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Finding the cause of your fatigue

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Finding the cause of your fatigue

The close matching of energy demands to delivery is fundamental for survival. When a saber-toothed tiger jumped out on one of our primitive ancestors, they would need to put in an Olympic-performance sprint requiring maximal energy delivery.

On the other hand, resting up in a warm nest means energy delivery can be reduced. This balancing all happens courtesy of the adrenal and thyroid glands. 

Broadly speaking, the thyroid gland base-loads to establish the basal metabolic rate, and the adrenals fine tune. For a seconds- to minutes-level response we have adrenalin, which may be followed by a minutes- to hours-level response determined by cortisol. 

Hibernating bears have low levels of thyroid hormones; we see levels of thyroid hormones in humans increase in the summer. This makes perfect evolutionary sense. Doctors have long failed to grasp the vital therapeutic significance of diet, micronutrients and mitochondria. This poor record continues with respect to thyroid and adrenal function. While absolute failures are diagnosed and treated, partial failures are not. 

There is a large gray area between 100 percent and zero function, which grows with age and fatigue but goes unrecognized by endocrinologists. Conventional blood tests for thyroid and adrenal function are blunt tools, and commonly misinterpreted. Doctors use tests as an excuse to dismiss patients despite their clinical symptoms, and so the need to treat is missed. 

Essentially, if the test results lie within population reference ranges, then the thinking stops. The clinical picture is ignored, and the fatigued patient is dismissed. 

Hypothyroidism, an underactive thyroid, is already common, affecting about 10 percent of Westerners, and yet underdiagnosed—less than 2 percent receive treatment. Dr Kenneth Blanchard, a consultant endocrinologist, estimates up to 40 percent of American women are hypothyroid and would benefit from thyroid hormones. 

In my experience, of the patients who consult me complaining of fatigue, all have metabolic syndrome, most have a thyroid issue and many have an adrenal problem. The severely fatigued also have mitochondrial failure. 

What causes adrenal fatigue?

I suspect adrenal fatigue is part of metabolic syndrome. Wobbly blood sugar levels are stressful to the body. Sugar is a very damaging molecule. It is ‘sticky,’ and that results in sticky blood and damage to the lining of arteries. 

Insulin is employed to control high blood sugar, so down come the levels. Suddenly there may be insufficient sugar to fuel the sugar-adapted mitochondria, and energy delivery starts to shut down. Panic! Release the instant panic hormone adrenalin, which is followed by cortisol, DHEA and others. 

Metabolic syndrome is characterized by spiking adrenal hormones so, not surprisingly, the adrenal gland gets fatigued. This increases its need for raw materials, especially vitamin C, and this is the commonest micronutrient deficiency in humans. 

Is an underactive thyroid a cause of my fatigue? 

Suspect hypothyroidism if you continue to suffer from many of the symptoms of failing energy detailed on page 40 despite eating a paleo-ketogenic diet (PK diet; see page 43), taking a basic package of micronutrients and being seen by a doctor who has told you that disease has been excluded and nothing more can be done. 

The first thing to do is measure levels of the hormones thyroid-stimulating hormone (TSH), free thyroxin (T4) and free T3 in the blood to make quite sure that you are not hyperthyroid, with an overactive thyroid gland. Sometimes a thyrotoxic patient (one with too much thyroxin) can suffer from fatigue. This blood test can be easily done on a DIY finger-drop sample of blood and sent to a laboratory (for labs that offer this test, see  

Next, it’s important to get a clinical picture. This can be done through measuring core temperature, pulse rate and blood pressure together with the ‘how do you feel’ test. 

If these suggest that there is biochemical and clinical scope for treatment, we can hypothesize that there is hypothyroidism. We then put that hypothesis to the test and go ahead with a trial. 

If the symptoms are ameliorated and the core temperatures, pulse and blood pressure normalize, then the hypothesis is confirmed, and the diagnosis made. In other words, if the treatment works, the diagnosis follows. 

This combined problem of thyroid and adrenal gray areas is so common, with patients being dismissed by doctors, that already we have, I estimate, hundreds of thousands of sufferers who have taken matters into their own hands and elected to treat themselves. I have seen many, and I’ve always been impressed by their knowledge and diagnostic acumen. Between us all, a safe and effective framework for recovery has evolved. 

Symptoms of failing energy

Symptoms of failing energy

The tools of the trade: glandulars 

Glandulars make effective therapy possible. For thyroid disease there are thyroid glandulars, for adrenal disease, adrenal glandulars. These are simply dried thyroid and adrenal glands from pigs or cows. But how do you get the dose right?  

Go through the list on using glandulars effectively (page 42) before starting them and before every dose increase. 

What, when and how much? 

• Start with 15 mg of thyroid glandular and increase in 15 mg increments every two weeks according to average core temperatures and the checklist on page 42.

