KEY BLOODWORK EVERY FATIGUED WOMAN NEEDS TO REQUEST
Dr. Krista Coombs, DrAc, IFMCP
July 4, 2025
In this week’s INSIGHTS for Healing by Design, let’s dive into reasons for those soul-crushing, deep-seated, fatigue-filled days many of us gals often experience and what bloodwork to request as part of figuring out where to put your currently limited energy so that you can recover.
Fatigue is a loaded word, my friend. It can have many reasons that take some real sleuthing to figure out.
In my clinical practice, fatigue is the second most common complaint I hear about (with pain being the first), so understanding what causes this symptom is always top of mind for me.
Let’s first discuss energy production in your gift of a body so that you can understand some of what can lead to progressive fatigue over time.
Your cells are set up to make fuel for your survival. The base fuel produced is ATP and your bacteria-like mitochondria in nearly every cell in your body is what predominantly makes it in abundance. And mitochondria in muscle cells make the most.
WHAT DO MITOCHONDRIA NEED TO MAKE ATP?
They need loads of co-factors, including but not limited to iron, copper, B vitamins (B2, B3, B5), phosphate, coenzyme Q10, and oxygen plus glucose from carbohydrates, fatty acids from fats and amino acids from proteins, ALL of which you get from your diet and breathing. This process is one of the most remarkable biochemical pathways I’ve ever studied! And it’s what keeps us functioning.
⬇️Let’s discuss 10 top contributors to fatigue and then we’ll dig into what bloodwork to test.
DISRUPTORS OF THIS REMARKABLE ENERGY FACTORY
CHRONIC STRESS: Chronic stress can deplete reserves of the building blocks for important biochemistry and shut things down. Chronic stress can also cause many changes in thyroid and adrenal function to slow the body down intentionally to help it survive.
CHRONIC PAIN: Chronic pain is a biggie too! It will deplete a lot of your nutrition to manage whatever is linked to the pain. Even just the mental energy required to deal with pain all the time can drain emotional capacity related to many organs, including the thyroid and adrenals as top contributors. Ensuring you get a handle on the root causes of chronic pain might require some expert guidance, a specialty of mine, so don’t hesitate to learn ways to manage this better.
SUGAR DYSREGULATION: Sugar dysregulation has a huge impact on energy levels. We see this in those with progressing insulin resistance that leads to diabetes (in all its forms), and it’s common in women with PCOS (polycystic ovarian syndrome) and in peri and post-menopausal women (most related to elevated FSH hormone and low estradiol levels).
IRON DYSFUNCTION: Given the ATP production is reliant on iron AND iron is necessary to carry oxygen around the body to do life, when iron management is dysfunctional in the body, energy production will be negatively impacted. So, this can look like elevated iron levels or low iron levels and poor iron transportation (which is a complicated process). Just taking iron supplements will not solve these issues either. Managing the menstrual cycle might, however, if you’re still cycling. Digging into this aspect is a worthy venture for all women.
AUTOIMMUNE CONDITIONS: Deep fatigue is a common symptom associated with autoimmune conditions (of which there are well over 100 diagnosable today). But the most common autoimmune condition on the planet – Hashimoto’s thyroiditis and hypothyroidism – seems to have bone-crushing fatigue as its hallmark symptom. This is because of the essential role of thyroid hormone (T3) in energy production. And with hypothyroidism, T3 production is very diminished and medication use can never compensate completely for the working of the thyroid organ itself.
NUTRITION DEFICIENCIES: Let’s not forget malnutrition or undernutrition as a reason for reduced energy production. I see this all the time in women who don’t eat much or who do not prioritize quality food consumption. If you aren’t eating and absorbing the nutrients needed for optimal energy production, it can’t magically be created.
SLEEP ISSUES: Chronically interrupted sleep will most definitely disrupt energy output. Without cleaning up the brain with proper sleep states, your brain can’t direct traffic very efficiently and this leads to loads of issues in downstream chemistry, including energy production. Your brain requires SO much ATP to function well, so this can become a vicious circle with poor sleep disrupting the brain then with reduction in body health you get further issues with the brain. If you can improve sleep hygiene, do it. If you have sleep apnea or a partner is snoring, get it dealt with asap. This is a crucial piece of any fatigue story and often ignored.
GENETIC ISSUES: Some people do have mitochondrial genetic issues, but it is not considered common as a reason for fatigue.
AGING: As the body ages, SO much happens and a lot of remodeling occurs especially in women as they start losing a lot of their estrogens, progesterone, testosterone production at the ovaries in peri and then post-menopause. This affects mitochondrial energy production profoundly. It can be managed well though, so stay tuned to my Instagram channel and in my private women’s group, The EASY YOUniversity, to learn how to navigate this natural hormonal transition with more ease.
