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!

Adrenal Fatigue - And The 4 Main Stressors On Our Body

Do you ever wonder what actually happens to our body and adrenal glands with chronic stress? Are you experiencing more than one main stressor leading to "adrenal fatigue" aka HPA dysfunction? More studies are showing negative long term side effects from chronic stress so lets get to the bottom of it and heal the body.

Ever heard the term "adrenal fatigue"? The adrenal glands sit on top of your kidneys and one of their main functions is to produce and secrete a hormone called cortisol. It is stimulated by the hypothalamus and pituitary signals, hence HPA axis. There are many receptors throughout our body that respond to cortisol to stimulate a "fight or flight" response - aka helping us run from that dangerous tiger. However due to four main reasons, our bodies may constantly be running from the tiger when it isn't even there! This of course takes a toll on us. 

Common symptoms of HPA dysfunction:

• fatigue
• insomnia
• brain fog
• anxiety, depression
• chronic colds and flus
• weight gain
• shakiness 
• PMS
• fibromyalgia
• diabetes 
• hypothyroidism
• eczema 

How is your body responding to the stress?

The more I practice, the more I realize the importance of discovering the underlying cause and response of these symptoms for each individual and treating it accordingly. For example, if one patient has more anxiety due to an inability to clear free cortisol effectively due to poor liver or thyroid function, I would treat this much differently than with a patient who is fatigued and depressed due to a down-regulated response in the HPA axis leading to low metabolized cortisol. 

Metabolized vs free cortisol what?? A DUTCH lab test, that I do in my practice and find very valuable, can actually differentiate these hormones and how they are broken down and metabolized. For example free cortisol is how much active cortisol is on our body, representing only 3-5% of our body's cortisol, and metabolized cortisol is what our adrenal glands actually produce, representing around 80%. Blood and salivary tests only test free cortisol, which is not the full representation of what is going on! 

(The DUTCH test actually test test SO MUCH MORE than cortisol, including sex hormones and their metabolites, melatonin and liver detoxification function...all so helpful to see!)

So what is actually causing this HPA axis dysfunction? It typically is not only the day to day stress we experience at our job or due to our daily schedule. If we can decrease these triggers the normal feedback systems within our bodies will recover and symptoms will improve.

Four triggers of HPA dysfunction:

1. Perceived Stress - This is the main trigger of cortisol dysfunction. Whether it be our go-go-go lifestyle preventing us from resting and recovering, or financial, job or relationship stress. Everyone perceives stress differently and some people may be less resilient than others. That trendy word mindfulness comes in here as well as simply taking time for yourself to recovery. 
2. Inflammation - This means ANY type of inflammation, including any autoimmune condition, an inflammatory diet full of sugar and inflammatory foods, gut issues, obesity, or chronic sickness. Inflammation of any kind up-regulates the HPA feedback system to put out the fire. 
3. Blood Sugar Dysregulation - High or low blood sugar affects insulin levels, which ultimately disrupts the HPA axis. This is why is it important to eat a low sugar diet with adequate protein, fat and fibre to slow down absorption of sugar and keep you full for longer. Look for foods with less than 7g of sugar, with full fat and good quality protein. Are you experiencing an energy crash in the afternoon? This means your blood sugar is not regulated! The first thing I suggest is changing your breakfast to include a protein and fat. 
4. Circadian Rhythm Disruption - I say it time and time again that our body LOVES routine. Too much exposure to light in the evenings, aka staring at a screen all evening, and not enough sun exposure during the day, aka too much time in an office and no sunshine, can affect the hormone cycles. Your cortisol can therefore be spiking at the wrong time. 

Once we establish your main triggers and how your body is actually responding to those triggers, several Naturopathic treatment options can help along the road to recovery. I love adaptogenic or nervine herbs to calm or support the HPA axis (more to come on the difference). IV therapy can help to support the immune system and adrenals (still discounted for the month of August!). Addressing the pillars of health of diet and lifestyle are always important as well. 

Questions about what was mentioned here or curious where your hormones lie? Come in for a visit!  I am always here to help. 

In health & happiness, 

Dr. Karen