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!

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

Estrobolome - The Gut-Hormone Connection

Improving your digestion goes beyond keeping your gut happy. It is connected to a number of different “systems” in our body, one being your hormones, estrogen in particular. When this isn’t in balance it can affect mood, weight, cycle, libido, acne and even bone health. 

What is the Estrobolome?

The gut microbiome is the collection of bacteria, both good and bad, in the digestive system. Ideally there should be no imbalance in the bacteria, called a dysbiosis, but due to diet, antibiotics, stress, or environmental exposure it is common for an imbalance to occur. 

Among many roles, the gut microbiome plays a crucial role in regulating circulating estrogen levels. Specific microbes in the microbiome, called the estrobolome, specifically do this. The microbes in the estrobolome produce an enzyme called beta-glucuronidase, which deconjugates estrogens into their active forms. This increases estrogens that are reabsorbs and capable of binding to estrogen receptors in the body and influencing those hormonal physiological processes. This process is known as phase 3 estrogen detox and when there is the right amount of beta-glucuronidase, estrogen homeostasis is maintained. When dysbiosis occurs, the estrobolome up-regulates or down-regulates beta-glucuronidase leading to a deficiency or excess of estrogen in the body. I most commonly see an estrogen excess. 

Common signs of excess estrogen which can be influenced by estrobolome are:

• bloating, especially before your period

• irritability 

• acne

• breast tenderness

• heavy periods

• headaches or migraines 

• PCOS picture 

Issues with deficient estrogens post-menopausal influenced by the estrobolome are:

• increased risk of osteoporosis

• increased risk of cardiovascular disease 

• increase risk of obesity 

What affects the estrobolome?

Anything that disrupt the gut microbiome typically affects the estrobolome as well. 

• Poor diet and lifestyle are the most common triggers for dysbiosis. Certain bacteria feed on certain food we eat (sugar and gluten as common examples), grow and in tern tell the brain to eat more of that food, causing an overgrowth. Studies have shown that a shift in the diet can induce microbial shifts within 24 hours. Focus on organic food when you can, cruciferous vegetables such as broccoli and brussels sprouts and fibre. 

• Antibiotics and birth control pills both have been found to alter the microbiome and estrogen levels, leading us to believe it is affecting the estrobolome. 

• A broad spectrum probiotic can influence the microbiome to shift positively. Antimicrobial herbs may be effective at eliminate an overgrowth. Talk to an ND like me to discuss if these are advised for you. 

• Calcium-D-Glucurate is a supplement that is a beta-glucuronidase inhibitor. This allows estrogen to remain conjugated, in its inactive form, to be safely eliminated from the body. This is very handy for someone with known estrogen excess. 

This gut-hormone connection proves to me that gut health is again at the root of many health concerns. We don’t want to forget proper liver support or hormone support with certain herbs, but it is important to not skip the gut! 

In health & happiness,

Dr. Karen

PMS: Recognizing the Signs and Calming the Craziness

Do you feel like you could snap at anyone who looks at you some days? Or some days do you feel like you could burst into tears at any moment? I get it…I’ve been there! You aren't crazy. These emotions might seem out of the blue, however if you are tracking your menstrual cycle they may actually happen at the same time every month. You’ve got it…this is the dreaded premenstrual syndrome or PMS. 

I see this often in practice and believe it is important to note that even though symptoms of PMS are incredibly common this is not a normal response. There is usually a reason behind these feelings and symptoms and things that can be done to mitigate them, besides jump to the birth control pill. 

Common symptoms of PMS:

• Very emotional - angry, teary, irritable
• Fatigue
• Breast tenderness
• Cramps
• Bloating
• Food cravings
• Back pain
• Acne

What is causing PMS:

Throughout the month your hormones have a cycle and rhythm (See the graph to the right). There is a monthly increase and decrease of both estrogen and progesterone, but they happen at different times. We need proper nutrients, a low stress level, proper blood sugar balance and healthy liver detoxification for these cycles to happen properly. If your body, especially your liver, is not able to metabolism estrogen well an imbalance in the estrogen-progesterone occurs and the above PMS symptoms occur. If you pituitary gland, one of the control centres for your hormones, is not stimulated properly signals to your ovaries aren’t regular, again causing an imbalance in hormones. 

Natural Approaches to PMS:

There are many interventions to decrease PMS symptoms however these are some of my favourites to start with. 

Going with the Flow

By tracking your menstrual cycle you become aware of how your body is responding to these hormone cycles and what symptoms or emotions can be contributed to your cycle. Recognizing this may help you get through it more easily and understand why you may be feeling a little crazy at times. Take time for yourself before your period, take a nice bath, go for a massage or get a good sweat on. 

Magnesium and B6

The birth control pill actually depletes our body of both magnesium and B6. Both of these are vital to hormone regularity, therefore both helpful to decrease symptoms of PMS. Talk to your Naturopathic Doctor about the proper dose for you. 

Broccoli Sprouts

In chinese medicine it is believed that PMS is due to “liver qi stagnation.” This means there is stagnation, or a lack of movement, in the liver. Broccoli sprouts, or in particular sulporophane, up regulates an enzyme in phase II liver detoxification important in excreting excess estrogen. Basically, it gets things moving. Adding broccoli sprouts to a salad, smoothie or as a snack is a good addition to your diet. More liver support may be necessary, including turmeric, I-3-C or DIM depending on the severity of symptoms. 

Seed & Oil Cycling

Since there is natural ebb and flow to our hormones throughout the month, creating a similar cycle in our food helps to produce the proper hormones at the proper time. The seeds and oils carry certain oils, vitamins, and nutrients that can help support the body’s production, release, and metabolism of hormones. Some of the seeds used in seed rotation are flax and pumpkin for the first half of your cycle and sesame and sunflower in the second half. We also add omega 3 and evening primrose oil to the rotation. Adding seeds to smoothies, oatmeal or roll them into energy balls are some ideas to eat them daily. There is the most evidence on the benefits of flax to balance hormones and omega 3s to decrease inflammation. 

Acupuncture

Acupuncture is able to address "liver qi stagnation" specifically with certain acupuncture points. There are several studies supporting the use of acupuncture for improving menstrual function and reducing symptoms of PMS. "One study found that acupuncture was as effective as NSAID therapy for dysmenorrhea, a cycle with severe PMS symptoms, especially cramping."(1) I find this a very helpful adjunctive treatment for both myself and my patients. 

Again, these are some interventions I like to to start with for PMS. If your symptoms are causing you a lot of distress, please reach out to myself or your local ND for further support. Testing may be necessary to assess hormone levels, or look for any concurrent issues such as PCOS, endometriosis or fibroids. 

In health & happiness, 

Dr. Karen