5 top markers to test if you’re tired all the time
If you’re feeling exhausted, you’re not alone. Fatigue is probably the most common symptom clients want to resolve when they come to see me. Often it’s part of a bigger picture - poor sleep, shifting hormones, weight gain, stress - but feeling tired is almost always part of the puzzle, and often the most immediate thing they seek to resolve.
And it’s not surprising we want to fix it fast. Low energy levels can impact and exacerbate most other symptoms (for example, if you’re knackered, you’re less motivated to exercise and eating well is harder if you’re craving foods for an instant energy fix, so weight management is harder), not to mention our quality of life. But understanding what’s driving fatigue is essential to be able to address it properly.
Firstly, if you’re feeling persistently tired, always see your GP. They are your first port of call, as they can assess your symptoms in the context of your health history, and can use their expertise to recommend appropriate investigations. If they do run tests, and anything’s out of range, they can prescribe supplements or medications to address deficiencies or any diagnosed health conditions, or if necessary make referrals to specialists.
However, there are some markers you can consider too - and being aware of these can help to inform conversations with your doctor. There are obviously many other markers involved in energy (or lack of it), but these are the most common I see deficiencies in, or even in-sufficiencies (which can still cause symptoms).
Vitamin D
If you’re not supplementing Vitamin D over winter in the UK, the likelihood is your levels will dip. Vitamin D is synthesised in the body when the skin is exposed to sunshine, and behaves more like a hormone than a vitamin in the body. It’s involved in many processes and functions - from immune system regulation to bone health, circadian rhythm, insulin sensitivity, mood and energy. Serum Vitamin D should be over 75nmol/L to be optimal.
Seek guidance from your doctor, pharmacist or a nutritional therapist on the correct dose for you, based on your levels and factors influencing your absorption from the sun (age, lifestyle and skin tone all effect how much we absorb).
Iron (including ferritin)
Iron is a crucial nutrient for energy. It makes haemoglobin, the protein in red blood cells that transports oxygen around the body. Ferritin is a protein that binds to iron, and stores it so it can be released when needed. It’s important to look at ferritin levels as well as other iron markers to give a full picture of iron status and iron use in the body. If stores are low, it can indicate that they’ve been drawn on because blood levels of iron are also low.
If you are vegetarian or plant-based, are highly active, pregnant or post-partum, have digestive issues or heavy periods it’s always worth considering iron if you’re experiencing tiredness. Other signs of low iron (or iron deficiency anaemia) are shortness of breath, dizziness, heart palpitations, pale skin and hair loss. If you’re experiencing any of these symptoms, it’s important you see your doctor. They will be able to prescribe iron supplements to increase your levels effectively and quickly.
To support iron levels through food, include red meat, lentils, black beans, chickpeas, kidney beans and peas and dark green leafy vegetables like spinach, kale and broccoli in your diet.
Folate
Folate is a B-Vitamin that plays an important role in energy metabolism. It aids in making red blood cells (which transport oxygen around the body) and is involved in proper cell growth and function by helping to synthesise DNA and RNA. Folate is needed for an essential biochemical process called methylation which among many other things supports neurotransmitter balance for mood, focus and sleep, regulates detoxification and cellular repair, gene expression and energy production. Folate works in partnership with B12 so these nutrient levels should always be considered together.
Folic acid is the synthetic form of folate, the nutrient which naturally occurs in food. Supplementing folate or folic acid is recommended for pre-conception and pregnancy, but may also be appropriate if dietary levels are low or there is increased demand. Regardless of supplementation needs, we should all be including folate sources in our diet daily to continously support the levels in our body. Build in dark green leafy veg, especially brassicas like kale, broccoli, pak choy, rocket and watercress, beans and legumes, nuts and seeds, avocado, beetroot and citrus fruits.
B12
With folate, B12 supports red blood cell formation, but is also involved in cellular energy - particularly mitochondrial function (mitochondria are the energy-centres of cells) and the conversion of food to useable energy. Crucially for mood as well as energy, it’s also involved in the role of the nervous system, creating the protective sheath that surrounds nerves, aiding in neural repair and regeneration and synthesising neurotransmitters that regulate our sense of well-being, motivation and reward.
B12 is found in animal-based foods - meat, eggs, dairy, fish. For those following plant-based or vegan diets, B12 supplementation is essential.
Thyroid function
The thyroid is a butterfly shaped gland in the neck that produces hormones that regulate the body’s metabolic rate. If thyroid hormones are low, symptoms can include fatigue, weight gain, feeling cold, dry skin, hair loss, irregular or heavy menstrual cycles, constipation - essentially signs of metabolic processes slowing down.
If thyroid function is under-active (known as hypothyroidism), it requires medication - and this is absolutely essential as it shouldn’t go untreated. But levels can be within range and still be sub-optimal. When this is the case, nutritional support can be helpful for improving thyroid health.
There are several markers that give a comprehensive view of thyroid function, but often the GP will look at TSH (thyroid stimulating hormone) and free or serum T4 first. If TSH is elevated, it indicates that the thyroid is having to work harder to make thyroid hormones and if T4 (thyroxine) is also low, this can be used to diagnose hypothyroidism. I like to also look at free T3 (the active form of thyroid hormone that the body converts from T4) and thyroid antibodies to see if there is an autoimmune response that is affecting the thyroid.
It’s worth noting that low iron can affect thyroid function in some cases, so it’s worth looking at these markers together.
Take aways if you’re tired
See your GP if your tiredness feels new, unusual or is affecting your daily life
Consider how energy markers work synergistically, and not in isolation (eg. folate + B12, thyroid + iron)
Think about your family history, lifestyle, stage of life and diet when considering what nutrient or hormone levels could be driving your fatigue (are you vegan with heavy periods? Is there a family history of hypothyroidism? Do you avoid the sun at all costs?)
Test don’t guess. Supplementing when you don’t need to, or at the wrong dose can be a waste of time, un-necessarily expensive and detrimental to, rather than supportive of your health. Get professional advice on which markers to test based on your health picture and symptoms, and then supplement accurately and effectively.
Want advice on how to investigate fatigue, or a nutritional plan to support you with a known deficiency (I can also work with you alongside medical management)? Book an introductory call.
