Fatigue is the #1 complaint of my patients. There are a myriad of reasons someone can be fatigued, but my first set of questions revolve around sleep. If you aren’t sleeping enough hours because you can’t get to sleep, can’t stay asleep, wake too early, or wake up feeling unrested, then that is the first thing that needs to be addressed.

Everyone’s need for a certain number of hours of sleep is different, but there are some generalities we can apply. For example, I had a teen who was staying up until 11 or 12 to finish her homework after her extracurricular activities, then trying to get up at 6 for school the next day. Teens need 8-10 hours of sleep a night, adults need at least 7.

Not being able to get to sleep is another big issue. If you haven’t already applied sleep hygiene techniques, then you need to get started immediately. Turn off your electronics and turn down the lights in your home as early as you can to signal to your brain that sleepy time is coming. Try meditating or calm, deep breathing before bed to set yourself up for the parasympathetic state you need to be in in order to fall asleep. Calcium may be a beneficial nutrient to help sedate the mind before bed.

In Traditional Chinese Medicine, waking 1-3 AM is caused by an imbalance in the liver. Some of the situations that can cause a liver imbalance include anger, alcohol, or conditions of the eyes or tendons. Waking 3-5 AM is a disturbance in the lung, which can be caused by grief/sadness, or conditions of the nose and skin. I’ve also seen insufficient Magnesium cause waking throughout the night.

B12, Inositol, and melatonin may also be needed to help with falling and staying asleep.

But the biggest and most controversial issue is caffeine. It’s not controversial because it’s not true, but because you won’t want to admit that it’s true. Consumption of more than 250 mg of caffeine will cause restless sleep and early waking, even if you only consume it in the morning. Most people only consider that late day consumption could make it difficult to fall asleep.

Believe it or not, a serving of regular brew is 6 ounces. So the smallest portion you will get anywhere is 12 ounces, and is already at the 250 mg threshold of insomnia. And that doesn’t count any caffeinated teas, soda, chocolate, or coffee flavored foods. I love black coffee and unsweetened iced tea, but learning this tidbit has revolutionized my sleep. I have personally noticed that days when I consume less than 250 mg, my sleep is much more restful.

Here’s a chart of common sources of caffeine: https://cspinet.org/eating-healthy/ingredients-of-concern/caffeine-chart

​The good news is that as you cut back on your caffeine consumption, your sleep will improve so you won’t feel the need to consume caffeine to excess. I personally found an unsweetened energy drink that has about 105-150 mg of caffeine, so that I can still get that little boost in the morning without fearing that an iced tea with lunch is going to wreck my sleep. Runa’s Clean Energy Drinks in Unsweetened Blood Orange and Lime flavors have no added sweeteners, natural or otherwise.

Have you taken Folate and it caused anxiety, insomnia, or other signs of agitation? You could be undermethylated.

If you've been tested for MTHFR and found to have a single nuclear polymorphism (SNP), often the first treatment is adding folate. But it isn't just about one enzyme in the methylation pathway; it's a tug of war between a bunch of enzymes on either side that can make you more undermethylated or overmethylated.
Methylation is also more than that one little biochemical pathway, sometimes called the one carbon cycle. Methyl groups can also modify genes and modify the expression of genes, either inhibiting or increasing expression.
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Instead of looking at one biochemical pathway, or just a handful of enzymes, I ask you a lot of questions about your signs, symptoms, tendencies, current pharmaceuticals, reactions to drugs and more. Then I send you to get some labs drawn at a standard lab that will give me answers about which nutrients would be most helpful and which doses would be best.
Just having an MTHFR mutation/SNP is not enough information, and neither is homocysteine. It's a piece of the puzzle, but not the whole answer. If you've gone down that road and not seen results, come in for an assessment and testing.

​If you've seen me already, you know I talk a lot about copper, especially in women. All those high estrogen conditions like heavy menses, cramping, endometriosis, fibroids, post partum depression, PMS/PMDD, etc. can all be due to copper. But where is it coming from?

Exogenous hormones used for birth control elevate your body's copper levels. Women who feel terrible on oral contraceptive pills, shots, implants, ring, IUD, and patches, are the most likely candidates.

Copper sulfate is an algaecide, bactericide, desiccant, fungicide, and herbicide. It gets sprayed on fruits and vegetables, even organic, and especially grapes. It's also in Centrum and similar one-a-day multivitamins as a source of copper. Municipal water sources use it to kill off various microbes and algae, and public swimming pools use it too.You could also get it from copper pipes and pans.

For people with adequate zinc, gall bladder function, vitamin A, and ceruloplasmin (a blood protein that binds to copper), you might not have any problems. The more dysfunctions and nutrient insufficiencies you have, the more problems you will see related to copper. And, it's not just about being "within normal range". You could have a completely normal copper, normal ceruloplasmin, but a really high free copper or free copper index. These calculations show us that you can have elevated production of Norepinephrine, which will make you more anxious or manic. And, because copper is Cu++ in the blood, it is very pro-oxidative and can cause a lot of damage.
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Lowering your free copper is possible with appropriate nutrient supplementation.

Sorry for the very technical post, but I've had two different MDs tell my patients that I was wrong regarding the testing and interpretation of copper and ceruloplasmin and resulting concern of the possibility of Wilson's Disease (WD).

Wilson's Disease is a genetic condition in which the body makes too little of a protein called ceruloplasmin. The result is that the body can't keep copper in the blood and it ends up getting deposited into the liver, brain, and eye tissue.

But here is what they are misinterpreting:
- Ceruloplasmin levels are LOW in WD
- Serum copper levels are LOW in WD
- *this is the part where they are confused* FREE copper levels are normal or HIGH in WD. So these physicians are telling my patients that they could not possibly have WD because they have low serum copper. Again, serum copper is not the same as free copper.

Labs report *serum copper* and usually not *FREE* copper (I've seen it calculated on some alternative labs). Free copper is a calculation in which the ceruloplasmin (in mg/dL) is multiplied by 3; this value is then subtracted from the total serum copper level (in μg/dL). When the result is above 25 μg/dL, AND the person has low ceruloplasmin, AND low serum copper, I send them to an opthalmologist to have a slit-lamp test to look for Kayser-Fleischer rings, a keynote symptom in many WD patients.
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This scenario doesn't happen often, but it does happen. If you have an MD who doesn't understand the difference, I'd be happy to explain it to them.

Whenever talk of antioxidants comes up, glutathione is the star of the show. It is the body's first line of defense against pro-oxidative factors which are dominant in psychiatric issues. However, it has a limited capacity, even with supplementation of cofactors like Vitamin C, Vitamin E, Selenium, and N-Acetyl Cysteine.

The antioxidant that is available on demand is called metallothionein (MT) and has numerous functions in the body, and whose rate-limiting factors include zinc and selenium. Selenium speeds up the kinetics of MT's function, but zinc is needed for proper function. Each molecule of MT contains up to seven zinc atoms. In addition, zinc supplementation will increase production of MT.

This protein is useful in brain development and repair, detoxification of heavy metals, maintenance of the intestinal and blood brain barriers, breakdown of triggering proteins like casein and gluten, kills candida, improve HCl production in the stomach, improve taste sensors on the tongue, and maintain thymic and lymphoid tissues for improved immune function.
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WHEW! In addition, poor MT function is associated with ADHD, autism, schizophrenia, Alzheimer’s Disease, and Parkinson’s Disease.