Why are you so tired (part 2)

Here is the second installment in the series, Why are you so tired?  If you missed part one, click here to go check it out.  In part one, I dealt with many nutritional reasons why a person can be tired.  In this post, I’m going to deal with hormonal reasons, sleep issues and blood sugar imbalances leading to tiredness.  As you will see, all 3 of these major causes for tiredness can overlap and influence each other.

The endocrine system is a complicated system that has many interconnections.  The endocrine system is made up of all the glands in the body that secrete  hormones, this includes thyroid, adrenals, reproductive system, pancreas, pineal gland, pituitary gland and many more. The endocrine system controls growth, metabolism, reproduction, regulates our response to light and dark, controls lactation, initiates labour, controls blood sugar, regulates calcium metabolism and has an influence on digestion.  The main parts of the endocrine system we are going to touch on in this post are thyroid, adrenals, reproductive system and pineal gland as they most directly relate to our energy levels.

Many tired people come into my office worried about their thyroid function and some of them are on the right track to solving their energy issues.  Having a low functioning thyroid can leave a person tired, makes it easy to gain weight (and difficult to lose weight), can lead to dry skin, constipation and can lead to menstrual cycle abnormalities including long or short menstrual cycle length and possibly heavy periods.  The main test for thyroid issues is TSH.  This test measures the level of TSH (Thyroid Stimulating Hormone) that goes from pituitary to thyroid to prompt the thyroid to secrete hormones (T3 and T4).  In theory, if the thyroid response is inadequate the TSH should rise and we should be able to see thyroid imbalances.  There are people who feel that free T3 and free T4 should also be checked for a more complete picture of thyroid health.  I think one of the main issues in TSH testing is that there is a broad range, most labs go from 0.35-5.0 as being normal values.  Having TSH monitored periodically over the years can help detect a change, for example if TSH has risen from 1 to 4.5 over the years, this is a good indicator that something is affecting the thyroid function.  One person might feel good at 3, another person might be feel good with TSH under 1.  Generally people are not addressed medically until their TSH is above 5 consistently over time and at that point the treatment is thyroid hormone, likely for life.  I find there are many people with normal tests, or high normal numbers (above 3 but not quite to 5) who respond very well to natural thyroid support either in the short term or on an ongoing basis.  Sometimes this natural treatment can leave a person feeling more energetic and lower their TSH level, possibly saving them from being on a long term medication.  There definitely is a time and place for thyroid medications and in some people it can be a good option when thyroid symptoms persist.  Thyroid controls metabolic rate and energy levels, having a balanced thyroid goes a long way toward steady energy levels.

Another type of gland that is very involed in energy levels is the adrenal glands.  Adrenal glands are not paid much attention in conventional medical circles unless someone has a life threatening issue such as Cushing’s (adrenal hormones too high) or Addison’s Disease (adrenal hormones too low).  In naturopathic circles, adrenals are extremely important.  Many times people who have had acute or ongoing stress show symptoms of adrenal fatigue.  Some people will present in the “tired and wired” phase, where they are tired but also anxious and unable to relax, which often leads to more trouble sleeping and more tiredness.  If adrenal issues persist, a person can get to a point of total exhaustion because the body is extremely burnt out.  Symptoms of adrenals fatigure/exhaustion include:  tiredness, dizziness on standing/rising, weakness, feeling run down, feeling the need for caffeine/sugary treats just to get through the day, sleeping too much (or not being able to relax into sleep at all), recurrent infections and many more.  Many naturopathic treatments can regulate adrenal function though I find there is a lot of variation between patients.  Some simple things that can help with adrenal fatigue that will benefit most people with chronic stress, take a B complex vitamin, try to get on a sleep schedule with a regular bedtime, limit caffeine and if there are no issues with high blood pressure, a little bit of licorice tea in the mornings can be a helpful adrenal tonic.  Sometimes adrenal fatigue can contribute to or mimick a thyroid issue and sometimes a weak thyroid can put a strain on the adrenal glands as they try to compensate.

Reproductive hormones can also affect energy levels.  Many women find their energy is lower before and during their period.  In some cases, this can be because an underlying adrenal issue is worse before the period.  In other cases, heavy periods and blood loss can weaken a woman.  Sleep can also be affected right before or during a period.  Cycle regulation is a complicated process and many different issues can arise, some leading to low energy at various points in the cycle.

