oxygen through your blood vessels. Without sufficient hemoglobin, your tissues and muscles won’t get enough oxygen to be able to work effectively, therefore leaving you fatigued.

If you are iron deficient, focus on increasing iron-rich foods into your diet. Some great examples of food high in iron are: lentils, beans, nuts, egg yolks, liver, oysters, grass-fed beef, peas, swiss chard and other leafy greens. There are different types of dietary iron. The iron found in animal sources is called ‘heme’ iron and is more absorbable than the plant based ‘non-heme’ iron. Adding food sources high in vitamin C can help to increase the absorption of non-heme sources of iron. So next time you eat a plant based iron-rich food, add a few orange slices to your plate as well.

It can take several months for iron levels to improve. Consider re-testing blood work after 3-4 months of increasing iron-rich foods into your diet. If iron levels have not improved through diet, talk to your health care provider about possible iron supplementation. Do not start any supplement before consulting with your doctor first.

Stress (Adrenal Fatigue)

Individuals living with an autoimmune disease are reported to have increased stress levels compared to the general population. This may stem from a constant worry over a chronic health condition, frequent doctors visits or tests and the variability in functioning from day to day that may impact your ability to work and perform other daily tasks.

The adrenals are small glands located above the kidneys that are responsible for secreting stress hormones. This increase in stress from living with an autoimmune disease in addition to basic life stressors can overwork these glands and lead to exhaustion.

It is critical to work on decreasing overall stress and work on mental health to help reduce the strain on these glands. Improving nutrition and practicing healthy lifestyle habits will give your body the ability to respond better to stresses that it may encounter. These positive changes will help decrease overall fatigue levels and lead to more days where you are able to optimally function.

Medication Use

Many medications that are used for autoimmunity work by modulating the body’s immune system. One of the biggest side effects of these medications is fatigue. If you have tried making changes in your nutrition and lifestyle to help combat your fatigue and have found no relief, talk to your doctor about your medication and if it may be contributing to your symptoms.

Other Tips for Dealing with Chronic Autoimmune Fatigue

*Light Exercise- It may sound counterintuitive, but adding some movement into your day can help increase your energy levels. Try short walks and light exercise to build more energy. They can be broken up into 5-10 minute segments so they are not too taxing on your body.

*Pace your Physical Activity- One of the most important aspects of controlling fatigue is learning to pace your physical activity. It is very easy to overdo it when you are feeling good, but you may end up with increased fatigue in the days following. Take frequent breaks if needed. Listen to the cues your body is giving you and rest when it is needed.

*Hydration - Ensure you are drinking at least 8 glasses of water a day to help keep your muscles and body systems hydrated to keep up your strength. Remember that some caffeinated drinks such as coffee and tea may be diuretics so you need to account for that.

*Get Outdoors - Fresh air and sunshine can be very beneficial for lifting your mood and improving your energy levels. Fatigue can be a symptom of Vitamin D deficiency so aim for at least 15-20 minutes of sun exposure when able.

*Quality Sleep - doing light exercise and getting some vitamin D from the sun during the day can go a long way in helping you achieve quality sleep at night. Create a calming bedtime routine and limit exposure to blue light within an hour of bedtime. Aim for getting at least 7-8 hours of sleep per night.

*Practicing Mindfulness - Incorporating meditation and relaxation techniques into your day can help to combat fatigue by giving your brain the rest it needs to get through your day.

If you have persistent fatigue symptoms, it is important to talk with your healthcare provider to see if you can determine the underlying cause. Working with a nutritionist can help guide you on the path to better gut health to ensure that you are obtaining the essential building blocks needed to give your body the energy it needs to thrive.

Although it is common, fatigue does not have to play such a big part of your everyday life when living with an autoimmune condition.

Written by: Liz Hoobchaak, PT, DPT, CNPT, CAHNS

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