Homo toxicus

CBC’s documentary series “The Lens” aired a program last night titled Homo toxicus. The program detailed a woman who had her blood tested for environmental contaminants, and found over 110 chemicals including PCBs and known carcinogens. The program investigated the woman’s search to see whether or not these chemicals were playing a role in her health problems, including poor fertility.

The link to the trailer is here, though I do not know when the program is to be repeated.

In testing my own patients, I consider both serum and whole blood tests for chlorinated pesticides, PCBs, and volatile solvents.

Why run a Volatile Solvent Test?

Overexposure or chronic exposure to volatile solvents damages the central nervous system and causes chemical-driven liver and kidney damage. Benzene, in particular, has a severe toxic effect on the hematological system and is a recognized human carcinogen. Other solvents contribute to atrophy of skeletal muscles, loss of coordination, vision problems, and depression of the central nervous system.

Why perform chlorinated pesticide exposure testing?

Chlorinated pesticides have been identified in over 98% of all persons studied, have an affinity for lipid-rich tissues, and are stored in various organs and adipose tissues. These toxins also bioaccumulate in our bodies, increasing our toxic body burden over time, are powerful mitochondrial toxins, and may be the root cause of many chronic illnesses. Identifying this body burden is why pesticide exposure testing is important.

The primary toxic effect of this family of pesticides is at the site of nervous tissue and muscle membranes. These poisons are absorbed across the gut and interfere with nerve impulse transmissions. In humans, this interference normally shows up as chronic neurological problems including mood disorders and difficulties with learning and memory. These poisons have also been shown to cause fatigue, obesity, diabetes, certain cancers, immune dysregulation, allergies, heart disease, and a host of other problems.

Why perform polychlorinated biphenyl testing?

A PCB burden affects children more than adults. PCBs are most often passed to children through breastfeeding and trans-placental transfer. PCB exposure in children can impede neurobehavioral and immune system development. These impediments may cause delayed neurobehavioral development such as motor skills, short-term memory, and lower scores on intelligence, psychomotor, and behavioral tests. A lowered immune system can create many problems in children including allergies, sensitivities, and chronic infections.

Source: Metametrix lab testing

In reality, chemical toxicity is usually a clinical diagnosis, independent of the labs. You can find an increased amount of these chemicals in many patients, simply due to the polluted environment we live in. Some patients are gravely ill and improve with detoxification even though their system has relatively low amounts of these chemicals, and other patients can have high levels without acute or current illness.

Treatment is a good detoxification program which involves sauna, exercise, metal chelators, ozone colonic and blood treatment, intravenous vitamin C. The detoxification program usually lasts 4 weeks (I will be posting a page on this at www.pannaturopathic.com soon.

Clinically, you have to consider which patients are most likely to have their chronic illness significantly contributed to by the chemical toxicity. Detoxification can always be supportive, but it is most likely to be a main treatment that gives the most benefit in conditions such as:

• asthma
• chemical sensitivities (of course) that lead to chronic headaches, brain fog, fatigue
• patients who are seemingly allergic to “everything”

www.pannaturopathic.com

Green tea slows prostate cancer

Population based, green tea is the most popular beverage world-wide, and with good reason. I have written before on the benefits of the calming amino acid theanine and the health benefits of the plant chemical EGCG (epigallocatechin gallate) that is present in high amounts of matcha tea, and now there is another study showing the benefits of yet another compound in green tea, this time in prostate cancer.

In this study, Philadelphia-based researchers tested a trademarked extract from green tea called Polyphenon E.

They were looking for a number of biomarkers – molecules – including vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) which are indicators of developing cancer.

They also looked for prostate specific antigen (PSA) – a protein only found in the prostate. Levels can rise if cancer is present.

‘12 cups’

The study included 26 men, aged 41 to 72 years, who had been diagnosed with prostate cancer and who were scheduled for radical prostate surgery.

Patients took four capsules containing Polyphenon E for an average of 34 days, up until the day before surgery – the equivalent of around 12 cups of normally brewed concentrated green tea.

The study found a significant reduction in levels of HGF, VEGF and PSA, with some patients demonstrating reductions of more than 30%.

