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Treatment of Low Ferritin Levels

​Ferritin is an indicator of how much iron is stored in your body.

Low ferritin levels can cause symptoms such as fatigue, shortness of breath, hair loss, and difficulty exercising.

In this article, I will discuss ferritin, signs and symptoms of low ferritin, the common ​reasons that cause low levels, how to test for it, and the benefits of getting if back into the optimal range.

Lets get started…

​What is Ferritin?

​Ferritin is a protein that contains iron.  It is the primary form of iron that is stored in cells. 

​The level of ferritin in the blood is a reflection of how much iron storage​ is in the body.

Iron is an essential element that the body needs in order to produce red blood cells.  Red blood cells are what carry oxygen to the cells​.

Our bodies cannot produce iron, so it much absorb it from the foods or supplements that we consume.

The majority of iron that we absorb is used to make hemoglobin, the oxygen-carrying molecule in red blood cells.  Most of the remaining iron is stored as ferritin in the cells.  

​If iron levels begin dropping for whatever reason (we will discuss these shortly), the body releases ferritin into the blood in order to ​provide the iron that is​ lacking. Eventually, the ferritin levels may drop which is the first indication of iron deficiency.

If this deficiency continues, the ferritin stores will eventually be depleted, hemoglobin production will be reduced, and anemia (low blood levels) will result.

Therefore, a ferritin level is the earliest indicator we have to detect a deficiency of iron.

​Signs and Symptoms of Low Ferritin

​There are many common signs and symptoms of low ferritin or iron, but none are specific to that condition.  In other words, the symptoms could also indicate a completely different issue than low ferritin. 

The most common symptoms of low ferritin include:

  • Chronic fatigue or low energy
  • check​Inability to tolerate exercise and reduced activity level
  • checkHair loss or lack of hair growth
  • checkFrequent illnesses
  • Autoimmune condition(s)
  • GI symptoms – bloating, low stomach acid, etc.

​If you are having some of these symptoms, it is important that you see your medical provider and get a thorough history and physical as well as lab testing to help determine the potential cause(s).

​Can You Have Low Ferritin but No Anemia?

​Absolutely yes!  

​A low ferritin level is typically the first lab abnormality that ​occurs when iron levels start dropping.  It can occur for weeks or even months before the ferritin levels are depleted to the point that iron and hemoglobin levels drop.  

As a result, many patients may have symptoms of low iron, but they are not treated because it has not progressed to the point of causing anemia which would then show up on standard lab tests.

​A ferritin level is often not included in the initial labs tests of patients with the above symptoms. You may have to ​specifically request it when you see your medical provider.

Causes of Low Ferritin

​Very simplistically, low iron/ferritin is caused by one of 2 things – either you aren’t absorbing enough iron or you are losing iron somewhere.

With that in mind, the most common causes of low ferritin that I see in my practice include:

  • Heavy menstrual bleeding
  • checkChronic internal bleeding – usually from somewhere in the GI tract, such as a stomach ulcer, colon polyp, or even an undiscovered malignancy.
  • Gastrointestinal malabsorption – very important but often hard to detect.  This can be caused by SIBO, SIFO, low stomach acid, intestinal dysbiosis, leaky gut, IBS, or inflammatory bowel disease.
  • Autoimmune conditions such as celiac disease or inflammatory bowel disease.  These damage the intestines which leads to malabsorption and even chronic bleeding.

​Lab Tests for Ferritin

​When evaluating for the possibility of low iron or ferritin, I recommend getting the following tests:

  • CBC – Indicates hemoglobin and hematocrit levels, plus will show other indices that can indicate iron deficiency.
  • checkTotal Serum Iron – Most labs list the normal range to be 60-170 mcg/dL.
  • Total Iron Binding Capacity (TIBC) – Levels > 450mcg/dL typically indicate low iron levels, while < 240 mcg/dL indicate high levels of iron.
  • Ferritin – Every lab is slightly different, but the typical reference range is 15-150 ng/mL.

​Keep in mind that like with many other tests, there is a difference between the “normal” reference range of ferritin and the “optimal” range.  

Obviously, any level below 15 is “low” and should be addressed.  However, people with ferritin levels in the “low normal” range of most laboratories can still be symptomatic.  If they are treated they will usually feel better.

Remember, a low or suboptimal ferritin level may be the first indicator of iron levels that are beginning to drop.  It may take weeks or even months before the other labs become abnormal enough to get the attention of your medical provider.

​That is why I consider the optimal range for ferritin to be 30-40 ng/mL.

​Benefits of Correcting Low Ferritin

​Besides reducing symptoms, why should you correct your ferritin level?  Let’s discuss the most obvious:

​1. Low Iron Impairs Thyroid Function –

​One of the biggest reasons to correct your ferritin level is its effect on​ the thyroid.

Many studies have shown that low iron impairs proper thyroid function.

That makes sense when you think about how so many of the symptoms of low iron/ferritin are the same as the symptoms caused by low thyroid – fatigue, hair loss, etc.

Replacing low iron levels should result in an improvement in your thyroid function.  This is especially important if you have known hypothyroidism.

​2.  Improves Hair Growth and Stops Hair Loss –

Iron plays a critical role in normal hair growth and repair.

Low iron/ferritin is an important and common cause of hair loss in premenopausal women.  In many of those situations, the hair loss is often blamed on genetics or thyroid problems when it’s actually from low iron.

Another study showed that in healthy women of childbearing age, a ferritin level of < 30 ng/mL was strongly associated with telogen hair loss.

As I discussed earlier, there is often a difference between a “normal” lab result and an “optimal” lab result.

If you are having hair loss and your ferritin level is < 30 ng/mL, it may be worth taking an iron supplement to see if the hair loss improves.

​Low iron is not the only nutrient that can cause hair loss.  Other nutrient deficiencies should also be considered, including selenium, zinc, and l-lysine.

​3.  Improves Energy Levels

​One of the primary symptoms associated with low iron and ferritin is fatigue or ​decreased energy levels.

This is thought to be ​caused by a couple of reasons:

​- Iron helps carry oxygen to peripheral tissues.  Oxygen is required for normal energy production in the mitochondria of the cells.  When the iron is low, oxygen transport may be impaired.

– Iron is directly involved with normal thyroid production.  Thyroid hormone is also involved with ​mitochondrial energy production.

Low energy production typically manifests as a sense of ​fatigue or lack of energy.

​Optimizing the ferritin level therefore helps to ensure that ​the mitochondria are producing energy at their peak ability which will increase the feeling of having ​a higher energy level.

​4.  Improves Exercise Tolerance

​As I just discussed, iron plays an important role in delivering oxygen to peripheral tissues.  This includes skeletal muscle.

A decrease in energy production in skeletal muscles will result in a decrease in strength and exercise capacity.

This will typically present as an increase in heart rate and worsening shortness of breath (more than you would expect at your level of fitness) while exercising.

This makes sense if you think about it.  If you have less oxygen getting to your tissues, then the heart rate will increase and the respiratory rate will increase to try to compensate.

If your amount of exercise decreases, typically your body weight will increase which worsens insulin and leptin resistance.

If you are experiences more shortness of breath during exercise than you think you should be having, you may want to consider checking your iron and ferritin levels.

​5.  Improves the Immune System

​A critically important yet rarely considered role of iron in the body is how it affects our immune system.

​Low iron changes immune function and limits the cellular response to bacteria.

Other nutrients such as zinc and vitamin D also affect the immune system, but if you are getting frequent infections, you may want to think about checking your iron and these other nutrient levels.

​The Cause of the Low Ferritin May Also Be Causing Other Nutrient Deficiencies

​If you are deficient in one nutrient such as iron, there is a good chance that you may also be deficient in others.

That is because the root cause of the low ferritin or iron may also be causing other nutrients to be deficient.

For example, if you aren’t absorbing iron because of low stomach acid or dysbiosis, that issue may also be reducing the amount of vitamin B12 that is being absorbed.

​Also, some nutrients are required for the normal absorption and metabolism of others.  For example, vitamin C is needed to absorb iron.

This is something to keep in mind if you find a deficiency of a nutrient such as iron, but correcting it doesn’t completely resolve your symptoms.  You may need to look for other nutrient deficiencies.

​Treatment of Low Ferritin

If you decide to take iron supplements in order to increase your ferritin level, there are some things to keep in mind:

​- ​Not enough iron is bad, but too much iron is also bad.  That is why I would not recommend supplementing with iron unless you know your ferritin level and your monitor it regularly.

​- Liquid iron is typically better tolerated than capsule/tablets.  This is because of the absorption issues ​I have discussed earlier.  Liquid iron is typically more rapidly absorbed and causes less constipation.  If you don’t tolerate liquid iron or if your ferritin level doesn’t improve, you may have to change to capsules.

​- B12 deficiency is commonly associated with low ferritin.  Make sure you monitor for both nutrients.  It is highly likely that you will need to supplement for both.

Don’t take iron within 2-4 hours of taking your thyroid medication.  Iron impairs the absorption of thyroid hormone, so always take iron as far away as possible from when you take your thyroid medication.

​- Extremely low levels may require IV iron infusions.  This will depend on the cause of the low ferritin, which should always be investigated.

My recommended brands for iron and B12 are listed below (click on each to be taken to Amazon.com):

​I typically recommend rechecking ferritin (and B12) levels 2-3 months after starting treatment and continuing treatment until the root issue has been investigated and corrected.

