“But doctor, I’m getting 8 hours of sleep and I’m still waking up tired!” There’s nothing more frustrating – the constant tiredness, the brain fog, the poor memory, the inability to form a coherent sentence, the joint pain, the breathlessness – only to be advised to try and get more sleep.
Of course, lack of sleep, or good quality sleep, may well be a factor, and “sleep hygiene” – tricks and habits to set you up for a peaceful night of uninterrupted sleep – is a good place to start. But it’s certainly not the end.
Even if your tiredness isn’t as extreme as the scenario described in the first paragraph, and you just tend to feel a mid-afternoon dip in energy and the need for a nap, there is usually more to it than simply running out of fuel. Those cups of coffee may help you get through the day, but they don’t deal with the underlying problem, and can even exacerbate it over time.
There is a myriad of causes of fatigue or tiredness. Let’s start with some of the more obvious ones. It’s very common to feel extreme tiredness after a viral infection, and there may be multiple reasons for this, which we’ll go into shortly. Non-infectious disease may also be involved: around 50% of people suffering from a chronic disease report feeling tired or run down, which may be due to the biochemical imbalances underlying their condition, or the medications they are taking for the condition. Drowsiness is a known side effect of many drugs, including antidepressants, blood pressure medications, antihistamines, epilepsy drugs, cancer treatments and more.
But knowing what your tiredness or fatigue is associated with is not the same as knowing the root cause of it. You may have post-viral fatigue, for example, but we need to identify what is going on (or awry) inside your body to cause that fatigue so that it can be addressed systematically. This goes for any condition, whether acute or chronic. The difference between conventional medicine and functional medicine is that the former attempts to treat (or suppress) symptoms, whereas the latter focuses on dealing with the cause or mediator of those symptoms.
In a 7-minute appointment, it’s almost impossible for a doctor to get to the bottom of such a common symptom that can have so many different causes. Even when the standard GP blood tests come back, the results may well be within the “normal range”, but from a functional medicine perspective, normal does not necessarily mean optimal, or even good. It simply means common: in other words, the majority of people who were tested for that marker in that lab fell within that range. Most of those people were being tested because their health was under par.
The upper and lower ends of those “normal” ranges give important clues and help me as a Nutritional Therapist to devise a tailored health plan for my clients. This is why test results can form an important part of the detective work that goes on after a consultation.
What are the tests that can help with this detective work?
1. Blood glucose
Imbalances and swings in blood glucose levels are a common cause of energy dips and persistent tiredness. HbA1c is a test that can be ordered through your GP which tells us how high your average glucose levels have been over the last three months. Ideally, this should be 48mmol/mol (6.5%) or below, or under 42 mmol/mol (6%) if you’re at risk of developing type 2 diabetes. Alongside a blood glucose test, an insulin test is a useful indication of how hard your pancreas is working to maintain the blood glucose at safe levels, although this is rarely provided by the GP as it is a more expensive test than HbA1c. “Insulin resistance” is what happens when the insulin receptors on your cells start ignoring the insulin in the bloodstream that are telling them to open up and let the glucose in. This makes the pancreas have to work harder to pump more insulin out in order to get rid of the glucose in the blood. After a spike in insulin comes a dip in blood sugar, which is when you may feel exhausted, light-headed and foggy.
2. Complete/full blood count (CBC)
This test is helpful in conjunction with a full iron panel and tests for vitamins B12 and folate, to determine whether you have anaemia, and which type. The CBC looks at red blood cells, white blood cells and platelets.
3. Full iron panel
For fatigue combined with breathlessness, the full iron panel (which includes ferritin, total/serum iron, total/transferrin, iron binding capacity, and transferrin saturation) is an important test for assessing anaemia. Too little iron means that the cells will not be getting enough oxygen, whereas too much iron causes inflammation and can be a sign of a serious underlying issue.
4. Vitamin B12 and folate
B12 is an essential vitamin that is involved with nerve-cell health and, along with folate, the formation of red blood cells and DNA. A B12 deficiency may manifest in the form of extreme tiredness that isn’t helped by improving sleep; mouth ulcers and/or a sore, red tongue, depression, pins and needles or tingling in the feet, hands or head, and issues with short-term memory and cognitive function. Elderly people with a B12 deficiency are sometimes misdiagnosed with dementia.
A folate deficiency can result in a type of anaemia in which the red blood cells are improperly formed. Folate is also responsible for converting the molecule homocysteine to methionine, and a folate deficiency can result in excess levels of homocysteine causing damage to the blood vessels.
5. Thyroid panel
The hormones produced by the thyroid gland are necessary for the metabolic processes that turn food into energy in our cells, so a dysfunctional thyroid can be a cause of low energy or fatigue. A GP will usually only be able to order a test for TSH (thyroid stimulating hormone) and free T4, but the full thyroid panel with several other thyroid markers, ordered from a private lab, is important to ensure that thyroid issues are correctly identified.
6. Liver function
The liver performs hundreds of functions in the body which support metabolism, immunity, digestion, detoxification, vitamin storage and more. If your body’s toxic load is too high, or the liver is impaired by insulin resistance or fat deposits, this may one reason why you are feeling extreme tiredness. Other symptoms of a dysfunctional liver can include jaundice, dark urine, nausea, vomiting, weakness, low appetite, a swollen abdomen, itchy skin, and abdominal pain. The liver markers that indicate the health of the liver include four liver enzymes plus albumin and bilirubin.
7. Vitamin D
Best known for its role in bone health, vitamin D is essential for supporting an array of other functions and processes, not least the immune system, and a vitamin D deficiency is implicated in depression, autoimmune diseases, some cancers, cardiovascular disease, infectious diseases, schizophrenia and type 2 diabetes. Those of us living at higher latitudes (above the 37th parallel) struggle to get enough sunlight to make vitamin D3, even in mid-summer, and especially those with darker skin. High doses of vitamin D3 in tablet form may be needed temporarily to address a deficiency or suboptimal level, after which, a maintenance dose of 3,000 IU is generally recommended. For an accurate assessment of how much to supplement, a vitamin D test should be done. This is relatively inexpensive and easy.
8. Inflammatory markers
If you are suffering from joint or other pain, headaches, depression and/or digestive problems along with your fatigue, then it may be worthwhile looking at the inflammation markers C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
9. Gluten antibodies (coeliac disease)
Coeliac disease is an autoimmune disease in which the body mounts an immune defence in response to gluten (a protein found in wheat and other grains). This immune response damages the intestinal lining which results in nutrients such as iron and B12 being poorly absorbed. Fatigue is one of the symptoms that can result, along with other inflammatory conditions, skin problems, cognitive issues and more. Normally, a test for coeliac disease involves eating gluten every day for 6 weeks beforehand, although genetic testing can be performed instead.
Fatigue is rarely the only symptom when processes go awry or need extra support. Any number of the above (or other things besides) may be going on at the same time in an interwoven mesh of connections and cascades. And it’s not always necessary to “fix” everything: sometimes by supporting your body, mind and spirit in a couple of areas, other functions gain the energy and nutrients they need to perform as they should.
That support means helping you to identify and eat the foods that serve you and avoid the ones that don’t. It means supplementing with targeted nutrients that your cells require more of, as well as using functional probiotics to rebalance your gut bacteria. It may mean using herbs or nutrients to help your body to detoxify. It will very likely also mean helping you to find ways to de-stress or find harmony.
For a free discovery call or in-person meeting, just drop me a line using the form below and let’s chat about how we can work together. I can’t wait to meet you!