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Fatigue & long covid

Exhausted all the time? Let's find out why

Persistent fatigue is one of the most common reasons people come to see me, and one of the most frustrating to live with. It rarely has a single cause. Careful testing usually shows several contributing factors that can be worked on.

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Free, no obligation. First consultation £354, including a health coaching session. See fees

20+ years in clinical practiceIFM Certified PractitionerBritish Acupuncture Council member

Tired woman resting her head in her hand with her eyes closed

The short answer

What causes chronic fatigue when blood tests come back normal?

Fatigue rarely has a single cause. Common contributors include nutrient deficiencies, thyroid and adrenal imbalance, lingering infections, gut problems, poor mitochondrial (cellular energy) function and a nervous system stuck on high alert, which is common after long covid. Charmaine Shepherd uses a detailed history and targeted testing to find which apply to you, then builds a step-by-step plan to rebuild energy.

WhoCharmaine Shepherd, IFM Certified functional medicine practitioner, 20+ years in clinical practice
Where4 Albyn Place, Edinburgh EH2 4NG, or online by video
CostFree 20-minute discovery call. Initial consultation £354, return visits £264
ReferralNot needed. You can book directly

Is this you?

Do these signs of fatigue sound familiar?

Tiredness that rest or sleep doesn't fix
Crashing after activity or exercise
Brain fog and poor concentration
Feeling worse since a virus, including covid
Aching muscles or joints
Unrefreshing sleep
Breathlessness or a racing heart on standing
Being told your blood tests are normal

If any symptoms are sudden or severe, contact your GP, call NHS 24 on 111, or call 999 in an emergency.

Why do I feel exhausted when my tests are normal?

Standard blood tests check for anaemia, thyroid disease and diabetes. They are important, but when they come back clear, many people are left with no explanation and advice simply to pace themselves.

Functional testing looks further: nutrient levels at optimal rather than minimum ranges, thyroid conversion, cortisol rhythm, gut health, hidden or reactivated infections, inflammation, toxins and how well your mitochondria (the energy-producing parts of your cells) are working.

Long covid adds its own layers. Research has highlighted inflammation, effects on the lining of blood vessels and the nervous system, which can help explain fatigue, brain fog and breathlessness. Each person's pattern is different, so each plan is too.

Looking for the cause

What causes chronic fatigue?

Most people have more than one contributing factor. The aim is to find yours, so treatment targets the cause rather than just the symptoms.

Nutrient deficiencies

Low iron or ferritin, B12, folate, vitamin D and magnesium are common and fixable.

Thyroid & adrenal function

Poor thyroid conversion or a disrupted cortisol rhythm can drain energy.

Infections & immunity

Post-viral fatigue, reactivated viruses and immune activation can keep you unwell.

Gut health

Poor absorption and gut inflammation affect energy and brain fog.

Mitochondrial function

Your cells' energy production depends on nutrients and is sensitive to oxidative stress.

Nervous system & sleep

A system stuck in fight-or-flight, or poor-quality sleep, keeps energy low.

How I investigate

Which tests help explain fatigue?

Testing is tailored to your history. It may include:

Functional blood chemistryfull blood count, iron studies, B12 and folate, vitamin D, inflammation markers
Full thyroid and adrenal stress profilesincluding cortisol awakening response
Chronic Fatigue Screen and NutrEvalnutrient, amino acid and mitochondrial markers
Comprehensive stool testingfor gut causes of poor absorption and inflammation
Oxidative stress and toxic element testingwhere history suggests it

Tests are priced separately and always agreed with you first. Bring any recent NHS or private results to your consultation. See all laboratory tests

How it works

How does working with Charmaine work?

Free discovery call

Free · up to 20 minutes

Tell me what’s going on and find out whether my approach is right for you.

Initial consultation

£354 · includes health coaching

A detailed look at your history, symptoms and lifestyle, with tests recommended only where they will help.

Your plan & follow-up

Return visits £264

A written plan covering nutrition, lifestyle and targeted supplements, reviewed as your results and symptoms change.

In person at 4 Albyn Place, Edinburgh, or online by video. See all fees

Patient stories

In their own words

“I've been searching for answers to my declining health and chronic pain for over a decade. Charmaine was able to review my long medical history and get a game plan going very quickly. I feel better than I have in years and I finally feel like I have a path out of this haze of poor health.”
Diana C., chronic pain and fatigue

Questions about fatigue and long covid

Can’t see your question? Book a free call or ring the clinic on 0131 235 1232.

See also: All laboratory tests · HRV & biofeedback

Do you treat ME/CFS?

I don't offer a cure for ME/CFS, but many people with a diagnosis find it helps to look for contributing factors such as nutrient deficiencies, gut problems, thyroid function or infections, alongside careful pacing.

Can you help with long covid?

Yes. I've seen a great deal of long covid in my practice. We look at inflammation, blood vessel health, nutrients, gut health and the nervous system, and build a plan around your specific symptoms.

I'm too tired to travel. Can I be seen online?

Yes. Many people with fatigue choose video consultations, and test kits are posted to your home.

Do you offer IV or vitamin injections?

The clinic offers vitamin injections and IV infusions where appropriate, including NAD+. These are only recommended if your testing and history suggest they would help.