Show Sponsors & Links

This episode is proudly supported by:

🌿 Madame Tiger - a delicious dairy-free, nut-free plant milk made from tiger nuts, naturally sweet and packed with prebiotic goodness.

www.madametiger.com

💧 Mineralyte - sugar-free electrolyte drops containing 22 electrolytes, minerals and trace elements, proudly made in Australia. Mix into any drink to support rapid hydration every day.

www.mineralyte.com.au

---

Connect with Dr Andrea Robertson:

🌐 www.andrearobertson.health

📲 Instagram: @andrearobertson.health & @nourishhealrisepodcast

Ready to go deeper? Learn more about the 3 Week Inflammation Detox and the 12 Week Whole Health Solution at www.andrearobertson.health

---

Dr Andrea Robertson is an Osteopath, Naturopath, and Nutritionist. The information shared in this podcast is for educational purposes only and does not constitute medical advice. Always consult your healthcare provider before making changes to your health regimen.

Show Notes

Episode Transcript

Episode 2

[00:00:00] The thing I hear most from women is this, "I knew something wasn't right, but nobody could tell me why." Today we are starting with sign number one, and it is the one I hear about more than any other in my clinical practice. It's fatigue. Not ordinary tiredness, but inflammatory fatigue. Inflame tired is when you go to bed at a reasonable hour, sleep through the night, and wake up in the morning feeling like you've never slept at all.

And here is something I want you to sit with for a moment. This is a cellular problem. It is happening at the microscopic level inside every single one of the trillions of cells in your body, which is why it feels so total body. this episode is going to give you a completely new way of understanding what is happening in your body

Before we dive in, a big thanks to our first sponsor, Madame Tiger. When I was planning this podcast, I reached out to a number of brands who I love and adore, and Madame Tiger didn't hesitate to support me. That [00:01:00] says something about the brand that makes me love them even more. So I've got my tiger nut milk chai right here with me today, and honestly, that's not for the promo.

This is my real-life, nearly every afternoon ritual. Madame Tiger's tiger nut milk, it's dairy-free, FODMAP-friendly, no nasty additives or seed oils, and it makes the most incredible chai. If you haven't tried it yet, go and check them out at madametiger.com. Our second sponsor today is Mineralite, an Australian electrolytes brand.

And I have to tell you how I found them because this is a genuine story. Now, I'm really into paddle tennis, some may say obsessed . And a friend of mine introduced me to Mineralite to use for my hydration support during games. I was a little curious because I'd been recommending clients avoid those terrible sugary sports drinks for years, but I wasn't really sure what other options were available.

I now know that Mineralite is the option I'll recommend. It's unflavored and contains no sugar, no sweeteners, no artificial colors, no nasty additives. Just clean [00:02:00] electrolyte support in drops you can add to your water or any hot or cold drink. And my paddle, it was noticeably different. My energy held, my focus held, and I even won some games.

Mineralite is now in my water every single day. Go and check them out at mineralite.com.au or find them in most pharmacies and health food stores throughout Australia and New Zealand.

In over 25 years of clinical practice, the thing I hear most from women is this, "I knew something wasn't right, but nobody could tell me why."

Today that changes, because understanding your body, like really understanding it, is where everything begins. I'm Dr. Andrea Robertson, osteopath, naturopath, and nutritionist, and this is Nourish, Heal, and Rise. Here we nourish because food is medicine, and what you eat changes everything. We heal because the body has an extraordinary capacity to self-repair when we remove what's blocking it.

And we rise because feeling well isn't the destination, it's the foundation for living the life you truly desire. [00:03:00] This is Nourish, Heal, and Rise.

 

Before we begin, a quick and important note. Everything I share on this podcast is for educational purposes only. It's not personal medical advice, and it can't be, because in the context of this podcast, I don't know your health history, your medications, and what else is happening in your body. What I want this podcast to do is give you the knowledge to ask better questions, understand your body more deeply, and make more informed decisions in partnerships with the practitioners who do know you.

If something resonates and you wanna take action, please work with a qualified healthcare provider who knows your full picture Welcome back to Nourish, Heal, and Rise. I am so glad you're here for episode two. If you listened to episode one, you heard me introduce the eight most common signs of [00:04:00] chronic inflammation that I see in women's bodies, and I promised that over the next eight episodes, we would go deep on each one, the sign itself, the drivers behind it, and most importantly, what you can actually do about it.

Today, we are starting with sign number one, and it is the one I hear about more than any other in my clinical practice. It's fatigue. Not ordinary tiredness, but inflammatory fatigue, the kind that sleep does not fix. So if you've been feeling this way, if you've been feeling exhausted despite doing everything right, this episode is going to give you a completely new way of understanding what is happening in your body, and by the end of it, you will have a set of practical, actionable steps you can start implementing today.

I want to tell you up front that this is one of those topics where I think the gap between what women are experiencing and what they are being told is particularly wide. The number of women I've seen in clinic and through my online programs over the years who have been told, "Your bloods are [00:05:00] all normal," like, "Your thyroid is all fine.

Maybe it's just a little stress," When what was actually happening was a complex multi-system inflammatory picture that nobody had looked at as a whole. That gap is exactly why this podcast exists,

and this episode is for every woman who's ever been sent home from a doctor's appointment feeling more invisible than when she walked in. Before we get into it, I just want to map out what we're covering today so you know what's coming. We are going to look at it what inflammatory fatigue actually feels like in the body, because naming it clearly matters.

