Fatigue makes life pretty miserable. Routine tasks become overwhelming, stuff you used to enjoy begins to feel like way too much work, and you may get down on yourself for feeling lazy, even though you can't help it. At one point, I recall my own fatigue making everyday tasks feel like moving mountains. It can make for a somber existence and while sometimes there is a simple answer for it (like diet and lifestyle), other times there is not.
When you've endured fatigue long enough to talk about it with your doctor, chances are a thyroid test was among the first thing that was ordered, but there are a few others you may want to keep in mind, based on what I've experienced myself and with clients. If your diet checks out, and you have healthy thyroid function, but you still feel sluggish and like you are dragging yourself through the day, you may find these tests very helpful.
1) Check your calcium and potassium levels with hair analysis
High calcium can be a true driver of fatigue, as it slows down your body. The average American today gets far too much calcium relative to potassium. Typically, this isn't because one is in too much calcium from food sources per say (although one could over-do it), but instead from calcium supplements, calcium fortified food, and/or increased calcium absorption from taking high dose vitamin D3. Part of vitamin D’s job is to tell your body to absorb more calcium from your food, pushing calcium levels even higher in the body, and pushing potassium levels lower. Pair that with a chronically low intake of potassium from fruits and vegetables, and you have yourself some powerful nutritional forces messing with your thyroid hormone's ability to do its job. This often manifests with symptoms like fatigue, brain fog, low body temperature, blood sugar issues (hypoglycemia), and sluggish digestion.
Luckily, you can find out what your calcium and potassium levels are with hair analysis. By assessing the ratio of your calcium to potassium levels, you can see how well your thyroid hormones are doing their job. Then, if needed, make supplemental and dietary adjustments to bring the ratio into better balance, supporting healthy thyroid function naturally.
If you’re curious if vitamin D supplementation has your thyroid function in hot water by way of high calcium levels, you may want to consider getting a hair analysis, to see how it's affecting your mineral levels. You can learn more about hair analysis or get started here.
2) Request an iron panel from your doctor to check for low or high iron
Did you know that both low iron and high iron levels (often called iron overload) can cause fatigue?
While checking your iron levels for iron deficiency (low iron stores) or iron-deficiency anemia (low red blood cell count) is pretty standard when fatigue is present, making sure your iron levels aren't too high doesn't get nearly as much attention. Approximately 10 million people in the United States have iron deficiency, including 5 million with iron-deficiency anemia. On the other end of the spectrum is hereditary hemochromatosis or milder forms of iron overload, which impacts approximately 1.5 million Americans. Excess iron acts as a rusting agent in your body and can accumulate in tissues, particularly in the liver, pancreas, heart, joints and the brain. Too much iron also increases the aging process and puts you at a much higher risk for vascular disease, cancer, as well as a shortened life expectancy, making it essential to know your iron status.
From what I've heard from some in the medical profession, an iron panel is inexpensive and used to be a pretty standard part of annual blood work up until 1997, but no longer is.
To learn more about your own iron levels, you can simply request an iron panel from your doctor, or you can always order one yourself and self-pay from somewhere like this for about $48. Then you'll of course want to work with your doctor or naturopath who can guide you on how to interpret the results and direct you as needed.
3) Find out if you have a MTHFR genetic mutation
Methyl-tetra-hydro-folate reductase (MTHFR) is an enzyme that your body uses to convert folate (B9) into the active form of folate used by the body. This process is methylation.
There are a few common genetic mutations that can influence how effectively your body is able to make this important conversion. Poor methylators commonly experience symptoms such as sleep disturbances, anxiety, depression, fatigue and/or chronic pain. Here are some of the most common versions of the MTHFR genetic mutation, and how much it influences your body's ability to convert folate from food and supplements into methyl folate, the form that is useable by your body:
- MTHFR C677T = heterozygous mutation (one mutated copy) estimated up to 40% loss of function
- MTHFR T677T = homozygous mutation (two mutated copies) estimated up to 70% loss of function
- MTHFR A1298C = heterozygous mutation (one mutated copy) estimated up to 20% loss of function (limited research and controversy here)
- MTHFR C1298C = homozygous mutation (two mutated copies) estimated up to 40% loss of function
You can also do simple blood work using whole blood histamine to check your methylation status. This can help identify any undermethylation or overmethylation patterns that may be expressing in your body.
4) Investigate your Viral Levels
Before you think fatigue is all in your head, request a viral panel from your doctor to make sure your immune system isn't bogged down by a virus. Everyone has viruses living inside their body, but it's often hard to tell if they causing active problems or not.
Once you have a virus in your body, it never goes away. In healthy individuals the virus or viruses often stay dormant, but when health falls below par or you have prolonged stress, antibiotic overuse, vaccinations, toxic lifestyle, and/or surgeries, a virus can be reactivated. A classic example of this is when you or someone you know gets a cold sore when they’re under a lot of stress, as cold sores are caused by the herpes simplex virus. Another example of this is when someone who had the chickenpox in childhood gets shingles later in life, it's just a reactivation of the chickenpox virus.
