3 Causes of Fatigue We Rarely Talk About + How to Get More Energy | Dr. Jolene Brighten

0:00This episode is brought to you by PayPal. You know how a mom's bag has everything? Sunscreen? Snacks? A stapler? The new PayPal app is like that, but for your money. Shop, pay, manage your account, and earn rewards all in one place. And with purchase protection on eligible items, biometric security, and pass keys, you're protected at every step. Download the new PayPal app to get started. See paypal.com slash protection terms. Low energy, unfocused, foggy, you might be dehydrated. Whether it's hot yoga, over 100 degree weather, or too much sun. Gatorlite, with a specialized blend of five electrolytes, was scientifically designed to help move fluids into the body faster for rapid rehydration.

0:47Shop now at retailers nationwide. Gatorlite hydrates faster than water. Is it in you? Symptoms noted are signs of mild to moderate dehydration. Consult a healthcare professional if symptoms persist. In some surveys, up to 90 % of women say they feel exhausted most days of the week. And yet only a tiny fraction ever get real answers as to why and what's going on. And worse, they're often told it's just aging. I always love that one. Oh, you're 30. You must be old. Or it's stress, right? Because women, our biggest problem is we just don't handle our stress. Like, again, it's all on you. Or that you just need to get more sleep.

1:28And I just want to say, like, as a new mom, like, yeah, we need to get more sleep. Or if you're in perimenopause, sure. But what if it's not just sleep? What if it's not just stress? What if it's not just part of aging? So what if I told you that your exhaustion, like feeling flatline fatigue, isn't normal? It's just common. And in today's episode, we are uncovering three hidden types of fatigue that you may have been living with and calling normal and that your doctor more than likely has missed. We're going outside of the anemia talk or hypothyroidism, for which I have episodes on, and I want to talk today instead of these three major areas that are impacting women's lives and are being completely glazed over, not even talked about, when it comes to feeling bone tired.

2:20And in this episode, you're going to walk away with real strategies to get your hormones and your energy back on track, whether you're dealing with hormonal crashes, neurodivergence burnout, or the wired yet tired cortisol spiral. And listen, if you are a subscriber, thank you so much. And if you're not yet, let's hit that subscribe button and hang out together more. And right now, as you're listening to this, wherever you're listening to this podcast, please leave a review, leave a comment. It helps us so much. Well, it's a small step for you. Us at the Dr. Brighton Show, it's a really big deal.

2:54We celebrate it. We appreciate it. And it helps signal to all the powers that be that this is the kind of information that they should be putting in front of women so that women can heal their bodies and understand them much better. Okay, so with that said, let's get into it. We're going to start by talking about PCOS fatigue, polycystic ovarian syndrome. So we're going to kick this off with a type of fatigue that is wildly underdiagnosed and often completely misunderstood. That is PCOS fatigue. Now, PCOS or polycystic ovarian syndrome is the most common hormone disorder in reproductive age women.

3:34And yet, we still largely ignore one of its most debilitating symptoms, which is crippling daily exhaustion. We're not talking about, I stayed up too late tired. We're talking about, I can't get out of bed tired. Caffeine does nothing. Tired. If you have PCOS and you're familiar with this, you're probably nodding your head right now. And with PCOS fatigue, this can sometimes feel like, you know, what I had one patient say to me is, I feel like I'm walking through mud all day, kind of tired. Like, you know, when your feet sink into the mud and you can barely move forward. it's that kind of fatigue where it's not just like, I yawn, I feel tired sitting at my desk.

4:23It's that I'm physically tired. I feel unable to move right now. My limbs are struggling. And here's the kicker. Most women are never told that PCOS can even cause fatigue. And if you're not familiar with what PCOS is, PCOS, it has three hallmark signs that we look for that are the Rotterdam criteria, which is anovulatory or irregular ovulation. So no ovulation, irregular ovulation happening. So that looks like irregular periods. Hair growth where you don't want it. Chin, chest, abdomen, hair loss on the head. This is hyperandrogenism. You could have acne, oily skin, and you might have polycystic ovaries, but odds are you probably won't because we only really see that in younger people and it is not one of the most important symptoms to look for.

5:16But I want to break down why does PCOS fatigue happen? Because it's not just about estrogen, progesterone, testosterone, which is a lot of what PCOS gets reduced to. It gets reduced to being a reproductive issue when it's really a system-wide endocrine metabolic issue. So up to 70 % of women with PCOS have some degree of insulin resistance, even when they're not overweight. And I did a whole episode on insulin resistance. I definitely am going to link to that because it's really important that you get the right lab work done. And I go through that in detail along with what you should be looking for in terms of lab results.