Then we're gonna go through every significant biological mechanism driving it in plain language. Then we're gonna move into nine practical steps you can begin implementing immediately, and we're going to finish with something that I think is often missing from these conversations, what recovery actually looks and feels like, so you know what to expect as you make these changes.

There is gonna be a lot here today, and my goal is to make it as practical and as clear as I possibly can.

Let's [00:06:00] begin by showing what inflammatory fatigue actually looks like. This is probably the number one thing I hear from women. They're sleeping seven, eight, nine hours a night and waking up exhausted. It's sleep that doesn't restore, that persistent low-level tiredness that sits in the background of everything.

And I want to be really clear about what I mean here, because there is a profound difference between being tired and being inflamed tired. Being tired makes sense when you've had a big week, when you've pushed hard, you've slept less, you've given a lot. That kind of tiredness responds to rest. Like you have a good night's sleep or a slower weekend, and you come back feeling really well on Monday morning.

That's normal. That is your body doing exactly what it should. Inflamed tired though, is completely different.

Inflamed tired is when you go to bed at a reasonable hour, sleep through the night, and wake up in the morning feeling like you've never slept at all. It's that heavy laden feeling behind the eyes. That sense of dragging yourself through the day on willpower rather [00:07:00] than actual energy. That moment at two or three in the afternoon when you would genuinely give anything to lie down, not because you're sleepy, but because your body feels like it is working so hard just to keep up.

Women describe it to me in different ways. Some say they feel like they're wading through mud. Some say their body feels heavy, like they're carrying something extra. Some say they feel fine in the morning, but they crash by midday, and some have a second wind in the evening that keeps them up late, and then the whole cycle repeats.

And some describe it as a kind of flatness. Not quite depression, not quite exhaustion, just a persistent dimming of the vitality that they used to have.

I had a patient that I can remember right now. I'll call her Sarah for privacy reasons. She came to me after four years of feeling like this, and she'd been to her GP, she'd had blood tests done twice actually, and she'd been referred to a specialist, and she'd been told everything was normal.

So [00:08:00] she tried sleeping in. She'd cut back on her exercise because she'd read that overtraining can cause fatigue. She'd tried going to bed earlier. Nothing was working. And when she first sat down with me and described her days,

What struck me was not just how tired she was, it was how unsurprised she had become by how tired she was. It was now her new normal. So she had normalized an energy level that was much lower than where her healthy levels should be. She had adjusted her entire life around a fatigue that was not meant to be permanent.

And that, I think, is one of the saddest things about inflammatory fatigue. Not just the tiredness itself, but how quickly women stop expecting anything different.

I know this feeling personally. During my burnout in my early thirties when I was seeing eighty patients a week and dancing professionally at night still, this was my daily reality. Getting up at five in the morning to go for a run because I'd gained weight, getting through the day on adrenaline, collapsing at night, [00:09:00] and sleeping but never actually recovering.

My body was just too inflamed to restore itself, and I had no framework back then at the time to understand why. If you wanna know more about that story, I shared it in episode one, where I shared my why about what I do. And there was a day where everything changed for me. It was the day that I sat in my car and burst into tears because I'd walked thirty minutes to where my car was parked and found that I'd left my keys back in the clinic. And that was the day I finally admitted that what I was experiencing was not tiredness.

It was something else, something deeper, something that sleep and running and pushing through were never going to fix. And now I understand it very clearly, and that is what I want to give to you today.

Let's go through what is actually happening in your body. When your body is chronically inflamed, your immune system is in a constant state of low-level activation. It is essentially running a background program all day, every day, that requires an enormous amount of energy. [00:10:00] Think of it as having, like, too many apps open on your phone at once.

The battery drains faster, the phone runs slower, and no matter how long you leave it to charge, it never quite gets back to full. That is your body on chronic inflammation. Now let me take you through the specific biological mechanisms because I think when you understand what is actually happening, it stops feeling mysterious and it starts actually making sense.

First, I wanna talk about the mitochondria. These are like your little cellular energy factories. Every cell in your body contains mitochondria. These are the tiny little structures inside your cells that convert the food you eat and the oxygen you breathe into energy. Think of them as like the little power plants of your cells.

When they're working well, you have abundant, consistent energy. When they're not, well, you do not. Inflammatory cytokines, These are the chemical messenger molecules that your immune system produces when it's activated. [00:11:00] These directly impair mitochondrial function.

They slow down energy production. They interfere with the electron transport chain, which is the series of biochemical reactions inside the mitochondria that actually manufactures ATP. ATP is the energy currency your cells run on. So your cells, quite literally, cannot produce energy as efficiently as they should, and the result is fatigue.

Not tiredness, fatigue. The kind that sleep alone cannot fix because the problem is not how much sleep you are getting. The problem is that your cellular energy factories are running at a fraction of their capacity.

And here is something I want you to sit with for a moment. This is a cellular problem. It is happening at the microscopic level inside every single one of the trillions of cells in your body, which is why it feels so total body. It is not just one thing that's off. Everything is running at reduced capacity simultaneously.[00:12:00]

Now I want to mention your cortisol rhythm. Cortisol, your primary stress hormone, follows a natural rhythm throughout the day. It should be highest in the first thirty to sixty minutes after you wake up, and this is what gives you that morning alertness and gets you moving, and then it should decline gradually throughout the day, reaching its lowest point in the evening to allow you to wind down and sleep.

This is called the cortisol awakening response, and it is one of the most important hormonal events of your day. It primes your immune system, it stabilizes your blood sugar, it activates your brain, and it gets your body into gear. When it is working well, you wake up, even without coffee, and you feel like you can function straight away.