Most anti-cancer research in green tea has focused on the EGCG compound, and the trademarked extract Polyphenon E seems to be important as well (likely has EGCG as a component). The advantage of taking the beverage over the capsule is that you do not need a capsule for each green tea compound, you get the whole food. And in this case with prostate cancer, a respectable 12 cups is not difficult once you acquire a taste for this beverage.

I still prefer matcha for its higher content of EGCG and of theanine, though it is higher in caffeine as well, which can be troublesome for some caffeine sensitive patients.

What’s the other evidence on green tea?

1. Genital Warts: a green tea ointment was able to clear warts in 24-60% of patients after 16 weeks treatment
2. Reduced cancer risk: increased consumption is associated with reduced bladder, esophageal, stomach, and pancreatic cancer
3. Reduced cholesterol: another compound called theaflavin (also present in black tea) reduced cholesterol. Population based data indicates that higher consumption of green tea is associated with lower cholesterol as well.
4. Low blood pressure: consumption reduces postural associated symptoms. Unfortunately, nothing special related to green tea here. It seems to be the caffeine that is helpful.
5. Reduces risk of Parkinson’s: again an association between increased green tea consumption and decreased or delayed Parkinson’s disease. In men the effect of the tea was more pronounced at more cups (5 to 30) cups, and in females increasing doses did not seem to be related to the protective effect.
6. Diabetes risk reduction: adults who drank 6 or more cups had roughly a third less risk. Again this is an association, so it might be that those who are prone to drinking green tea tend to have healthier diet and lifestyles than those who don’t. However, there is sufficient biochemical reason as to why green tea probably exerts a separate medicinal effect.

www.pannaturopathic.com

Vitamin D deficiency is associated with more plaque build up in arteries

A recent study in type I diabetics gives us another reason, other than swine flu to make sure our vitamin D levels are optimized. 375 patients with type I diabetes were studied and their vitamin D levels measured. When the levels were below 25 nmol/L (SI, Canadian units) these patients were almost 3 times as likely to develop calcified plaque blockages in their arteries than those who had levels above 75 nmol/L. Further, deficiencies were likely to cause progression of the calcified blockages.

Interestingly, this vitamin D deficiency made patients more likely to have plaque build up even in comparison to sugar control, age, and male sex.

A similar correlation was found in patients undergoing hemodialysis due to kidney disease. Vitamin D deficiency was associated with increased hs-CRP (inflammation in the blood vessels), and increased calcified plaque in the arteries.

Here’s the best part: a third study looked at patients who had no symptoms but were found to have calcified plaque in their arteries by calcium scoring (I prefer EBT or electron beam tomography for calcium scoring of the arteries in my patients). The patients were treated with a statin drug, niacin (vitamin B3), omega 3 fish oils, and vitamin D (to get levels to 125 nmol/L). 44% had reductions in their plaque levels (reversing the build up in the arteries), 49% had slowed growth, and only 3/45 patients had plaque growth more than 30%.

www.pannaturopathic.com

Fasting sugar is not the best marker for pre-diabetes

I query most of my patients during the initial exam and history as to whether or not they have any diabetes in the family. Often I am told that they do, and that they themselves “have been tested” for diabetes and are fine. This almost always means that they have had a fasting glucose measurement which was normal.

A fasting sugar level that is elevated confirms diabetes. If the level is between 5.7-6.0, it may not be diabetes but rather, pre-diabetes. Still, I never believed that a fasting sugar level was sufficient to assess the relative risk of developing diabetes in the next 3-5 years. I have always used a fasting insulin in combination with fasting sugar to get a better functional idea of how the body is handling sugar. I wrote about sugar, diabetes, and insulin resistance here.

Simplistically, the higher the fasting insulin, the harder your body is trying to lower the blood sugar. The sugar might be normal, but your body may be having trouble keeping it normal. There is evidence that high insulin levels increase cardiovascular risk, cancer risk, and contribute to chronic fatigue issues.

Now, in the journal Lancet, June 2009, another good study has been published confirming this. This study showed that a fasting sugar might show a prediabetic condition 3 years prior to diabetes. However, measuring insulin resistance showed increase resistance 5 whole years prior to the onset of diabetes. That is a lot of time to intervene and avoid drug therapy.

