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Why Am I So Tired When My Labs Are "Normal"? · Doctor Turned Health Coach

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  Welcome to the Doctor Turned Health Coach Podcast. My name is Dr. Ashori.
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  And on this podcast, really, we talk about everything health-related,
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  but it's the place where you're going to get the expertise of a physician and
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  the support of a health coach to get you to your ideal health goals.
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  Today's episode is about why am I so tired? Why is it that everything I've done,
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  I'm still so fatigued, I'm so exhausted? What do I do? What did I do wrong?
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  When you've already gone to the doctor, you've had multiple blood tests done,
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  and maybe you've already tried a few things at home, but you still remain fatigued.
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  It's going to really frustrate you because the doctor is going to tell you,
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  or your doctor is going to tell you that nothing's wrong, all the tests are normal.
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  And yet, you yourself don't feel normal.
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  You don't feel like you're either previous energetic self or you're in this
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  state where you just don't have the stamina to do things.
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  Let's dive into a few causes that are often overlooked and the labs don't capture.
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  Number one, probably the most important thing to realize when you go through
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  this process is that labs are not everything.
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  Labs can be helpful, but labs don't show everything. And the way labs are interpreted
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  are also open to discussion.
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  So, for example, you can get thyroid tests done, you can get vitamin level tests
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  done, You can get mineral testing done and electrolyte testing done.
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  All of these things might show a normal range, but they're really there to capture
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  certain abnormalities with very serious diseases.
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  Your range may not be optimal.
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  And that goes into this whole other, basically, rabbit chasing, was it goose chase?
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  Like wild goose chase where like, oh, OK, but sodium was a little bit like this.
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  And the potassium was a little bit like that and the magnesium was like this.
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  But even if you correct those, you may not see a difference.
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  Oh, my vitamin D level was super low. That's why I was exhausted.
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  And then you go change the vitamin D level with some supplementation,
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  but you don't really feel that different.
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  So don't think of labs as anything more
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  than a guide to give us a sense of direction as to where we should go.
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  One of the most powerful things that you can do that you can track is your actual symptoms.
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  When we empower ourselves as patients with the knowledge of what is really going
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  on with our body, we then end up being able to come up with a good strategy to correct it.
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  The good news, guys, if you're listening to this, you're not alone.
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  There are a lot of people with fatigue, and fatigue is definitely something
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  that you can get a handle on, and you can improve it.
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  You can improve it. That is one thing that I can tell you. having worked with so many people.
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  One important thing with tracking your symptoms is to develop an objective method
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  of jotting down not only the things that you do on a daily basis,
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  how are your bowel habits,
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  what did you really eat, right? How much sleep did you get?
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  What was your objective sleep measure?
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  And then you really want to come up with a strategy of defining what fatigue means to you.
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  For one person, fatigue is not being clear-headed. For another person is feeling tired.
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  For another person is not having stamina.
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  But there is no universal definition of fatigue.
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  Yes, there's clinical definitions, there's World Health Organization definitions,
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  but you want to come up with your own definition because that's the one that
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  you are going to use with your health coach, with your physician,
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  your clinical team to try to then improve.
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  So, keeping a very objective journal that makes sense to you,
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  where you truly can capture the differences on a day-to-day basis, is very important.
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  Another one is to try to understand what is the source of the fatigue.
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  What I mean by source, there is a perceived fatigue, and then there is a physical fatigue.
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  By no means am I saying that you're not experiencing fatigue.
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  By no means am I saying that this is all in your head. I totally understand
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  where my patients come from and how frustrating it is for anyone to be told
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  that, oh, it's in your head, it's not real,
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  that's just, not only do I find that ridiculous, but I find it demeaning.
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  So, it is real. If you feel fatigue, it is real, period.
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  However, there is an aspect, for example, when we talk about pain,
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  and pain and fatigue have a lot of similarities when they're measured on fMRI scans,
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  where there can be a more neurological source of fatigue, where it captures
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  factors in the brain imaging, but it's not really captured in the physical aspect.
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  And there can be a very physical aspect to fatigue that's not captured in the
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  neurologic aspect. So we need to understand the source.
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  In the pain analogy, somebody can experience a lot of pain in their finger,
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  but there's really nothing wrong with the finger.
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  We can go in every source, we can actually do surgery on that finger.
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  We can actually give numbing medication in that finger, and we'll see that the pain doesn't change.
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  And the reason the pain doesn't change is because the circuitry from the brain
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  has gotten crossed or has gotten sensitized.
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  And for that reason, the sensation of pain is there. Same thing with fatigue.
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  My body is functioning okay. If I, I can go run a 10k, no problem.
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  I have plenty of stamina. And if I track my sleep, my sleep was actually pretty
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  good. But for whatever reason, I am still left with severe fatigue.
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  And that could be central. It could be neurological. And that is important to
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  find out because it has a different approach.
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  All the approaches that we take with fatigue, with tiredness,
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  is to help you perceive your level of tiredness as something that you can overcome.
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  It may never be perfect, but it definitely should be something that doesn't
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  hold you back from your day-to-day life and doesn't take away from the joy of
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  your day-to-day life. That's the key.
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  Sometimes when we try to cure fatigue or come up with that one unifying diagnosis
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  that's going to explain fatigue, that can be very bad, that can be detrimental,
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  because then we're just chasing diagnoses.
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  And that's often not very helpful.
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  What's a lot more helpful is to try to say, can we take this perceived fatigue
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  and take it from a 9 out of 10 down to 8.5 out of 10?
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  What did it take to get there? And now can we take that eight and a half and take it down to an eight?
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  Step by step, habit by habit, feedback by feedback, we can make drastic improvements
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  in these symptoms and it can be life-changing and life-altering.
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  When I really dive in to fatigue and tiredness with my health coaching clients,
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  we really dive into everything.
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  Maybe this person is thinking too much, so they're getting that central fatigue.
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  Maybe they're exercising too much, and so they're getting that peripheral fatigue.
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  Maybe they're not exercising enough, and that can cause it.
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  Maybe they're exercising, but their muscle mass is not enough,
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  and so they're getting a different type of fatigue.
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  Other times, of course, it could be nutrition, some sort of a lack of nutrition,
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  mineral deficiency, vitamin deficiency. It's not as common, I'll be honest with
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  you, it's not as common in all of these coaching clients that I've had over the years.
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  But sometimes we can identify something and even if we replace that nutrition,
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  that mineral, that may not be enough.
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  We still would have to get the body back to its normal baseline.
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  The body has to be retrained. Okay, you fix this hormone problem just because,
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  let's say you are thyroid deficient, if I just give you thyroid hormones,
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  you're not going to go back to normal.
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  We're still going to have to build you back up to your previous self,
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  and that's going to take some work.
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  Insulin problems, insulin sensitivity, insulin resistance, these have to be in very good balance.
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  For example, your hemoglobin A1c might be good, but your HOMA-IR score,
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  which is your fasting glucose and your fasting insulin levels,
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  may not be where they should be.
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  Sometimes your triglyceride levels, the fatty deposition around the liver,
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  sometimes those can cause some problems.
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  Yes, I know people will chase down things like heavy metal. Absolutely,
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  that's something your doctor can definitely check for you.
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  But again, remember that chasing that one single diagnosis is not always the right way.
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  So I hope this gives you a sense of the
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  many ways you can approach tiredness fatigue and maybe
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  hope that there's always a fix and you can figure it out i hope this content
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  is of value if you know anybody dealing with fatigue please share this with
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  them and you can go to the show notes to find information about my coaching
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  program and thank you for listening.