If you are always tired — tired in a way that sleep does not fix — and you have been told your bloods are "normal," you are not making it up. Persistent fatigue is one of the most common reasons people feel dismissed by the conventional system, and one of the most treatable once you find what is driving it.
"Tired all the time" is not a diagnosis. It is a symptom with many possible causes — post-viral illness and long COVID, ME/CFS, burnout, nutrient depletion, thyroid and hormonal shifts, blood sugar swings, poor sleep, gut problems, hidden infection. The work is in finding which of these apply to you.
My role is to take your exhaustion seriously, investigate it properly, and rebuild your energy and immune resilience using herbal medicine, nutritional medicine, and FSM — at a pace your body can take.
Why "normal bloods" does not mean nothing is wrong
A standard GP blood panel rules out a handful of serious causes — and that matters. But "normal" often means "nothing flagged in the narrow range we tested," not "optimal." Ferritin can sit at the bottom of the range and still leave you flat; B12, vitamin D, thyroid function, and blood sugar regulation can all be quietly suboptimal while technically "in range."
There is also a crucial distinction I make early. Ordinary tiredness improves with rest. Post-exertional malaise — feeling significantly worse for hours or days after even modest activity — does not. That single feature changes the whole approach, and it is the hallmark of ME/CFS.
Symptoms I see most often
- Exhaustion that sleep and rest do not resolve
- Post-exertional malaise — a delayed crash after physical or mental effort
- Brain fog, poor concentration, word-finding difficulty
- Unrefreshing sleep, or sleep that has become broken or reversed
- Frequent colds, infections that linger, slow healing
- Aching muscles and heaviness in the limbs
- Dizziness or palpitations on standing
- Low mood, anxiety, loss of motivation and drive
- Poor stress tolerance — the "wired but tired" pattern of burnout
- Reduced capacity for work, exercise, and social life
The causes of always feeling tired — what I look for
- Post-viral fatigue and long COVID fatigue — exhaustion that began or worsened after an infection
- ME/CFS — where post-exertional malaise is the defining feature
- Burnout and chronic stress — a dysregulated stress response and depleted reserves
- Low iron and ferritin, low B12 or folate, low vitamin D
- Thyroid imbalance — including sub-clinical patterns missed by TSH alone
- Blood sugar dysregulation — energy that peaks and crashes through the day
- Gut dysbiosis and poor nutrient absorption
- Reactivated viruses such as Epstein-Barr
- Disrupted, unrefreshing, or insufficient sleep
- Mould exposure as an overlooked driver
My approach
There is no single protocol — the plan follows the cause. A typical approach combines:
Finding and treating the driver
The starting point is always investigation. We work out what is actually driving your fatigue, because adaptogens and supplements layered on top of undiagnosed low iron or an unrecognised infection will only ever half-work.
Pacing and energy management
If post-exertional malaise is part of your picture, this comes first. Current NICE guidance no longer recommends graded exercise therapy for ME/CFS; the priority is staying within your energy envelope and pacing carefully.
Herbal medicine
Adaptogenic and restorative herbs — chosen to your picture — to support the stress response, steady energy, and, where relevant, immune and antiviral resilience. Prescriptions are individualised and introduced gently.
Nutritional medicine — rebuilding energy at the cellular level
Correcting the deficiencies that testing reveals, and supporting the mitochondria with targeted nutraceuticals: CoQ10, B vitamins, magnesium, and iron where needed. Practitioner-only, food-state supplements at clinical doses.
FSM — supporting recovery and the nervous system
Frequency Specific Microcurrent protocols for fatigue, the vagus nerve, and a nervous system stuck in "survival mode." Often a helpful piece for people whose energy and stress response have not reset on their own.
Sleep, blood sugar, and the foundations
Restoring genuinely refreshing sleep, steadying blood sugar across the day, and rebuilding gentle, sustainable routine. Unglamorous, and essential — no protocol outperforms broken sleep.
The evidence
- NICE (2021). Guideline NG206 on ME/CFS recognises post-exertional malaise as a core feature and no longer recommends graded exercise therapy — a significant shift towards pacing and energy management.
- Appelman et al. (2024), Nature Communications. In long COVID, skeletal muscle shows measurable abnormalities — including impaired mitochondrial function — that worsen after post-exertional malaise, giving fatigue a demonstrable biological basis.
- Castro-Marrero et al. (2021). A randomised, double-blind, placebo-controlled trial in 207 people with ME/CFS found that coenzyme Q10 plus NADH supplementation reduced perceived fatigue and improved health-related quality of life.
Testing
- Full iron studies including ferritin — not haemoglobin alone
- B12, folate, and vitamin D
- Full thyroid panel — beyond TSH alone
- Blood sugar and metabolic markers
- Comprehensive stool analysis (GI-MAP) — gut function and dysbiosis
- Organic Acids Test (OAT) — mitochondrial, metabolic, and yeast picture
- Viral serology — Epstein-Barr and other reactivated viruses
- Adrenal / stress-hormone (cortisol) assessment where burnout is suspected
What to expect
A first consultation is 60–90 minutes, in person at my Fulham clinic or by online appointment. Timelines vary with the cause. A straightforward nutrient deficiency can turn around within weeks; post-viral fatigue and ME/CFS take longer — meaningful improvement is realistic over 1–3 months, with continued progress beyond. We pace the work to your energy.
FAQ
Is this the same as ME/CFS?
Not necessarily. ME/CFS is one cause of chronic fatigue, defined by post-exertional malaise. Many people are exhausted for other reasons entirely. Part of the first consultation is working out which applies to you.
My GP said my bloods are normal — can you still help?
Yes. "Normal" means nothing serious showed up in a narrow set of tests. It does not mean your iron, B12, thyroid, or blood sugar regulation are optimal, and it does not explain the fatigue. We look more closely.
Do you recommend exercise?
It depends entirely on the cause. For ME/CFS and post-exertional malaise, I follow current NICE guidance — no graded exercise, careful pacing instead. For fatigue from deconditioning or stress, gentle, gradual movement may have a place, introduced cautiously.
Can you help with long COVID fatigue?
Yes. Long COVID fatigue is one of the most common reasons people come to me. The approach combines pacing, mitochondrial and immune support, and FSM, alongside your NHS long COVID care.