With such a simple inexpensive test, for those who have diabetes in the family, are overweight, or have other risk factors, it is well worth checking in order to quantify risk and to follow with lifestyle changes, nutritional support, and other therapies (such as exercise and oxidative therapies).

www.pannaturopathic.com

Back at it…

After a long delay due to being too busy at home – I am back to semi-frequent posting.

The news this morning has stated that the World Health Organization is preparing to declare the Swine Flu a pandemic. The preparations they are speaking of are more to avoid a panic amongst the general public.

The World Health Organization is preparing to declare a swine flu pandemic, officials hinted Tuesday, saying that the goal now is to prevent countries and populations from panicking.

“One of the critical issues is that we do not want people to panic if they hear that we are in a pandemic situation,” Feiji Fukuda, WHO’s acting assistant director-general, said in a media call Tuesday.

“We know the virus is spreading and we are now seeing activity picking up in a number of countries. We know that we are getting closer to probably a pandemic situation,” Fukuda said.

(CanWest)

The media, as of a few weeks ago, has stopped stoking fear in the public with the mass-reporting of every new swine flu incident.

From a naturopathic standpoint, prevention involves hygiene and immune support.

1. Wash hands frequently and before consuming foods or touching mucus membranes
2. Use effective disinfectants appropriately
3. Optimize your vitamin D levels and check with a blood test called 25-OH vitamin D3 (calcidiol)
   1. The journal Archives of Internal Medicine in February of this year reported that those with the lowest vitamin D levels in blood were more likely to have a recent upper respiratory infection that those with the highest levels of vitamin D (and the highest levels in that study were not all that high at all)
4. with hygiene, consider nasal rinses with a dilute saline solution (Neti pot, or NeilMed available at most pharmacies)
5. Consider immune supporting herbs such as ginseng formulas (Adreset) and Astragalus
6. Get plenty of sleep
   1. The journal Nature Reviews, Neuroscience has this to say:
      1. Good sleep is necessary for physical and mental health. For example, sleep loss impairs immune function, and sleep is altered during infection. Immune signalling molecules are present in the healthy brain, where they interact with neurochemical systems to contribute to the regulation of normal sleep. Animal studies have shown that interactions between immune signalling molecules (such as the cytokine interleukin 1) and brain neurochemical systems (such as the serotonin system) are amplified during infection, indicating that these interactions might underlie the changes in sleep that occur during infection. Why should the immune system cause us to sleep differently when we are sick? We propose that the alterations in sleep architecture during infection are exquisitely tailored to support the generation of fever, which in turn imparts survival value.
7. Stress can raise cortisol and suppress proper immune system surveillance – increase “anti-stress” activities such as moderate exercise, yoga
8. If you feel yourself starting to become ill, consider
   1. intravenous vitamin C
   2. Home-based constitutional hydrotherapy

www.pannaturopathic.com

Chemical toxicity in the news…

Drycleaning in the water

A small town near a military base outside of Quebec City has found out recently that there has been a leak of a chemical into their water supply for the last few years. The chemical, TCE or trichloroethylene, is a probably carcinogen.

From the Globe and Mail:

QUEBEC — Marie-Paule Spieser lost her best friend to a rare form of liver cancer in September of 2000. As an experienced nurse in her mid-40s, Ms. Spieser knew something had to be wrong.

Her friend’s husband had also been diagnosed with cancer and it seemed nearly every household in the neighbourhood where she lived was stricken with some form of the disease.

Then a few weeks later, just before Christmas, Ms. Spieser along with the 4,000 other residents of Shannon, a small town located just outside the Valcartier military base near Quebec City, learned that their water supply had been contaminated for years with the chemical solvent trichloroethylene, or TCE, a probable carcinogen.

The link between the chemical and the cancer cluster in that town has not been proven, and there is now a class-action law suit involving 1300 people.

Trichloroethylene is used in drycleaning, and is one of the reasons to consider reducing the frequency of drycleaning. A simple carbon filter, such as Brita, can remove trichloroethylene and other chemicals from drinking water.