5:55Now, this insulin resistance makes your cells bad at bringing glucose in and generating energy. And so the result is blood sugar swings, energy crashes, brain fog all day. It's not a good way to go through life. So that's the first part of PCOS. We have the insulin resistance, the insulin dysregulation taking place. Now, number two is inflammation. PCOS is associated with low-grade chronic inflammation that keeps your immune system basically turned on all the time. And guess what? That burns through your energy reserves. It stresses your mitochondria, which are like the little cellular energy factories, little power plants of your cells.

6:40And it demands a response from cortisol because cortisol helps dampen inflammation. And that's the third part of what's going on with PCOS. We can see cortisol dysregulation. Because PCOS creates an internal stress response to your HPA access that I've talked about in other episodes. Again, I'll put it in the show notes if you want a deeper dive on that. This is basically the system that controls cortisol. It can become dysregulated. Even more so, there can be a form of PCOS where you're actually getting androgen production happening from the adrenal glands by way of DHEA. So with PCOS and this cortisol picture, you might feel wired but tired, struggle to fall asleep or wake up feeling unrefreshed.

7:28And those are all classic signs of stress adaptation fatigue that's being layered on top of PCOS. Now, the fourth thing is androgen excess. So I told you androgen excess is one of those hallmark signs of PCOS. So that's high testosterone, but it also can be high DHEA and that can disrupt sleep quality and it makes it harder to get into restorative deep sleep. So you might even be like, you're like, I'm logging eight hours. I get into bed. I go to bed. I wake up, but like, I don't, I don't feel refreshed. You may not be getting that deep sleep. Now, why is this PCOS fatigue so often missed? Here's the frustrating part.

8:12Most doctors are focused on bikini medicine. That is, wherever a bikini would fall on your body, that's all they see because you were born with ovaries. Most doctors, if you actually get the diagnosis of PCOS, when you do get the diagnosis, they're just focused on your period and usually just your period. So they're like, let's just give you the pill and let's worry about fertility in the future if you ever decide that you want to have a baby. They're not talking to you about inflammation or insulin resistance or the fact that you're at higher risk for type 2 diabetes and cardiometabolic disease in your future.

8:47It's a very punt the ball of like, let's just get your withdrawal bleed with the pill and we'll call it we've fixed your hormones. And that's all, it's all dishonest. And women deserve a lot better. And PCOS women, like the real talk is, if you're not actively trying to conceive, you usually just get brushed off. There's like this algorithm where doctors are like, do you want a baby? No, just take the pill. See you later. We'll see you when we see you. You do want a baby? Oh, stop everything. We have to help her get pregnant. And really, whether or not you want to have a baby shouldn't dictate the quality of care you're getting.

9:25And when it comes to PCOS, when it is actually diagnosed, fatigue is rarely treated as a core issue because so few practitioners are trained to connect the metabolic inflammatory adrenal pattern that drives all of this. And not to mention, it can take two to three practitioners, sometimes even more just to get the diagnosis. So PCOS is just, it's a really frustrating thing that here we are in 2025 and this stuff is still playing out in women's medicine. So let me say this very clearly. If you have PCOS and you are tired all the time, it's not in your head. It's in your biochemistry. industry. So I want to talk to you about what you can do to restore your energy now.

10:13We're going to talk solutions, and this is where you start to take your power back. Because the thing about PCOS, and I love these new guidelines that came out, and they were like, lifestyle and nutrition should be first intervention for every woman because it's so effective with managing PCOS. Now, one of the number one things that we do, and this is going to help your energy, is we stabilize blood sugar, and it's literally like it's your full-time job and it's super lame because you get so little wiggle room. As somebody who has multiple autoimmune diseases, I feel this. I'm like, why can't I just be the person who eats in and out and be fine?

10:51That's not in the cards for me. And you know what? Honestly, there's way better food. There's way better food out there. Anyhow, so what we need to be doing is eating 20 to 30 grams of protein at every meal. We want to include healthy fats and fiber, getting fiber for a total of 25 to 35 grams daily. And if you go to drbrighton.com slash plan, I actually have an anti-inflammatory recipe plan that it's a meal plan with 21 recipes that'll show you how to start integrating these, the higher protein meals and getting more fiber. I do want to say about fiber. If you haven't been eating a lot of fiber, We don't hit 25 grams all at once.

