Download Feeling Tired Too Often The following information is for GPs

Feeling Tired Too Often
The following information is for GPs only. It is not intended for use by the general public. It is not
intended to promote the services of any nutritional therapist but is provided for GPs to better
understand how a nutritional therapist may work.
Nutritional therapy is recognised as a complementary medicine. In the case of an individual feeling
tired too often, that individual should first visit their GP and undertake any GP recommended tests
to exclude any serious medical issues. Practitioners never recommend nutritional therapy as a
replacement for medical advice and always refer any individual with any new or undiagnosed signs
or symptoms, especially ‘red flags ' to their medical professional.
Once the GP has excluded common organic causes of fatigue such as anaemia, infection, pregnancy,
diabetes mellitus, hypo or hyperthyroidism, perimenopause etc., a nutritional therapist will take a
full case history including family history, past and current symptoms; review a food and lifestyle
diary and take a holistic approach, considering the interrelationship of co-morbidities. They may
consider whether some the following may be contributory factors to an individual’s health status:
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Suboptimal diet including high intake of refined carbohydrates, stimulants, processed foods
Dysglycaemia (Blood sugar imbalance)
Subclinical hypothyroid
Suboptimal adrenal function
Suboptimal digestive function
Low grade inflammation
Suboptimal immune function
Mitochondrial dysfunction
Essential Fatty Acid deficiency
Sub optimal liver function
Food allergies or intolerances
Micronutrient imbalances
Lifestyle factors such as stressors and sleep
Case study 1. Mrs N:
In September 2012 a female aged 47 years presented with low energy levels, shortness of breath on
climbing stairs and palpitations. She was initially asked to see her GP and the nutritional therapist
also wrote to the GP asking if they would provide serum iron, ferritin and B12 tests and noting that
her diet was entirely vegetarian, and therefore devoid of haem iron and dietary sources of vitamin
B12. The nutritional therapist made a number of dietary recommendations to Mrs N including
boosting mineral and protein intake.
The GP subsequently reported that test results were normal.
The nutritional therapist undertook dietary analysis which revealed that the Mrs N was eating a
seemingly healthy diet; vegetarian with significant volumes of raw and sprouted foods. However
overall levels of protein were low with no meat, eggs or fish; omega 3 essential fats were low and
breakfast tended to be high glycaemic load (GL). A case history revealed high levels of historic and
current stressors, and that Mrs N had been following a self-medication programme including a
‘cleansing’ preparation called Zeolife and supplementation with DHA, Rhodiola and a B vitamin
complex. The Nutritional Therapist felt that likely contributing factors included low protein intake,
poor adrenal function and possible low status in some micronutrients partly due to long term use of
the Zeolife.
Mrs N and the nutritional therapist agreed together how best to reduce Mrs N’s glycaemic load at
breakfast and increase her protein intake overall. The nutritional therapist also recommended that
Mrs N cease the self-medication and undertake tests to measure salivary cortisol and DHEA and
urinary metabolites to indicate nutrient status. She was also given advice to reduce stressors. Mrs N
was extremely compliant and by mid-October reported that the palpitations had stopped and that
she was ‘no longer falling asleep in front of the TV in the evenings’.
In November 2012 the nutritional therapist wrote to the GP as follows.
Dear Dr X,
In September I wrote requesting that you tested Mrs N’s iron status as she presented with fatigue
and shortness of breath on climbing stairs in addition to low mood and palpitations. Thank you for
providing the tests, the results of which were normal.
I am writing to let you know that further testing revealed poor adrenal function and possible
deficiencies in the anti-oxidants vitamins A, C and E, a number of the B vitamins and magnesium. Low
status of almost all amino acids was evident. Dietary analysis suggested paucity in essential fatty
acid and protein. Mrs N made significant changes to her diet and embarked on a 3 month course of
food supplements, due to complete in January 2013. She attended a third appointment with me
today in which she reported that her symptoms have resolved.