Fatigue is one of the most common concerns that I hear from patients.

For some, it is a more recent occurrence. Others, have had it for years. 

Often, people have had normal work-ups at their routine medical exams. They are told that their labs look normal. 

So, is that it? Are they stuck with being tired?

Absolutely not!

This is one of the ways that a holistic approach shines. 

When I meet with someone and they tell me that they are often tired I look at all parts of their life.

Frequently, prior labs haven’t been in-depth. They’ve been ordered in a way to rule-out disease but not in a way to determine if the body is operating optimally. 

Some important items to investigate for those experiencing fatigue:

Iron

For example, people may have a normal CBC so it’s assumed that there’s enough iron in their system. When I test their serum ferritin levels, they may have suboptimal levels that are contributing to their fatigue. In one study, women who had normal hematocrit levels but suboptimal ferritin levels (under 50 ug/L) experienced a 50% decrease in fatigue with iron supplementation over 12 weeks. 

Thyroid

Another example is thyroid function testing. The most common test for thyroid function is a test for TSH (thyroid stimulating hormone) levels. However, there are some other thyroid hormones that can give a fuller picture of what might be causing the fatigue. Sometimes people have normal TSH levels but the other hormones, free T3 and free T4 may not be optimal. They may benefit from some extra thyroid support in the way of thyroid hormone supplementation or supplements that can boost proper thyroid function. 

Sex Hormone Testing

Hormones play an important role in how energetic one feels. Most cycling women can relate to varying levels of energy during their cycles. Other than assessing testosterone levels in men, serum levels are often not very helpful. I rely on the Precision Analytical DUTCH testing which tests dried urine to get a thorough picture of what is occurring with estrogen and progesterone levels. It’s really been a game-changer. It gives insight as to how many hormones are being metabolized and if they are balanced or not.

HPA Axis

This is the system most affected by stress. It, in turn, affects all the other systems. Often referred to as adrenal fatigue, a more accurate description is the hypothalamic-pituitary axis or HPA dysfunction. This is another example of how serum testing is not too helpful. The information available on functional testing is revealed by the collection of multiple samples throughout the day via urine or saliva to provide insight into one’s typical cortisol rhythm. 

Nutrition

Nutrition is an important part of the integrative work-up. Some people have nutritional deficiencies as a result of diet or poor digestive function. Frequently people have blood sugar and insulin regulation issues that contribute to their overall health. Another nutrition issue related to energy levels is a high intake of pro-inflammatory foods like sugary and processed foods. Food sensitivities are common and avoidance of these foods can boost energy levels. 

Sleep

Last but not least is the importance of a good night’s sleep. Sleep is impacted by many things that include poor sleep hygiene, caffeine, medications, trauma, hormones, and sleep disorders. We spend almost a third of our lives asleep! This is not an area to be overlooked.

The treatment of fatigue requires thorough investigation due to so many possible factors. While this list may be helpful, it doesn’t cover all the possible reasons for fatigue. It’s definitely worth the investment because life is so much more enjoyable when you can meet it with genuine energy. 

Resources:

Riemann, D., Nissen, C., Palagini, L., Otte, A., Perlis, M. L., & Spiegelhalder, K. (2015). The neurobiology, investigation, and treatment of chronic insomnia. The Lancet. Neurology, 14(5), 547–558. https://doi.org/10.1016/S1474-4422(15)00021-6

Vaucher, P., Druais, P.-L., Waldvogel, S., & Favrat, B. (2012). Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: A randomized controlled trial. CMAJ : Canadian Medical Association Journal, 184(11), 1247–1254. https://doi.org/10.1503/cmaj.110950