When it's not working well, no amount of coffee produces that feeling. You're pushing against a biology that's not cooperating. When you are chronically inflamed, this rhythm becomes disrupted. Some [00:13:00] women end up with cortisol that is completely flat all day. No morning peak, no real energy at all. Just a flat, gray, colorless tiredness from the moment they wake.

Others have cortisol that's low in the morning when it should be high, so they can't get going, but then it spikes at night when it should be dropping, so they can't switch off. They can't sleep properly, they can't sleep deeply, and they wake up exhausted despite hours in bed During my burnout years, this was exactly my picture.

Running on adrenaline all day, which masked the cortisol flatness, and then lying awake at night because my poor little nervous system, it couldn't quieten down. I was tired but wired. Have you heard that expression, tired but wired? A pattern that is extraordinarily common in inflamed women, and one that conventional medicine rarely identifies because it requires cortisol testing across the whole day,

not just once in a morning blood draw.

I wanna go a little deeper on the cortisol story because I think it helps explain something that confuses a lot of women. [00:14:00] The HPA axis, the hypothalamic pituitary adrenal axis, is the command system that governs your stress response. Think of it as a chain of communication between your brain and your adrenal glands.

So your hypothalamus in the brain perceives a stressor. It signals to the pituitary gland, which is also in your brain, to then signal to the adrenal glands, which sit just above your kidneys, to then produce cortisol. The cortisol then feeds back to the brain to signal that the threat has been handled, and then the alarm gets turned off.

In acute stress, this works beautifully. You encounter a stressor, cortisol rises. You deal with it, cortisol falls, and the system resets. In chronic stress, which is what chronic inflammation essentially is, it's a low-grade biological stressor that never fully resolves, the feedback loop stops working properly.

The alarm keeps firing, and over time, the adrenal glands become less and less able to produce adequate cortisol [00:15:00] on demand. This is what is often referred to as adrenal fatigue. Though the more precise term is HPA axis dysregulation. The result is that the normal cortisol rhythm breaks down.

You cannot produce cortisol cleanly in the morning when you need it. You cannot suppress it at night when you need it to wind down. And the whole architecture of your energy throughout the day becomes erratic and unreliable. This is not a character flaw. This is a system that has been running on emergency power for far too long and is running very low on its reserves.

Now let's go to the thyroid gland, your metabolic engine. Your thyroid is a small butterfly-shaped gland that sits here at the base of your throat It produces hormones that regulate your metabolic rate, essentially how effectively your body burns energy at rest. like to think of it as a stress barometer, essentially, that determines whether your engine is running at full capacity or at half speed, and it has to adjust to everything in your internal and your external environment.

[00:16:00] So chronic inflammation directly suppresses thyroid function in multiple ways. It reduces the production of thyroid hormone, it interferes with the conversion of the inactive thyroid hormone T4 into the active form T3, the form that your cells can actively use.

And it increases the production of something called reverse T3, which is essentially a decoy molecule that sits in the thyroid receptors and blocks the active T3 from doing its job. It's like having a key made that looks right, but doesn't actually turn the lock. The result is a metabolism that is running slower than it should.

It's not flexible. It can't adjust to those internal and external stresses.

And a woman who feels cold, tired, foggy, and like she needs to eat less than everybody else just to maintain her weight. She may have dry skin, thinning hair, constipation, low mood, like the whole picture of thyroid underfunction, and yet she can be told her thyroid is perfectly fine.

The frustrating thing, and this is something I see constantly, is that standard thyroid testing [00:17:00] only measures TSH. Like, that's the first thing. TSH gets measured usually on its own, and this is the pituitary gland signaling to the thyroid.

It's not a direct measure of thyroid hormone levels in the blood. And a TSH within normal range does not tell you whether the thyroid is actually producing adequate hormone in response.

It does not tell you whether T4 is converting to T3 effectively, and it absolutely does not test for reverse T3, which means many women with significant thyroid-related fatigue are told their thyroid is just fine because the right questions are not being asked of the right tests.

If your fatigue is significant and your TSH has come back as all normal, please ask your GP to also test free T3 Free T4 and reverse T3. Or come and chat to my team and I because we can help you with that too. And a broader thyroid panel, including antibodies also, tells a much more complete story. Now I wanna mention the gut, [00:18:00] where your energy and mood has its foundation.

Your gut is not just digesting your food. It's producing something called neurotransmitters, which are little transmitters that send messages along the nerves, and the gut produces approximately ninety percent of your serotonin, which is your primary mood-stabilizing and energy-regulating neurotransmitter. Think of serotonin as your sunshine chemical, the one that makes you feel calm, capable, and motivated.

Your gut is also producing dopamine precursors like something called GABA, it's your calming neurotransmitter, and a host of other signaling molecules that directly affect brain function and energy levels. So you can see the gut is not just a passive digestive tube.

It is an active endocrine and immune organ that is in constant communication with your brain. When your gut is inflamed and dysbiotic, meaning the balance of good and not so good bacteria is off, serotonin production is directly [00:19:00] impaired.

The integrity of the gut lining also becomes compromised. That's a state we refer to as intestinal permeability, otherwise known as leaky gut. And inflammatory particles that should stay inside the digestive system begin to enter the bloodstream.

This triggers a systemic immune response, which feeds back into the mitochondrial dysfunction we talked about earlier, and which also directly affects neurotransmitter production and brain chemistry.

