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A lot of women are walking around exhausted and treating it as normal. When I asked Dr. Arwa Hussain whether she agreed, she said yes, and she counted herself as one of them.

"I think that a lot of women normalize exhaustion."

Arwa is a clinical pharmacist and Integrative Health Practitioner who helps women understand brain fog, fatigue, and hormone changes. She's also the host of The Energized Summit, a virtual women's health summit happening October 16 to 18, where I'm one of the speakers. When I met her, I knew I wanted to have this conversation on Episode 115 of the Living Inspired podcast.

Here's what we talked about.

Why So Many of Us Push Through

Arwa sees a few reasons women get used to being tired. We carry so many roles at once: mom, full-time job, running a home. If we don't get it all done, we feel less productive. And then there's the guilt, mom guilt or the guilt of simply resting when we feel we should be doing something.

Her own story started in her 20s. She was working with a trainer, exercising, and changing her diet, and her body still wasn't responding the way she expected. Growing up Indian, she'd been exposed to Ayurveda, and that curiosity led her past what she'd learned in pharmacy school into nutrition, hormones, metabolism, gut health, and stress.

Later came pregnancy, single motherhood, and a full-time job. She told me she was going to work on two hours of sleep and living in survival mode for years, until she crashed and couldn't sleep at all. A health coach helped her see something she hadn't considered:

"Your body is under stress internally... your cells are stressed out. They're inflamed."

That was the light bulb moment that started her healing.

I hear versions of this all the time. As women, we keep pushing forward, and many of us don't realize how much stress we're under until we hit a wall. That wall often shows up in midlife, partly because the hormone changes of this season leave us with less resilience than we used to have.

Fatigue Doesn't Have One Cause

"Fatigue is such a common symptom, I would say, but it doesn't have one cause."

When Arwa was healing, she worked on one thing and it helped a little. Then she tried sleep, then nutrition, then her gut. It was only when she was working on all of it that she started feeling progressively better.

So if you've worked on your sleep and you're still exhausted, don't give up. Everything is connected. Spend some time on your gut health. Spend some time on joy. You will find your way.

When Your Labs Come Back Normal

We've talked about this on the podcast before, and it came up again here. You feel exhausted or foggy, you have labs drawn, and you're told everything looks fine. Arwa's take:

"Just because your labs are normal doesn't mean they're optimal for you."

She pointed out that standard lab ranges are very wide, and she likes the saying "treat the patient, not the number." Look at your results, and then look at them alongside what you're feeling. She sees poor nutrition, low protein, chronic stress, and inflammation as common reasons women feel unwell even when their labs look normal. Low-grade inflammation can run in the background for years before it starts to show up somewhere in the body.

Before our conversation, I saw an Instagram post where Arwa named three labs I also think are so important and are rarely run in a regular doctor's office: ferritin, T3, and fasting insulin. Write those down. If you're having labs drawn, it's worth asking whether they're included and what your numbers are.

A Word About Your Thyroid

I didn't plan to ask Arwa about the thyroid, but I'm so glad we went there. When women have symptoms that could be thyroid related, often only TSH is checked. T3 is the thyroid hormone your body can use, so looking at T3 gives you a fuller picture of how your thyroid is working.

Arwa explained that the thyroid affects so much, including blood sugar, insulin, and the brain. When it's struggling, you may feel drained and fatigued, lose hair, or notice brittle nails. Her approach is to ask what the thyroid needs to function, including minerals you can get from food and, when appropriate, supplements.

She was also clear that medication and supportive work can go together:

"You could be on medication and do the supportive work."

In her experience, some people find they need a lower dose over time once the foundations are in place, and that's always something to work out with your healthcare provider. The same goes for any medication you take.

I often tell clients the thyroid is like the innocent bystander. Chronic stress and inflammation take a toll, and the thyroid takes a hit while it works overtime to keep you okay. So right now, put your hand over your neck where your thyroid sits and send it a little love.

How It All Connects

I asked Arwa how hormones, sleep, stress, blood sugar, gut health, and nutrient status all play into low energy. She walked through one example.

If your blood sugar swings through the day, you may notice energy crashes, cravings, irritability, or trouble concentrating. That can affect your sleep. When you don't sleep well, it affects your stress hormones, appetite, and mood. Then there's digestion. You can eat the best food in the world, but if you aren't breaking it down and absorbing it well, you aren't getting the full benefit of those nutrients. The hormone changes of perimenopause add another layer on top of it all.

