This is something I hear at least once a day in my practice. I spend the majority of the appointment listening for clues as to the root cause of the fatigue because there are so many factors and reasons why many of us, at one time or another, feel exhausted & burnt out.
What may seem like a simple complaint such as fatigue can bring about a multitude of questions and thoughts that run through my head…
- “Could it be a thyroid problem? We can run a few tests to check how it is functioning.”
- “How much stress is this person experiencing or has experienced in the past?” The adrenal glands are taxed when there is no relief from stress. “Our modern lifestyle is so calm & peaceful that stress-related problems are so rare.” Ha! We all know THAT isn’t true!
- “What time of the day is the fatigue the worst or is it all day long? Do they feel tired all day and then as soon as they lay down to sleep at night, they are suddenly wide awake and can’t fall asleep for hours? “
- If this is a woman who is still having a menstrual cycle, “How heavy are your periods? How frequently are they coming?” Have you ever had iron deficient or insufficient anemia?”
- “How is this person’s sleep? Are they getting at least 7 hours of uninterrupted sleep? Are they practicing good ‘sleep hygiene’ by sleeping in as dark of a room as possible, no TV or computer on and no cell phone or other electronics near their bed?”
- “What is this person’s current diet like and are there foods they are eating that could be contributing to their fatigue?”
- “Are they a vegan or vegetarian and possibly not have enough vitamin B12 in their diet?”
- “What other symptoms does this person exhibit that may or may not be related and under what time frame did all of these symptoms arise?”
After thoroughly examining these various aspects, I usually have a good idea where we should focus our attention & what labs might be a useful piece of the puzzle to rule in or rule out an area of concern. Most people assume fatigue is the result of an under-functioning thyroid gland since that seems to be what we hear the most about but as you can see, there can be many underlying reasons. Some of them can be discovered through more thorough blood work. Most conventional physicians order very basic, focused blood work which may not reveal the whole story or they may only look for values that are out-of-range. I am not only looking for high or low values but also where in the given range the value lies. In many instances, I am evaluating the numbers with a more narrow range in mind or an optimal range not just what is considered “normal” for a given group of people. For example, the given range for a thyroid lab called TSH is 0.45-4.5. That’s a huge range! Naturopathic doctors know that the thyroid should be functioning optimally with a TSH below 2. When it appears above 2, I know it is not performing at its best & I make decisions based on that knowledge.
Many times, basic blood work doesn’t give enough information and a few more in-depth labs may reveal the key. An example here that I see all of the time is that a doctor will run a serum (blood) iron level. It almost always comes back in the normal range because the body will do just about anything it can to keep the blood iron level within that range (even if it is in the low range) because it is so crucial for the body. The doctor will say, “Nope! It isn’t your iron. The iron numbers are just fine!” What is not often looked at is the serum ferritin level. Ferritin is generally the body’s iron storage level. I tell my patients that ferritin is like your overdraft or savings account. When the iron in the blood gets low, it dips into its “savings” to boost its numbers while the “savings” dwindles if it isn’t replenished. Just this one extra lab value helps me to identify an iron insufficiency that can be treated before it becomes extreme and the patient’s fatigue is relieved.
Many, many, many times I end up addressing the adrenal glands first as the underlying reason for feeling tired. The adrenals are highly overworked but highly under-appreciated and undernourished little glands that sit atop our kidneys. Conventional medicine practically sweeps their importance under the rug but we as Naturopathic Physicians are highly versed in the needs of the adrenals and we have just the right tools to implement to support them, help reduce the body’s response to stress and help to relieve fatigue at the foundational level.
The next blog will discuss the adrenal glands in more detail. Stay tuned!
If you are feeling fatigued and haven’t been able to get to the root of it, come in to see me and follow the natural path…