​Can Low Ferritin Cause Weight Gain?

​Yes, but most likely due to its relationship with the thyroid.

​Low ferritin reduces thyroid hormone production because of heme-dependent thyroid peroxidase.

Also, low thyroid results in insulin resistance and leptin resistance, both of which lead to weight gain.

What About High Ferritin Levels?

​A high ferritin level may mean that there are high iron levels in the body, but it can mean other things as well.

If someone has normal or even low iron levels but their ferritin is high, it typically means that there is some type of inflammation occurring in the body.

​That is because ferritin is what we can an acute phase reactant.

If the ferritin is >150 mcg/dL and the iron is normal or low, then other inflammatory markers should be tested, including CRP and ESR.  This will need to be ​investigated under the direction of a knowledgeable medical provider.

​Summary

​Iron is a nutrient that is critical to many vital functions in the body.  

A deficiency of it can cause many negative symptoms.  These include fatigue, poor exercise tolerance, shortness of breath, and hair loss.

Ferritin is an indicator of the amount of iron stored in the body.  When ferritin is low, it indicates that the body is deficient in iron.

High ferritin levels typically indicate that an inflammatory process is occurring in the body.

Other nutrient deficiencies may be associated with low iron and should be investigated.

​Finding the root cause of the low ferritin level and correcting it is crucial for long term correction success.

Now it’s your turn…

​Have you ever had low ferritin levels?

What was the cause?  Did treatment help reduce your symptoms?

What treatment helped?

Please leave any questions or comments below.

Why Am I So Tired All the Time?

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​Why am I so tired all the time?  I am asked that question multiple times EVERY DAY.

​​Our society is exhausted, and it’s only getting worse.

​Do you ever wake up refreshed, make it through the day ​easily, then still have energy in the evening for home activities and family time?

​If you do, consider yourself fortunate.  Most of us don’t​.  Not by a long shot.

In this article, I will discuss the most common ​reasons why you may be tired and give you some pointers on how to regain some energy and quality of life.

Let’s get started…

More…

​What Does It Mean To Be Tired?

What do people mean when they say they are tired?

Sometimes they may be frustrated – “I am so sick and tired of this traffic.”

Others may mean they are emotionally spent – “I am so tired of fighting with my husband.”

Still others may mean they are physically worn out – “I am so tired from that ​workout.”  Or “I am so ​exhausted.  The baby kept me up all night.”

For the purpose of this article, when I talk about being tired, I am primarily referring to a lack of energy.

​In my online hormone practice, I always start the first appointment with a new patient this​ way:  “Give me 3 goals that you have in meeting with me.”  95% of the time, the first 2 things that people list are:

1.  Lose weight​

2.  More Energy

​People are simply exhausted​, both physically and emotionally.

Let’s dive into the most common causes​ of fatigue that I see in people and discuss some solutions to this national epidemic…

​Common Causes of Being Tired

​Fatigue may be occassionally due to a single obvious reason, but most of the time it is because of several things, not just one.

Like most health issues, what you eat and your ​level of activity play a ​huge role in your energy level.​

There ​may also be some hormonal issues​ as well as other things going on in your body that you need to consider.

Let’s break these down further…

​1. Adrenal Issues

​As you know, we live in a very high stress society.  Most of us are on the move constantly, then we wonder why we feel so tired!

This type of lifestyle plays havoc on our adrenal system.

​One of the major functions of our adrenal glands is to produce cortisol, DHEA and epinephrine in response to stress (physical and mental).

These hormones help regulate our immune system, heart rate, and energy storage.

Under normal situations, a stressful event will trigger the adrenals to release a surge of cortisol which then signals the mitochondria in our cells to temporarily increase energy production​.

That increase in energy helps us to get through the physical or emotional stress we are experiencing.

When the stress passes, the cortisol levels then drop back to the normal range.

When the body is under CONSTANT physical stress, such as a chronic infection, inflammation from obesity, insulin resistance, an autoimmune condition, etc., the adrenals are under pressure to continuously secrete large amounts of cortisol.

The same is true for constant emotional or mental stress.

High cortisol levels promote hypothyroidism.

It also worsens insulin resistance and leptin resistance.

​With all of these conditions, ​fatigue is a common symptom.

Eventually, the adrenals will no longer able to produce adequate amounts of cortisol, so the levels in the body begin to drop. Adrenal fatigue results.

When this situation occurs, constant fatigue is a hallmark symptom.

​Even normal day-to-day activities become exhausting.  Exercise ​may make you feel wiped out for days.

To test for adrenal or cortisol issues, I usually start with an 8am serum cortisol level.

​If your levels are <11 or >18, you have adrenal issues that should be addressed.

That may require getting salivary or urine cortisol levels 4 times throughout the day.  You should discuss this with your doctor.

What What Can You Do About It?

To learn more in detail about management of adrenal issues, read my article here.

As a quick summary, here are my recommendations that you can do even without a doctor if your serum cortisol levels are abnormal.

If your morning cortisol level is >20​, consider these supplements:

  • checkPhosphatidylserine:  Phosphatidylserine has been shown to reduce cortisol levels if taken in doses up to 600mg per day.  Use 4-6 capsules at night (each capsule is 100mg) and recheck cortisol levels in 2-3 months.
  • checkAshwagandha:  Ashwagandha is an adaptogen that can actually help to lower cortisol levels when they are high and raise them when they are low.  It also can boost libido and may help with weight loss. It can also reduce anxiety symptoms caused by chronic stress.  Doses vary from 500-2000mg per day depending on tolerance and severity of symptoms.
  • checkMelatonin:  Melatonin has been show to reduce cortisol levels and may actually help improve your sleep at night.  Even if you are sleeping well, melatonin can still help reduce cortisol levels and should be considered.  It can also help with depression symptoms.  Doses vary from 1-3mg, but most people tolerate 3mg well.

​If your morning serum cortisol is < 11​, consider these supplements:

  • checkAdrenal glandulars:  These work best for patients with very low cortisol levels.  They also tend to provide an immediate boost to energy levels.  Using glandulars in combination with other supplements listed below may be necessary.  Should be used for 6+ months.
  • checkAdrenal Adaptogens:  Adaptogens can actually help to lower cortisol levels when they are high and some can even raise cortisol levels when they are low.  There are many types of adaptogens but I find that blends of multiple adaptogens tends to work best.  These can be combined with glandulars as well for more benefit.  Should be used for at least 3 months.
  • checkCoQ10:  This coenzyme is involved in proper mitochondrial energy production and can help increase energy levels, which can be very helpful in adrenal-related issues.  Use 2 capsules (240mg) per day for several months.
  • checkAlpha Lipoic Acid:  ALA helps increase mitochondrial energy production, acts as a powerful antioxidant, reduces peripheral neuropathy, and lowers inflammation.  ALA can also help with weight loss due to its effects on insulin.  Start at 600mg daily and increase up to 1800mg daily as tolerated.
  • checkVitamin B6:  Vitamin B6 is used in several pathways in the creation of adrenal hormones and many patients are deficient in it.  Taking higher doses of B6 during the acute phase of treatment may be necessary for a short period of time.

If your levels are either extremely high or low, it is critical that you see your doctor for further testing.  You could have undiagnosed Addison’s Disease or Cushing’s Disease.

​Besides supplements, learning some stress management techniques is also critical for optimizing your adrenals and improving your fatigue.

These include things such as yoga, daily meditation, prayer, and even just going outside for 15-30 minutes every day.

​2. Thyroid Issues

​If you are more tired than you think you should be, checking your thyroid should be high on your list.

Since the thyroid is your “metabolism” gland, any conditions affecting it will affect your energy level.

​Besides feeling tired, thyroid issues can cause these common symptoms:

  • checkWeight gain or inability to lose weight
  • checkFeeling cold all the time
  • checkBrittle nails
  • checkThinning hair or hair loss
  • checkConstipation
  • checkLow body temperature
  • checkMood changes, such as anxiety or depression
  • checkBrain fog
  • checkHormone imbalances – irregular periods, PMS

​If you are having some of these symptoms, you should ask your doctor to run a complete thyroid panel:

​Only checking ​the TSH level could miss up to 80% of patients with a thyroid condition.

​Ideal levels for your thyroid tests include:

  • TSH – ideal range ​is 0.5-2.0
  • search​free T4 – ideal range is in the upper 1/3 of the testing range
  • free T3 – ideal range ​is >3.5
  • searchreverse T3 – should be < 15
  • searchTPO antibody – >35 is diagnostic for Hashimoto’s thyroiditis
  • searchThyroglobulin antibody – >35 is diagnostic for Hashimoto’s thyroiditis

So What Can You Do About It?

​If any of your labs are out of these optimal ranges, you should talk to a doctor that is knowledgeable about the thyroid.  Supplements and prescription medication made be needed to boost your thyroid function.

If your doctor isn’t willing to work with you, consider finding a certified functional medicine doctor from the Institute of Functional Medicine.

​To learn more about the thyroid, click here to read my article on hypothyroidism and click here for my article on Hashimoto’s thyroiditis.

​3. Blood Sugar Imbalance

​Blood sugar fluctuations are a common cause of feeling tired.  You may be experiencing this especially if you ​have any “crashes” during the day when you feel weak, tired, and dizzy.

​Most ​people are on a constant roller coaster – they eat a diet high in sugar or processed carbohydrates. This causes their blood sugar to rise rapidly.