11:38We really want to go to like bowel tolerance. So what I often do with patients is I add five grams a day for a week and then we go to five grams more the next week and we work our way up to that. The other thing we want to do is that we want to be eating, if you eat grains, we want to eat whole grains. If you eat carbs, we want to partner those carbs with protein, fat, and make sure that we're having fiber come in. Why? That will help you blunt the glucose spike so that you're not spiking glucose all at once and it will help you feel full longer. Now, I know a lot of people talk about how PCOS, you should just go no carb, low carb.

12:22The thing is, is you've got to be bringing fiber in. You cannot refute the research that shows less visceral adiposity for what you are at risk for and will make you more exhausted. Less visceral adiposity, the more our fiber intake is around that 25 grams plus. You also need to avoid skipping breakfast and you actually want to front load your calories earlier in the day to support the circadian insulin sensitivity, but also starting the day with more protein. Most people are going to do better with their carb loading happening earlier in the day than at night, that's definitely individualized.

13:00If you're like, no, actually I'm totally fine. If you're someone who wears a continuous glucose monitor, I know this is like so controversial. Let me just like take a minute here. Because I don't know why continuous glucose monitors became so controversial, but I've used them in my patients with PCOS. And people are like, how dare you use a continuous glucose monitor if you don't have diabetes or you haven't been diagnosed with diabetes? It's like, okay, hold up. Slow your roll. Why the hell are we waiting until you have a diagnosable condition and your eyes are already being damaged and your kidneys are already being damaged?

13:36Your heart is being damaged. Like, damage is done, okay? It has happened when you get that diagnosis of diabetes. Now, I will refer you to the episode that I did all about insulin resistance, what to be testing for, how to catch things sooner. But here's the thing. 70 % of women with PCOS have insulin sensitivity issues or insulin resistance. That stimulates the ovaries to produce androgens. This is one of the mechanisms that leads to an ovulatory cycle. So not ovulating, irregular ovulation, poor egg quality, lots of androgen production, not having periods. So you get endometrial hyperplasia, big buildup of endometrium.

14:18Then we end up with the risk of endometrial cancer in the future. Like, do you see where this is going? So if I could put a continuous glucose monitor on you and listen, like sometimes we're successful in getting insurance to cover it. Love that. But sometimes it is a barrier. It's hard to get access to that. If I can put a continuous glucose monitor on you and you can have real-time data of exactly how your system is responding to your food and you can start to optimize your insulin sooner and you never get that diagnosis of diabetes, which you are absolutely staring down with PCOS, like why wouldn't we do that?

14:52It is so short-sighted, but also like, I just don't get this like hating on people wanting to be as proactive as possible. This mindset in the United States where it's like, just wait until you have diabetes, then you can do something about it. Like that's, no, that's not for me. I bet it's not for you either. And that's why you're here because you're like, no, I would like to live optimal health, not just like finding disease and then move it, trying to reverse it. Anyhow, so I do want to talk about the anti-inflammatory aspect though, because it is important with PCOS that you are increasing your omega-3 fatty acids, like getting cold water fish, salmon, mackerel, sardines, bringing in herbs like turmeric, ginger, making sure that you're eating magnesium rich foods.

15:39if you know you have PCOS considering something like myo-inositol that has been shown in multiple research studies to not only help with insulin sensitivity but it supports regular ovulation energy production egg quality and it is best when you are pairing myo-inositol with d-chironositol I even like to bring in extra support like chromium and having nutrients that are shown to support blood sugar and androgens, that you'll find that in our myo-inositol plus formula. I'll go ahead and link to that. So if you want to see an example, you can buy my supplement, you can not buy my supplement, and just use it as an example of a guideline of what to look for in a supplement.

16:19But I formulated it based on what the research has told us is most helpful for PCOS. But I want to reiterate that we are starting with diet and lifestyle first. So it's not like you can just take myo-inositol, skip your omega-3 fatty acids, eat whatever you want, and everything will be fine. I wish it was that way. If your ADHD feels different across your cycle, postpartum, or in perimenopause, ADHD in Women explains why hormones can change your brain and what you can do about it. Pre-order now and for a limited time, get the first chapter audio read by me, Dr. Jolene Brighton, for free. Plus a bunch of other bonuses like a free recipe guide and a PMDD workshop.