Compromised serotonin means compromised energy, compromised mood, compromised motivation, and compromised sleep quality. So the gut-energy connection is profound, and it is one of the reasons why gut healing is so consistently associated with improvements in energy levels, often in ways that surprise women who did not expect their digestive health to be so connected to how tired they feel.

Okay, now we go on to blood sugar instability, which can really cause an energy rollercoaster Every time blood sugar spikes and [00:20:00] then crashes, which happens with that diet high in refined carbohydrates, sugar, and meals that lack enough protein and healthy fats, cortisol rises to rescue the falling glucose.

Think of it this way. When blood sugar drops below a certain threshold, the body perceives it as a threat. The cortisol alarm goes off to mobilize stored glucose from the liver and get blood sugar back up. This is a significant energy drain. So each blood sugar crash is like a mini stress event for your body, and multiple blood sugar crashes per day, which is really the reality for many women eating the standard modern diet, these create a cumulative cortisol load and a cumulative energy drain that by mid-afternoon

leaves women reaching for caffeine and sugar just to keep functioning. Here is what I want you to understand about this pattern. The afternoon energy crash that so many women experience around two or three in the afternoon is not [00:21:00] inevitable. It is not just part of modern life. It is, in most cases, a blood sugar crash, which is entirely addressable through how you eat, and we are absolutely gonna be talking about that later in the podcast.

Now, let's go to iron deficiency and low ferritin, which is one of the most missed causes of fatigue in women. Ferritin is your iron storage. Think of it as your reserve tank for iron in your body. And low ferritin is one of the most common and most consistently missed causes of fatigue in women, particularly women of reproductive age who are losing iron through their monthly periods.

Here is the critically important thing about ferritin. The conventional medicine reference range for ferritin goes as low as twelve micrograms per liter in some laboratories, which means a woman with a ferritin of fifteen will be told that her iron is fine. But in functional medicine, the optimal range for ferritin, where you've got your best health, [00:22:00] that level is where the body has adequate iron stores to support energy, thyroid function, neurotransmitter production, and immune function.

That range is between seventy and one hundred micrograms per liter. So a woman with a ferritin of fifteen is literally running on empty. Her cellular energy production is significantly impaired, and she will almost certainly be tired, often profoundly tired in a way that does not respond to sleep. Iron is essential for hemoglobin production.

Hemoglobin is the protein in your red blood cells that carries oxygen to every cell in your body. So without adequate iron, your cells are literally oxygen deprived. And oxygen-deprived cells cannot produce energy efficiently This is mitochondrial impairment by a completely different mechanism, and yet the results feel identical.

Heavy, unrelenting, sleep-resistant fatigue. If you have not had your ferritin specifically tested, not just a general iron check, please [00:23:00] add this to your list of things to ask your GP for. It's one of the most actionable and most impactful pieces of blood work available for understanding fatigue in women.

Now, I want to go on to estrogen and progesterone, where we can talk about the hormone-energy connection. Both estrogen and progesterone play significant roles in energy regulation, and this is an area I think is drastically underappreciated, even amongst women who are relatively health conscious.

Estrogen supports mitochondrial function,

it actually helps your cellular energy factories work more efficiently by upregulating the enzymes involved in ATP production. It also supports serotonin activity, dopamine signaling, and the density of serotonin receptors in the brain. Think of estrogen as one of the key regulators of your neurological energy economy.

As estrogen declines through perimenopause, sadly that support diminishes. Energy [00:24:00] production at the cellular level becomes less efficient, and brain chemistry also sadly becomes less stable. Now, progesterone. Progesterone has a calming restorative effect on the nervous system. It supports deep sleep by enhancing GABA activity.

It reduces the hypervigilance of the stress response, and it creates the conditions for genuine overnight recovery. Think of progesterone as the off switch for the stress response, the hormone that allows your nervous system to finally stand down at the end of the day. But as progesterone declines, which happens before estrogen in the perimenopausal transition, sleep quality often deteriorates.

The nervous system becomes more reactive, and the restorative capacity of sleep reduces significantly. This is why fatigue so often intensifies during the perimenopausal years, even in women who are doing everything right. The hormonal changes are directly affecting the cellular [00:25:00] and neurological foundations of your energy.

Now, sleep itself. I want to add one more mechanism here because I think it is one of the least understood pieces of the fatigue puzzle. Sleep is not a single state. It has distinct stages, light sleep, deep sleep, and REM sleep, and each stage serves a different biological purpose. Deep sleep or slow wave sleep is where your body does the majority of its physical repair.

Human growth hormone is released. Cellular repair happens. The glymphatic system, which I just love, it's like the lymphatic system of your brain. The glymphatic system is like your brain's waste clearance system, so it activates and flushes out metabolic debris, including inflammatory proteins that have accumulated throughout the day.

REM sleep is where emotional processing, memory consolidation, and neurological restoration happens. When inflammation is high, you [00:26:00] often get much less deep sleep. Inflammatory cytokines directly interfere with that slow wave deep sleep architecture, which means that even when a woman with chronic inflammation sleeps for eight hours

Which means that even with which means that even when a woman with chronic inflammation sleeps for eight hours, she may be spending very little of that time in the deep restorative stages. She gets the hours, but she does not get the repair, and she wakes up feeling as though she has not slept, because at the cellular level, she effectively has not.

This is why addressing sleep quality and the inflammation that is disrupting it is so much more important than simply adding hours in bed

[00:27:00]

 

Now, let's chat about what you can actually do about inflammatory fatigue.

This is the section I want you to [00:28:00] pay the most attention to, because understanding what is happening is powerful, but having a clear, practical path forward is what creates real change. I'm going to go through nine actionable steps you can begin implementing immediately. Step one is to stabilize your blood sugar from the moment you wake up.

