Natural Health News Summer 2009: Why Are You So Tired? Two Major Hormones Could Be To Blame

SF Natural Medicine: Natural Health News
Summer 2009
photo of Carl Hangee-Bauer, ND, LAc; Amy Day, ND and Erika Horowitz, ND
Carl Hangee-Bauer, ND, LAc
Amy Day, ND
Erika Horowitz, ND

Why Are You So Tired? Two Major Hormones Could Be To Blame
by Amy Day, ND

Even if you are getting eight hours of quality sleep every night, you may still be battling fatigue and trying to figure out why. There are many possible underlying causes, including anemia, sleep apnea, depression, food allergies, infectious diseases and chronic fatigue syndrome. The neuroendocrine system, with its complex chemical and hormonal balance, can also play a major role in determining your energy levels. Let’s take a closer look at two of these critical hormone glands—the adrenals and the thyroid. Problems with these two hormones are quite common but are often overlooked in conventional medicine. They are relatively easy to identify with a thorough history and appropriate lab tests, and can be successfully treated with naturopathic medicine to help you feel great again.

The adrenal glands are small walnut-sized glands that sit on top of the kidneys in the mid-back. They produce cortisol, also known as the stress response hormone. They help you to survive during life-threatening crises and then are able to recover during times of rest. However, modern life is so demanding that, with one crisis after another, the adrenals sometimes just can’t keep up.

When you face a stressful situation, cortisol levels increase to shift the body into crisis survival mode. During this “fight or flight” response, the heart rate and blood pressure rise, blood sugar is released from storage, eyes widen and the senses sharpen. After the stress has passed, cortisol drops, the body returns to normal, and the digestive and immune systems can resume their regular function.

Cortisol is also largely responsible for your circadian rhythm. There is a natural increase in production in the morning to help you “get up and go.” Levels taper down in the afternoon and then drop at night to allow for restful sleep.

Your body can adapt quite well to acute stress followed by periods of calm and relaxation. However, in the face of chronic stress, a condition called adrenal fatigue can occur. In the early phases, there will be high cortisol or a dysregulated daily rhythm. This results in a “tired but wired” feeling, which drives many people to consume caffeine and sugar for energy boosts. In the later stages of adrenal fatigue, cortisol is very low all day long, and the fatigue can be quite severe.

The thyroid gland is in the lower part of the neck, just below the Adam’s apple, but many parts of the body are important in helping it to work. A pituitary hormone from the brain called thyroid stimulating hormone, or TSH, controls its function. The TSH level is an indirect indicator and is the inverse of thyroid activity. When the thyroid is underactive it requires more stimulation, and TSH levels will be higher. When the thyroid is responding correctly, it produces T4 and T3 hormones, which are critical in regulating metabolism. T4 can also be converted into the more active T3 by the liver and kidneys.

Problems with thyroid function can arise at several different steps in the process. Nutritional deficiencies, such as iodine and selenium, can cause low production and improper conversion of thyroid hormones. In some cases, there may be excess levels of the proteins that bind and carry hormones through the blood, preventing these hormones from being active. In other cases, the immune system may produce autoantibodies that interfere with thyroid function.

Hypothyroidism is too often missed on standard tests because the normal ranges are quite wide, and most doctors only test for TSH. When someone has hypothyroid symptoms such as fatigue, weight gain, dryness or low body temperature, they might have “subclinical hypothyroidism,” even if their TSH is in the normal range. In these cases, it is important to look at the complete picture using more comprehensive tests.

Finding Answers for Your Fatigue
As you struggle to find answers for your fatigue, know that these are just two of the many causes. A naturopathic assessment, including an in-depth interview and thorough testing, can help determine the underlying causes in your case. Your fatigue can then be individually addressed through lifestyle counseling, stress management, diet, nutritional and herbal medicines and hormone therapy when appropriate. If you are looking for a holistic approach to help you feel healthy and energized, please give us a call.