A virus works by invading healthy normal cells and take advantage of them, using them to multiply. By living inside your cells, they are protected from typical medicines that swim around in your bloodstream, making them hard to treat.
The most common viral signs are fatigue, night sweats, fever, and painful joints. If these symptoms are familiar, it's time to consider checking in with a doctor or naturopath that can get you tested. Here are just a few things to consider testing for, although your doctor should know exactly what you need:
- Herpes simplex type 1 (HSV-1): commonly an oral infection - cold sores
- Herpes simplex type 2 (HSV-2): commonly a genital infection - genital herpes
- Varicella-zoster virus (VZV/HHV-3): commonly known as chickenpox
- Epstein-Barr virus (EBV/HHV-4): prevalence: 80-90% of population
- Cytomegalovirus (CMV/HHV-5): prevalence: at least 60% of U.S. population exposed
- Herpesvirus type 6 (HBLV/HHV-6): very common, often symptomatic in adults, linked to chronic fatigue syndrome
You can self-pay and order these kinds of test here, but it's more cost-effective to go through your doctor. If you want to learn more about my favorite supplements to help support an immune system weakened by viruses, you can find that here.
5. Gut Testing
Did you know that an imbalance in gut bacteria or gut pathogens can cause fatigue?
If your microbiome balance is off it can lead to everything from digestive issues, malabsorption, impaired detoxification (from endotoxin production, poor bile recycling and constipation) encouraging the recycling of toxins, hormonal issues like estrogen dominance, impaired mental health, immune system suppression, skin issues and even more. All of these gut conditions can put a huge strain on your energy levels.
If some of the above issues are familiar, your gut may be to blame. Testing that helps give you insight on your gut microbe is essential. My favorite gut tests are the Organic Acids Test (OAT) and the GI Maps Test.
6. Thiamine (vitamin B1) Testing
Did you know that a simple vitamin deficiency can cause fatigue?
To put it simply, thiamine is needed to turn what you eat into energy (ATP). Because of the foundational importance of thiamine in the body, the ramifications of deficiency can be vast and extreme. And easy to miss or mis-diagnose as another health issue.
By and large, the primary cause of thiamine deficiency is processed food. That is, empty calories that deplete nutrient stores in the body because the foods themselves contain none. So while you need thiamine to process carbohydrates property, a processed food diet doesn't provide the needed thiamine.
According to Elliot Overton, Nutritional Therapist and Thiamine guru of the UK, whole-blood thiamine pyrophosphate (TPPE) is the best lab test to check your thiamine levels and is available through LabCorp.
Read more on thiamine deficiency here.
7. Fatty Acid Testing
I saved the best for last. This one is so foundational to your health and I can't emphasize it's importance enough.
Have you ever tried working from home when your internet was down? You couldn't connect to your work server, communicate with your co-workers, exchange important documents or, well, do anything that felt productive or efficient. Your mood probably even got a little inflamed with agitation and frustration.
A similar thing happens in your body when your cell membranes aren't healthy. You have 30+ trillion cells in your body and when the outer phospholipid bilayer is out of fatty acid balance, it gets too rigid (instead of fluid and jelly-like) it can't do its job properly. This means, it can't communicate well with other cells, take out the trash, take in nutrients, etc. You get the point.
This state of inflammation in the cell membrane can trigger some very undesirable things in your body such as chronic inflammation, insulin resistance, unwanted gene expression, fatigue, anxiety, weight gain, cardiovascular disease, vascular disease, and the list goes on... and on.
Luckily, cell membrane health is easy to fix, once you know what is out of balance! A simple test (that no one is talking) you can take at home for around $100 will tell you all you need to know and help you choose food and supplements to feed your cells what they need. Find out more here.
8) Liver Labs
When your liver gets sluggish, fatigue often follows.
This is because when you're accumulating toxins faster than you're able to excrete them, the functioning of your whole body takes a hit. More toxins slowly start to overwhelm all your body's systems.
If you think your liver might be at the root of the issue, consider the following labs to check in:
- plasma zinc (screen for zinc deficiency)
- iron panel + ferritin (screen for iron deficiency/iron overload)
- serum copper (screen for copper overload)
- vitamin A/retinol (screen for vitamin A toxicity)
- whole blood histamine (assess methylation status — overmethylation or undermethylation)
- AST/ALT (liver enzymes)
- GGT (damage to bile ducts)
Become a client to get started with a blood lab package.
Next Steps to Consider
If you feel like you've tried everything for your own fatigue but gotten nowhere, I hope this post helps you get to the bottom of the issue. I've found these tests invaluable on my own health journey include most of these in my comprehensive 3 and 5 month programs.
Have any of these tests helped you uncover the root cause of your own fatigue? Please share in the comments!
- Medical Medium