The 3 Types of Fatigue in Burnt-Out Parents (And What Your Body Is Actually Trying to Tell You)
- 2 hours ago
- 11 min read
By Dr. Daniel Min, ND | Port Coquitlam
Reading time: 8 minutes
You've had the bloodwork done. Your doctor looked it over, told you everything is normal, and sent you on your way.
But you don't feel normal. You feel exhausted in a way that sleep doesn't fix. You're running on caffeine and willpower, snapping at your kids over small things, collapsing into bed at the end of the day, and somehow still lying awake at 11pm because your brain won't shut off.
You've Googled your symptoms. You've tried the supplements. You've downloaded the sleep app. And still, nothing has meaningfully changed.
Here's what I want you to know: you're not lazy, you're not broken, and it's not just stress. In most cases, there's a specific physiological pattern driving your fatigue, one that standard bloodwork isn't designed to catch.
In my practice, I see three distinct types of burnout-style fatigue in parents and professionals. Each has a different pattern, different root causes, and a different approach to treatment. Understanding which one you're dealing with is the first step toward actually fixing it.
Why "Normal" Labs Miss the Point
Before we get into the three types, it's worth understanding why most people end up in my office after being told they're fine.
Standard bloodwork is designed to screen for disease. The reference ranges, the numbers your doctor compares your results to, are set by looking at a large population and marking the outer 2.5% on either end as "abnormal." If you fall in the middle 95%, you're "normal."
But normal doesn't mean optimal. A ferritin of 18 is normal. A TSH of 3.8 is normal. A fasting glucose of 5.7 is normal. And yet someone with all three of those results can be profoundly exhausted, foggy, and struggling, because those values aren't optimal for thriving. They're just not sick enough to flag.
This is where naturopathic medicine, at its best, fills a gap: not looking for disease, but looking for why you're not functioning well, even when the standard screen says you should be.
With that context, here are the three patterns I see most often.
Type 1: Functional But Flat
What It Feels Like
You're getting through the day. You're showing up to work, taking care of your kids, meeting your commitments. From the outside, you look fine.
But on the inside, everything feels like you're moving through mud. Your motivation is low. Your mood is flat. You used to feel like yourself, engaged, sharp, energetic, and now there's a version of you going through the motions, but the spark is gone.
You're not crashing dramatically. You're just... dim. Functional, but flat.
Common Symptoms Include:
Low but persistent fatigue that doesn't lift even after a good night's sleep
Difficulty concentrating or low mental sharpness
Reduced motivation or sense of enjoyment
Feeling cold more often than you used to
Hair thinning or slower nail growth
Low mood, sometimes dismissed as mild depression
Slower recovery after exercise or illness
Digestive sluggishness
What's Usually Driving It
Functional-but-flat fatigue is most often driven by one or more of the following:
Low iron stores (ferritin):Â Ferritin is your body's iron storage protein, and it's one of the most commonly missed causes of fatigue. Standard bloodwork checks hemoglobin, which tells us if you're anemic. But ferritin can be depleted long before anemia develops, and even mildly low ferritin (under 30-50 ng/mL) is enough to cause significant fatigue, brain fog, and low mood. Many people, especially women who menstruate, walk around with ferritin in the teens or low 20s, told their iron is "fine" because their hemoglobin is normal.
Suboptimal thyroid function:Â The thyroid gland regulates metabolism, temperature, mood, cognition, and energy. Standard thyroid screening checks TSH only, which measures how hard your pituitary is working to stimulate the thyroid. But it doesn't tell you how much active thyroid hormone is actually circulating. Free T3 (the active form) and free T4 can be in the lower end of "normal" while causing significant symptoms. Thyroid antibodies (TPO, anti-Tg) can also be elevated for years, indicating autoimmune thyroid disease, before TSH moves out of range.
Blood sugar dysregulation:Â Persistent low-grade blood sugar swings throughout the day are one of the most underappreciated causes of fatigue. When blood sugar spikes after a carbohydrate-heavy meal and then drops, your energy crashes with it. Over time, this pattern leads to insulin resistance, where your cells become less responsive to insulin's signal, and your body has to work harder to manage glucose. Fasting insulin is rarely checked on standard bloodwork, but it's one of the most useful early indicators of this pattern.