OVEREXERCISING: : I see so many women working their bodies too much rather than meeting it where it's at and treating it with more kindness. This is especially common to see in menstruating women. You can push your body to do work beyond what is healthful, so figuring out how to exercise in a way that supports the body is a useful art to master. And, your exercise needs will change as you age into post-menopause. Get educated from geeks in the know, like myself, so you help your body, not hinder it and causing crushing fatigue and energy crashes.
Plus other contributors, including but not limited to, chronic eye strain, chronic infections, hormone dysregulation (like with PCOS, menopause, pregnancy, breast feeding), concussions, toxin exposures, some medications use (such as with blood pressure medications, antacids, pain relievers, some antidepressants, etc), nasal polyps, shallow breathing, etc…
So, you can see from even this list, energy issues are complex to investigate! But, once we determine the most important impactors for your YOUnique situation, the work begins to choose the most impactful solutions to get you started on recovery.
Often in my clinical practice I begin with running comprehensive bloodwork to help find clues to why a patient is so fatigued. Then I interpret this data in context of the patient’s YOUnique body and her current lifestyle and health history to figure out where to start for recovery.
Below is a list of bloodwork biomarkers to request for this investigation. This list is not exhaustive, but it would provide many clues to what is behind the fatigue. Just remember that the results are the clues, not the cause. We need to figure out the cause(s).
BLOODWORK BIOMARKERS TO TEST
▶️ Full Iron panel (ferritin, iron saturation index, serum iron, total iron binding capacity & CBC)
Iron deficiency and dysfunction is by far the top contributor to fatigue among women in my practice, whether still menstruating or in menopause. But I don’t stop there because there are always other causes of the iron issues that need investigation. The listed biomarkers in this category can help determine if there is low iron intake or true iron anemias or elevated iron. So, get your iron levels checked and make sure your ferritin is at least 50 and preferably above 70 up to about 110 because anything less than 30 or if really elevated above 150 is part of your fatigue. If the specific iron biomarkers are not at good levels, you’ll need to ensure a CBC (Complete Blood Count) panel is tested too so they can check levels of RBC’s (red blood cell count), hemoglobin, hematocrit, and MCV and RDW (size of RBC’s) plus Vitamin B12 to confirm varying types of anemias. If iron is very high, it could be hemochromatosis and you can be tested for that.
▶️ Vitamin B12
Vitamin B12 is essential for so much of your biochemistry that affects your mood, brain, energy production and metabolism (rate at which you burn fuel). Not everyone absorbs B12 from food or supplements equally, due to genetics, autoimmunity, low stomach acid and more. Additionally, not everyone absorbs B12 into their cells from their bloodstream equally. So, your B12 level could be high in serum but low inside cells. At least see if it’s low in serum (under 500) and if so, you’d benefit from methyl B12 (methylcobalamin) supplementation (plus all the other B vitamins as they work in tandem) AND determining if there is a dietary and/or digestive issue involved. That’s when you need a geek like me to help! (For more information about B12, check out my blog article.)
▶️ Vitamin D
Vitamin D is an essential hormone for immune cells, mood management, bone health, hair growth, and much more. And it is commonly deficient in people who live at latitudes within anywhere in Canada. Knowing how to support your body’s needs can be the difference between Wintertime depression and enjoying that time, being sick often or recovering from colds and flus more quickly, etc. Unfortunately, Vitamin D will not always be a possible marker to have Alberta Health Services pay for. AHS will test Vitamin D in Celiac patients and those with osteoporosis but not frequently. However, there are functional blood spot test kits from private labs available for an out-of-pocket fee to test this marker a couple of times in a year (Fall and Spring), at least once, to be certain of your YOUniqe body’s needs (I have these test kits for sale if desired).
▶️ Thyroid function tests - TSH, free T4 (FT4), free T3 (FT3)
These three hormones are the fundamental hormones related to thyroid function to request a couple of times a year. They vary seasonally, during periods of extreme stress, if malnourished and more. So, seeing how your YOUnique body manages them within your life’s ups and downs can help you learn better how to support your body. TSH is the brain hormone that asks your thyroid organ to produce the storage thyroid hormone, T4, and a little T3. So, we are investigating the brain AND thyroid with these three biomarkers. Adequate FreeT3 (FT3), the bioavailable thyroid hormone, is essential for metabolism, energy production, immune function and hundreds of biochemical processes. If the balance of these three hormones is not at optimum levels, your energy WILL BE low. The most common reason for high TSH with low FT4 is autoimmune attack against the thyroid, called Hashimoto’s thyroiditis (my medical specialty). The common reasons for low FT3 if there is adequate FT4 are chronic stress, poor conversion of T4 to T3 in liver and gut especially, and low selenium, Vitamin A and zinc. You need a geek with specialized training to be able to help you figure this out and get you on track to better health more quickly. I love to add testing the biomarker RT3 (reverse T3) since when it is elevated it indicates significant body stress and energy will be very low even if FT3 is adequate. Unfortunately, this is very hard to get tested in Alberta today.