Health Canada has added 8 more chemicals to a “toxic” list

Of relevance to human health include looking on the ingredient list of cosmetics for thiourea, which European and US groups state should be investigated as a possible carcinogen. Pigment yellow 34 and red 104 contain chromium and lead, and are foudn in some plastics.

This is a similar list to where the plastic chemical BPA was added to. I wrote in one of my first posts, before the widespread news, on how BPA in plastics should be a concern,

The Environmental Working Group has an excellent site on chemical toxicity and exposure in everyday products. They have a page on tips for reducing BPA exposure. Simply, using inert materials for cooking and storing foods and liquids is most prudent, sticking with materials such as stainless steel and glass.

Keeping yourself clean

Exercise is one of the best methods of detoxification. Cardiovascular exercise for 20-30 minutes, enough to bring on marked sweating, can help to mobilize and excrete stored chemicals from fat. Sauna therapy works on the same principle, and can provide for more rapid detoxification.

Ginger and green tea are two natural compounds that increase fat excretion in the stool. The liver is responsible for clearing fat soluble toxins. Once it has been processed, the metabolites and toxin byproducts are excreted into the urine or the stool. The problem with excretion in the stool is that there is a high rate, greater than 95%, reabsorption of bile from the stool, back to the liver, bringing toxins back into the system. Increasing the amount of fat and bile that stays in the stool increases the amount of chemical excretion. Ginger and green tea can double the amount of excretion that stays in the stool.

A 3 week detoxification program, including a special diet and a medical food that promotes the detoxification process in the liver, can be done as well. This is a bland diet that reduces toxin intake to the liver, and is calorie reduced to help with mobilization of toxins from fat. The medical food has nutrients that help the liver process the toxins much more efficiently than normal. Usually a baseline blood panel is done, along with a few in office measurements in order to measure progress.

www.pannaturopathic.com

A few updates to the web page:

Lyme disease treatment

Chronic lyme disease is an overlooked area of treatment for some cases of chronic fatigue syndrome and fibromyalgia. It is a complex illness that requires intensive treatment to improve. Symptoms of unexplained neuropathy (nerve pain / symptoms), muscle pain, arthritis, and fatigue warrant investigation.

Multiple chemical sensitivity

Multiple chemical sensitivity describes a syndrome in which patients react to many chemicals, even if present in very low amounts which do not bother most people. These patients symptoms of asthma, itchy eyes, rash, fatigue and headache from exposure to low doses of multiple chemicals.

Chronic fatigue syndrome treatment

This page describes an effective treatment protocol for those who meet the criteria for chronic fatigue syndrome.

Headline: fish oils no benefit; Actual study: fish oil reduces cardiac death!

News is always meant to be the information equivalent of “junk food” – giving instant satisfaction with very little real nutrition. This is why headlines (in Vancouver too!) are meant to capture and pique your interest and then give something to talk about over at the water cooler. This makes most Vancouver naturopaths irritated.

Unfortunately, this type of mentality has spread over to news stories that are about natural health products. One of the most unequivocal axioms of nutrition and health is that good fats are good for you, and especially that fish oil is good for your heart. And thus, when a study is published in the BMJ that reviews the effects of fish oil, it receives press in the most sensational way.

The headlines read: “Benefits of fish oil supplements questioned” and “Study questions fish oil benefits” and “Fish oils Hold no benefit for arrythmia patients” - which leads the casual observer to believe that fish oils don’t help heart disease patients. Only the last headline gave one of the conclusion of the study.

Directly quoted from the actual study:

We observed a significant 20% reduction in deaths from cardiac causes. This is similar to previous systematic reviews that included studies of dietary intake of fish oil either by increased intake or supplementation, which showed a significant reduction in cardiovascular events (including strokes). Most of these events were, however, related mainly to a reduction in deaths from coronary events with a reduction in risk ranging from 24% to 36%.^{8 22 23 24} Experimental studies have proposed that fish oil helps to stabilise the atherosclerotic plaque through several mechanisms

A 20% reduction in cardiac deaths didn’t make the news. Unfortunately, the only thing that made the news was that fish oil does not manifest its benefit through reducing abnormal heart rhythm. It manifests its benefit by stabilizing plaque in arteries.