Nutrient depletions:Â B12, vitamin D, and magnesium are the three I check most consistently. B12 deficiency is common in people who eat limited animal products or who have reduced intrinsic factor (a protein needed for B12 absorption). Low vitamin D is almost universal in BC, especially in winter. Magnesium is depleted by chronic stress and is involved in over 300 enzymatic reactions in the body, including those that produce cellular energy (ATP).
What I Look For In Testing
For functional-but-flat fatigue, I run:
Ferritin (not just hemoglobin or serum iron), target range 50-100 ng/mL for optimal energy
Thyroid panel:Â TSH, free T3, free T4, anti-TPO, anti-Tg
Fasting glucose AND fasting insulin (insulin is almost never checked on standard panels)
HbA1c (3-month blood sugar average)
B12, vitamin D (25-OH), RBC magnesium
CBC and iron studies (hemoglobin, hematocrit, MCV, serum ferritin, TIBC)
First Steps That Help
If this pattern fits, the most impactful starting points are usually:
Iron repletion (if ferritin is low):Â Not just "eat more spinach." Therapeutic iron supplementation, the right form, dose, and timing, to bring ferritin into the optimal range. This often takes 3-6 months but the energy improvement is significant and consistent.
Protein-forward breakfast:Â Eating 25-35g of protein within an hour of waking stabilizes blood sugar from the start of the day, prevents the mid-morning crash, and provides amino acids for neurotransmitter production. This single habit has a disproportionate impact on all-day energy.
Thyroid optimization (if indicated): Depending on results, this may involve botanical thyroid support, nutrient co-factors for T4→T3 conversion (selenium, zinc, iodine), or a referral for further workup with your GP or endocrinologist.
Type 2: Tired But Wired
What It Feels Like
This is the pattern I see most often in parents, and the one I know personally, now that I have a one-year-old at home.
You're exhausted all day. You're dragging yourself through meetings and school pickups and dinner and bedtime routines. You're counting down the hours until you can finally rest. And then you get into bed, and your brain turns on. Thoughts racing. Can't wind down. Lying there, tired but completely alert, scrolling your phone because sleep won't come even though you desperately need it.
You finally fall asleep around midnight, wake up feeling like you haven't slept at all, drag yourself through the morning on caffeine, and do the whole thing over again.
Common symptoms include:
Exhausted during the day, alert or anxious at night
Difficulty falling asleep despite feeling tired
Racing thoughts at bedtime
Waking between 2-4am and struggling to fall back asleep
Short fuse, low frustration tolerance, snapping at people you love
Feeling "on" all the time, unable to fully relax
Reliance on caffeine to get started, wine or alcohol to wind down
Jaw clenching, tension headaches, tight shoulders
What's Usually Driving It
Tired-but-wired fatigue is primarily a nervous system and cortisol rhythm problem.
Cortisol rhythm disruption:Â Cortisol is your primary stress hormone, but it's also your primary wake/alertness signal. In a healthy pattern, cortisol peaks sharply in the 30-45 minutes after waking (called the Cortisol Awakening Response, or CAR) and gradually declines through the day, reaching its lowest point around midnight. This curve is what makes you feel alert in the morning and sleepy at night.
In tired-but-wired individuals, this curve is often inverted or flattened: cortisol is low in the morning (explaining that groggy, can't-get-started feeling), flat through the day, and then elevated in the evening when it should be dropping. This is why the brain turns on at exactly the wrong time, cortisol is spiking when it should be declining.
HPA axis dysregulation:Â The hypothalamic-pituitary-adrenal (HPA) axis is the body's central stress response system. Chronic stress, irregular schedules, poor sleep, and blood sugar swings all dysregulate this axis over time. The result is a nervous system that can't effectively shift between "sympathetic" (go-go-go) and "parasympathetic" (rest-and-digest) modes. It gets stuck on ON.
Blood sugar and sleep disruption:Â Blood sugar drops in the middle of the night, which can happen when dinner was carbohydrate-heavy or when the last meal was too early, trigger a cortisol response as the body compensates. This is a common cause of 2-4am waking. Stabilizing blood sugar before bed (a small protein-fat snack if needed) can significantly improve sleep continuity.