This is the single most impactful thing most women can do immediately for their energy levels, and it starts with breakfast. A breakfast that is predominantly carbohydrates, so toast or cereal or fruit juice, even a smoothie that is mostly fruit. These create a rapid blood sugar spike followed by a crash, and that crash triggers a cortisol release, and that cortisol release on top of the already disrupted cortisol rhythm that inflammation creates, sets you up for an energy rollercoaster for the entire rest of the day.

You spend the morning managing the fallout from breakfast before you've even started. [00:29:00] The other day, I was teaching barre at Club Balance in Hampton in Melbourne, where I teach on a Friday morning, and I walked in the door at quarter to 6:00 in the morning And I saw a bowl of Easter eggs left over from Easter, and I was like, "Ooh, I might have just one of those little tiny Easter eggs."

It was not a good idea having this little tiny Easter egg on an empty stomach at quarter to six in the morning. But I ate it, and within 10 minutes I was teaching and I felt a bit sick in my stomach. But that was a very minor symptom compared to what happened for the rest of the day. I was on this rollercoaster.

I felt like my energy went up and my sugar spiked down. I had terrible cravings, which I never have, and I just felt awful. I couldn't wait for the day to end. So that was a little lesson and a reminder to myself to always have a good quality breakfast and not have that sugar hit, that big carbohydrate hit on an empty stomach.

And so a protein-rich breakfast, 25 to 30 grams of protein, does the opposite to a carbohydrate-heavy breakfast. It creates a slow, [00:30:00] stable blood glucose response. It supports the cortisol awakening response rather than spiking it reactively, and it sets your blood sugar up for stability throughout the morning, dramatically reducing the afternoon energy crash, and importantly, keeps you fuller for longer so you are not reaching for something sweet at 10:30 in the morning just to get through to lunch.

Practical breakfast options that hit the protein target can be eggs in any form, like scrambled or poached, or an omelet with vegetables or a hard-boiled egg, and eat that quickly on the go if you're in a rush. Even a protein smoothie with a quality protein powder. My favorite is hemp protein for those who are dairy-free.

Blend that with some healthy fats and a small amount of fruit and you've got a beautiful smoothie there that's high protein. And then think leftover protein from the night before, like cold chicken or a piece of salmon or some roast legumes.

Smoked salmon with avocado on buckwheat cakes is one of my favorite breakfasts. The exact form matters less than the consistent principle, so 25 to 30 [00:31:00] grams of protein every morning before anything else. Non-negotiable every morning.

Step two is get outside within 30 minutes of waking. Now, this sounds almost insultingly simple. But the evidence behind it is genuinely compelling, and I have seen it make a measurable difference for women who implement it consistently. Morning light exposure, even five to ten minutes of natural light, ideally without sunglasses, directly stimulates the cortisol awakening response by activating specialized photoreceptors in the retina of your eye that send signals to the suprachiasmatic nucleus.

This is your brain's master clock Think of this as pressing the start button on your circadian rhythm. When that button is pressed in the first thirty minutes of waking when the light hits your eyes, your energy rhythm for the day is set on the right trajectory. It also does something that will pay dividends at the other end of the day.

Morning light exposure triggers a timed [00:32:00] release of melatonin, that's your sleep hormone, approximately fourteen to sixteen hours later. So by getting light onto your eyeballs at 7:00 in the morning, you are setting up your melatonin to rise naturally at 9:00 or 10:00 PM at night, supporting your ability to fall asleep and your sleep quality improves.

So this is not about going for a run, it's not about going for a walk if you don't have time. It's about standing at your front door or sitting by a window, or walking to the letterbox and letting natural light reach your eyes five minutes every morning.

The impact on energy rhythm practiced consistently for two to four weeks is measurable and significant.

Then step three, support your mitochondria through your nutrition. Remember, mitochondria are your cellular energy factories, and they need specific nutrients to function well. The good news is that these nutrients are available through real food and through targeted supplementation when dietary sources [00:33:00] are insufficient.

So there's a couple of key mitochondrial nutrients that I want to go through. First one is magnesium. Magnesium is involved in over three hundred enzyme processes in the body, including energy production. So think of magnesium as the spark plug for your cellular engine. Without adequate magnesium, ATP production, that's the actual energy currency of your cells, that gets impaired.

And magnesium deficiency is extraordinarily common in women because the mineral is depleted by stress, by caffeine, by refined foods, and by poor soil quality. Magnesium is found in dark leafy greens, nuts, seeds, and legumes. And magnesium glycinate as a supplement, three hundred to four hundred milligrams before bed, is one of my most consistent clinical recommendations for women with inflammatory fatigue.

The glycinate form is highly absorbable and particularly supports sleep quality as an additional benefit.

Then B vitamins, particularly B1, B2, [00:34:00] B3, B5, and B12 are all directly involved in the mitochondrial energy production cycle. They're the cofactors, like the helper molecules that allow your cellular energy factories to convert food into energy. Without them, the biochemical machinery of energy production stalls.

Low B vitamins means inefficient energy production regardless of how well you eat.

Now, an activated B complex, meaning one that contains the methylated bioavailable forms of these vitamins, it is the supplemental form that I commonly recommend, particularly for women who carry the MTHFR genetic variant, which affects B vitamin metabolism.

So some people do really well on that version of a B supplement, some people don't. But we will do a dedicated episode on methylation because I think that's a topic that deserves its own episode. So watch this space. We then also have CoQ10, coenzyme Q10.