The rise in blood sugar triggers their pancreas to release insulin to carry the sugar into the cells to be used as fuel.

​The blood sugar then drops, sometimes rapidly, which makes them feel tired, moody, and even dizzy.

​It also triggers their hunger, so they eat more sweets or high carb foods and the cycle starts all over again.

​This situation is made even worse by:

​- Insulin Resistance

Half of Americans already have insulin resistance and most have no clue.

​When we constantly eat a diet high in sugar and/or processed carbs, our insulin levels remain high to try to manage the sugar load.

Our body responds to anything that is present in excess by learning to ignore it.  That is what happens with insulin when we have insulin resistance.

​We respond to the persistently high insulin levels by down-regulating the insulin receptors in our cells. This protects the cells from getting overloaded with glucose.

This causes the insulin and glucose levels to gradually increase.  Eventually, pre-diabetes and type 2 diabetes occurs.

I bet you don’t know many if any diabetic patients that feel energetic, do you?

​- Poor Diet

​We eat way too much sugar and processed carbs.  Most of us know that intuitively.

In a little over 100 years, the average consumption of sugar has increased from about 40 pounds per person per year to well over 100 pounds per person per year!

​We have also increased our consumption of grains (wheat, corn, etc) by almost 50% over the past 40 years.

I was raised ​in a small town.  Growing up, my diet was full of poor food choices.  Every breakfast had some form of grain and sugar – cereal, pastry, etc.  Every other meal did not seem complete unless it included some form of bread and a sweet dessert.

​With the changes that have been made to wheat and the continued increased processing of our food, we are learning that we have to make some conscious changes to our diets in order to improve our long-term health.

So What Can You Do About It?

Try to eat a whole food, nutrient-dense, high quality diet which is high in lean meats and organic vegetables.

If you need more help, a great starting point would be starting the Whole 30 diet or ketogenic diet.

​I would also suggest hiring a certified nutritionist that is knowledgable about functional medicine.

​4. Sedentary Lifestyle

​When someone ​spends the entire day either sitting or laying down, should they be surprised that they feel tired?

Our bodies were made to move!  Lack of movement with cause atrophy of our muscles and a general ​decline in our fitness level.

One study showed that regular, low-intensity exercise can reduce the feeling of fatigue by 65% and increase energy by 20%.  12 population-based studies showed similar results.

This study showed it specifically in women.

Have you ever been on an exercise program, then because of life events, had to stop for a few days?  Isn’t it amazing how quickly you lose your level of fitness and feel tired?

Now multiply that times 100 and you can get an idea of what a sedentary lifestyle will do to you and your energy level.

So What Can You Do About It?

Simply put, start moving!  Anything that you start doing now will be more than you ​were doing before.

If you aren’t currently exercising, start with a brisk walk at least 3 times per week. ​

Listen to your body.  If it exhausts you, you may need to back off of the intensity.  This is especially true if you are having some adrenal issues.  Increase the time and intensity as tolerated.

Eventually, you will want to incorporate some simple weight training and high intensity interval training (HIIT).

If you are struggling with knowing exactly what to do and how much, I would strongly recommend hiring a personal trainer who can design a workout schedule just for you.

They will also serve as a form of accountability for you and make sure you are doing everything safely.

I highly recommend realfitness.net.  Jessica is a world-class trainer as well as a certified nutritionist.  She has helped many of my patients (including myself).

If you have significant health issues – heart problems, uncontrolled blood pressure, etc. – discuss it with your doctor before starting.

​5. Poor Sleep

​Sleep is our body’s way of recharging itself and giving it the energy to function the next day.  ​When we don’t sleep enough or the quality of sleep is poor, we are going to feel tired.

If you are chronically tired, you need to take a long hard look at your sleep habits and sleep quality.  Your energy will not improve if you are sleeping poorly.

– Poor Sleep Hygiene

​Many people have developed horrible sleep habits over time.

This can include drinking caffeine throughout the day (including the evenings), sleeping in uncomfortable beds, sleeping in a bedroom that ​is too light or too hot, and staring a some sort of electronic screen the entire evening right up until bedtime.

The excessive use of electronic devices has become an epidemic in children and adolescents.  In fact, this use has a direct effect on their quality of sleep.  It has also been linked to the increase in depression in adolescents.

​Normally, around 9pm at night, the pineal gland in our brain begins secreting melatonin.  Melatonin helps our body to relax and prepares it for the night of sleep.

Excessive light, especially blue light, has been shown to suppress the secretion of melatonin in our brains.

I also see tons of patients that try to function on as little as 4 hours of sleep per night.  That simply isn’t enough.  You body will eventually start breaking down.

– Obstructive Sleep Apnea

​It is estimated that 22 million Americans suffer from obstructive sleep apnea.  What’s worse, up to 80% of those are undiagnosed!

Ask yourself these questions.  Ask your spouse to answer them about you as well:

1. Do people complain that you snore like a freight train?

2. Has anyone ever noticed that you frequently gasp or even stop breathing while you are asleep?

3. Do you wake up exhausted in the morning, even if you have ​slept for 7-8 hours or more?

4. Do you find yourself dozing off during the day if you sit still for more than a few minutes?

If you answered yes to one or more of these questions, you should make an appointment to talk to your doctor about it.

​Obstructive sleep apnea is a condition where the tongue falls back against the soft palate and the soft palate collapses against the back of the throat.

​The ​result is the airway closes.  You have to wake up out of deep sleep enough for your body to overcome the obstruction.  This can happen multiple times every hour.

Since you don’t stay in the restful deep stages of sleep, you don’t truly get good rest.

Untreated obstructive sleep apnea has been associated with an increased risk of​ heart disease, congestive heart failure, and stroke.

Obesity is a risk factor for obstructive sleep apnea, but obstructive sleep apnea also worsens obesity, thus creating a vicious cycle.

​It has also been shown to worsen insulin resistance and fatty liver disease.

So What Can You Do About It?

​If you have sleep apnea, fortunately, all of these risk factors can be reversed with the use of a continous positive airway pressure (CPAP) device.

Your doctor can order an overnight sleep study which will determine whether you have sleep apnea or not.

Everyone should follow these common sense sleep habits:

  • checkTry to sleep a minimum of 7-8 hours every night
  • checkReserve the bed for sleep and sexual relations only
  • checkConsider installing blackout curtains in your bedroom
  • checkReduce your thermostat to keep your bedroom cool at night
  • checkMake sure you have a comfortable, supportive bed and pillow
  • checkTurn off all electronic screens at least 2 hours before bedtime
  • checkAt the very least, install a blue light filter on your smart phone, tablet and computer to use after dinner

​6. Digestive Issues

​Gut issues are often the root cause of many conditions of the body.  The gut can also be playing a major role in your fatigue.

Here are some gut issues to consider:

– Leaky Gut

​Leaky gut (intestinal permeability) occurs when the inflammation in the intestines causes gaps between the cells.  These gaps allow foreign ​substances such as bacteria and other proteins to be absorbed that wouldn’t be normally.

Those foreign substances trigger a strong immune response which further increases inflammation.  That inflammation results in symptoms such as fatigue, mood swings, abdominal bloating and pain, achiness, headaches, and others.

The inflammation also prevents the absorption of many nutrients from what we eat, such as iron and vitamin B12.  A deficiency of these nutrients worsens feelings of fatigue.

Leaky gut can be caused by a poor diet of processed foods, prescription medication, thyroid disorders and autoimmune disorders.

What Can You Do About It?

​Remove processed foods from your diet, especially gluten and sugar.

Replace it with natural, organic whole foods.  I also recommend fermented foods that are full of healthy bacteria that our body needs.

Fermented foods include sauerkraut, kumbucha, kefir, kimchi and yogurt.

There are also several gut-healing supplements that can help.  These include:

  • checkProbiotics – I recommend that it have at least 10 bacterial strains and at least 50 billion cfu.
  • checkL-glutamine – this amino acid helps repair damage in the GI tract.  Take 1000-3000mg daily in divided doses between meals.
  • checkDigestive Enzymes – these enzymes help breakdown the fats and proteins in our meals. Take 1-2 with each meal.
  • checkQuercetin – this product has bioflavanoids which help to balance histamine levels and helps with digestion and allergies.  Take 2-4 capsules per day.
  • checkBetaine Hcl with Pepcin – these are vital components of gastric acid secretion.  It assists with digestion of food and absorption of nutrients.  Take 1 with each meal.  You may increase by 1 capsule per meal as needed.  If you develop burning in your stomach, reduce the dose by 1 capsule with each meal.

– Food Intolerances

​Many people are sensitive to certain foods and may not even know it.  Although they may not be truly “allergic,” consuming those foods still triggers inflammation and a reaction from the body.  Again, a common feature of inflammation is fatigue.

What Can You Do About It?

There is not a good lab test for food sensitivities.  The gold standard for determining them is the Elimination diet.

With the elimination diet, you remove the most common foods that cause food sensitivities for 3-4 weeks.  ​If your symptoms improve during that time, you know that you are most likely sensitive to at least one of the foods.

You then re-introduce the foods one at a time and see if you react.  If you don’t, you are most likely not sensitive.  If you do react, then you need to avoid that food as much as possible in the future.

