Low Energy? What blood work an ND may want to see.

If I was to ask you to rate your energy on a scale of 1-10 (10 being great) what would you say? If you said lower than 5/10, even after a good nights sleep, it is something that should be addressed.

I like to review blood work first when fatigue is a concern, as a few common nutrient and hormone deficiencies can be the culprit. The reference ranges I refer to may be slightly different than your MD for a few reasons.

1. I want to optimize your levels to sustain better energy.

2. I am referring to the newest reference range recommendations that will hopefully be reflected in blood work soon.

3. I see results when patients levels reach a certain level.

So what blood work do I like to see and what levels should they be at? This may vary slightly depending on someone’s health history.

• Vitamin B12 - This should be above 200 pmol/L, ideally above 450 pmol/L.

• Ferritin - You have iron deficiency anemia if your ferritin level is below 30 ug/L. Unfortunately, this is becoming more and more common in today’s society. A full iron panel is not often needed.

• TSH - Your thyroid stimulating hormone should be between 0.8-2.5 mIU/L. This can fluctuate during times of stress or hormone changes. Medication is not often needed until the level gets much higher, however supporting adrenals (stress hormones) and the thyroid gland if out of this range can help.

• Morning Cortisol - Between 7-9am your level should ideally be between 450-550 nmol/L. Cortisol is an essential hormone that plays many important roles, including regulating your body's stress response. If it is low you are most likely suffering from burnout!

There are several reasons why someone may be deficient in any of these and it is important to address the cause as well as supplement for the deficiency.

Take a look at your most recent blood work. What are your levels like? I’m happy to help improve them and ultimately your energy!

Welcome Dr. Paige!

If you have come to the clinic in the past year or so, you may have seen or heard of my lovely associate Dr. Paige Weatherbee-Sakr! She started during my second maternity leave and has continued seeing patients on Wednesdays since. She will be at Symmetry for the foreseeable future, so it is probably time to introduce her properly! She is a great asset to the team. I want to highlight that she is completing a Mental Health Fellowship this year as this is an area of interest to her in practice as of late. I’ll pass it over to Dr. Paige to tell you more about herself.

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Hi my name is Paige and I am a Naturopathic Doctor working at Symmetry Wellness Centre with Dr. Karen! Some of you may have met me while I was covering for Dr. Karen’s second maternity leave. For those of you who did not, I figured I would share a little about myself, so you know who I am if I pop up in the blog or in her office!

I started covering for Karen in May of 2023 and have found myself continuing to work in her office on Wednesdays at Symmetry Wellness Centre in Burnside. I am also certified in IV therapy like Karen and so I provide 1:1 visits as well as IV care in the office.

When I am working, I like to work from a place of addition – whether that be food, sleep, habits or water - my goal is to make sure you are getting enough! I do this through a lot of listening, a lot of helping people with introspection and leaning on the tools at our disposal – IVs, Botanicals, Nutrition, Nutraceuticals, Exercise, Counselling and Diagnostics.

I am also interested in research and how we blend that with clinical experience, specifically in the world of mental health and the digestive system. With this interest, I am also currently pursuing a year long program to improve my grasp on the research around mental health support and Naturopathic medicine. I hope to be able to share the fruits of this program in 2025!

When I am not in the office, I can be found in the kitchen (since I love food), in the woods (since I love to geocache and hear the birds), Watching shows or in a book (since I love science fiction and fantasy), or just spending time with loved ones (since I am a wife/sister/daughter/aunt/dog + cat mom).

I hope you find as much joy as I do both professionally and personally! Hope to see you in Dr. Karen’s Office soon!

Heart rate variability - A valuable tool to track well-being

A healthy heart does not beat like a metronome, but actually changes its rhythm with each heart beat. The constant variation between each beat is called your heart rate variability (HRV). This is something I have been speaking about to several of my patients recently, as more people have smart watches and other health tracker apps that can measure this.

What affects HRV?

