From the desk of the “energy doctor” Dr. Angila Jaeggli:
Hey friend, have you ever had the experience of feeling exhausted, going to see your doctor, and being told that all of your bloodwork was ‘fine’?
Or that it was natural to be tired because you’re getting ‘older’ (that one is my favorite – not!). Well, I’m here to tell you that being exhausted is not normal, nor is it normal to be tired just because you’re ‘older.’
There can be many contributors to feeling tired, but I wanted to give you the top tests that I would begin with when evaluating fatigue. You can certainly dive deeper, and we definitely do; but if you want a simple place to begin, that won’t break the bank, here’s where you start.
Here are the top 5 labs tests I would consider when you’re fatigued:
1) TSH – TSH is a measurement of a brain hormone that stimulates the production of thyroid hormone, which contributes to metabolism, energy, muscle repair, etc. There is definitely a better range than the standard on the lab sheet. I prefer to see the result under 2.5. If it is higher than this, it is worth diving into further thyroid hormone testing to explore if the thyroid hormones ratios are good and if you’re producing any autoimmune thyroid antibodies.
2) Cortisol – Cortisol is a hormone secreted by the adrenal glands (little glands that sit on top of the kidneys) that greatly contributes to your feeling of energy and stamina throughout the day. We have our highest levels in the morning when we wake, although this can be different for people who have night shifts. If you have a ‘regular’ schedule (think awake 6am to 10pm for example), you would test your cortisol in the morning, as close to waking as possible. This can be tested through blood or saliva. Ideally, your morning cortisol should be towards the top of the expected curve. If its low or towards the lower end, then you can count adrenal fatigue as a contributor to your fatigue.
3) Homocysteine – Homocysteine is a metabolic marker which reflects your level of Vitamins B6, B9 (folate) and B12 in your body. Ideally, you want to see this level around 7.0 – this number reflects a good balance of your B-vitamins – which are the cornerstone vitamins of great energy and stamina. However, two things to note. If you are normal, this does not mean you are out of the woods for the need for more B’s. When you’re tired – it’s possible that you have a super-physiological need for B’s which can be seen when we evaluate methylation. (see below) Secondly, if you are above 7.0, or definitely above the standard lab range – you are B-vitamin deficient. And not just in B6, B9, and B12 – but all the Bs. They inherently work together to boost energy and metabolism, and will all become depleted with stress and poor diet.
4) Iron and Ferritin (iron stores) – If you are severely anemic, your doctor may see this reflected in your Complete Blood Count (CBC). But just because your CBC is normal, does not mean that you are not iron deficient – which is why it is important to look directly at their levels. The function of iron is to carry around oxygen, so your cells can breathe, (and you can breathe), and so the cells can make energy – and therefore give you energy! You want to see Iron totals within the normal range – and not towards the lower end of the normal range. Now here’s the tricky thing. Ferritin – which reflects your body’s stores of Iron – should not be low, or too high. The ideal is at a maximum of 70. Any higher than this, even though it shows as normal on the lab range, is toxic to your cells. High ferritin has been shown to contribute to damage of both cardiovascular and brain cells. If your level of ferritin is very high, see your doctor about this. You could have a condition known as Hereditary Hemochromatosis or be a carrier of this condition.
5) Epstein Barr Virus – EBV (Epstein Barr Virus) is the most commonly known Mononucleosis virus. What isn’t commonly known is that once you catch mono, the EBV virus lives in your body for the rest of your life. The body typically does a pretty good job of suppressing it, but when you have stress and/or a poor diet, your immune system could struggle to keep it down, and the virus reactivates. Most people who have reactivated EBV can feel fatigued, lethargic, achy, or like they are coming down with something that never comes. You can measure this virus by ordering an EBV IgG Ag, and EBV IgG Early Ag. And if you suspect that you caught it recently – I would add an EBV IgM Ab.
Bonus test for men: Testosterone – Men, take a look at both your Free and Total Testosterone levels. Low testosterone in men can contribute to chronic fatigue, depression, loss of muscle, insomnia, mood variability, erectile dysfunction and more. While there are other ways to support testosterone beyond supplementation, it is good to know where your levels are so you can have a baseline to compare to as you make changes.
Bonus testing: Methylation panel +MTHFR – Both of these tests reflect an exciting new area of testing and ways to support amazing health, energy, stamina, and detoxification in the body. You can find MTHFR in your medical reports from Stratagene.org, or GeneticGenie.org (they pull raw data from your ancestry.com or 23andme.com). The Methylation panel we use is from Genova labs and covers a wide range of methylation and amino acid markers we use to help determine detoxification and energy-creation ability.
The purpose of sharing these tests is to give you a starting place in the exploration of your fatigue. I would encourage you to ask your doctor to help you with the ordering and interpretation of these tests. Of course, we would love to see you at Sage Integrative and would be happy to include these in your work up on fatigue. I do know that you can order these tests yourself online, which I think is fine. However, make sure to loop in an integrative or functional medicine doctor like ourselves to help you come up with the best treatment approach, and to dig further if needed.
I’m also excited to announce that I will be offering a course on Beating Chronic Fatigue in 2020! In this course, we will explore how to dive deep into finding your obstacles to feeling amazing, while creating a sustainable plan to create your optimal energy! If you would like to be on our list to learn more and receive updates as we get closer, along with receiving lots of other educational health updates and specials – join our newsletter at sagemedclinic.com.
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Kindly yours, Dr. Angila Jaeggli