Related links from my website:

Fish oils, Vioxx, and heart disease: how they are linked
Studies on chelation therapy as a natural treatment for heart disease
Aggressive natural therapies for coronary artery disease
Plaquex and phosphatidyl choline for heart disease and removing plaque
Why I love treating heart disease

www.pannaturopathic.com

Disinfectants for use in the house…

Most people already know that we should be using separate cutting boards for raw meat and vegetables. Hopefully after having a good turkey dinner, clean up wil have been thorough to get rid of reisdual bacteria from raw turkey that has been in contact with counters and surfaces.

While these aren’t the type of chronic infections that can contribute to many diseases, food poisoning is no fun and can make good hydration difficult.

Here are two disinfectants that are very effective (surfaces should be relatively clean first):

1. acidified bleach

Regular laundry bleach is often diluted for disinfection purposes, but when acidified, it is up to 100 times more effective as a disinfectant, especially when surfaces aren’t completely cleaned first. 1 part bleach can be added to 500 parts water, and then 5 parts vinegar added. The proportions are large, but can be tapered down, as the solution should be made fresh. It can be sprayed or wiped onto surfaces, and then either left to dry or wiped clean after 5-10 minutes.

The fumes can be irritating, so anyone with asthma, respiratory diseases, or chemical sensitivities should use the next formula instead.

2. hydrogen peroxide, vinegar one-two punch

Fill one spray bottle with regular 3% hydrogen peroxide, and a second with regular vinegar, undiluted. Spray the surface to be disinfected with either bottle first, then with the second bottle. A very effective, non-irritating, disinfectant.

www.pannaturopathic.com

Sleep matters… for more than neurodegenerative disease

15 years ago I was involved in competitive martial arts, and competed nationally as part of a provincial BC team. The training often involved heavy sparring at mid-to-full contact. Nowadays I tend to dream about naturopathic medicine, but back then my dreams were definitely about martial arts.

In fact, in many of the dreams I found it interesting that I would “act out” one or two moves in the dream, and thus a punch would be accompanied by a very large muscle twitch that would wake me up.

I thus found this piece of news very interesting:

WASHINGTON, Dec. 25 (Xinhua) — People with a sleep disorder that causes them to kick or cry out during their sleep may be at greater risk of developing dementia or Parkinson’s disease, according to a study published in the Dec. 24 online issue of U.S. journal Neurology.

The sleep disorder is called REM sleep behavior disorder. People with the disorder do not have the normal lack of muscle tone that occurs during REM sleep, often known as the dream stage of sleep. Instead, they have excessive muscle activity such as punching, kicking, or crying out, essentially acting out their dreams.

The study involved 93 people with this type of sleep disorder who had no signs of a neurodegenerative disease, such as dementia or Parkinson’s disease. The participants were followed for an average of five years.

During that time, 26 of the people developed a neurodegenerative disease. Fourteen developed Parkinson’s disease,11 developed dementia and were diagnosed with either Alzheimer’s disease or Lewy body dementia. One person developed multiple system atrophy, a rare disorder that affects movement, blood pressure and other body functions.

The estimated five-year risk of developing a neurodegenerative disease was 18 percent, with the 10-year risk at 41 percent and the 12-year risk at 52 percent.

I have since stopped “acting out” any dreams, but the study still piques my curiousity. Sleep is vitally important to health. There are studies that link and associate poor sleep with chronic obstructive airway disease, kidney disease, cardiovascular disease, depression, diabetes, and of course fatigue, including chronic fatigue syndrome and fibromyalgia.

I did come across an interesting study in the journal Sleep Medicine Reviews 2007 that summarized a few interesting biochemical mechanism of how sleep deprivation –> weight gain –> diabetes.

Sleep and glucose tolerance

Sleep of less than 6-7 hours per night (depending on the study), caused a patient to be more likely to have a poor response to sugar (impaired glucose tolerance). Thus, chronic sleep deprivation would make a patient more likely to have higher levels of blood sugar after a carbohydrate meal, compared to a patient who had normal sleep and had the same meal. This alone is a risk factor for metabolic syndrome and diabetes.