Later in life, female hormones can also affect energy.  I have many patients in perimenopausal years or menopausal years who has lower energy than they used to have.  Again, sometimes this is from underlying adrenal and thyroid issues that have shown themselves at this point in life.  Other times, hot flushes and restless sleep from hormone changes can leave a woman feeling very tired and run down.  Supporting adrenal glands is often necessary at this stage to prevent a woman from getting more run down, also after ovaries stop producing estrogen and progesterone the adrenals are the main source of precursor hormones that turn into both estrogenic (female) and androgenic hormones (male).

Talking about reproductive hormones, I don’t want to leave the men out of the discussion.  Testosterone is also very important in maintaining energy levels in men.  Many men in the 40s or older, start to experience declining energy levels related to hormonal changes.  Low testosterone levels can lead to sexual difficulties, changes in body composition (less muscle, more fat), irritability, depression and tiredness.

The next gland, starts the discussion about sleep issues affecting energy.  The pineal gland is responsible for regulating our internal clocks.  The pineal gland is strongly influenced by light and dark and secretes melatonin in response to darkness.  Melatonin helps us sleep soundly.  I sometimes will use supplementary melatonin in patients to try to train their systems into healthy sleep patterns.  I especially find this useful in patients who have jobs that involve shift work, are strongly affected by seasonal time changes or who travel and suffer from jet lag.  Natural ways to encourage healthy melatonin levels include getting some sun exposure into your eyes (no sunglasses) in the mornings (at least 20 minutes if possible) and having your bedroom as dark as possible at night.  Some forms of deep breathing and meditation can also raise melatonin levels naturally.

When dealing with sleep issues, I often need to find out whether we are dealing with onset issues or sleep maintanance issues (or both).  Some of the most common sleep onset issues can include anxiety, inability to unwind at the end of the day, too much caffeine and delaying bedtime too late and missing a good sleep window.  Common sleep maintanance issues can include menopausal issues, blood sugar drops in the night, difficulty with positioning (ie. hip pain waking a person up in the night to change positions), nightmares, having to get up to urinate and waking thinking of work/things to do the next day.

I think it is always best to try to get to the bottom of what is causing the sleep disturbance, which can take a bit of detective work.  Without a clear reason for sleep issues, there are many healthy habits that can help sleep quality.  Setting a regular bedtime and sticking to it (even on weekends when possible) is a step that is often underestimated.  Preferably setting a bedtime early enough to be soundly asleep by 11 will work better for people with restless sleep than a slightly later bedtime.  In acupuncture, an imbalance in the liver (which usually is the result of stress) will cause restlessness between 11 and 3, so getting to sleep before this time period starts will often result in better sleep.  Rescue remedy (Bach Flower) or passionflower or chamomile can be all gentle ways to relax your body to get ready for sleep if anxiety is an issue.  Sleep somewhere comfortable, quiet, dark and preferably a little bit cool.  Try to restrict fluid intake in the evenings to prevent frequent bathroom trips.  Try to resist caffeine through the day, the temporary boost in energy during the daytime could be contributing to your restlessness at night, leading to poorer sleep which can run a person down and leave them reaching for more caffeine, making the cycle worse.

Lastly I want to deal with blood sugar issues.  Both high blood sugars (such as diabetes) and low blood sugar (hypoglycemia) can lead to tiredness.  In both cases, eating enough protein, focusing on carbohydrates that have fibre rather than white, refined products (white flour, white rice, sugar) and focusing on good fats can help stabilize blood sugar.  Eating regular meals (and snacks if necessary) can also help to stabilize blood sugar.  Diabetics often notice that tiredness is one of the first signs that their blood sugar is off track.  In people with a tendency toward low blood sugar, often when they have gone too long without food or eaten a low protein meal (especially if that meal has a high level of starch or sugar) they might find that they start to feel tired and draggy.  Sometimes this is associated with anxiety, crankiness, shaking or headache.  If at this point, people grab a sweet snack or drink (which they will often crave at this point), the cycle continues.  Blood sugar will spike up quite high because all the sugar and starch digest quickly, then insulin levels rise and then blood sugar crashes back down leaving them tired again.  This up and down can affect energy levels all day long.  If blood sugar dips happen while a person is sleeping, they can wake up anywhere between 2 and 6 am and have trouble getting back to sleep.  At this point sometimes a snack can help someone get back to a restful sleep.  If this is a recurrent problem, addressing the cause and looking at the diet through the day is more successful at fixing the problem.  I have often seen that adjusting protein intake in a day will regulate a person’s sleep and daytime energy levels.

As you can see, getting to the bottom of why your energy is low can be complicated, but naturopathic doctors can help identify health priorities and help focus on getting you to feel like your energetic self again.

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