Fatigue is one of the most common reasons that people reach out to me for naturopathic care. Many don’t feel like their old selves; they have a hard time getting out of bed in the morning and feel sluggish throughout the day. They often push themselves to get through daily activities, whether it’s work, household errands, or taking care of their children. After becoming reliant on coffee or sugary treats to provide a bit of a boost to tackle the day’s tasks, many long for the vital energy they once had. As a naturopathic doctor, my job is to assess why someone may be experiencing such fatigue, for which there are many different causes. In this article, I review the three most common causes of fatigue that I see in my practice. Once we identify the factors contributing to your fatigue, you can take back your health.
1) Anemia or suboptimal iron levels: Low iron levels are particularly common in women and those following a vegetarian or vegan diet. This is best identified through blood work: a complete blood cell count (CBC) and ferritin, which can be ordered by either your medical or naturopathic doctor. In naturopathic medicine, we are looking for both overt iron deficiency anemia and suboptimal levels. I find most women feel their best when ferritin levels are 50 and above. In addition to supplementation of iron in these cases, it is also important to identify why an individual may have low iron levels. Are levels low because of heavy or prolonged menses, inadequate dietary intake, or poor absorption of nutrients? The naturopathic approach seeks to address the root causes of low iron levels as well as raise levels with supplementation.
2) Thyroid Imbalance: The thyroid gland is a key part of our hormonal system and is responsible for setting our metabolic rate and maintaining energy levels. Hypothyroidism or an underactive thyroid gland is very common in North America, and is estimated to affect 4.6 percent of the population. Aside from fatigue, symptoms associated with hypothyroidism include difficulty losing weight, constipation, dry hair and skin, discomfort in cold temperatures and more. The recommended screening blood work for hypothyroidism is called Thyroid Stimulating Hormone (TSH), and can be ordered by your medical or naturopathic doctor. As a naturopathic doctor, I’m looking for both overt hypothyroidism as well as subtle thyroid imbalances. This means that if TSH is not within an optimal range of 1-2 mU/L, I will generally order a broader thyroid panel including T4, T3 and thyroid peroxidase (TPO) antibodies for a more comprehensive assessment. Subtle thyroid imbalances that are not commonly picked up through conventional medicine can often be addressed with naturopathic therapeutics including diet and lifestyle recommendations, herbal medicines, and vitamin and mineral supplements. In more overt cases of hypothyroidism, thyroid medication is used.
3) Adrenal Dysfunction: The adrenal glands are an important, but often overlooked organ. Intimately involved in the stress response, the adrenals produce the hormones cortisol and adrenaline. Under chronic stress, the body attempts to protect itself by dialing back our output of stress hormones. When cortisol output is low, you can feel both tired and wired, or just flat-out exhausted. The normal circadian rhythm of cortisol output can also be altered, with abnormally high levels released at nighttime contributing to difficulty sleeping. Poor sleep in and of itself can of course lead to fatigue. In my practice, we will look at your history of stress and symptoms in detail to determine whether adrenal dysfunction may be an issue for you. Also available is salivary cortisol testing, which can help assess the severity of adrenal dysfunction and fine tune treatment. With stress management techniques, good nutrition, herbal medicine and vitamin and mineral supplementation, stress hormone balance and restoration of your adrenal health can be achieved.
In good health,
Dr. Carla Cashin, ND