That's why she looks at everything together instead of treating fatigue, stress, or sleep as separate problems. It's also why it can be so hard to see your own story. You're living in it. I have someone who helps me see my bigger picture, and so did Arwa. When you're wondering whether to start with your gut, your sleep, or your hormones, a guide can help you choose one small, simple first step.

Start by Tracking

My favorite part of our conversation was Arwa's answer to "Where does she start?" Her answer: track what's happening for seven days. What are you eating? When are you sleeping? How is your energy?

She took it further with her own cycle. For four months, she wrote down how she felt on day one, day two, and every day through the end of her cycle. When she looked back, the similarities surprised her. Day 13 in January felt almost exactly like day 13 in March. She learned which days were her high-energy days, when she'd plan a great workout, and which were her low-energy days, when she'd take it slow.

"I'm not gonna feel guilty about it 'cause that's just how my body is."

Other things she suggests noticing:

• Do you feel tired, foggy, or bloated after certain meals?

• Are you waking up in the middle of the night, and can you get back to sleep?

• Are you skipping meals and then having cravings later?

Then pick the top three things that stand out and start there. As Arwa put it, "It doesn't need to be complicated or perfect."

This one hit home for me. I didn't learn how my hormone cycle connects to how I feel until functional nutrition school in my late 30s, after about 20 years of having a cycle. Now I watch my 14-year-old daughter, and she said something recently that stuck with me: "Guys have no idea, because they just wake up and they're the same, but we wake up and we're different every day." She's exactly right.

The women I work with do short, simple kinds of tracking too, and they're always surprised by what they learn. I hear things like, "I had no idea that food would make me feel like this." Paying attention to how you feel, instead of pushing through, is such an act of self-love.

Medication and Lifestyle Can Work Together

There's a lot of conventional medicine versus functional medicine talk right now. Coming from healthcare as a nurse, I see the value of both, and so does Arwa as a pharmacist.

"Medications can be lifesaving and essential in emergency situations, acute situations."

Where she sees a disconnect is with chronic conditions. Being on medication to get stable is completely fine. Lifestyle work, like nutrition, gut health, movement, and stress, takes longer, and that's where she sees a big difference over time. She shared that she's had clients with diabetes who wore a glucose sensor, worked on their diet, and were able to come off high doses of insulin.

"The goal is not to tell everyone to stop taking medication, but to use the appropriate tools while also asking, 'What can I do to support myself and my own health?'"

I think part of what holds people back is not believing lifestyle habits will make a difference. I remember my dad telling me that eating certain foods wasn't going to do anything. We live in a quick-fix culture, and lifestyle habits aren't quick fixes. They are what works, and I've seen it over and over.

If we want quality of life in our 40s, 50s, 60s, 70s, 80s, and 90s, it starts now. It doesn't start when life calms down. And it doesn't start by overhauling everything. It starts with the next simple step.

Join Us at The Energized Summit

Arwa created The Energized Summit to bring together experts who approach women's health from different perspectives, so women can understand the bigger picture behind fatigue, brain fog, sleep problems, and hormone changes without scrolling through one conflicting reel after another. It runs October 16 to 18, from 1:00 to 3:30 PM ET each day, and it's free to attend.

My session is on Sunday, October 18. I'm talking about perimenopause, the hormone changes that come with it, and why so many of us feel more exhausted at this stage of life. I would love to see you there, and please share it with the women in your life.

Save your seat at The Energized Summit

Arwa has also generously offered her Brain Fog Guide as a gift to Living Inspired listeners. It walks through what might be behind your brain fog and simple places to start with food, sleep, stress, and daily habits. Download the Brain Fog Guide

You can find Arwa on Instagram at @drarwahussain, where she's most active. She'd love for you to send her a DM and say hello.

Lots of love,

Rachel

This post is for education only and isn't medical advice. Please talk with your own healthcare provider about what's right for you.

Rachel's Free Resources:

Mood Swings? Get the 5 minute audio to calm them now. https://rachelcartarn.com/sos

Do you want to understand more of what's changing in your body in midlife and get a few simple tools to feel better now? Get the free guide: The Real Reason You Still Feel Off.

Ready to Talk: Book a Clarity & Relief Session here.

More Resources:

Eat Well Made Easy Course