Fatigue? It could be your hormones
I am learning a lot about fatigue while I help some of my patients with chronic fatigue issues. I have one in particular who’s case study I would like to discuss.
He has a hard time going to bed at a reasonable hour, considers himself a night owl, and needs more sleep than usual. He can sleep 9-10 hours and still feel tired and unrested when he wakes up. He also does not have vivid dreams and cannot recall his dreams at all, which may indicate dopamine deficiency. He often skips meals and does not eat at regular times. He often reports low blood sugar and feeling “hangry” when he goes too long without eating. His stress tolerance is rather low, and he seems to be completely intolerant of any stress after 8pm. He also has some hormone complaints, low testosterone, which I did not realize may have been linked to some of the topics addressed in this module. He also does not exercise consistently and snacks on processed foods before bedtime as a way to “relieve” stress. To address his sleep problem, I ran the Dutch hormone test to see if we can find some clues to some of his complaints.
Below are some screen shots of relevant Dutch test data. Overall, he has low cortisol, and his morning cortisol is low, which aligns with his fatigue. He also has very low DHEA for his age (44), at 952, his value should be closer to 3000. This may be contributing to his low testosterone levels. He also has low melatonin and oxidative stress is on the higher end of the range.
Here are some strategies for my family member, based on information from this module and his lab results:
- Improve nutritional status- This includes reducing intake of processed carbohydrates before bed, transitioning to a lower carb dinner, and eating at regularly times and not skipping meals. He should consider eating breakfast. Skipping breakfast and eating irregularly were strongly associated with poor sleep quality. (St-Onge et al., 2016). Early time restricted feeding may not be a good strategy for him at the moment, at least until he gets his glucose under control. I recommend a formula for energy production called Mitochondrial NRG, that contains various nutrients that may help with energy production such as vitamin B12, B-6, magnesium, d-ribose, l-carnitine, coq10, malic acid, and niacin. Adding in Chromium GTF may also help optimize glucose metabolism as well.
- Adopt some of the sleep hygiene strategies such as going to bed between 10:30 and 11pm, obtaining 7.5 hours of sleep, removing electronics and blue light and avoiding eating processed foods, particularly before bedtime
- Licorice root may be helpful in the morning or afternoon to help prevent breaking down too much cortisol, particularly when he is feeling the most fatigued.
- Topical DHEA supplementation may help support his low DHEA levels. Recent evidence reveals that DHEA is more than a pro-hormone, but can also regulate processes in the CNS, such as neurotransmitter synthesis, cognitive function, neurogenesis and neuronal survival (Placzek, 2017). “DHEA and DHEA-S bind to and activate/modulate the NMDA glutamate receptor, potentiate dopamine and serotonin signaling, and inhibit the GABA A receptor activity” Placzek, 2017). In fact, both DHEA and DHEA-S can stimulate dopamine in different ways. “DHEA-S uses genomic, slow, long-lasting mechanisms to do so by upregulating tyrosine hydroxylase levels, the enzyme responsible for dopamine production. DHEA, on the other hand, signals to increase dopamine levels in rapid, intense, short-lived bursts” (Placzek, 2017). A big clue here for dopamine deficiency is that he does not recall his dreams. Topical DHEA can raise salivary and serum DHEA, but may have little effect on DHEA-S, in which the oral route may be preferred. Care should be taken to investigate SNP’s that may impair DHEA-S to be readily converted to DHEA, however, when supplementing. Also, it is important to continuously monitor the patient’s symptoms and any reported changes while supplementing.
- Following an anti-inflammatory diet, rich is antioxidants and phytonutrients can improve his elevated oxidative stress. He recently identified intolerance to dairy and gluten, so consistently staying gluten and dairy free would be a good approach to keep inflammation at bay.
- CBD oil may be helpful in promoting day time alertness and reduce daytime sleepiness, as mentioned above.
- Melatonin -To increase melatonin, he can eat foods that promote melatonin production such as goji berries, walnuts, almonds, pineapple and bananas. Lavender is an essential oil that can also raise melatonin. And getting adequate sunshine can shut down daytime melatonin production, improve alertness and increase melatonin production at night. 10 minutes a day around noon is sufficient for this process. Cutting out blue light before bedtime can also assist in improving melatonin, which aligns with the recommendation to reduce electronic use before bedtime. And finally, if the strategies listed are not helpful, experiment with melatonin supplementation, taken at 10:30pm. Start with 1mg and work his way up to see if there are any improvements in sleep quality and subsequent morning arousal and alertness.
I believe what I see most commonly with clients with sleep issues are related to stress management and poor habits and the dysfunction that develops as a result. Often times this is the result of poor work-life balance, which leads to poor eating habits and lack of exercise that can then lead to downstream effects on sleep. This starts a viscious and self-perpetuating cycle that then can lead to dysregulations on a cellular and biochemical level with HPA axis, hormone imbalance, dysglycemia, obesity and eventually adrenal dysfunction.Moving forward, I will evaluate all my clients on their sleep quality, regardless of if that was one of their main complaints. Oftentimes, people may not realize their sleep is dysfunction, and they may have succumbed to the dysfunction as being “normal” for them. I will be running either the salivary cortisol or Dutch test for clients that are experiencing chronic sleep disturbances. I also believe that addressing the fundamentals, such as nutrition, exercise, and targeted allopathy can improve sleep quality in most clients I will work with by addressing most of the key elements discussed earlier. A small percentage of people may need to seek psychological and behavioral therapy in conjunction, so it will be evaluated as a case by case scenario.
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