Adrenal/Thyroid Testing

Lab Tests for Adrenal and Thyroid Function
by Erika Horowitz, ND

If you are struggling with fatigue, weight gain, anxiety, poor sleep, or depression, ask one of our doctors how a functional lab test that quantifies hormone and neurotransmitter levels can uncover your neuro-hormonal imbalances, and how managing these imbalances can alleviate your symptoms. These tests allow the doctor to pinpoint common imbalances that underlie a broad spectrum of chronic illnesses.

The best way to test your adrenal health is to measure your level of free adrenal hormones such as cortisol and DHEA. Saliva testing is preferred as it measures the amount of free and circulating hormones instead of the protein-bound hormone commonly measured in blood test. Also saliva testing is conveniently done at home four times throughout the day in order to map out your body’s rhythm and evaluate your adrenal glands’ function.

A comprehensive thyroid assessment is a thorough analysis of thyroid hormone metabolism, including central thyroid gland regulation and activity (TSH), thyroid production and secretion (free T4), peripheral thyroid conversion (free T3, reverse T3), and thyroid autoimmunity (anti-TG and anti-TPO antibodies).

If you think you may be suffering from adrenal fatigue or hypothyroidism, these self-tests can help you determine if your symptoms are related to these conditions.

Adrenal Fatigue Self-Test

0=Never  1=Sometimes  2=Regularly  3=Often  4=Constantly

Tendency to gain weight and inability to loose it, especially around the waist.  0 1 2 3 4
High frequency of getting cold/flu, symptoms tend to last longer than usual.  0 1 2 3 4
Tendency to tremble when under pressure. 0 1 2 3 4
Reduced sex drive. 0 1 2 3 4
Lightheaded when rising from a lying-down position. 0 1 2 3 4
Unable to remember things. 0 1 2 3 4
Lack of energy in the mornings and also in the afternoon between 3 to 5 pm. 0 1 2 3 4
Feel better suddenly for a brief period after a meal. 0 1 2 3 4
Often feel tired between 9 - 10 pm, but resist going to bed. 0 1 2 3 4
Need coffee or stimulants to get going in the morning. 0 1 2 3 4
Crave salty, fatty, and high protein food such as meat and cheese. 0 1 2 3 4
Increased symptoms of PMS for women 0 1 2 3 4
Pain in the upper back or neck with no apparent reasons. 0 1 2 3 4
Feels better when stress is relieved, such as on a vacation. 0 1 2 3 4
Difficulties in getting up in the morning 0 1 2 3 4

Add up your overall score:
10 or less = satisfactory level
11-20 = possible adrenal fatigue
21 or more = probable adrenal fatigue

Hypothyroid Self-Test

Severe fatigue, loss of energy  0 1 2 3 4
Weight gain, difficulty losing weight 0 1 2 3 4
Depression and depressed mood 0 1 2 3 4
Joint and muscle pain, headaches 0 1 2 3 4
Dry skin, brittle nails 0 1 2 3 4
Brittle hair, itchy scalp, hair loss 0 1 2 3 4
Irregular periods, PMS symptoms, infertility 0 1 2 3 4
Difficulty tolerating cold and lower body temperature 0 1 2 3 4
Constipation 0 1 2 3 4
Sleeping more than average 0 1 2 3 4
Diminished sex drive 0 1 2 3 4
Puffiness in face and extremities 0 1 2 3 4
Hoarseness 0 1 2 3 4
Bruising/clotting problems 0 1 2 3 4
Elevated levels of LDL (the “bad” cholesterol) 0 1 2 3 4
Allergies that suddenly appear or get worse 0 1 2 3 4
Persistent cold sores, boils, or breakouts 0 1 2 3 4
Tingling sensation in wrists and hands that mimics carpal tunnel syndrome 0 1 2 3 4
Memory loss, fuzzy thinking, difficulty following conversation or train of thought 0 1 2 3 4
Slowness or slurring of speech 0 1 2 3 4

Add up your overall score:
15 or less = satisfactory level
16-25 = possible thyroid hormone deficiency
26 or more = probable thyroid hormone deficiency


Summer Solstice! It's time to . . .
Detox with the Doctor

Saturday, June 20
2:00 - 3:00 p.m.

