Fatigue Health Workup

1. Adrenal Fatigue: If you have the symptoms of adrenal fatigue, have an integrative physician or naturopathic physician order salivary adrenal testing to look at your cortisol curve. Your regular physician can order the testing at Labcorp in the U.S. or you can order yourself online at DirectLabs.com.

2. Nutrition deficiencies: Most of these can be measured with standard testing:

a. Iron: To assess your iron status, have your physician order

- complete blood count, assessing for anemia

- serum iron and iron binding level

- ferritin level (which is a measure of your iron storage)

b. B12: A serum B12 is a fairly accurate measure of deficiency. Keep in mind that the "normal" range is 200-600, but a fair number of women are deficient between 200-400. If your results are in this lower range, you may want to get a serum methylmalonic acid test, which is a sensitive test for B12 deficiency

c. Folic acid: Serum folic acid is a simple blood test

d. Other B vitamins (B1, B2, B3, B5, B6, and biotin): B1 (thiamine) can be measured in the serum

e. Magnesium: have your physician order a red blood cell magnesium test, which is a better measurement than a serum magnesium test as it measures magnesium within the cell

3. Medical Conditions:

a. Hypothyroidism: Have your doctor order a TSH, free T4, and free T3. Remember that the TSH is not normal if it close to or above 4 microIU/ml, and that you may have early hypothyroidism. If your labs are abnormal, have your physician check your TPO antibodies to see if you are having an autoimmune reaction, known as Hashimoto's Disease.

b. Anemia: Have your physician order a complete blood count (CBC) to start. Other tests, such as a ferritin level, which reflects the body's iron stores, or a Vitamin B12 or folic acid level may also be appropriate.

c. Chronic diseases: In addition to a CBC, I would recommend a Comprehensive Metabolic Panel as an initial workup for all patients with fatigue as it gives us information on blood sugar, diabetes, and kidney and liver function.

d. Infectious diseases: If no other obvious causes are found, the fatigue is prolonged, and specific symptoms suggest infection, discuss testing for infectious diseases with your doctor.