The most common food sensitivities include:

  • checkGluten
  • checkDairy
  • checkSoy
  • checkProcessed or refined sugar
  • checkPeanuts
  • checkEggs
  • checkCorn

– Dehydration

​Water constitutes up to 75% of the body weight of infants and up to 55% of the body weight of adults.

Most of us are mildly dehydrated on an almost constant basis.  That results in symptoms of fatigue, headache, brain fog, and mood swings.

Studies show that even mild dehydration can affect our mood, energy level and mental functioning.  Here is another study.

Thirst is one of the last symptoms that you may feel when you are dehydrated.  Fatigue and the other symptoms may already be present by the time you feel thirsty.

So What Can You Do About It?

​Simply drinking more water may be the simplest yet most effective thing that you can do to increase your energy level.

As a general rule, I tell my patients that they should have to urinate at least every 2 hours.  If you are going longer than that, chances are you are dehydrated.

A simple way to determine your daily water needs is to take your weight in pounds and divide that in half. That number will be the approximate amount of water in ounces that you should drink daily.

For example, if you weight 140 pounds, you should be drinking about 70 ounces of water per day.

By the way, that amount is just for your baseline water needs.  If you are exercising, you need an additional 8 ounces for every 30 minutes of exercise.​

Eating a diet high in moist vegetables such as celery, cucumber and carrots is another way of increasing your water intake.

​7. Other Causes to Rule Out

​Although feeling tired is a common symptom that all of us have at times, it can also be a sign of something more serious going on in your body.

If your fatigue is more severe and lasts longer than it typically does, it is extremely important that you see a doctor for a complete history, physical exam, and blood work.

Some of the more serious potential causes of your fatigue include:

​- Anemia

​Anemia is a condition where you have lower levels of red blood cells.  Red blood cells carry oxygen in the blood to be used by the cells in the body.

Anemia is actually a symptom and not a diagnosis.  Something is causing the anemia.  That cause needs to be investigated thoroughly.

As a general rule, if someone is anemic, either the red blood cells are not being produced adequately by the bone marrow, or ​there is either blood being lost somewhere or the red blood cells are being destroyed somewhere.

Not only does anemia cause fatigue, it can also cause symptoms of weakness, dizziness, shortness of breath, pale skin, and an irregular heart beat.

​Some causes of anemia include:

  • checkHeavy menstrual periods
  • check​Iron, vitamin B12 or folic acid deficiency
  • checkGI bleeding – ulcer, gastritis, hemorrhoids, colon polyp, GI malignancy
  • checkAnemia of chronic disease – cancer, autoimmune disease, and other inflammatory conditions can suppression bone marrow production
  • checkBone marrow suppression – leukemia, multiple myeloma
  • checkAplastic Anemia – the bone marrow stops making red blood cells.  Can be caused by autoimmunity, infections, medications, and toxic exposures
  • checkHemolytic anemia– a condition where the body destroys the red blood cells faster than they can be made.
  • checkSickle Cell Anemia – a genetic condition caused by a defective form of hemoglobin

​Many of these causes of anemia are life-threatening and should be worked up by a medical professional.

​If you are anemic, don’t just assume it is from something like heavy periods or a bleeding hemorrhoid. Have it evaluated!

– Autoimmunity

​Inflammation in general taxes our bodies and will usually cause us to have significant fatigue.

If your fatigue is persistent or progressive, you should see your doctor.  Make sure that you request that your blood work include inflammatory markers, including the following:

– Complete Blood Count (CBC)

​- Erythrocyte Sedimentation Rate (ESR)

– C-reactive Protein – (CRP)

If any of these tests are abnormal it indicates an increase in inflammation and further workup is required. Several autoimmune conditions could be the cause including Hashimoto’s thyroiditis, rheumatoid arthritis, lupus, and many others.

– Malignancy

​As stated above, various different malignancies may have fatigue as one of the​ primary symptoms.  This could include cancers of the blood, gastrointestinal system, reproductive system, and lungs.

It is critical that you see a doctor for evaluation if your fatigue is persistent and an obvious source has not been found.

​Summary

​If you are tired, there are probably several reasons that you should consider.

You may have some hormonal issues such as insulin resistance and thyroid dysfunction.

Your diet and activity level ​are also probably playing a role.

You should also look into your stress, sleep habits, gut function, and level of hydration.

​There are also many potentially serious causes that need to be considered.  Therefore, it you are excessively fatigued, see your doctor!

Now it’s your turn…

​Are you tired?

​What ​did you ​find that cause​d your fatigue?

Any advice you would have for others?

Leave your questions and comments below.​

The Best Natural Treatments for Adrenal Fatigue

Are you constantly tired no matter how much you sleep?

Do you get overwhelmed by stressful situations that you could handle in the past?

Is it hard to get out of bed in the morning even after a long sleep?

Do you depend on caffeine or sugary drinks just to get through the day?

If you answered yes to any or all of these questions, there is a strong chance that you are dealing with adrenal issues, particularly adrenal fatigue.

In this article I will discuss the symptoms of adrenal fatigue and how to diagnose it.

I will then walk you through the best natural treatments for adrenal fatigue and lifestyle changes that will help you regain your energy and your life.

Here we go…

More…

What is Adrenal Fatigue?

So what is adrenal fatigue? 

When the body is under stress, the adrenal glands will release hormones such as cortisol, DHEA, and epinephrine.

These hormones regulate heart rate, the immune system, energy storage, and more.

Cortisol is our “stress hormone.”  When its levels are elevated, that signals the mitochondria in our cells to increase energy production to help us get through whatever stress is occurring.

When the body is functioning correctly, the cortisol will only be elevated for a short period of time then drop back to the normal pre-stress levels.

However, under high stress situations such as chronic illness, relationship issues, death in the family, a job you hate, and others, the cortisol level remains high for an extended period of time.

Eventually, the adrenal glands will be unable to keep up with the cortisol demands and the levels will drop.

Energy production in the cells decreases, which causes symptoms of fatigue.

These people often resort to consuming large amounts of caffeine, sugar, or other stimulants just to get through the day.​

This is what we call adrenal fatigue.​

If something causes ​the adrenals to essentially stop all cortisol production (such as autoimmune disease or other damage), it can be life-threatening.  This is called adrenal insufficiency or Addison’s Disease.

These patients require oral steroid replacement in order to live.​

On the other hand, Cushing’s Disease is a syndrome that causes an incredibly high amount of cortisol in the body which leads to many serious and potentially life threatening conditions.

As a general rule, conventional medicine does not recognize any adrenal issues until it reaches one of these extreme levels.

If your cortisol levels are in the normal reference range of the labwork, you will be told you are “normal” and sent on your way.

Like other hormones in the body, small changes to concentrations of these hormones can lead to big symptoms that are felt throughout the body.

People with suboptimal levels of cortisol can have significant symptoms that affect their quality of life, so it deserves our attention.

There are 4 basic stages of Adrenal Function/Dysfunction:​

    • “Surviving” – In this scenario, the normal cortisol slope is absent because of increased cortisol production. (This is actually MY cortisol curve during a very stressful time of my life)
    • “Thriving” – Cortisol production is normal.
    • “Wired and Tired” – The cortisol levels are high during the day then drop during the evenings.  That makes you feel anxious in the morning then exhausted by evening.
    • “Crashed Stage” – The adrenal gland is no longer able to keep up with the cortisol demands so the levels drop very low.  Extreme fatigue is the predominant symptom.

Cortisol has been shown to increase insulin resistance.  It also worsens leptin resistance.

Elevated cortisol also promotes hypothyroidism.

All of this leads to weight gain and lack of energy.

Adrenal Fatigue Symptoms

Symptoms that suggest you have adrenal problems and that you may need to get your cortisol level evaluated include:​

These symptoms indicate a problem with energy production and adrenal issues.

Remember, cortisol is a “stress hormone” and is typically secreted in to response to a perceived stress.

These stressors can include:

    • Frustration or emotions related to your job, work or social life
    • Over-exercising
    • Anything that is physically stressful on the body (exercise, manual labor, etc)
    • Lack of sleep (especially if prolonged over months or years)
    • Pressure of school work/work load
    • Poor diet or food choices (especially diets lacking in fruits and vegetables)
    • Constant use of stimulants such as caffeine
    • Complete lack of exercise or sedentary lifestyle
    • Chronic medical conditions (high blood pressure, insulin resistance, chronic pain, etc)
    • Recent illness
    • Anything else that causes your annoyance, frustration or stress

Please note that many of these symptoms are non-specific and can also indicate that something else is going on in the body.

That is why it is important to get a thorough evaluation by a qualified medical professional.

How to Diagnose Adrenal Fatigue

So how do you diagnose adrenal fatigue, especially if your labs fall in the “normal range?”

There are several ways to test for cortisol available.  Some are better than others.

I’m going to discuss the ones that I think are best.

It is easiest to start with a serum cortisol level.

This test can be very frustrating because is has a very large “normal” reference range.

However, it’s cheap and usually easy to get. 

Levels that fall in the middle of the reference range will not be particularly helpful, but it can show us a lot if it falls in the low normal or high normal of the range.​

So what is low normal or high normal?

    • Low normal cortisol range – 8am serum cortisol levels ranging from 4 to 10
    • Normal cortisol range – 8am serum cortisol levels ranging from 11-18
    • High normal cortisol range – 8am serum cortisol levels greater than 20

​It is important to check your serum cortisol level at 8am because that is when it is at its ”peak” level.

