As a functional medicine doctor who looks at the whole person, I take into account everything. I look for hidden nutrient deficiencies, hormonal imbalances, bugs like candida (yeast), food intolerances, heavy metal burden. I think outside of the box, and because I have 90 minutes during an intake, I have time to listen to the patient. If the patient has overwhelming clinical symptoms of low thyroid, despite having normal blood markers of thyroid function, I will recommend natural thyroid alternatives to them. Often times, doing an elimination diet might uncover a hidden and subtle food intolerance that is the culprit. Some patients improve with heavy metal detoxification, while others require balancing of several hormones or correcting nutrient deficiencies. Finally treating for candida can also help with fatigue.
Some patients early on in their treatment may require some additional nutritional boosts so to speak.
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