THE MEDICAL WAY: Catherine Caron, Physician and Assistant Professor of Family Medicine at the University of Ottawa
Many women come in to be treated for fatigue. They’re usually hoping for a quick fix, but only 10 percent of the cases I see have a purely physical cause. I’ll do blood tests to uncover deficiencies such as anemia and a lack of vitamin B12; those are fixed with supplements. Or I might find hypothyroidism, an autoimmune disease. I tell patients it’s like their thermostat is turned down: Along with feeling sluggish, women may gain weight and feel cold and their hair may thin. To treat it, I prescribe a cloned version of the thyroid hormone, which gradually builds up to normal levels in the bloodstream. The patient will have to take it for the rest of her life.
More than a third of my patients who report fatigue are depressed and don’t realize it. I evaluate patients using the Hamilton scale, which addresses things like sleep habits, appetite and irritability. I’ll prescribe medication or cognitive behavioural therapy (CBT). Some antidepressants increase the mood-boosting hormone serotonin; CBT corrects distorted thinking patterns, which will improve a patient’s mood. Both options have been proven effective for mild to moderate depression.
Some alternative specialists diagnose patients who feel tired with “adrenal fatigue,” a condition that hasn’t been proven. Sometimes they treat this with good nutrition, exercise and stress management, all strategies I also discuss with my patients. But there’s also the potential to cause harm by missing other conditions, such as depression, which will then remain untreated.
THE ALTERNATIVE WAY: Lena Kim, Naturopath in Edmonton
When my female patients say they’re tired all the time, I start by asking how regular and heavy their periods are, about their diet and sleep habits, and if they have other symptoms, such as digestive distress. This helps me screen for illnesses, hormonal imbalances and depression.
If I suspect it’s a physical issue, I’ll order blood tests. If they have a thyroid problem, I’ll refer them to a doctor, because they’ll have to take medication. For vitamin deficiencies, I’ll try to rule out other issues, such as heavy periods or colitis, before prescribing supplements.
Even if a vitamin B deficiency doesn’t show up in a blood test, I might prescribe a supplement anyway; it helps the adrenal glands. I’ll assess their functioning with a salivary test to find out how much of the stress hormone cortisol is being released. Cortisol works with adrenaline to increase blood pressure and blood sugar. If those levels are out of balance, due to stress or anxiety, for example, the adrenal glands can tire out. If a patient has low cortisol levels, I’ll prescribe herbs, such as licorice and Siberian ginseng.
Another cause of fatigue could be a lingering viral infection. I’ll prescribe immune-boosting herbs, such as astralagus, or homeopathics. Or a patient may have food sensitivities, which could mean she’s not absorbing enough nutrients; I’ll suggest eliminating common allergens, such as wheat, dairy and corn. I might also prescribe enzymes and probiotics. Lifestyle changes will also help the adrenals; everything comes together to help your body function optimally.