This represents the highest level your cortisol will be throughout the day.  If it’s already low normal at 8am, it will only get worse from there.

In order to get a full evaluation of your cortisol levels it may be necessary to evaluate the “rhythm” of your cortisol throughout the day. ​

By checking your cortisol several times per day you can accurately see how your body is responding to various situations.

This allows for more detailed information which can then be used for treatment.

The most accurate form of testing is through urinary measurements taken several times throughout the day (compared to a 24 hour urine test).

This is even more accurate than salivary levels.

My favorite is the DUTCH test.​

With the DUTCH test, you check your urinary cortisol levels 4 times throughout the day.  This gives a much better representation of how your cortisol level is trending.

Although this test is the best, it is expensive and more difficult to perform.

So should every patient that we suspect has adrenal fatigue have their urinary cortisol level tested?  No.

I would recommend starting with an 8am serum cortisol level.  Depending on what it shows, then moving to a DUTCH test may be necessary.

It is also worth doing a trial of treatment if your levels are “normal” but you are still symptomatic with several of the symptoms I discussed earlier.​

Natural Treatments for Adrenal Fatigue

So based on your symptoms and perhaps a low normal serum cortisol test or even an abnormal DUTCH test, you have been diagnosed with adrenal fatigue.

What can you do about it?

Actually, there are a lot of things that you can do.

Many of them are common sense.  Others are more targeted treatments that will depend on which stage of adrenal dysfunction you are in.

For now, let’s divide into 2 main groups – those that have low cortisol levels and those that have elevated cortisol levels.

Supplements​

Treatment for Low Cortisol (“Wired and Tired” and “Crashed”)

Click on each supplement to see my recommended brand.

    • Adrenal glandulars:  These work best for patients with very low cortisol levels.  They also tend to provide an immediate boost to energy levels.  Using glandulars in combination with other supplements listed below may be necessary.  Should be used for 6+ months.
    • Adrenal Adaptogens:  Adaptogens can actually help to lower cortisol levels when they are high and some can even raise cortisol levels when they are low.  There are many types of adaptogens but I find that blends of multiple adaptogens tends to work best.  These can be combined with glandulars as well for more benefit.  Should be used for at least 3 months.
    • CoQ10:  This coenzyme is involved in proper mitochondrial energy production and can help increase energy levels, which can be very helpful in adrenal-related issues.  Use 2 capsules (240mg) per day for several months.
    • Alpha Lipoic Acid:  ALA helps increase mitochondrial energy production, acts as a powerful antioxidant, reduces peripheral neuropathy, and lowers inflammation.  ALA can also help with weight loss due to its effects on insulin.  Start at 600mg daily and increase up to 1800mg daily as tolerated.
    • Vitamin B6:  Vitamin B6 is used in several pathways in the creation of adrenal hormones and many patients are deficient in it.  Taking higher doses of B6 during the acute phase of treatment may be necessary for a short period of time.
    • DHEA:  DHEA is the precursor to testosterone and other estrogen metabolites.  With low cortisol and low adrenal hormone production, supplementing with hormone precursors may be of benefit.  Start with a low dose every 2-3 days and increase to daily as tolerated.  Be careful because DHEA can turn into androgens or estrogens in high doses.
    • Pregnenolone:  Pregnenolone is another hormone precursor and can be helpful if used along with DHEA.  Watch out for acne as a side effect and like DHEA, start low and go slow.  The use of these hormones may be necessary for 3+ months.

​Treatment for High Cortisol (“Crashed” stage)

    • Phosphatidylserine:  Phosphatidylserine has been shown to reduce cortisol levels if taken in doses up to 600mg per day.  Use 4-6 capsules at night (each capsule is 100mg) and recheck cortisol levels in 2-3 months.
    • Ashwagandha:  Ashwagandha is an adaptogen that can actually help to lower cortisol levels when they are high and raise them when they are low.  It also can boost libido and may help with weight loss. It can also reduce anxiety symptoms caused by chronic stress.  Doses vary from 500-2000mg per day depending on tolerance and severity of symptoms.
    • Melatonin:  Melatonin has been show to reduce cortisol levels and may actually help improve your sleep at night.  Even if you are sleeping well, melatonin can still help reduce cortisol levels and should be considered.  It can also help with depression symptoms.  Doses vary from 1-3mg, but most people tolerate 3mg well.

Other Treatments

Using supplements alone will not be enough to adequately treat your adrenal fatigue and increase your energy level.

​It will be critical for you to make the necessary lifestyle changes as well.

Why?  Because your lifestyle is what got you here to begin with!

If you don’t learn how to reduce stress, get better sleep, and eat better, your adrenal fatigue symptoms will eventually return.

On the flip side, if you make the necessary changes in these areas, it will result in long term improvement for you.

Stress Management

Boy, this one is easy to say but hard to do!​

However, there is nothing you can do that will be more important to your success than learning how to better manage your stress.

​If there are stressors in your life that you can remove, then that should be a priority.

That may mean changing jobs, avoiding certain unhealthy people, or selling your kids (just kidding).

Unfortunately, there may be several stressors that can’t be removed, such as a sick family member, issues raising children, or others.

If that is the case, then you need to learn tactics that will help you manage stress and reduce its impact on your quality of life (and your cortisol!).

These stress reduction strategies can include:

    • Relaxation exercises such as yoga
    • Spend 20 minutes per day in prayer or meditation
    • Start doing something you enjoy (hobby, sports, etc)
    • Go outside!  Walking or hiking in nature can do wonders for our stress
    • Count your blessings and write them down.  It’s easy to get caught up in the negative cycle of only focusing on the things that are wrong in our lives.
    • Do something good for someone else without expecting anything in return, especially for someone less fortunate than you.
    • Donate your time or money to a worthy cause.
    • Make yourself smile everyday (even when you don’t feel like it)

Quality Sleep

I cannot stress enough how important it is to get a good night’s sleep every single night.

Your quality of sleep directly impacts your melatonin production when then impacts your cortisol level.

Lack of sleep also increases inflammation in the body and ​causes weight gain.

If you deal with sleep issues or insomnia, then this needs to be a priority for you.

You should be getting a minimum of 8 hours of sleep per night.

When you wake up, you should feel refreshed and energetic.

If this doesn’t describe you, then you need to make some changes.

These changes include:

    • Go to bed at the same time every night and get up at the same time every morning
    • No electronics (TV, phone or computer) for a least 2 hours before bedtime
    • Keep your bedroom cool and dark
    • Avoid stimulants (especially in the evenings)
    • Use supplements if necessary.  I discuss them in more detail in my article The Leptin Resistance Treatment Guide.

Diet

Diet is the most basic and one of the first things you should do to improve your energy and normalize your cortisol.

Something as simple as cutting out sugar and refined carbohydrates can do wonders for you.

Basically, you should focus on eating whole, natural foods and avoid processed food.

A simple question to ask yourself is, “Is this food natural or processed?”  Obviously, choose natural food.

In some cases, more stringent dietary instruction may be needed, but for now just realize that you HAVE to eat a healthy diet to increase your energy levels.

I would recommend starting with a good, whole food diet such as the ​Whole 30 diet or the Paleo Diet.

Summary

​There are definitely things that you can do to help you feel better and give you more energy if you have adrenal fatigue.

Start by checking your serum cortisol level along with other hormones such as insulin, leptin, and a complete thyroid panel.  You may want to consider urinary cortisol levels after the initial blood tests.

Once you have a clear picture about which stage of adrenal dysfunction you are in, supplements can be used to target your specific cortisol issues as well as other hormonal imbalances.

Appropriate lifestyle interventions will also be crucial for your success.  These include diet, stress management, and improving your sleep.

It is important to remember that correcting adrenal issues is not a quick fix – It may take 6 months or even longer.

​Be consistent and patient.  You can do it!

Now it’s your turn…

Do you have adrenal fatigue?

What supplements have you used?

Has your treatment been successful?

Leave your comments below.

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8 Common Causes of Thyroid Fatigue and How You Can Fix Them

Are you still fatigued even though you are taking your thyroid medication faithfully?

Why?

The fatigue found in thyroid disease can be because of many things.

Just taking your thyroid medication may not be enough to reverse these symptoms.

The many causes of thyroid fatigue include adrenal issues, autoimmune inflammation, food sensitivities, nutritional deficiencies, dietary issues, and even taking the wrong thyroid medication.

I will discuss each of these possible sources of fatigue and show you how to correct them.

Let’s get started…

Causes of Thyroid Fatigue

Multiple things can influence your energy level.

Unfortunately, there usually isn’t just one simple thing that you can do to reverse your fatigue.

It will require investigating all of the contributing factors and determining which of them may be playing a role in your particular situation.

​Most doctors don’t have the time in their busy office to dive into all of the possibilities.  Plus they may not even understand several of the causes or how to correct them.

That’s why you need to become aware of the causes so that you can take more control of your own health and get yourself on the road to recovery.

​1.  Adrenal Fatigue and Cortisol

The adrenal gland is your “stress” gland.  It produces the hormone cortisol.

Cortisol functions in the body by regulating blood sugar and metabolism, it activates the central nervous system, maintains blood pressure, and has anti-inflammatory actions.

Cortisol levels will go up during times of physical or emotional stress.  It speeds up metabolism so we are able to fight through that stressful time.

At first, people with elevated cortisol feel shaky, their heart may race, and they may have insomnia problems.