17:03Claim your bonuses at drbrighton.com slash ADHD and women. That's D-R-B-R-I-G-H-T-E-N.com slash ADHD and women. Sometimes because that would be like really easy answer. It's just not that way. That's the reality. Now, the other thing we want to look at, and this is true for like literally any human on the planet, but definitely those with PCOS, is we want to limit our sugar intake by way of added sugar. People freak out about fruit and PCOS. I'm not as concerned about that. Like, look, if you're going to sit down and you're going to eat an entire bowl of fruit and that's your meal, we might have problems.

17:47This is honestly where like continuous glucose monitor shows us that we have problems. Like, you know, beans, for example, those act a lot like a carbohydrate. However, I've had patients with a continuous glucose monitor and they're like, I'm fine when I eat beans. I have no spice. I have other patients who are like, oh my God, beans are like the worst thing for my system. Anyhow, I just want to remind you that fruit is not the devil. It's not your enemy. Fruit is full of antioxidants. They are so good for your brain health, ovarian health. When you've got an inflammatory condition like PCOS, you've got free radicals happening.

18:27This fruit is full of antioxidants to help with that. What we're more looking at is how many other sources of added sugar are we bringing in? So are you drinking soda or pop? Are you eating like a cookie with lunch and dinner? Are you eating ice cream every single night? You know, are you eating yogurt that has added sugar in it? Are you eating something that you were like, I thought this was a health food. I thought this was a good protein bar that has added sugar in it. Now that's not to say don't ever eat a cookie. Like I'm gonna eat some ice cream. I'll tell you that. Uh, it's to say we want to, we want to limit to 25 grams or less in a day.

19:09And we want to be mindful that that's not our meal. Donut is not breakfast. Um, it's gotta be like a hearty breakfast, right? I'm not saying you can never have a donut. I'm just saying that like, we have to think about protein, fiber, fat first? And then do we have the other fun foods later, right? There are fun foods. They're not going to be nutrient dense, but they're going to be like soul reviving dense in some ways, right? And sometimes these are about situations where we are with friends and family. So I don't ever want anyone to feel like they're being deprived, but I want you to start to build mindfulness around what does your sugar intake look at?

19:50And one of the sneaky places these days where sugar intake is just off the chains is electrolyte beverages. And I had patients who are like, I think I'm doing everything right. And we like start talking through stuff because they're like, I'm still struggling. And, you know, with belly fat is usually the thing that comes up with my patients, but they're still struggling. And we go through them when the electrolyte comes up and it's like some electrolyte beverages have 25 grams of sugar. I'm like, oh okay so when you thought you were doing 25 grams and then you were drinking this thing and you missed it like we're doing 50 grams in a day and we know that is associated with more visceral adiposity so the fat that packs around your organs that is going to increase inflammation anymore ever even more and the propensity towards insulin resistance and the nutrient dense foods to have things in it like magnesium chromium i talked about that in the insulin episode how good chromium is for blood sugar management and omega-3 fatty acids, like those foods that are going to help with your blood sugar, help with inflammation, those are going to be nutrient-dense foods.

20:56So again, focusing on how much nutrient density can we bring in, how can we optimize our blood sugar with diet, and still enjoy those other foods but not taking them to excess that starts to cause metabolic damage. I actually, if you read Beyond the Pill, you know I refer to this as metabolic obscenities where you're literally cussing at your body because you're like, I'm just going to eat a donut for breakfast or I'm just going to drink black coffee for breakfast. And the body's like, I don't like this. No, thank you. Now, the third thing we want to be doing with PCOS is get moving, but gently.

21:32Okay. So forget the HIIT bootcamp extreme kind of burnout if you are so fatigued. Okay. So for PCOS fatigue, we're looking at walking, long walks, getting your heart rate up to a fat burning zone with that strength training. Yes. And gentle movements. These are all your sweet spots. If you are pushing it, over grinding it, and you're already tired, you're going to feel more tired. You're going to feel less motivated for the next time. And these gentle movements, they can improve insulin sensitivity without spiking your cortisol. So we love that. And you're still doing intense workouts. You're just not pushing yourself to such an extreme where you just feel wiped out and fatigued.

22:12Other thing we got to look at is fixing your circadian rhythm. So getting sunlight 30 minutes within waking, no screens one hour before bed, or at least 30 minutes before bed. Think about magnesium glycinate, like 150, 300 milligrams before bed, lavender spray on your pillow, nice warm shower in a cold bedroom, and a consistent bedtime routine, even on weekends that has you sleeping in a completely dark room. Skipping sleep, getting poor sleep one night is trouble for your insulin, your blood sugar. The next day, that is going to impact your energy. Insulin and glucose get off, your brain energy production gets off.