Sleep and appetite

Leptin is a hormone secreted by fat cells and it promotes satiety, or a sensation of fullness. Interestingly, leptin has a daily rhythm and rises markedly during sleep. Chronic sleep deprivation may lead to a “deficiency” in leptin, and thus may contribute to excess calorie intake, eventually leading to weight gain. 7-7.7 hours seemed to be the length associated with healthiest body weight. The effect may be small, with someone only getting 2-4 hours a night being 2.35 times more likely to be obese compared to someone getting 7 hours a night.

Sleep loss contributes to weight gain through the effects of impairing sugar tolerance (diabetes risk), through increasing appetite, and probably by contributing to poor food choices and to decreased exercise.

Tips for helping sleep (from the University of Maryland)

• Fix a bedtime and an awakening time. Do not be one of those people who allows bedtime and awakening time to drift. The body “gets used” to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.
• Avoid napping during the day. If you nap throughout the day, it is no wonder that you will not be able to sleep at night. The late afternoon for most people is a “sleepy time.” Many people will take a nap at that time. This is generally not a bad thing to do, provided you limit the nap to 30-45 minutes and can sleep well at night.
• Avoid alcohol 4-6 hours before bedtime. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.
• Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.
• Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime. These can affect your ability to stay asleep.
• Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep.

Your Sleeping Environment

• Use comfortable bedding. Uncomfortable bedding can prevent good sleep. Evaluate whether or not this is a source of your problem, and make appropriate changes.
• Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.
• Block out all distracting noise, and eliminate as much light as possible.
• Reserve the bed for sleep and sex. Don’t use the bed as an office, workroom or recreation room. Let your body “know” that the bed is associated with sleeping.

Getting Ready For Bed

• Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep.
• Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension.
• Don’t take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a “worry period” during the evening or late afternoon to deal with these issues.
• Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.
• Get into your favorite sleeping position. If you don’t fall asleep within 15-30 minutes, get up, go into another room, and read until sleepy.

Related links:

Glucose tolerance and how the hormone insulin is VERY bad for you
Poor glucose tolerance can lead to non-alcoholic fatty liver disease
Treating poor glucose tolerance and diabetes with naturopathic and natural methods
Chronic fatigue syndrome natural treatment

www.pannaturopathic.com

Dealing with chronic fatigue

Perhaps the number one complaint that accompanies a patient into any doctors office is chronic fatigue. It is definitely not the only complaint, but it usually is most prominent amongst a list of symptoms. And it is very important, as it is difficult to have a good quality of life if there is no zest or energy to enjoy life.

I’ve written many times before on fatigue, but we need to keep in mind it is only a symptom. Any doctor will test to make sure that reasonably likely underlying diseases are not present, which may be causing the fatigue. Most commonly, we will think of oxygen delivery to the tissues. Thus, doctors will rule out any major heart problems; if the pump to move oxygen-rich blood is not working well, you will be tired. Doctors will rule out major lung problems; if there is not good oxygenation of the blood, the heart can pump all it wants but it is delivering nutrient-poor blood. Anemia will be checked for, as you need to have enough blood cells (and iron, B12 etc, for those blood cells) to carry oxygen in the blood. Finally, hypothyroidism (low thyroid function) is usually checked for, as this can be a relatively common cause of fatigue.

All the above comes back “normal” 90% of the time.

This is where a naturopathic doctor usually moves into the “functional” or naturopathic diagnostic work up. Common causes that are looked into include:

hypoglycemia: poor blood sugar control. These patients have to eat every 2-3 hours or else they will get anxiety, fatigue, and headaches. They find that even eating frequently can just barely control symptoms, and they often don’t feel 100%, and thus still speak of chronic fatigue. This is diagosed by a insulin-glucose tolerance test, where you come into the office fasting, insulin and blood sugar is measured, and then you are given a carbohydrate-rich beverage. Tests are run for 3-4 hours and symptoms are recorded so that we can confirm if fatigue, anxiety, or headaches are coming with certain peaks and troughs in insulin or sugar.