There are certain situations that result in a higher HRV and other situations resulting in a lower HRV, reflecting your hearts ability to respond to different situations. This ultimately reflects how your nervous system is responding. HRV can react to stress and/or illness before resting heart rate, which makes it one of your body’s most powerful signals—providing useful insights into your stress levels, recovery status, and general well-being.

Generally a lower HRV is associated with your “flight or flight” response, stress or illness. A higher HRV is associated with your “rest and digest” response, general fitness and good recovery. It is amazing how we can track how just a 5 minutes meditation exercise can improve your HRV.

There are some things we cannot control that affect HRV such as age, hormone cycles, illness and amount of stress we have. However, to improve HRV there are things we can control such as sleep routine, alcohol and caffeine intake, how we manage stress and fitness level.

Tracking HRV

A high or low HRV is relative to each person. It is therefore best to track your own HRV over time and generally aim for a higher level, or track what improves it and decrease it, instead of comparing to others. It can range from 20 to above 150 depending on the tracker. Also, sometimes it is ok to see a lower levels for a short period of time, eg. during a strenuous activity where our nervous system is working hard to increase our heart rate. It is then how we recover that matters.

HRV fluctuates often throughout the day so is is helpful to track it in a controlled setting like sleep. However, some trackers, like the smart watch may limit this if you don’t want to wear it at night.

I see a lot of digestive issues, fatigue, insomnia etc in my practice and it almost always has a component that connects back to the nervous system. If we can help manage our stress response and improve HRV, that can help us tremendously over time. Ultimately, you don’t NEED to track HRV to check in with how you are doing overall. However there are some pretty neat tools out there now that can track things like HRV that we can use to our advantage.

Thoughts? Check in with me if you have questions.

Dr. Karen

Burnout & Energy Crashes - Unpacking Reasons Why

Burnout or fatigue...a very common concern I see in practice. 😞😴 But I promise you don't have to feel like this forever! ⠀
If you have been feeling emotionally and physically drained for awhile now let's dig into some common reasons why this may be. ⠀

1. Nutrient deficiency

Have you had blood work done to check nutrient levels lately? Some common blood work I like to see for those who are struggling with energy are:⠀⠀

• ferritin (your iron stores)⠀

• B12⠀

• Thyroid panel - additional symptoms may point us to look into this⠀

• D3 - surprisingly common to be low in those that are struggling

This is often where I start because it may be the simple solution. Symptoms such a heavy periods, or poor digestion may push me to get these checked sooner rather than later as well. ⠀
If these look good, we dig a little deeper...

2. Adrenal insufficiency (aka burnout)⠀

This is the one of the most common causes of fatigue I see in practice. You may be or have been in "fight or flight" for awhile, bombarding your body with cortisol and adrenaline (those get up and go hormones). It's telling you it has had enough and won't be listening to the signals anymore. Your body has decreased its production of cortisol, affecting your circadian rhythm. ⠀
We need to support your body with adaptogen herbs such as rhodiola, ashwagandha and holy basil and vitamins such as vitamin C, magnesium and Bs to support cortisol production again. ⠀
OR....⠀
We need to calm down your nervous system with nervine herbs such as passionflower or lemon balm to decrease the "fight or flight" response. ⠀
Is this you? 

3. Female hormone imbalances

This is a big topic itself so I'll just be brushing the surface here, but hormones can definitely affect your energy level. ⠀
Do you see a cycle to your fatigue? This could mean it is related to your menstrual cycle and therefore related to imbalances in estrogen and progesterone levels. ⠀
This is normal to see happen to some extent but not to the extent it interferes with your life. I’ve touched on this before but typically we see an increase in energy the week before ovulation (we are more extroverted) and then it decreases before your period (and we are more introverted). But if you feel so wiped several days before your period we assume either progesterone is low (do you also have spotting before your period?) or estrogen is too high (crazy mood swings or breast tenderness as well?) creating an imbalance. ⠀
What is great is that we can test these hormones through blood or urine with the DUTCH test and there are many great herbs and more natural modalities such as acupuncture that can help balanced it all out. 

Any of these signs common to you? Let’s explore together.

In health & happiness,

Dr. Karen