• Start with 125 mg of adrenal cortex glandular and increase in 125 mg increments every week according to the core temperature range (or wobble) and the checklist. If, despite getting to 750–1,000 mg of adrenal cortex glandular, the core temperature is still wobbling, this may point to your body’s attempt to run a fever to get rid of a chronic infection. See my book The Infection Game (Hammersmith Books, 2018)for more detail. 

• Most people need daily thyroid glandular doses of 30–120 mg. For many, the last
15 mg seems to make a world of difference. 

• Most need 250–750 mg of adrenal cortex glandular to feel well. 

• Both should be taken in two doses, half on waking, half at midday.

• Bigger people need a higher dose than smaller people.

• Many people vary the dose a little from day to day to deal with demand.

• As we age, the prevalence of hypothyroidism and poor adrenal function increases. 

The causes of thyroid dysfunction

The causes of thyroid dysfunction

What are the long-term risks of glandulars? 

Dose is critical. Without thyroid and adrenal hormones, we die. With inadequate amounts, we risk disease and premature death—poor quality and quantity of life. Two commonly cited complications of mild overdosing are atrial fibrillation (irregular and often rapid heart rate) and osteoporosis. Should we be worried about this? 

Both of these conditions are multifactorial, and by paying attention to all factors, the risk of any such complication is mitigated. 

Atrial fibrillation. There are two major risk factors for this. The first, metabolic syndrome, is completely reversible with a PK diet. The second common cause is heavy metal toxicity. This can be mitigated by taking the basic package of nutritional supplements (see box, left) and glutathione. If there is any history of toxic metal exposure, then this can be easily measured on a urine sample following oral chelation therapy with DMSA. (Search for “DMSA” at for more info.)

Osteoporosis. Again, the major risk factor for this is metabolic syndrome. This is followed by lack of exercise; of course, correcting thyroid and adrenal function will give the patient the energy to exercise. Adrenal hormones, especially DHEA, protect against osteoporosis. Should there be any concern, then you can safely measure bone density using heel ultrasound (no radiation and minimal cost; see Treatment with natural strontium, 250 mg daily, is proven to be effective and very safe. (But do not use the synthetic strontium ranelate, which is formulated with aspartame.)

Using glandulars effectively 

Go through this checklist before starting glandulars and before every dose increase.

Using glandulars effectively 

Essential supplements

I recommend all my patients take a basic package of nutrients including:

• A good multivitamin and multimineral

• Vitamin C (5–15 g daily). Take to bowel tolerance

Sunshine salt, which contains all the essential minerals from sodium and selenium to magnesium and manganese, together with vitamins D (5,000 IU) and B12 (5 mg) in a 1-teaspoon (5 g) dose. Use instead of regular salt for cooking (available from

The Paleo-Ketogenic diet

The evolutionarily correct diet is the paleo-ketogenic (PK) diet. It’s a non-negotiable part of my treatment plan. Paleo means no dairy and no gluten grains; ketogenic means that the body is powered by fat and fiber, not sugar and starch. All our energy delivery mechanisms evolved to run primarily on fat, and the human gut, brain, immune system, heart, muscles and liver further benefit.

For all the details on the what, why and how,
see my book The PK Cookbook (Hammersmith Books, 2018), but here are the basic guidelines.

What to eat

Eat as much as you like of the following:

• Fats—saturated fats for energy such as lard, butter, ghee, goose fat, coconut oil, palm oil.

• Oils—unsaturated fats that are also fuels but contain essential omega-3 and -6 and beneficial omega-9 fatty acids. Hemp oil is ideal, containing the perfect proportion of omega-6 to omega-3. These must be cold-pressed and not used for cooking or you risk ‘flipping’ them into toxic trans fats. Only cook with biochemically stable, saturated fats. 

• Fiber—this is often included in the carb count of foods on packaging and leads to some confusion.

• Foods that contain less than 5 percent carbs, such as: Linseed, coconut cream, brazil and pecan nuts, salad—lettuce, cucumber, tomatoes, peppers, etc. Also, green leafy vegetables, mushrooms and  fermented foods, such as sauerkraut and kefir.

Take care with the following:

• Meat, fish, shellfish and eggs. Don’t eat too much, as excessive amounts can be converted back to  carbohydrate.

• Salt—1 tsp (5 g) daily (ideally Sunshine Salt).

• Coffee and tea. Drink in moderation.

• Foods that are 5–10 percent carbs, such as berries and almonds.

Avoid foods containing more than 10 percent carbs such as:

• All grains, pulses, fruits (apart from berries and rhubarb) and their juices

• Many nuts and seeds

• Junk food like sweets, cakes and crisps

• All dairy products except ghee and butter

• All sweeteners, natural or artificial.


Excerpted from The Energy Equation by Dr Sarah  Myhill and Craig Robinson (Hammersmith Health Books, 2021)

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