It is a compound that sits right at the heart of [00:35:00] mitochondrial energy production process. It is essential for the electron transport chain, the process through which your mitochondria produce ATP. Think of CoQ10 as the essential worker inside a power plant.

Without adequate CoQ10, the plant can't run at its full capacity. CoQ10, very sadly, declines with age, which is one of the reasons energy often diminishes in midlife, even in the absence of anything particularly wrong, like any obvious pathology.

And it is also significantly depleted by statin medications which people are often put on for high cholesterol. So if your doctor has put you on a statin, please make sure you also take a CoQ10. It is found in small amounts in organ meats and in oily fish, and it is available as a supplement, ideally in the ubiquinol form, which is the more bioavailable active form and is definitely worth the extra cost.

Next is omega-3 fatty [00:36:00] acids, EPA and DHA. These little fellas support the integrity of mitochondrial membranes. That's like the walls around the energy factories, and they reduce

The inflammatory cytokines that are directly impairing mitochondrial function. Found in oily fish like sardines, salmon, mackerel, anchovies, and in quality fish oil supplements. Aim for a combined EPA and DHA dose of at least two grams per day from supplementation form, especially if oily fish is not a consistent part of your diet.

And I will add one more here that I cannot leave out, which is creatine. Most people associate creatine with athletes and muscle building, and it is exceptional for that. But creatine is also one of the most evidence-based supplements available for energy production, cognitive function, and mitochondrial support, particularly in women over forty.

So creatine, the science behind it, creatine donates a phosphate group to ADP to regenerate ATP. [00:37:00] Now, I know that is a bit sciencey, but it means that it directly refuels the energy currency your cells run on. I take it daily, and I recommend it to many of the women in my clinical practice and in my programs.

I think creatine deserves its own full episode, so I'll definitely do that in the near future.

Then let's go to step number four of what you can actually do about inflammatory fatigue, and that is get your ferritin tested today. If you have not had your ferritin specifically checked, please make this a priority. Ask your GP for a full iron panel, including ferritin, serum iron, transferrin, and transferrin saturation.

Not just a general blood count or a full blood examination known as FBE. The FBE will only flag anemia once it has become severe enough to affect your red blood cell integrity, and that happens long after ferritin has already been depleted. So you can be profoundly iron deficient at the storage level and have a completely normal FBE, which [00:38:00] is exactly why ferritin needs to be requested specifically.

When you get the result, ask for the actual number, not just whether it's in the normal range because as I explained earlier, the conventional normal range for ferritin can be as low as twelve, and a level that low will almost certainly be producing significant fatigue regardless of what the reference range says.

Optimal ferritin, remembering, from a functional medicine perspective, is between seventy and one hundred micrograms per liter. So if yours is below that, and particularly if it's below fifty, iron support is almost certainly gonna make a meaningful difference to your energy levels And if you eat meat, make sure you're having red meat a couple of times a week.

And if supplementation is needed, iron bisglycinate is the most bioavailable And the gentlest form of iron supplement, causing significantly less digestive upset than the ferrous sulfate form that is most commonly prescribed or [00:39:00] purchased at the pharmacy.

Now, always take iron away from calcium, away from coffee and tea, which impair absorption, and always take it with vitamin C, either a vitamin C supplement or eat some orange or drink some lemon in warm water, because vitamin C dramatically increases iron absorption.

And also take iron every second day only, which also helps to increase absorption. Then retest your ferritin after three months of supplementation to track progress, because restoring iron stores takes time, and you wanna know that what you're doing is working.

Then we have step number five, remove the primary dietary inflammatory triggers. Now, fatigue is never always about adding stuff in. It's equally about removing what is getting in the way of your body's natural ability to produce energy.

Refined sugar, industrial seed oils, the sunflower, canola, corn, and soybean oils that are in almost every packaged food. So removing those [00:40:00] ultra-processed foods, removing gluten for people with sensitivities, conventional dairy, and alcohol. All of these are directly impairing your mitochondrial function, driving the insulin resistance that disrupts your energy metabolism and sustaining the inflammatory cytokine production that is suppressing your thyroid and impairing your cellular energy production.

Now, I wanna speak to alcohol specifically here because it is the one that women are most reluctant to address. Alcohol is profoundly disruptive to your sleep quality. Even moderate amounts consumed in the evening measurably reduce deep slow wave sleep and REM sleep.

Alcohol raises cortisol. It depletes your B vitamins and magnesium. It impairs liver detoxification, which affects hormone clearance, and it is directly inflammatory. So if you are experiencing significant fatigue and you are

Drinking regularly, even one or two glasses of wine in the evenings, four to five times a week, [00:41:00] removing alcohol is gonna be one of the most meaningful things that you can do for your energy. And I say this not to judge, but because I see it with ladies I work with every week. Removing these foods and alcohol, even for a defined period of six to twelve weeks, though my wish list for you is to eliminate ultra-processed foods and alcohol forever for long-term best health.

But reducing them or eliminating them for six to twelve weeks gives your mitochondria, your thyroid, your gut, and your immune system the space to begin functioning better. And the energy improvements that result are often striking. My three-week inflammation detox and my twelve week8 nutrition mindset movement programs are both specifically designed to take you through this process in a supported, structured way, and the results the women report in energy alone within the first few weeks are consistently remarkable.

Okay, step six of what you can actually do about inflammatory fatigue is to protect your cortisol awakening response. We talked about morning [00:42:00] light, but there is another critically important piece of cortisol rhythm restoration, and that is what you do not do in the first thirty minutes after waking. Do not check your phone.

