All blog posts from Dr. Allott are provided for educational and informational purposes only. As Dr. Allott is also a licensed medical practitioner, we must make it clear that nothing on the blog is intended to constitute medical advice, consultation, recommendation, diagnosis, or treatment. If you are concerned about your health, please seek appropriate care in your area.
This video talks about how glucose levels impact mood, focus, and fatigue - and shows an example of what hypoglycemia looks like on a continuous glucose monitor. Learn more at KristenAllott.com
We're working on short videos this year and would love your feedback and suggestions for topics!
By Dr. Kristen Allott, ND, L.Ac.
It has been a challenging two years, with consequences for all of us! At various times, or perhaps throughout, we’ve each experienced physical, emotional, mental, and social stresses as we navigated the impacts of the pandemic. We may know people recovering from the virus and have a diagnosis of Long Covid. We may also know people who are struggling with extreme fatigue. This fatigue could be from fighting the virus or from, quite frankly, the consequences of the last two years of chaos.
Long Covid is caused by lingering symptoms after being infected by one of the variants of the SARS-CoV-2 virus. However, I have also seen people who have just felt fatigued since the pandemic began - perhaps due to the infection or may be caused by other challenges that came with the pandemic.
In this article, I’m not going to sort out the causes of this fatigue, primarily because it’s a combination of many things: infection, isolation, lack of routine, lack of social support, malnutrition, financial stress, increased substance and internet use, lack of movement, irregular sleep hours, historic trauma, and response to the vaccination, all layered alongside the trauma of living during a pandemic. (I want to be clear that I am in support of the vaccine, and some people have had adverse reactions to it, as with any medication)
What I want to discuss in this blog is what labs we should advocate for when there is fatigue and unresolved physical symptoms, including those on the CDC common symptoms list for Long COVID:
Difficulty breathing or shortness of breath
Cough
Chest or stomach pain
Diarrhea
Dizziness on standing (lightheadedness)
Change in smell or taste
Mood changes
Changes in menstrual period cycles
Tiredness or fatigue
Symptoms that get worse after physical or mental activities (also known as post-exertional malaise)
Fast-beating or pounding heart (also known as heart palpitations)
Difficulty thinking or concentrating (sometimes referred to as "brain fog")
Headache
Joint or muscle pain
Pins-and-needles feeling
Sleep problems
Fever
Rash
One of the things I find striking about the above list is how common these were in my patients even before COVID. When somebody is experiencing tiredness and/or fatigue, it can easily lead to depression, and - likewise - depression can lead to tiredness and fatigue. (For the geeks out there, a common cytokine, Interleukin 6, is known to contribute to both depression and fatigue). Fatigue can cause and be caused by a whole host of other physiological, hormonal, and neurological problems. These disruptions can be caused by stress, trauma, lack of adequate nutrition, poor sleep, and the lack of movement—most of these were disrupted during the last two years.
As we move out of the acute phase of the Covid pandemic, I have some concerns that the physical fatigue caused during the last two years will just be diagnosed as a mental health condition. Not having enough physical laboratory diagnoses isn't a new problem, it's just likely going to be exaggerated in this (almost) post-pandemic phase.
Additionally, we need to recognize that most medical professionals have also experienced additional trauma from the pandemic. It’s in our own best interest to help them as much as possible to understand that we are not at our best and that we want to align with them to be curious to why we are fatigued.
If you’re experiencing extreme fatigue, or supporting someone dealing with fatigue and depression, and/or anxiety, it’s helpful to start differentiating these symptoms before you meet with your healthcare provider. The PROMIS Profile, from Health Measures, referenced on the CDC website, can be helpful to bring to the provider to start this conversation.
Next, we need to advocate for basic labs that are helpful in assessing fatigue, especially with accompanying depression. Here are some of the labs that the CDC and I both think are important to assess in this post COVID world:
Basic physiology testing: These tests are like checking the oil and gas level in your car.
Complete Blood Count (CBC) looks at the functioning of red and white blood cells and platelets.
Comprehensive Metabolic Panel (CMP) looks at electrolytes, liver function, and kidney function.
Urinalysis looks at what your kidneys are excreting, and for urinary tract infections
Inflammation markers:
C-Reactive Protein (CRP) is an inflammation marker. Inflammation needs to be low, and as it goes up, people experience fatigue and depression.
Ferritin is an iron storage molecule that often seems to increase with a Covid infection and is considered an inflammation marker. However, Ferritin levels below 50 ug/ml can cause fatigue and depression in women.
Thyroid Function: TSH and T4. Thyroid hormone significantly impacts our energy levels. Hashimoto's thyroiditis is a common thyroid condition and can increase after high inflammation events such as covid.
Vitamin D: Low Vitamin D has been linked to worse outcomes with COVID respiratory viruses in general; it is linked to cancers and autoimmune conditions.