 Eventually the adrenal gland will not be able to produce enough cortisol to keep up with demand and the levels will drop and stay low.  This is called adrenal fatigue.

The thyroid and adrenal functions in the body are closely linked.

In fact, the TSH and cortisol levels tend to track together.

Even small changes in your cortisol level can cause significant symptoms, especially fatigue and brain fog.​

Your symptoms will vary depending on how long you have been under stress.

To determine if you have an adrenal issue, I recommend either salivary cortisol testing or better yet, ordering a DUTCH test.

You can also also ask for a serum am cortisol level from your doctor.  This does not tell you as much information as a urinary cortisol level tested 4 times in a day, but it can still be helpful.

​If your serum cortisol level is < 8, you most likely have an adrenal fatigue problem.

If it is >18, that also needs further investigation and treatment.

What to Do About It 

Stress management is essential for normal adrenal function.

This can include yoga, meditation, regular exercise, and scheduling time for hobbies and other things you enjoy.​

It is also important to avoid stimulants such as caffeine and even ADHD medications.

​Caffeine helps produce energy by putting pressure on your adrenal glands to produce more cortisol and increase adrenaline production.

That is not a good thing when the adrenal system is already weakened.

Therefore, try to wean off of your caffeine dependence if you have one.

Supplementation can also be extremely beneficial.​

How to Supplement with Adrenal Support

Why I Like It

May boost energy and well being

Almost ALL hypothyroid patients have adrenal problems

May help boost immune function

Most patients experience improvement in 1-2 months

How to Tell if You Need

I don’t always recommend testing for cortisol levels prior to treatment in every patient but if you do I recommend checking the following:

    • Serum Cortisol – AM cortisol should be between 14-16, anything less may be a problem (note: normal serum level doesn’t rule out adrenal fatigue)

How to Use

    • 1-2 Tablets per day if using Glandulars (preferably taken in the am and at noon)
    • If using supplements designed to lower cortisol like phosphatidylserine then use it at night

My Recommended Brand and Product

Adrenal Glandulars (for more severe cases of adrenal fatigue.

Get Adrenal Glandulars Here

Adrenal Adaptogens (for less severe cases of adrenal fatigue.

Get Adrenal Adaptogens Here

Phosphatidylserine (for cases of ELEVATED cortisol)

Get Phosphatidylserine Here

​2.  Inflammation from Autoimmunity

​Up to 90% of hypothyroidism is caused by Hashimoto’s Thyroiditis.  Up to 10% of the population has Hashimoto’s.  It is especially common in women (up to 20% of women may have it!).

Hashimoto’s is an autoimmune condition.  This means that something has caused your immune system to go rogue and attack a part of yourself (in this case, the thyroid gland).

This attack results in inflammatory cells increasing in that part of the body. 

Inflammation causes you to feel “worn down,” similar to how you feel when you are sick with a virus.

What to Do About It 

If you don’t know if you have Hashimoto’s, ask to be tested for it.​

This is a blood test that checks for 2 antibodies:​

  • TPO antibodies
  • Thyroglobulin antibodies

If either antibody level is >35, you have Hashimoto’s Thyroiditis.

You should also talk to your doctor about any other autoimmune conditions that could be present.​

It is also important to eat organic, natural food and avoid ​processed food and sugar.

Meal plans such as Whole 30, Paleo, and others are great for helping you stay on track and reducing the inflammation caused by the inflammatory food-like substances found in much of the standard American diet.

If you need more help, I would strongly recommend hiring a certified nutritionist to help you learn how to eat properly.​

This will be discussed more below under blood sugar imbalances.​

3.  Food Sensitivities

​Thyroid disease is commonly associated with food sensitivities.

The most common of these is gluten.  Gluten is a protein found in grain products, especially wheat.

It is estimated that up to 1/3 of the population has some level of gluten sensitivity.

About 90% of all food sensitivities occur from the following foods:

  • Wheat
  • Milk
  • Soy
  • Eggs
  • Peanuts
  • Tree Nuts
  • Shellfish
  • Fish

These food sensitivities cause inflammation of the digestive tract which can impair its ability to absorb nutrients.  When you are deficient in nutrients, fatigue is typically a major symptom.

What to Do About It 

The gold standard for identifying food sensitivities is the elimination diet.

​You can either remove one food at a time for 3 weeks, then reintroduce it and see if you react. This process could take 6 months or more to get through all of the foods.

Or, you can bite the bullet and remove all of the top 8 culprits together for 3 weeks, then reintroduce each one separately every few days.

If you react, keep that food out of your diet. If you don’t react, you can continue to eat it then reintroduce the next one on the list.

There are also some reference labs that have IgG food sensitivity testing available.

I believe the data supports that ALL thyroid disease patients ​should be gluten-free and probably dairy-free, even if you don’t react while eating an elimination diet.

I will discuss diet more under Blood Sugar Imbalances below.​

4.  Low Ferritin/Iron

​Ferritin is the storage form of iron.

Having optimal iron levels in the body is essential for normal energy production.  It also is required for normal thyroid hormone production.

A deficiency of iron causes fatigue and other symptoms such as hair loss, decreased exercise tolerance, frequent infections, and GI issues such as gas and bloating.

Hypothyroidism also affects the ability to properly absorb iron.  This creates a vicious cycle that results is severe fatigue.

Even when there is no evidence of anemia (low hemoglobin), supplementing with iron has been show to  improve energy and reduce fatigue.

What to Do About It 

​Ask your doctor for a complete iron study.

This will include a serum ferritin, total iron, and TIBC.

If your levels are suboptimal or if you continue to have symptoms of low iron, consider supplementing.

How to Supplement with Iron

Why I Like It

May boost energy levels

Up to 50% of Hypothyroid patients are deficient in iron

Helps promote thyroid conversion & function

Generally works within 1-2 months

How to Tell if You Need It

Check your iron studies and only supplement if your levels are sub optimal or low:

  • Ferritin – Optimal Levels = 40-50
  • Serum Iron – Middle of the reference range
  • TIBC (Total Iron Binding Capacity) – Middle of the reference range
  • Percent Saturation – 35-38%

How to Use

  • Liquid Iron:  start with 10 ml each day, do not exceed 20 ml per day (if you take more than 1 dose per day make sure to split it apart from one another and take at least 4 hours away from your thyroid medication)
  • Iron Capsules:  start with 1 capsule of iron and increase up to 3 per day as tolerated and based on your serum iron/ferritin levels (take at least 4 hours away from your thyroid medication)

    My Recommended Brand and Product

    Use liquid iron if you have intestinal issues such as gas, bloating, diarrhea, constipation or if you have previously failed capsule forms of iron:

    Get liquid iron here

    Use this capsule form if you don’t tolerate the liquid iron version above (some patients have various symptoms on liquid iron such as teeth pain or simply can’t tolerate the taste or texture of the liquid):

    Get iron capsules here

    5.  B12 Deficiency

    Thyroid disease is commonly associated with low stomach acid levels.  If you don’t have adequate stomach acid, you can’t fully digest your food and extract the nutrients from it.

    Inflammation from autoimmunity such as Hashimoto’s only makes the absorption of the nutrients worse.

    Lack of thyroid hormone causes nutrient deficiencies in certain vitamins such as B12.​

    In fact, up to 40% of hypothyroid patients have suboptimal levels of vitamin B12.

    B12 is directly involved in energy production due to its effects on mitochondria in the cells.

    A deficiency of B12 will decrease the efficiency of the mitochondrial energy production, which will result in fatigue.​

    If the deficiency is severe, it can also cause a type of anemia called pernicious anemia.

    – MTHFR​

    Up to 60% of the population has some form of this gene mutation.

    MTHFR (methyltetrahydrofolatereductase) is an enzyme that adds a methyl group to certain nutrients which allows our body to metabolize them.  When that enzyme is deficient, we cannot metabolize nutrients as efficiently​ which can result in a deficiency of that nutrient.

    The B vitamins such as B12 and folate are metabolized in this way.  Their levels can be suboptimal in a patient with an MTHFR mutation.

    It can also cause an elevation in homocysteine levels, which increases the risk for cardiovascular disease.​

    Read more about MTHFR by clicking here.

    What to Do About It 

    You should ask your doctor to be tested for the following:

    • Serum B12 – should be > 1000
    • MCV (mean corpuscular volume) – part of a Complete Blood Count – should be >92
    • Homocysteine – should be < 9
    • MTHFR – if heterozygous or homozygous for either mutation, you will need to take a methylated B vitamin supplement.

    If any of the results are abnormal, consider supplementation. 

    Supplementing with a B complex in addition to vitamin B12 shots can dramatically improve energy levels.

    Make sure to find a B complex with high levels of B6 like this one.

    You should also consider supplementing with B12 shots.

    Why not oral or sublingual?​

    ​Shots are superior to oral forms because they get directly into the tissues and bypass gastrointestinal absorption.

    Many thyroid patients have issues with constipation, SIBO, ​and other GI related issues that can impair absorption of nutrients.

    Completely bypassing the GI tract can help ensure that the B12 is absorbed as much as possible.

    B12 shots are one of the best ways of increasing energy levels in hypothyroid patients.

    Remember – It is important to make sure your B complex and your B12 shots are methylated unless you know that you don’t have the MTHFR mutation.