Join us for our next 10-day group cleanse. This time Dr. Erika Horowitz will lead the group and participate in the cleanse too. Our last group cleanse was with Dr. Amy Day in April, and it was very successful. If you couldn't make the last one, here's your chance. This fun group program is a safe and effective way to kick-start your health and help you look and feel your best. The fee is $199 and includes the class, handouts, supplements and online chat. Preregistration is required, so call us now to reserve your spot. If you sign up with a friend, you'll each get $10 off.

Yelp us

Yelp Reviews

If you are satisfied with the quality health care you receive from us,
how about saying so on Yelp? If you write a review, please include the full name of your doctor in the review. Thanks, we appreciate it.

Medical Massage & Therapeutic Bodywork Now Available at SFNM

Gayl Hyde is an advanced certified massage therapist (CMT) specializing in medical (clinical) massage and therapeutic bodywork, and is now offering personalized sessions at SFNM. She has specialized training in deep tissue massage, Asian bodywork, chiropractic-style physical therapy techniques in muscle stretching and lengthening, and is a 7th generation, level II Usui Reiki practitioner. Gayl recently graduated from SCNM with a doctorate degree in Naturopathic Medicine and will soon be taking national board exams to become a licensed ND and building her practice as a doctor.

Her areas of expertise include trigger point and myofascial release, lymphatic clearing, acupressure, cupping, Gua Sha, Tui Na, Reiki, and Post-Isometric Relaxation (PIR). These therapies can help reduce heart rate, lower blood pressure, increase blood circulation and lymph flow, relax muscles, improve range of motion, stimulate weak, inactive muscles, increase endorphins, relieve pain and stress, enhance athletic performance, aid in total body detoxification, and improve the general health and well-being of the recipient. Sessions with Gayl are available on Wednesdays, Fridays, and by special appointment on weekends. Through September 15, receive 20% off your first session; package prices are also available. Call today to book your appointment!

Clinic News

Change is in the air . . . again! Many of you have expressed positive feedback about Marie, our receptionist for the last several months. She has really done a fabulous job and has gotten the front desk extremely organized and efficient. Marie has decided that her calling might be in the legal field and has decided to go to paralegal school. We wish her all the success she deserves in her new endeavors. Good bye, Marie.

Meet the New Receptionists


"Hi. My name is Gayl, and I’m happy to announce that I am now assisting with front desk duties as the receptionist on Tuesdays and Thursdays. I recently received my doctoral degree from naturopathic medical school (SCNM), and am now in the process of getting my ND license, taking the board exams in August.

I’m originally from the east coast, and loved living in The Village of NYC for many years where I worked as an art director for the fashion and publishing industries. Life circumstances and my passion to help others inspired me to return to school to pursue a career in medicine. I enjoy the beach, water sports, yoga, running, art, traveling, my two pooches, and having fun! I look forward to meeting all of you and assisting you during your visits at SF Natural Medicine!"


"Hi. My name is Silvie, and I am happy to be working as one of the new receptionists at San Francisco Natural Medicine in beautiful Potrero Hill. It has been a long-awaited goal of mine to find work in a holistic clinic, so I am very pleased to be working alongside of and learning from the great NDs at SF Natural Medicine. I am currently researching graduate studies programs at various holistic health universities, trying to find a good fit for myself. I anticipate learning a great deal about the many different modalities available in natural health care, and focusing in on a few specifically so that I may begin training for my own career as a natural health care provider. I look forward to getting to know all of the patients who walk through the doors at the clinic, and being able to offer the best service and assistance possible!"

© 2009 

San Francisco Natural Medicine
1615 20th Street
San Francisco, CA 94107