Autoimmune function tests: Stressful events can increase the likely hood of autoimmune disease. There is some concern that people post COVID will have more autoimmune diseases such as Celiac, Hashimoto's thyroiditis, Guillain-Barré syndrome, cold agglutinin syndrome (CAS), and autoimmune hemolytic anemia. Sometimes these conditions start slow and build over time. Catching the spike in antibodies against these early helps lower the damage they can do. Here are some tests to request depending on your symptoms:
Antinuclear antibody, Thyroid antibody, Celiac Panel
My recommendation is to create a document before your appointment with your primary care provider. In the document include the following:
The questions that you want to be addressed in the appointment
List all your symptoms and the consequences of those symptoms on how you are living your life
A timeline outlining when the symptoms started and what you have tried
List all the supplements and medications that you are currently taking
List what labs you would like to have done and why
This document will not only help you make the most of the small amount of time that you have with the provider, but it will help you communicate more clearly.
Be sure to ask the provider to add this document, as well as the PROMISE Profile, to your chart. Your medical chart is legally yours and you can add your own notes to the file.
Here is a link to additional resources that discuss labs.
If you use this material, please let us know if it was helpful!
In case you have not met pharmacogenetics testing, may I introduce you? It is a testing tool that takes the guesswork out of prescribing medicines and their appropriate dosages for individual patients.
The screening tool will indicate which medications the patient’s liver can successfully process. A patient with a slow metabolizing liver will need a smaller dosage to successfully reach a therapeutic window; fast metabolizing livers will need larger dosages of medication to reach the therapeutic window. The types of medications and conditions that the genetic information can impact are medications for depression, anxiety, elevated cholesterol, blood thinners (especially warfarin), and cancer.
I’m interested in spreading the word about pharmacogenetics testing and its possibilities because of its power to reduce adverse drug reactions. Approximately 30% of the people I’m seeing in my office these days have spent more than a year trying out various medicines in order to find the most effective ones for treating their symptoms. These searches can be impossibly long and unsuccessful. Pharmacogenetics testing can dramatically shorten the search times for the “just-right” medications and can help prevent adverse drug reactions.
Some of my clients are suffering from unnecessary side effects caused by over-medication. The test can aid in recommending appropriate dosage. Finally, pharmacogenetics testing can predict conflicting side effects, when these types of medications are used in combination with other prescriptions.
A 55-year old executive with depression tried out most available antidepressants over a period of three years. He felt extremely frustrated and declared: “I just can’t—no, I won’t continue using those medications.” He experienced being “physically uncomfortable, clumsy, and mentally foggy.”
The pharmacogenetics testing revealed that he had a slow metabolizing liver. Therefore, for success, he needed to be taking much smaller medication doses. Making those adjustments can be handled fairly painlessly and quickly.
The people who should consider pharmacogenetics testing are individuals who have had adverse reactions to medications and/or who have not had good success treating mental health conditions despite multiple attempts.
In your areas around the country, ask providers near you if they do pharmacogenetics testing. Or inquire if the provider knows anyone that does this type of testing.
The procedure is very simple: a doctor swabs the inside of patient’s cheeks and sends the swabs to a lab for genetic testing. Depending on the patient’s insurance, the screening may cost 0-$400 dollars. Medicare actually pays for the screening because it has been shown to be a cost reducer. It is certainly worth investigating if it provides life-long data that will benefit you and/or your patients.
I am so excited to be a part of Dr. Mariza Snyder's podcast, Essentially You. Mariza has spent the last 2 years creating something incredibly valuable to help reinvent your health with safer, more effective natural solutions and powerful lifestyle changes.
As you know, I believe that lab testing is the way to get the inside scoop on what’s really going on in your body and what could be causing your symptoms.
For so long, anxiety, depression, and fatigue have been completely separated from your nutrition, hormones, and physical health. But by understanding what’s going on under the surface, you can take simple steps to heal your mind and body and restore your energy.
Having the right nutrients and balance of hormones in your body can create a mental, physical, and emotional shift that will help you get back to your energized self faster.
Tune in to this episode today to hear me and Mariza talk about exactly what labs to request, how to interpret them, and which nutrients you can start adding to your routines today to experience relief!
Here’s a short video of what you’ll hear on the podcast!
I’m honored to be part of Essentially You!
I am reluctant to write this post. I’m sure I’m going to make a few people mad. In last month’s Connectors Meeting there were questions about how different diet types contribute to mental health concerns. When a person's diet choice restricts food categories, they can find over time that their diet is contributing to increased anxiety and depression. This is because a diet that limits food groups can lead to nutrient deficiencies if health metrics are not carefully monitored through diagnostic labs.
In this post I’ll review some things to watch out for when eating significant amounts of highly processed foods, following vegetarian or vegan diets, and keto/paleo/Atikins types of diets.
Diets high in processed foods have been shown to increase depression and anxiety. These are diets with lots of white foods (bread, rice, potatoes, pasta, muffins, bagels, chips, sweets, fast food). With this diet, when I look at an individual's labs what I typically see are deficiencies in nutrients that help to synthesize dopamine and serotonin. Common deficiencies are protein, B vitamins, magnesium, zinc, omega 3, Vitamin D3, and fiber. Additionally, there is increased inflammation as indicated by elevated C-reactive protein (CRP) levels. Inflammation contributes to depression, fatigue, bipolar, cardiovascular disease, dementia, and diabetes, to name a few concerns. Dr. Felice Jacka provides a whole body of research about the impact of diet on mental health. Here is her seminal paper: Association of Western and traditional diets with depression and anxiety in women.