Caffeine timing:Â Caffeine blocks adenosine receptors, adenosine is the chemical that builds up through the day and creates sleep pressure. Caffeine consumed after noon has a half-life of 5-6 hours, meaning half of a 2pm coffee is still active at 8pm. In people who are already cortisol-dysregulated, late caffeine significantly worsens nighttime alertness.
What I Look For in Testing
For tired-but-wired fatigue, the most important test is a 4-point salivary cortisol panel with CAR, this is the EndoInsight PLUS panel I use through USBioTek.
Standard blood cortisol (done in the morning) only gives a single snapshot and is not adequate to assess cortisol rhythm. We need multiple points throughout the day, morning, noon, evening, and bedtime, to map the actual curve.
I also look at:
DHEA-SÂ (the "anti-stress" adrenal hormone, often depleted in chronic HPA dysregulation)
Free and total cortisol at 4 time points
Cortisol Awakening Response (CAR), the early morning spike pattern
Sex hormone metabolites (estrogen, progesterone, testosterone via urine), hormonal shifts significantly affect sleep architecture and stress resilience
Fasting glucose and insulin, to assess blood sugar stability
First Steps That Help
Nervous system downshift routine:Â The most impactful intervention for tired-but-wired fatigue is building a consistent transition between "on" and "rest" in the 30-60 minutes before bed. This means dim lights (bright light suppresses melatonin), no screens, and something that activates the parasympathetic nervous system, slow breathing, gentle stretching, reading, or a short walk outside. It sounds almost too simple, but the consistency of this routine is what trains the nervous system to expect sleep.
Caffeine cutoff:Â Move your last caffeine to before noon if possible, or no later than 1pm. This is one of the most reliably impactful changes for improving sleep onset and quality.
Magnesium glycinate before bed:Â Magnesium has a well-documented calming effect on the nervous system via GABA receptor modulation. The glycinate form is the best tolerated and most bioavailable. 200-400mg before bed.
Blood sugar stabilization:Â Protein-forward meals, avoiding large carbohydrate loads in the evening, and if needed a small protein-fat snack before bed (almond butter on a rice cake, for example) to prevent the overnight glucose dip that triggers 2-4am waking.
Type 3: Crash and Burn
What It Feels Like
You operate in cycles. You push hard, sometimes for days, sometimes for weeks, running on adrenaline, getting things done, feeling almost superhuman in your productivity. And then you crash. Hard. You get sick. You sleep 10 hours and wake up exhausted. You can't function for days. Then you recover just enough to start the cycle over again.
Or maybe the crash is cumulative, not dramatic, but a slow erosion. You used to be able to bounce back. Now you don't bounce back at all. Every illness takes longer to recover from. Every stressful period leaves a deeper deficit. The resilience you used to have just isn't there anymore.
Common symptoms include:
Cycling between high-output periods and crashes
Getting sick frequently (every 4-6 weeks)
Extended recovery time after illness, exercise, or stressful periods
Feeling like you're running on borrowed energy
Complete exhaustion after relatively minor exertion
A sense that your "reserve" is gone, nothing left in the tank
Feeling worse after trying to exercise (post-exertional malaise)
Brain fog that doesn't lift, even after rest
What's Usually Driving It
Crash-and-burn fatigue typically represents a more advanced stage of dysregulation, often what happens when tired-but-wired goes unaddressed for long enough, or when the body has been under sustained high demand without adequate recovery.
Depleted iron and nutrient reserves:Â Extended periods of high output, poor nutrition, or heavy menstrual losses deplete the reserves that energy production depends on. Unlike functional-but-flat fatigue where ferritin is mildly low, crash-and-burn individuals often have multiple depletions simultaneously, iron, B12, vitamin D, magnesium, and zinc.
Adrenal exhaustion pattern:Â After prolonged HPA axis dysregulation, cortisol output can become globally low, not just at night, but throughout the day. This is the "flattened curve" pattern: no morning peak, no midday support, no evening spike. Just a consistently flat, low cortisol output that can't respond adequately to demand. This is what creates the characteristic "borrowed energy" feeling, the body is borrowing from reserves it doesn't have.