▶️ Thyroid antibodies - TPO antibodies (TPO = thyroperoxidase) and Tg antibodies (Tg = thyroglobulin)
As mentioned, the #1 cause of hypothyroidism (when your thyroid cannot produce enough thyroid hormones for your body’s needs) is the autoimmune condition, Hashimoto’s thyroiditis. And yet, most medical doctors aren’t running the two antibody tests to confirm autoimmunity is at play. I’ve been told the reason they don’t usually test the antibodies is because their treatment of hypothyroidism wouldn’t be any different whether autoimmune or not. Sadly, this means they are not keeping up with current research and are not helping patients adequately to prevent suffering over time. The autoimmunity must be managed (and CAN be managed) to slow health decline. If one or both of these antibodies are elevated above upper level, they indicate that your immune system is attacking your thyroid and causing thyroid gland decline; autoimmunity is at play. It is possible your thyroid can be attacked regularly for up to 10 years before blood testing indicates a need for supplemental thyroid hormones (what we call hypothyroidism). When the thyroid hormone levels are inadequate for health, fatigue is the most dominant symptom. Please note that 97% of hypothyroidism cases are caused by autoimmunity! Knowing this for you could change the course of your life dramatically if you’re willing to work on managing the autoimmunity with lifestyle medicine.
▶️ Sugar management panel: fasting blood glucose, fasting insulin, c-peptide & HbA1C
The most common metabolic problem I see in my medical practice is insulin resistance. Insulin resistance, simplified, is when your cells become resistant to allowing sugar to be shuttled inside (and remember, mitochondria rely heavily on glucose to produce energy). It’s your cells saying they have enough sugar and can’t tolerate more. This then means extra sugar will float around in your bloodstream, creating havoc everywhere - such as chronic pain/inflammation, brain fog, fatigue and much more. Learning how your body currently handles the sugar load from your current diet can help you learn how to eat better to help your body get back to normal sugar balance without becoming diabetic. Fasting blood glucose is simply that - how much sugar is found in your blood after fasting for 12+ hours. It should be at baseline (around 5) and if it isn’t, you need to change your diet and maybe even timing of when you eat. Fasting insulin is a measure of the hormone insulin in circulation that should be at a low amount like a baseline glucose, and if not, again, diet must change. C-peptide is a breakdown product of circulating insulin that lingers longer in the body than insulin does. So, even if fasting insulin looks good, if c-peptide is elevated, we know the pancreas is having to work very hard to produce a lot of insulin. And finally, HbA1C is a marker of how much of your hemoglobin protein on red blood cells has sugar attached in the past 3 months (in general, this applies to most everyone). If it is above 5.5%, you need to change your diet! Call a geek – me 😊 - for assistance 😊
▶️ hs-CRP (C reactive protein)
This test looks at your levels of general inflammation which can make you tired and increase your risk of perpetuating chronic diseases. It is not a perfect marker for inflammation, but over time, if the value goes up, we can infer inflammation is worsening, and if it’s decreasing, we know inflammation is improving.
Once you have this information, ensure you have someone very knowledgeable view the results and find any patterns associated with your level of fatigue. You’re NOT only looking for red flags: biomarkers under or over the listed lab ranges for a particular marker. Instead, you must look for what I call pink, yellow and green flags - where biomarker levels fall within functional ranges - and compare their levels to other biomarkers to see patterns in how your organs systems are functioning together. Then we MUST put this data in context of YOU! This is a big part of what sets Functional Medicine practitioners like me apart from mainstream medical practitioners.
If your medical practitioner of choice does not cooperate with you for testing these markers, you can reach out to me for support as I have developed relationships with many pharmacist colleagues who can give you bloodwork requisitions, based on my requests, in Alberta. If outside of Alberta, and if you’re not able to come to Alberta for blood testing, I can at least write up a formal bloodwork request for you to give to a trusted physician or nurse practitioner or pharmacist in your area and then review the data with you. If you’d like to dig into why you’re so fatigued and test even more markers than those listed above, purchase my Comprehensive Bloodwork Package and let’s get started!
And if you already have this bloodwork information available from the past 3-4 months and would like it evaluated by a Functional Medicine practitioner, you can reach out to me for support.
Experiencing fatigue to any degree for longer periods of time is not something you have to just live with! But I know that is what a lot of women are told every day by their doctors – “It’s just menopause” or “It’s because you have young children” or “It’s all in your head” and so on. This is gas-lighting at its most ignorant!
There is ALWAYS a solution to perceived problems and don’t let anyone ever dismiss your concerns. I can help when you’re ready and I am certain we can figure out the root causes of your fatigue and set up a strategy you can act on.
Hugs,
Dr. Krista xX
DrAc, IFMCP
CHECK OUT HOW TO WORK 1:1 WITH ME (Acupuncture, Consultations)