22:56Now, we're not just tired physically, but our brain, we like do a task and we're like, why am I so tired? Energy production. What are the mitochondria doing? Now, the fifth thing I would say is to ask your provider to test the full picture. You want to look beyond just testosterone. And in fact, for women with PCOS, we want to look at free testosterone and sex hormone binding globulin as well. Other things you should ask for that I covered in the insulin episode is fasting insulin, hemoglobin A1C, CRP, C-reactive protein, which is a marker of inflammation. We also want to look at ferritin because this could be related to a low iron issue.

23:39Getting a CBC, a complete blood count will tell us about are you iron deficient. And your provider might want to do an ACTH and an 8am cortisol, or you might have a functional medicine or naturopathic physician who wants to do a four-point salivary cortisol or maybe like a Dutch test to look at your cortisol, cortisone ratio, DHEA, what is happening throughout the day. Lab testing can be helpful to understand what else is going on and how extreme has the body already taken things before we've caught it. So I hope that helps with PCOS. I want to now talk about our second type of fatigue, which is neuro fatigue.

24:22That's what we're going to call it. Okay, so this is a kind of fatigue that doesn't come from your body. It comes from your brain. And so if you are somebody who has been diagnosed with ADHD, autism, pathological demand avoidance, rejection sensitivity, dysphoria, high functioning anxiety, or you're somewhere else in the neurodivergent bucket, it's incredibly common to experience this fatigue, especially in women, because we are expected to be able to multitask. Many of us are mothers or caretakers of another kind. Like we've got societal expectations to do more. However, on top of being expected to do more, we're expected to mask more.

25:13So we're constantly adapting. You're managing like 50 open tabs in your brain all at once and you're doing it while trying to act like everything is totally fine. So masking is a state of trying to seem neurotypical when you're not in a neurotypical world so that you fit in and you have friends. It's a normal thing for you to want to do. But here is what happens. Dopamine can crash, leaving you feeling unmotivated, foggy, emotionally flat. Sensory overload leaves you feeling fried after just a trip to the grocery store. Oh my god. me in Costco with like amber glasses, noise canceling headphones.

25:57And still sometimes I'm like, forget this cart. I got to go. There's too many people. I'm getting touch. The music, people are offering me freaking like samples left and right. Some people love that. I am not one of those people. And, you know, with all of that, you know, there's the added layer of things like rejection, sensitivity, dysphoria, RSD, that makes even like small perceived criticism or just feedback feel devastating, like physically devastating, and then that takes more energy from you. If you have anxiety and depression, they're often co-occurring, just so you know. They're not a character flaw, and we know that fatigue are symptoms of that.

26:37If you are neurodivergent, there is evidence that your brain already struggles in energy generation, that your mitochondria are not as effective and efficient at producing energy, that you've got inflammation sometimes. That's impacting energy production. So this all isn't just a mental thing. It's a real biological fatigue from running your nervous system in overdrive all day. And I also want to say like if you have anxiety and depression, that can also be rooted in inflammation, and mitochondrial dysfunction in your brain. And so all of these things can leave you fatigued. And we don't talk about this.

27:20Doctors don't talk about this. And yet we have to recognize it. And if you recognize yourself in any of this, here's what you can do. So number one thing, create energy boundaries. This is a practice, okay? And you're never going to be perfect at it. I certainly am not. But you don't have to say yes to everything, okay? Start by asking, does this cost or give me energy? Literally, I will do this practice. Sometimes I'll just say, like, is this an infinity with me? Like, okay, so is it something that's actually like vibing with me? And then I'll be like, how much is it going to cost me versus going to give me?

27:55It's a no if it's going to be too much of a cost. My kids deserve a mom fully functioning, okay? We also need to fuel our brain first thing in the morning. Protein, healthy fat, that's dopamine support. Think things like eggs, avocado, Greek yogurt, chia seeds, even a high-protein smoothie. If you're on my newsletter when the burnout episode came out, and I'll link to that, you'll know that I put in like the burnout breakfast, which is like the laziest breakfast that you could possibly make that's still nutrient-dense. And I literally was like, this is just you're grabbing stuff from your fridge and putting it on your plate.