    How to Supplement with B12 Shots

    Why I Like It

    May boost energy and reduce fatigue

    May help increase metabolism and fat loss

    Help improve mood and increase concentration

    Generally works within 1-2 weeks

    How to Tell if You Need It

    Patients with the following symptoms should consider using B12 shots:

      • Obesity or weight gain
      • Fatigue or low energy levels
      • Lack of sleep or insomnia
      • Depression or anxiety
      • Hair loss or lack of hair growth
      • Serum B12 levels < 1000
      • Homocysteine levels > 9
      • MCV (mean corpuscular volume) > 92
      • High levels of inflammation

    How to Use

      • Take 5,000 mcg of Methylcobalamin every 7 days for at least 10 weeks
      • You will need 10 weeks worth of injections to saturate tissues and increase cellular B12 levels

    My Recommended Brand and Product

    Make sure you get methylcobalamin shots in a high enough dosage (5000 mcg) for best results.

    6.  Blood Sugar Imbalances

    The standard American diet is loaded with processed foods, sugar, and simple carbs.​

    Sugar and simple carbs provide a quick energy boost because they are rapidly absorbed and metabolized, but they are harmful in the long run.

    When you eat sugar or simple carbs, your glucose level surges.  That triggers your pancreas to release insulin which transports the glucose into the cells.

    The insulin then drives down your sugar.  Sometimes your body overcorrects and your glucose levels​ drop too low.

    This causes symptoms such as fatigue, shakiness, brain fog, and the desire to eat more sweets or carbs.

    You therefore eat more sweets or carbs, and the cycle starts all over again.

    The higher levels of insulin also results in long term weight gain and/or difficulty losing weight.

    If you find yourself feeling tired around late morning and mid afternoon, your blood sugar is probably on such a roller coaster.

    What to Do About It 

    The body can produce energy by using 2 substances for energy:  sugar or fat.

    Since most people eat way more sugar and carbs than they should, their bodies use sugar as the default energy source.

    In order to get off of the sugar/carb roller coaster, you will need to “train” your body to use fats preferencially over sugar.

    The best way to do this is to cut sugar and simple carbs completely out of your diet.

    Yes, you can do it!

    It typically takes 3-4 weeks to convert your body into a fat-burning machine.

    You might feel a little woozy and tired the first few days, but those symptoms will go away. 

    You will then notice a increase in energy and a drop in your appetite.  Plus, you will most likely drop several pounds.​

    There are several excellent diet plans on the market that can help you make this lifestyle change (I don’t like the word diet, which sounds temporary).​

    My favorite dietary programs include:

    7.  Poor Sleep Hygiene

    Low (or high) thyroid hormone may directly reduce the QUALITY of your sleep.

    It has been shown that thyroid hormone is involved in both REM and non REM sleep.

    This may explain why some patients can still have fatigue despite sleeping 10 or more hours per night.

    It doesn’t matter how long you sleep if the quality of that sleep is poor.

    If hypothyroidism is causing a reduction in your quality then you will need thyroid hormone replacement to fix this problem.

    If you aren’t sleeping well as a result of high stress, anxiety or reliance upon caffeine then you really need to step it up and focus on getting more sleep.

    Another important factor is to consider WHEN you are getting your sleep.

    People tend to have better functioning circadian rhythm’s when they sleep through the EVENING, and not through the daytime.

    ​In fact, studies show that people who work nights have an increased risk of DEATH from all causes and an increase risk of heart attacks.

    What to Do About It 

    Get at least 8 hours of sleep per night.

    Your bed should be reserved for sleep and sexual activity ONLY.  Avoid TV, reading, computer work, or playing on your smart phone while in bed.

    Try to go to bed at the same time every night and get up at the same time every morning.

    We are creatures of habit.  Our body will respond better to a consistent routine.

    Avoid any stimulants in the evening.  They will affect your sleep pattern.​

    Obstructive sleep apnea is also a common cause of sleep issues.  You should consider seeing your doctor to have it ruled out if nothing has worked to this point.​

    If sleep apnea has been ruled out and you are still not sleeping or sleeping well, it may be time to consider supplements.​

    How to Supplement to Improve Your Sleep

    Why I Like It

    May help improve energy levels

    May help to decrease levels of inflammation

    May help reduce brain fog and mental slowness

    Requires lifestyle change for best results

    How to Tell if You Need It

      • You should be getting 8 hours of quality sleep every night.
      • If you find yourself waking up exhausted then you should consider checking for sleep apnea or a trial of the following supplements to improve sleep

    How to Use

      • Take each supplement as indicated on the bottle or as recommended below
      • In addition to these supplements make sure you practice adequate sleep hygiene, that means: black out curtains for your bedroom, noise cancelling ear plugs, having a consistent sleep schedule, and avoiding all electronics 3 hours prior to your scheduled bed time

    My Recommended Brand and Product

    For minor sleep issues start with supplements containing 5-HTP which may promote proper melatonin production and induce sleep naturally (take 100mg 30 minutes before your scheduled bed time):

    Get 5-HTP Here

    For more difficult cases consider the addition of melatonin + 5-HTP, start with 1-3mg of melatonin and don’t be afraid to use melatonin if you need it.

    Get 5-HTP and Melatonin Here

    For more the most difficult cases consider using serotonin and GABA potentiators. These supplements help enhance GABA and serotonin neurotransmitters in the brain and help induce deep sleep.

    Get GABA/Serotonin Potentiators Here

    ​8.  Are You On The Right Thyroid Medication?

    It’s important to end this article by discussing your thyroid medication.

    Most physicians are trained to manage thyroid disease by monitoring the TSH level.​  “Normalizing” the TSH is typically the only treatment that is done.

    However, even when the TSH is “normal,” studies show that patients may have 20-30% less circulating T3 and T4 levels compared to age-matched controls.​

    The most sensitive marker to determine cellular levels of thyroid hormone is the reverse T3:free T3 ratio​.

    That’s why it’s important have a complete thyroid panel drawn, not just a TSH.

    By far the most common medication used by physicians when treating hypothyroidism is a T4 only medication like levothyroxine or Synthroid.

    If you’re body isn’t converting T4 to T3 like it should, then adding a T4 only medication will not be enough to increase your cellular thyroid hormone levels.​

    If your cellular thyroid levels are low, fatigue will be a predominant symptom.​

    What to Do About It 

    ​Ask your provider to order a complete thyroid panel which includes:

    ​If your reverse T3:free T3 ratio is < 0.2, ask your provider about changing to a natural dessicated thyroid (NDT) medication such as Armour Thyroid, WP Thyroid, or Nature-throid.

    These medications consist of about 20% T3 and 80% T4.

    Adding T3 only medication such as Cytomel to your levothyroxine is also an option.

    I discuss thyroid medications in much more detail in my article found here.​

    If your doctor is unwilling to do this, you may need to find a different doctor that is willing to work with you.  A doctor who specializes in functional medicine would be preferred.

    ​Summary

    Fatigue is a very common symptom of thyroid disease and may indicate a deeper problem ranging from hormone imbalances to nutrient deficiencies.

    Simply replacing thyroid hormone may not be enough to completely energize your body and reduce your fatigue.

    It is important to take a comprehensive approach to the problem and investigate all potential contributing factors.

    The combination of these therapies above has proven to be very effective in my patients and I believe they can help you as well.

    Make sure to employ ALL of the therapies that are relevant to you and your situation.

    Now it’s your turn:

    Are you suffering from thyroid fatigue?

    What have you tried?

    Leave your comments below! ​

    Why Testosterone Is So Important

    Why is testosterone so important?

    It may be the most misunderstood of all of the hormones in the body.

    Thanks to anabolic steroids and the misuse of them, many people are afraid of testosterone and have received lots of false information about it.

    In fact, it is an essential hormone that both men AND women need to live happy, healthy, energetic lives.

    If the levels of testosterone are not optimal in your body, it will be almost impossible to have the quality of life that you should ideally have.

    If you are having fatigue, loss of muscle strength, loss of libido, night sweats, headaches, cold intolerance, and if you are gaining belly fat, you may have a testosterone problem.

    Let’s dive into this hormone further to learn more about it and address much of the misinformation that many people may have. I will also discuss symptoms, testing and treatment.

    More…

    What Is Testosterone?

    Testosterone is a hormone that is produced in the testes and to a lesser degree in the adrenal glands in men. It is produced in the ovaries and adrenal glands in women.

    Testosterone is the hormone that grows tissue in the body.

    It is responsible for muscle growth, bone growth, hair growth, sexual function, sexual drive (libido) and is essential for overall health and feelings of well-being.

    Testosterone Facts

    • Men aged 30-70 will lose 1-3% of their total testosterone every year.
    • Women will lose half of their testosterone production between ages 20 and 40.

    Consequences of Low Testosterone

    Let’s dive into these more.

    Heart Disease –

    I believe that optimizing hormones is key for prevention of disease, including heart disease

    Several studies have shown that testosterone not only doesn’t cause heart disease, it is actually protective. Here is another study.

    A study from the American Heart Association’s journal Circulation showed that as the testosterone level drops in men, their risk of heart disease increases.

    The authors even suggested that the testosterone level could potentially be used as a marker for predicting which patients were at high risk of developing heart disease.

    By the way, doctors today are taught that statin medications (Lipitor, Zocor, etc) are essential to reduce the risk of heart disease.

    In fact, if you follow some of the guidelines, the majority of adults should be on a statin.

