Why am I tired, bloated and foggy? The pattern I missed in my own health
You might recognise this. You wake up feeling reasonably well. By the afternoon your energy has disappeared, your stomach feels uncomfortable and you keep losing your train of thought.
Perhaps you’re blaming the tiredness on poor sleep or those annoying ‘perimenopause hormones’. The bloating has become one of those things you put up with. You reach for something loose, an elasticated waist if possible (leggings are good!). You always know where the nearest bathroom is when you’re out. The rest of the time you just try to get through the day, usually on autopilot.
Then it tips into something a bit harder to ignore. You’re planning your schedule around the possibility of a nap. If you can just fit in 15 minutes before the end of the working day, you’ll be less snappy with the kids tonight and you might not end up ordering a take away. Even then you feel as though you are wading through treacle...
I hear this story a lot and I’ve lived it myself. When tiredness, digestive symptoms and brain fog keep turning up together, I always want to know more, to highlight the pattern.
Why was I still so tired months after giving birth?
After the birth of my second daughter, I couldn't work out why I wanted to nap all the time. I was suddenly reacting to foods I'd eaten for years, and gluten or dairy could send me running to the bathroom.
I thought I was doing all the right things as I had just graduated as a herbalist and spent years working on my health alongside. But her birth had been complicated and I'd needed several rounds of antibiotics. My little one wouldn't sleep in her cot either, so there were plenty of obvious reasons to feel tired. Still, about six months later I remember saying to a doctor, "I'm just not right. I'm so tired and foggy and low."However, my thyroid tests came back within the normal range, so I was reassured that everything looked fine and sent on my way. Except I didn't feel fine.
My gut history went back much further. I'd had IBS and what I now recognise as other gut issues most of my life. As a child I was on antibiotics again and again for repeated ear infections and constant sore throats, those horrible syrupy bottles that seemed to be the prize for visiting the doctor. But those seemed to be the main options available at the time. It was simply what we all did and what we knew.
Later, after I'd been reassured that my initial tests were “normal”, more comprehensive blood testing arranged through a functional medicine practitioner I was working with overseas revealed folate-deficiency anaemia. Suddenly, things started to make much more sense.
The antibiotics — first as a child, then as a teenager and young woman, and again around the births of my children — my gut health, and the way I was absorbing and using nutrients were not necessarily separate issues. They were all pieces of a much bigger picture. It even helped me make sense of periods of low mood I'd experienced over the years, once I began to understand just how closely the gut and brain communicate.
It's one of the reasons I now look so closely at the gut microbiome, even when someone's symptoms don't immediately seem to be coming from their gut. Fatigue, brain fog, low mood, skin problems, hormonal symptoms or nutrient deficiencies might not make you think “gut”, but sometimes that's exactly where I want to look for another piece of the puzzle.
I continued working with nutrition professionals while deepening my own training. I was already a qualified Medical Herbalist, but my search for answers led me to complete a Master’s in Personalised Nutrition and, later, my Functional Medicine certification. Gradually, I began to understand what had been going on in my own body and that of loved ones too. With the right nutritional and herbal support, and a much greater focus on restoring my gut health, those afternoon naps I had relied on for years were no longer necessary. I remember the first day I got through from morning to night full of energy, ticked off my whole to-do list and could hardly believe it.
That experience changed how I listen when a woman tells me she's bloated, exhausted and can't think clearly. I want to know how long it's been happening and what changed around the time it began. I also notice whether the symptoms move together.
Can digestive problems leave you feeling tired and foggy?
They can, and my own folate result is a good example. Your gut is where you break down food and absorb the nutrients your body runs on. If it isn't working as well as it should, it isn’t just low iron levels that can leave you struggling - folate and vitamin B12 can run low too, and depleted levels of those can leave you exhausted and struggling to think clearly.
Genetics might add another layer. MTHFR variants, for example, affect how your body converts folate into its active form, and they're not rare or ‘abnormal’. A large proportion of the population carries one. If your gut function is also compromised, it can be harder for your body to get what it needs to address these variants, which is what happened for me.