When I see vegetarians and vegans in my office, they tend to be very anxious individuals and the anxiety often leads to depression. I’m not saying that all vegetarians and vegans struggle with anxiety and depression. Rather, that individuals who are anxious and depressed and vegetarian tend to have higher levels of anxiety and depression due to nutrient deficiencies. Their anxiety is often caused by fluctuations in blood sugar levels because of the low carbohydrate to protein ratio in many of the foods they typically consume.
For example, let’s consider a bean burger. Beans have some protein and some carbohydrates. The bread is all carbohydrates. So this bean burgers contain a lot of carbs and not a lot of protein
Clinically, I have seen anxiety decrease significantly when we assure that they are getting enough protein throughout the day (8 grams per 20 pounds of body weight or at least 65 grams divided throughout the day for anyone over 140 lbs.)
There is a large body of research that suggests vegetarians have better physical health then omnivores. Vegetarians tend to have lower body mass index and cardiovascular disease. However, an Australian study with 9113 participants indicated that vegetarians and vegans have more anxiety and depression then omnivores.
Here are two more studies that may be of interest:
Vegetarian diet and mental disorders: results from a representative community survey
Food and Nutrient Intake and Nutritional Status of Finnish Vegans and Non-Vegetarians
For vegetarians, the labs that I carefully look at are total protein, Omega 3, ferritin (iron stores), B vitamins, and Vitamin D3. In my client base, vegetarians and vegans tend to carry less muscle mass and more fat mass.
For vegans, I will also look to see what their primary sources of fats are. The addition of coconut milk and oil can help with fatigue caused by a lack of cholesterol in their diet; consuming enough cholesterol is important because it helps synthesize hormones.
I am going to make a “no duh” statement… But it’s one we often forget: Weight does not determine health.
High-fat mass can impact health, but it’s not everything. I’m far more concerned about an individual's ability to be self-compassionate, eat primarily health-sustaining foods, engage in some level of regular movement or exercise, sleep well, and have healthy labs.
I have seen a number of individuals who started on a keto diet (low carbohydrate with high protein and high fat) to lose weight. However, after the initiation phase of just meat and fat, they did not add fruits or veggies back into their diets for years. They explain that primary reason for staying with this phase is because adding back fruits and veggies caused them to gain back the weight they had lost. This is true, because when we do quick weight loss programs it’s hard to not do quick weight gain as well. However, there are some serious health consequences not eating fruits and vegetables.
One of the consequences is that they became very low in B vitamins and Vitamin K. For women following this type of dietary restrictions, they started having heavy menses because their blood was not clotting well. This then also led to iron deficiency, which contributed to their story of depression/fatigue.
Check out these articles:
Diets that support physical health do not always support mental health. Diets that are low in nutrient dense foods can contribute to mental health concerns through presentation of depression/fatigue and hypoglycemia/anxiety. When someone is considering medications or has tried medicines without the expected positive impact, it’s worth suggesting that they ask their primary care providers for a laboratory workup for fatigue. Going to a naturopathic physician, nutritionist, or acupuncturist to have their diet evaluated for deficiencies that could be contributing to their mental health status is also a good option.
Here are some additional resources:
In the United States, 33.7 million people live with some type of mental health issue. Studies show that prolonged fatigue is linked with anxiety and depression and all too often we assume that these symptoms emotionally driven without taking the time to rule out potential physical triggers, such as hypoglycemia, anemia or even possible drug interactions.
In part, this is because differentiating fatigue from anxiety and depression is hard to do and those suffering often don’t know what questions to ask.
I always recommend that people begin by describing their symptoms to their primary healthcare providers as fatigue rather than anxiety or depression. The medical questions around fatigue can be answered with a number of blood tests. Be sure to ask for the following labs:
While there is a cost for running these labs, the cost of treating fatigue strictly as an emotional symptom is even higher. A recent article in Money magazine states that the treatment costs for mental disorders is more expensive than treatment of diabetes or hypertension– and that the cost falls mostly to the patients. Insurance companies put up road blocks for receiving mental health treatment, finding in-network care can be challenging and, if you do, the cost of prescribed medications is high. Very often, mental healthcare is a budget buster. Particularly if the primary care provider, prescriber, or therapist have not addressed the true problem – Fatigue. Nutritional studies are showing that poor nutrition and dysfunctional physiology cause 50% of the symptoms of fatigue.
I've created a sample letter requesting the above blood work from your primary care physician that you can use to help start this discussion.
In addition to asking your healthcare provider for the lab work, I have seen the following self-care steps help in relieving fatigue:
If these steps feel hard, ask yourself what you can do to make it happen. Don’t think of it as a lifestyle change, but consider it an experiment. Start with one of the above steps and commit to doing it for at least 3 days to see if it helps.
If there was one solution for fatigue, everyone would be doing it. Ask your provider to rule out the most common causes of fatigue/depression. It may not be all in your head ─ it may be that your body needs help.
References:
Kristen Allott is dedicated to optimizing brains and bodies for better decision making, creativity and health.
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