Do not open your email. Do not scroll social media. Do not read the news.

I know this is gonna be a hard one for some of you because the habit of reaching for your phone before your feet hit the floor is deeply ingrained for most people. But here is what is actually happening when you do that. The immediate exposure to stimulating, alerting, potentially stressful content like your inbox, your to-do list, your social feed, a news headline, all of that triggers a reactive cortisol spike before the cortisol awakening response has had a chance to unfold naturally.

So instead of cortisol rising cleanly and purposefully over the first hour, which produces a sense of grounded, sustainable energy in the morning, it spikes in reaction to that perceived threat or urgency, and that reactive pattern sets up a [00:43:00] dysregulated cortisol rhythm for the rest of the day.

What I'm asking you to protect is just thirty minutes. Thirty minutes where your brain and your body can wake up without being immediately asked to respond to the demands of the external world. Morning light, a protein-rich breakfast, some gentle movement, even five minutes of stretching, a few slow breaths before you open your eyes.

And then you can address the wider world.

Those 30 minutes are not indulgent. They are the foundation of your energy for the rest of the day. Okay, step seven, address sleep quality, not just sleep quantity. Your hours in bed are not the same as restorative sleep. And for women with inflammatory fatigue, sleep quality is almost always compromised, regardless of how many hours they are technically sleeping.

As I explained in the mechanism section earlier, inflammation directly disrupts [00:44:00] deep sleep quality. So the goal is not just to sleep longer, the goal is to create the conditions in which the sleep you're getting can actually be restorative. I've got five practical steps that make the most difference specifically for sleep quality in inflamed women, so let's go through those.

Number one is a cool, dark bedroom. The body needs to drop its core temperature by approximately one degree to enter and sustain deep sleep. So aim for 16 to 19. Yes, that's right, 16 to 19 degrees. Even a single degree warmer than this measurably reduces time spent in slow-wave sleep.

Then have a protein-containing snack before bed, like a small handful of nuts, a boiled egg, a tablespoon of almond butter, to stabilize your blood sugar overnight and to prevent the cortisol spike that wakes so many women at 1:00, 2:00, or 3:00 in the morning. That middle-of-the-night waking can often be a blood sugar crash, which triggers cortisol, which wakes you [00:45:00] up.

So a small protein and healthy fat snack at 9:00 or 10:00 PM just before you go to sleep prevents it. Now, there's a caveat. There's always a caveat with nutrition, so if you've got some weight loss goals and you're aiming for some time limited fasting, especially if there's any signs of insulin resistance there, that's a good thing for you to be doing.

It does make this tricky. But if you can do everything else that we're talking about here, you will be on track. Then magnesium glycinate before bed, 300 to 400 milligrams, which supports GABA, the brain's primary calming neurotransmitter, and measurably improves both sleep onset and sleep depth.

This is one of the most consistently effective sleep interventions I use in clinical practice. And very important, no screens for at least 30 minutes before bed because blue light exposure suppresses melatonin production. So your phone, your laptop, your television, all of them delay the natural melatonin rise that signals to your brain that it's [00:46:00] time to sleep.

And finally, have a consistent bedtime because your circadian rhythm responds powerfully to regularity. Going to bed and waking up at approximately the same time every day, including weekends, is one of the most powerful things you can do to restore the cortisol and melatonin rhythms that govern your energy.

When sleep quality improves, genuinely improves, not just in hours, but in depth and restoration, energy begins to shift, often more dramatically and more quickly than any other single intervention.

Then step number eight on reducing inflammatory fatigue. Move your body. However, match the intensity to your current capacity. This is one where I want to be very specific because the conventional medic- because the conventional message around exercise and fatigue is frequently counterproductive for inflamed women.

The message many women receive is that if you are tired, exercise more. They're told this because there's a truth in that, [00:47:00] like in the long run. Regular movement improves mitochondrial function, it regulates cortisol, it improves sleep quality, it supports insulin sensitivity, and it reduces systemic inflammation.

Like that is science. I'm not questioning that. But the type and intensity of exercise matters enormously when your body is carrying a significant inflammatory burden. High-intensity exercise, think HIIT classes or long runs or intense cardio or heavy lifting to failure, those themselves are an inflammatory stressor.

And for a body that is already inflamed and already struggling to recover, adding more high-intensity stress on top can actually worsen the fatigue rather than improve it. This is exactly what I was doing in my burnout. I was running at 5:00 a.m. in the morning because I thought I had to push through, but I was adding to the very burden that I was trying to address.

What the research and my clinical experience consistently supports for inflamed women is this. Start with movement that has a net anti-inflammatory and nervous system calming effect. Walking in nature, swimming, [00:48:00] Pilates, yoga, barre, slow strength training with adequate recovery between sessions.

Sunny, stop it. As inflammation reduces and energy returns, intensity can increase. But in the early stages of recovery, move gently, move consistently, and prioritize recovery between sessions as seriously As you prioritize the sessions themselves. And finally, we have step number nine, support your nervous system directly.

The HPA axis dysregulation I described earlier, like the stuck stress response, the tired but wired pattern,

the tired but wired pattern does not resolve through diet alone. The nervous system needs direct support, and this is a piece that is often left out of the fatigue conversation entirely. Chronic inflammation keeps the nervous system in a state...

Chronic inflammation keeps the nervous system... Chronic inflammation keeps the nervous system in a state of low-level sympathetic activation. So your sympathetic nervous system is your fight or flight nervous system, the fight [00:49:00] or flight mode. The body's always scanning for threat. The muscles hold tension.