Bloating on its own doesn't mean you have a deficiency, though. It can come from constipation, food intolerances, coeliac disease or IBS related gut issues (IBS is an umbrella term for all sorts of things), and tiredness and brain fog have plenty of other causes too. That's why persistent symptoms are always worth getting checked properly.
What I listen for is the rhythm. A woman tells me she wakes up with a fairly flat stomach and looks several months pregnant by lunchtime. Or she feels fine when she gets up and is wiped out after breakfast. Or she notices that on the days her digestion is off, her head is foggier too. Antibiotics, illness and stress can all change the balance of bacteria in your gut, which is why I look at the microbiome as well as the symptoms.
Details like these tell me where to start looking, and that's far more useful than any single symptom on its own.
Why is my tummy so round?
One of my earliest memories is of my very loved and very fashion conscious Nana standing in front of the mirror and moaning about her tummy. She thought it stuck out, and she had to choose her clothes to accommodate it. "Why is my tummy always so round?" she'd say. I didn't think too much of it at the time but did notice she was always on a diet to counteract it (it never did).
It was only after my studies that I looked back and realised she had gut issues, and that she probably had SIBO (small intestinal bacterial overgrowth). Gut problems run through a lot of my family, and I won’t go into her other illnesses here but I suspect the gut affected her health in other ways in the years that followed.
Bloating that shapes what you wear, how you feel in your body and how you feel about yourself is something so many women live with. It certainly was in my family.
Could your bloating, tiredness and brain fog be connected?
Women can put up with digestive symptoms for years. "I've always been a bloated person." "I've always had to know where the nearest bathroom is when I go out to the shops." "Certain foods have never agreed with me." When something has been there long enough, it starts to feel like part of you.
You can get used to a dull feeling of rubbishness too. It might not be a medical term, but it describes the experience rather well. You're functioning, but you can't remember the last time you felt properly well.
So you try something for energy, cut out a food for the bloating and buy something else for concentration. Before long you have a cupboard full of supplements and still don't know what's helping.
That's why I always ask about the timeline. Did things change after a pregnancy, an illness, a stressful patch or a course of antibiotics? Do the symptoms flare together? Do they get worse as the day goes on? For me it was a combination of the above, but I didn't see it until I looked at it as one story rather than three separate problems.
You don't have to work all of that out in your head. A good place to start is much simpler.
How can you start noticing what affects your energy and digestion?
One of the most useful things you can do is also one of the simplest: keep a diary. It gives you your power back. Nutrition is very personal, so there's no generic formula that will work for everyone, and nobody knows how you feel after lunch except you. It also shifts the question from "what's wrong with me?" to "what helps me feel well?"
Before you change your diet again, spend three days noticing what's already happening. Keep it ordinary. Don't suddenly eat perfectly because you're writing it down. You want a snapshot of your real life.
For three days, record:
What you eat and drink, and roughly when.
Any bloating, discomfort or changes in your bowel movements.
Your physical energy at different points in the day, scored out of ten.
How clear or foggy you feel, also out of ten.
Anything else that might have affected the day, like a bad night's sleep, unusual stress or a change in medication or supplements.
When the three days are up, read it through in one sitting. Does your energy dip after certain meals? Does the bloating build as the day goes on? Do the bloating and the brain fog show up at about the same time? You may spot something that's hard to see when you're relying on memory.
A diary won't diagnose a food intolerance or tell you exactly what's going on, but it gives you real information about your own body. If you'd like help making sense of it, that's where I come in as a functional medicine practitioner.
What if you need help making sense of your bloating pattern?
A diary can bring things into view. You might also look at yours and think, "I can see something is going on, but I still can't make sense of it." That's completely normal, and it's where I can help.
In my one-on-one program, Feel Like Yourself Again, we start with your health history and your symptoms, then add a gut microbiome test to see what's happening beneath the surface. I go through all of it with you, so you're not left trying to decode a report on your own. Together we work out what matters most and where it makes sense to begin.
I remember what it was like to be tired, bloated and foggy - and unsure why. It's a very good feeling when the pieces start to fit together. Feel Like Yourself Again
Juliana O'Boyle
IFM-certified functional medicine practitioner, medical herbalist and naturopath
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