Immune dysregulation:Â Chronic stress and cortisol disruption significantly impair immune function. The frequent illnesses, the extended recovery times, the sense that your immune system just isn't working properly, these are consistent findings in people with long-standing HPA dysregulation.
Mitochondrial insufficiency:Â At the cellular level, chronic oxidative stress and nutrient depletion impair mitochondrial function, the organelles responsible for producing ATP, the body's primary energy currency. This is part of why crash-and-burn fatigue feels different from ordinary tiredness: it's not just that you need more sleep, it's that the cells themselves aren't producing energy efficiently.
What I Look For in Testing
For crash-and-burn fatigue, I want everything from Types 1 and 2, plus:
Full 4-point cortisol + CAR, looking for the flat/depleted pattern
DHEA-S, often very low, reflecting adrenal depletion
Full CBC with differential, looking at immune cell distribution, red cell morphology
Comprehensive metabolic panel, liver, kidney, electrolytes
Full iron studies, ferritin, serum iron, TIBC, transferrin saturation
Thyroid full panel, particularly free T3, which drops significantly in depleted states
hs-CRP and homocysteine, markers of chronic inflammation and oxidative stress
Fasting insulin and HbA1c, blood sugar is often dysregulated in this pattern
First Steps That Help
Crash-and-burn fatigue requires the most careful, staged approach, because doing too much too fast can actually worsen the pattern. The priority is stabilization before optimization.
Reduce the output before trying to increase the input:Â This is counterintuitive for high-achieving parents, but attempting to push harder while depleted accelerates the depletion. The first step is identifying and reducing non-essential stressors, not adding more supplements or protocols.
Targeted nutrient repletion:Â Based on lab findings, systematically address the most critical depletions. This is not a 30-supplement protocol, it's typically 3-5 targeted interventions, in the right order, with the right forms and doses.
Sleep architecture as medicine:Â In crash-and-burn fatigue, sleep is genuinely therapeutic, not just restorative. Prioritizing sleep quantity (8-9 hours) and quality (dark, cool, consistent timing) is a primary treatment, not an afterthought.
Nervous system protection:Â Identifying and maintaining hard limits around demand, work hours, social commitments, exercise intensity, to protect the small amount of reserve that remains while the body rebuilds.
Which Type Are You?
Most people reading this will recognize themselves in one of these patterns, though some will see overlap, which is common. Tired-but-wired and functional-but-flat often coexist. Crash-and-burn almost always has elements of both.
The reason I find it useful to think in these categories isn't to put people in boxes, it's because each pattern points toward different root causes, and different root causes require different interventions. Treating a tired-but-wired pattern the same way as a functional-but-flat pattern will get poor results. The testing, the supplement protocol, the lifestyle foundations, and the sequencing all differ.
This is also why "I've already done bloodwork" doesn't always mean we have the information we need. Standard bloodwork answers some questions, but it rarely includes the fasting insulin, the full thyroid panel, the ferritin, or the cortisol rhythm data that are most relevant to burnout-style fatigue.
What Working Together Looks Like
If you're in the Vancouver/Tri-Cities area and you recognize yourself in any of these patterns, the best starting point is a free Health Strategy Session, a 15-minute call where we talk through what's been going on for you and figure out whether a more comprehensive workup makes sense.
From there, my approach involves targeted lab testing (bloodwork, thyroid, and a comprehensive hormone and stress profile), a thorough review of your history, and a clear written plan, not a 30-item supplement list, but a prioritized set of foundations designed to work even on your worst weeks.
The goal isn't perfection. It's a plan that actually fits your real life, addresses what's actually driving your fatigue, and gives you steady, calm energy back, not a short-term boost that requires everything to go right.
Book a free Health Strategy Session: https://evokemedicine.janeapp.com/locations/port-coquitlam/book#/staff_member/51/treatment/837
I work with burnt-out parents and professionals in Port Coquitlam and the Tri-Cities area. Let's figure out what's actually driving your fatigue and build you a clear, realistic plan.
Dr. Daniel Min is a naturopathic doctor at Evoke Medicine in Port Coquitlam, BC. He works with burnt-out parents and professionals in the Tri-Cities and Greater Vancouver area. His practice focuses on root-cause assessment of fatigue, hormonal health, and nervous system regulation.