The breath stays shallow. And then the parasympathetic nervous system, that's your rest, relax, digest, repair, restore nervous system, it can't fully activate. To shift this, we need to deliberately and consistently activate the parasympathetic nervous system. This is not optional self-care.

It is essential self-care. The most evidence-based and practically accessible way to do this is through breathwork, specifically extended exhale breathing, where the exhale is longer than the inhale. So a simple pattern, breathe in for four counts, breathe out for six to eight counts, and do five to ten repetitions.

This directly activates a fabulous little nerve, actually not a little nerve, it's a big nerve, a big long one, in our body called the vagus nerve. It's the main nerve of the parasympathetic system, and it measurably reduces cortisol, lowers heart rate, and shifts [00:50:00] nervous system out of low-grade activation when it's turned on, and shifts the nervous system out of low-grade activation.

This breathwork done for a minimum of ninety seconds, like just ninety seconds before sleep, can have a measurable impact on sleep onset and on sleep quality, and then done during the day as well, particularly in moments of overwhelm or fatigue. It is one of the fastest tools available to shift your physiological state.

Other practices that support vagal tone, which is your vagus nerve working, And parasympathetic activation is humming or singing in the shower, or not in the shower, humming or singing anywhere.

Cold water on the face, gentle movement, time in nature, meaningful social connections. These are not luxuries. They are biological inputs that allow your nervous system to return to a state from which genuine repair is possible. And so that's them. That's my nine steps of what you can actually do about inflammatory fatigue.

So let's summarize them again. Stabilize your blood sugar [00:51:00] from the moment you wake up. Get outside within thirty minutes of waking. Support your mitochondria through nutrition. Get your ferritin tested. Remove the primary dietary inflammatory triggers. Protect your cortisol awakening response.

Address sleep quality, not just sleep quantity. Move your body, and support your nervous system directly. I want to finish today with something I think is profoundly important and often missing from the conversation about fatigue. Recovery from inflammatory fatigue is not linear, and it does not happen in a week.

When I went through my own recovery, it took three months to feel sixty percent better, three years to feel eighty percent better, and ten years to feel one hundred percent well again. Now, that is not a timeline to discourage you. It is a timeline to help you set realistic expectations and practice the self-compassion that sustained healing genuinely requires.

What I want you to understand is that the early [00:52:00] changes, the energy shifts in week two or three when you stabilize your blood sugar, the improvements in sleep by week three or four when you remove alcohol and take magnesium, those early changes are not the end of the journey. They are the evidence that the direction of your journey is right.

I always laugh when I say journey because it sounds so cliché, but it's true. These are the signals that your biology has responded, so keep going. Most women in my clinical programs notice a meaningful improvement in energy within three to six weeks of implementing these changes. Now, it's not perfect, but it's meaningful.

The fatigue is not gone, but it is lighter, and there are moments of genuine energy that had not been there before. Sleep begins to feel more restorative. The afternoon crash becomes less severe. That trajectory sustained over months is where the real transformation happens. Something I encourage every woman I work with to do during this process is to keep a simple energy log.

Not an elaborate journal, just a note at the end of each day. So like a [00:53:00] one to ten for energy on waking, a one to ten for energy at midday, A one to 10 energy for energy at 3:00 PM. Sleep quality out of 10, and perhaps one line about what you ate for breakfast. This takes three minutes, and over four to six weeks, the pattern it reveals are extraordinary.

You will start to see in your own data what exact interventions are moving the needle, and which days correlate with better energy. That feedback is enormously motivating and it is your own biology telling you what it needs. It also gives you something concrete and tangible to bring to a practitioner if you're working with someone.

Instead of just telling them, "I'm tired," you have a trend or a pattern, that beautiful data, the story that's so much easier for them to act on. So do not wait until you feel better to start paying attention to how you feel.

Start now. The data from where you are now is the baseline, and everything you implement from here gets measured against it. Inflammatory fatigue is not inevitable. It is not simply what getting older feels like, and it is most certainly [00:54:00] not something you need to manage indefinitely with caffeine and willpower.

It's a signal, a very clear, specific signal that your body is carrying an inflammatory burden that is impairing its ability to produce energy effectively. And when you understand the drivers, the mitochondrial dysfunction, the cortisol dysregulation, the HPA axis dysregulation, the thyroid suppression, the gut connection, the blood sugar instability, the ferritin picture, the sleep architecture piece, the hormonal changes, and when you can address them systematically with the steps we have covered today, that's when the energy comes back.

Not overnight, but meaningfully, measurably, and sustained over time. So start with step one today, a protein-rich breakfast, 25 to 30 grams, and get outside within 30 minutes of waking. Those two things alone, practiced consistently, will begin to shift your energy rhythm in ways you will notice within days.

Next [00:55:00] episode, we are moving on to sign number two of systemic inflammation, and that is weight that will not shift. We'll talk about why fat loss becomes so physiologically difficult in the context of chronic inflammation and what to do about it.

All of my free resources, my three-week inflammation detox diet, and my 12-week whole health solution can be found at andrearobertson.health. Everything you need is right there waiting for you. If you loved today's episode, please take 30 seconds to leave a review on Apple Podcasts, Spotify, or wherever you listen to your podcasts.

It genuinely helps more women find the show so they can nourish, heal, and rise too.

Until next week, nourish your body, keep healing, and never stop rising.

I'm Dr. Andrea Robertson, and this has been Nourish, Heal, and Rise.

[00:56:00]