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HORMONAL IMBALANCES: Your hormones are like the dimmers on your headlights — when you need bright lights, you turn on certain hormones to increase the energy sent to that area (for example, your immune system) and to decrease usage elsewhere. This fine-tuning starts in your hypothalmus and pituitary. Thus, there's a strong association between hormonal issues and energy issues. We see these changes primarily with slow-functioning adrenal and thyroid glands, but small important changes happen minute to minute. Stress causes increases in cortisol, which increases sugar in the bloodstream and insulin resistance — and that wastes energy in distributing sugar into fat instead of where it is needed to produce ATP. The tough part here is that it's not always clear what the best ways are to deal with hormonal issues. Case in point: We physicians aren't sure whether to treat the numbers or to treat the symptoms patients have. We often try to "normalize the numbers from the blood tests" even if we're not eradicating the symptoms. The so-called normal range of blood levels for many hormonal levels is defined as the middle 95 (95!) percent of those people with those levels; the top 2.5 percent are considered high and the bottom 2.5 percent are considered low. Unfortunately, that's just not good math for the individual. It's like saying that if the number that is normal is size 6 to 11 in shoes, then a 6 shoe would be okay for you, even if you have a size 4 foot. Not a good fit, but you'd be wearing a "normal"-size shoe.

Instead, we docs can choose to treat the symptoms as long as the treatment doesn't cause levels that are very abnormal on blood tests. Here's one example of why treating the symptoms (it's what docs learn to do — most important, listen to the patient) and not just getting a number on your blood test in the 95 percent range is important. If a T3 (free thyroid hormone) level up to 1.4 is normal but we have to get up to 1.5 to eradicate your symptoms, we think we should listen to you and do that, periodically backing off to see if you can be symptom free with less thyroid hormone. Because when hormones aren't regulated to levels that are right for you, you've got a dimmer that keeps flipping from producing power full-time to producing power half-time. So that lack of thyroid hormone means your energy factories can't use the food you've eaten to produce those ATPs efficiently. That makes you feel tired.

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