    However, whether statins actually reduce the incidence of heart disease is controversial.

    I personally think it is more important to get the body into balance, including hormones. Most inflammation and disease will resolve without the need for medications.

    Alzheimer’s Disease –

    Studies have shown that low testosterone has been associated with worsening cognitive function in older men.

    On the flip side, it also appears that testosterone therapy improves mental function in men.

    In case you’re wondering, it also seems to help in women.

    Diabetes –

    A study published in 2013 found that low testosterone levels may help predict if a man will develop insulin resistance or type 2 diabetes in the future.

    It is unknown whether low testosterone increases the risk of diabetes, or if both conditions are due to the majority of those patients being overweight.

    Regardless, there is a definite connection between low testosterone and type 2 diabetes.

    Prostate Cancer –

    Doctors have been taught that testosterone can cause or worsen prostate cancer.

    This simply is not true.

    This belief was based on a flawed study from 1941.

    Multiple studies have since shown no increased risk – ​Here, here, here, and here are some examples.

    In one study, healthy males were given super high doses of testosterone, but they had no increase in PSA or the size of their prostate glands.

    In fact, having low levels of testosterone was shown to be a risk factor for developing prostate cancer!

    Osteoporosis –

    1 in 7 of postmenopausal women have osteoporosis.

    Half of all women over 50 can expect to suffer an osteoporosis-related fracture during their lifetime.

    After a hip or vertebral fracture, death either caused directly from the fracture or due to a secondary problem is as high as 25-35%!

    That is why we should do all we can to reduce this risk.

    Testosterone has been shown to increase bone density.

    By the way, calcium does not increase bone density significantly, but vitamin D reduced the risk of fractures by 16%.

    Breast Cancer –

    Testosterone also seems to protect against breast cancer.

    It is believed that testosterone down-regulates the estrogen receptors in the breast which inhibits breast cancer growth.

    Conditions such as PCOS where the testosterone levels are elevated are not associated with higher breast cancer rates. In fact, they may actually have lower rates.

    By the way, micronized progesterone does not increase breast cancer and may in fact be protective.

    If you are on synthetic progesterone (medroxyprogesterone, norethindrone, etc), you should talk to your doctor about switching to micronized progesterone (Prometrium or bioidentical).

    There is also evidence that iodine supplementation reduces breast cancer risk.

    Symptoms of Low Testosterone In Men

    Symptoms of Low Testosterone in Women

    If you have 5 or more of the above symptoms, you have a high likelihood of having a low testosterone level and it’s time to go get tested.

    Many of the symptoms of testosterone deficiency mirror those caused by other hormone issues, especially hypothyroidism and adrenal fatigue.

    Are you tired because you have low thyroid, low testosterone, or adrenal fatigue?

    What about your insomnia, or weight gain, or mood swings? Which one is causing it?

    The answer is possibly all of them!

    That is why you need a thorough history and comprehensive lab tests performed before your individual story becomes clear.

    Bonus information for women: If you have hot flashes during the day – 40 seconds of heat that begins in your chest then moves to your face – you most likely have low estrogen levels.

    If you have night sweats – you wake up drenched in sweat to the point that you sometimes even have to change clothes – you are most likely low in testosterone.

    Diagnosing Testosterone Deficiency

    I believe it is essential to diagnose and treat adrenal and thyroid issues before addressing the sex hormones such as testosterone.

    They should at the very least be addressed at the same time.

    If your testosterone is low but you are also dealing with adrenal and thyroid issues, you simply won’t feel better until your adrenal and thyroid issues are corrected, even if the testosterone becomes optimized.

    So, how do you know if you are low in testosterone?

    Labs for Low Testosterone

         Men –

      • CBC
      • CMP
      • PSA
      • Total Testosterone
      • Free Testosterone
      • Estradiol
      • Lipid Panel
      • 25-Hydroxyvitamin D
      • Complete Thyroid Panel – TSH, free T4, free T3, reverse T3, TPO ab, Thyroglobulin ab

         Women –

      • CBC
      • CMP
      • Lipid Panel
      • Total Testosterone
      • Estradiol
      • FSH
      • 25-Hydroxyvitamin D
      • Complete Thyroid Panel – TSH, free T4, free T3, reverse T3, TPO ab, Thyroglobulin ab

    At this point, I have found insufficient evidence that salivary testosterone measurements are a reliable form of testosterone testing. I therefore recommend serum testing only.

    It is important to point out that there is a difference between a “normal” reference range on a lab result and an “optimal” testosterone level.

    On most labs, the normal reference range for testosterone in men is about 300 to 1200. That is a HUGE range.

    Most insurance plans require 2 different total testosterone levels below 300 before they will pay for testosterone replacement therapy, whether the patient is symptomatic or not.

    But people that are having symptoms may benefit even if their testosterone level is as high as in the low 600s.

    The optimal range in men should be in the upper 1/3 of that range (I prefer 900-1100).

    In women, most labs list a normal reference range of about 15-70 ng/dl.

    However, excluding conditions such as PCOS, the optimal range for testosterone in women should be 150-250 ng/dl.

    Who Qualifies for Testosterone Therapy?

    Men –

    A man qualifies and should be considered for testosterone therapy if:

    • Serum total testosterone is <600
    • He has several of the symptoms listed above
    • His PSA is <2.5 (if >2.5, he should have a urological evaluation before being considered for therapy)
    • Any vitamin D, adrenal, or thyroid issues have been addressed
    Women

    A woman is a candidate for testosterone therapy if:

    • She has several of the symptoms listed above
    • Her total serum testosterone is <100
    • She has had a mammogram in the past year
    • Any vitamin D, thyroid, or adrenal issues have been addressed

    Treatment of Low Testosterone

    Studies have shown that testosterone therapy improves many things, including libido, quality of erections, increased lean mass, increased bone density, improved lipid parameters, reduced fat mass, and improved blood sugar control. Here are 2 examples – here and here.

    With that in mind, let’s look at treatment options.

    Men -​

    There a 3 types of testosterone therapy available for men – topical, injections, or subcutaneous pellets.

    1. Topical – Androgel®, Axiron®, Fortesta®, Testim®, Vogelxo®, transdermal patch-

    Advantages –

    • no injection or insertion procedure required
    • bioidentical testosterone

    Disadvantages –

    • messy (creams or gels)
    • expensive
    • can be transferred via skin contact to your partner if it’s not rubbed in adequately
    • can be difficult to achieve optimal levels of testosterone because of inconsistent absorption
    • not always covered by insurance

    2.  Injections – testosterone cypionate, testosterone undecanoate

    Advantages –

    • once weekly dosing
    • usually covered by insurance
    • relatively inexpensive

    Disadvantages –

    • requires weekly shots
    • testosterone level varies greatly (high at first, low late in the week)
    • may cause an elevation in red blood cells (erythrocytosis) – must be monitored
    • synthetic testosterone

    3.  Subcutaneous Pellets

    Advantages –

    • bioidentical testosterone
    • lasts 6-7 months
    • more consistent blood levels
    • lower incidence of erythrocytosis

    Disadvantages –

    • expensive
    • requires an office procedure to implant the pellets
    • not covered by insurance
    • slight risk of infection at the implant site

    Women –

    There are currently no pharmaceutical testosterone therapies for women.

    However, there are still 2 treatment options that can be extremely beneficial:

    1. Compounded bioidentical creams

    Advantages –

    • less expensive
    • multiple compounding pharmacies available

    Disadvantages –

    • inconsistent absorption

    2. Subcutaneous pellets

    Advantages –

    • lasts for 3-4 months
    • consistent blood levels

    Disadvantages

    • expensive
    • requires an office procedure to insert the pellets

    If she has a history of breast cancer, she could receive testosterone pellets with anastrazole – but no estrogen.

    Side Effects of Testosterone Therapy

    When prescribed correctly, side effects are usually minimal.  However, we are talking about a hormone, so it is possible to notice some changes. They may include:

      • Increased hair growth on the face (usually the “peach fuzz” primarily
      • Enlargement of the clitoris (women).  Reverses when therapy is stopped.
      • Erythrocytosis – increased hemoglobin and hematocrit.  Usually mild.  Treated with regular blood donation.  CBC should be monitored.
      • Mood Swings/Irritability – less common with bioidentical testosterone
      • Water Retention – rare and usually only the first few weeks of therapy.
      • Voice Changes – rare with bioidentical testosterone.  Most commonly seen with anabolic steroids.  Of note, 34% of women have voice changes as they age, so it may not be from the testosterone therapy.
      • Injection Site Irritation or Infection – rare and usually mild
      • Insertion Site Infection with Pellet Therapy – rare and usually mild
      • Excessive Estradiol Conversion – Occasionally men will have an overactive aromatase enzyme which will convert the testosterone to estradiol.  This can cause breast tenderness and mood swings.  Treated with the supplement DIM or a  medication such as Arimidex or Femara.

    Summary

    Testosterone is an important hormone in the body and is vital for well-being and energy.

    Studies show that it helps prevent heart disease, dementia, osteoporosis, and possibly breast cancer.

    When managed closely by an experienced provider, it is a safe and effective therapy for multiple symptoms associated with menopause, andropause, and the aging process.

    Now it’s your turn.

    Do you think you have low testosterone?

    Have you been tested?

    Have you ever been treated for low testosterone?

    Did testosterone therapy help you?

    Leave your comments below!

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