adrenal fatigue: this is not Addison’s disease, but rather a maladaption to chronic stress. Cortisol, a hormone from the adrenals, can either be too high (short term) or too low (chronic adaptation). This fatigue is worst on waking. The patient never wakes refreshed. There is a second wind that comes in the night just before bed, often contributing to insomnia. This patient feels “stressed and wired” all the time. I’ve written on this before here, here, and here. Testing is done through blood tests and a 4 point saliva test done throughout one day to assess hormonal rhythm.

hidden allergies: to foods, molds, or chemicals are very common. These patients feel worse after eating certain foods, but can’t seem to pin down which ones. Mold sensitive patients often have sinus problems, and are worse in warm, damp, moist environments. Chemically sensitive patients are worse around perfumes or smells from cleaners, and can get physically ill or have a severe headache. This is the realm of environmental medicine, allergy, and detoxification. Testing is done through skin testing and blood tests for antibodies against specific allergens.

chronic infections: including lyme disease, chronic fatigue syndrome. These patients are always fatigued, often have muscular pain coexisting, have poor exercise tolerance, and can have a host of related symptoms (such as dizziness, balance problems, brain fog). Testing is done through western blot for lyme, inflammation tests, and often a treatment trial.

Of course, there are many other components of working up fatigue from a naturopathic perspective, but the above are the most common that I see.

What if you are healthy and just a little stressed or tired? Should you wait until you have fatigue day in and day out?

That was a rhetorical question, but if fatigue is a recurring concern, a basic exam and workup should be done to rule out the conventional causes. Many of us are just a little too busy and have trouble dealing with a hectic schedule. Some of the tips below may be helpful:

Controlling stress and anxiety:

Having good hydration can decrease stress. Vitamin C and niacin (no flush form) can be useful. Breathing techniques, done when feeling slightly anxious, as described below can be done.

Starting with 2 slow, deep breaths, a deep inhalation, and then going through the rapid exhalations to a count of 20 is excellent, followed by another 2 slow, deep breaths. This can be done twice a day.

Adding graduated exercise:

The most important thing here to deal with fatigue is to add in short bursts of mid-level intensity activity. For example, weight control aside, a short and brisk walk outside for 5-10 minutes done after lunch and right after work goes far at helping circulation and reducing that stagnant feeling of fatigue.

Adding protein:

Stabilizing your blood sugar is important at all times, but especially at times of stress. You shouldn’t have to eat every 2-3 hours, (and if you do, you need to be worked up naturopathically for this) – but adding more protein to your main meals, especially breakfast, will help to keep a stable source of fuel throughout the day. Limiting efined carbohydrates and adding vegetabler fiber to lunch, along with protein, can further prevent fatigue that tends to happen towards the end of a work day.

Don’t multi-task, if you can avoid it:

Multi-tasking is very “stressful” and usually stimulates more beta-activity type brain waves. These type of beta waves will make you feel alert while doing your tasks, but burn out will be sure to happen. Giving 100% effort on one task at a time, in a relaxed manner, perhaps with the aid of some green tea for its theanine content, is more inducive of alpha wave activity. Theanine increases alpha wave activity in your brain, which is associated with an alert, focused, meditative type state. Less burn out is likely.

Find out if morning exercise or after work exercise works better for you:

If you are generally healthy, usually exercise is already part of a 3-4 times a week routine. Sometimes, even short bursts of 15-20 minute jogging or rope jumping is enough to reset the adrenals, improve circulation and oxygenation, and keep energy high. The key is to find whether your day is better and more productive with you exercising right on waking up, or right after work. Squeezing in the 15-20 minutes is sometimes difficult, but usually easier at the two above times. The vast majority of my patients will do better with morning exercise as it does seem to help the adrenals adapt to daily stresses and rhythm better.

All in all, fatigue usually falls into one of three categories.

1. A symptom of an underlying disease that can be found with conventional medical workups, including heart, lung, and basic blood tests for anemia, iron deficiency, etc
2. A symptom or early warning sign that is difficult to detect or classify with conventional medicine, and in which naturopathic work ups and treatments for things like adrenal deficiency, allergies, hypoglycemia, chronic infections, lyme disease, etc can be markedly helpful
3. A symptom of a busy lifestyle and your body catching up – of which the above tips can help.

www.pannaturopathic.com