Fatigue is one of the most common reasons people go to the doctor. As NDs, we talk about energy, or lack of, with patients everyday. Fatigue also has many different causes, so a thorough history, relevant physical exams, and laboratory testing are all indicated to help determine which causes are most likely relevant for you!
Other symptoms that might provide helpful context and are important to tell your doctor about, if present, include:
hair loss
feeling cold all the time
pale skin or easy bruising
mood concerns like anxiety or depression
frequent colds or flus
weight change
changes in periods
constipation or other digestive concerns
muscle or joint pains
sleep disturbance
new supplements or medications
A comprehensive lab panel to evaluate fatigue includes:
iron studies: hematology (CBC), ferritin and iron/TIBC (often skipped)
other common nutrient deficiencies: B12 and vitamin D
blood sugars: HbA1C and fasting glucose (or better yet fasting insulin)
thyroid levels: TSH and T4 (and sometimes T3 and thyroid antibodies)
testosterone (for people with penises)
and a home sleep apnea test (HSAT) to evaluate for obstructive sleep apnea if other criteria are met (such as: loud snoring, episodes of waking gasping for air, and high blood pressure, especially in patients over 50 years old, and those with obesity)
One test most people don’t need is AM cortisol. A single value doesn’t tell us much or influence treatment planning. The result can actually be influenced by the stress of the blood draw itself, and there’s a lot of