1. Food Intolerances: most commonly wheat, gluten, sugar and dairy. I would guess that about 90% of the time that I suggest eliminating gluten from one's diet (wheat, rye, barley, oats and spelt) patients come back to me in a state of disbelief about how much better they feel. Try eliminating all of these foods for 4 weeks and then add back one at a time, paying attention to how you feel. It may change everything!!! 
2. Dehydration: how many of you are drinking 8-10 glasses of pure water daily? Low grade dehydration is extremely common and manifests as fatigue, foggy thinking, depression and uncontrolled appetite. Get a water bottle that is calibrated and keep it full and with you at all times. That way you can measure how much you are drinking. Not thirsty? Thirst only comes once you are actually dehydrated. Must begin drinking before that point! And if you don't like water, squeeze 1/2 an orange or lemon in it! Extra vitamin C is good for you anyway.
3. Thyroid Imbalance: Traditional doctor saying your thyroid is "normal"? The TSH or Thyroid Stimulating Hormone is the test most doctors run to see if there is enough circulating hormone in your system. However, the range of "normal" for TSH is between .4-4.5 which is like saying you could wear a size .4 shoe or a 4.5 size shoe and walk comfortably! There can be sluggish thyroid symptoms anywhere in that range and it is crucial that we compare how you are FEELING to the numbers we are seeing. Even more crucial that we are measuring the end hormones such as free T4 and free T3 to make sure that your thyroid hormone is converting correctly. If your fatigue is partnered with constipation, weight gain, sluggish thinking and low libido, this could be something to look into. 
4. Too Much Processed Food: we have all had those days where we could describe our meals in 2 colors "brown and yellow"...yes? cheese, bread, meat, repeat.... not getting enough fruits and vegetables saps our systems of vitamins, minerals and co-enzymes that are necessary for proper energy and vitality. Every plate should be 75% vegetables and should include as many colors of the rainbow as possible. The other 25% should be whole grains and lean protein. 
5. Low Vitamin D:  because we do live in the Northwest. And in return for all the beautiful greenery and lush mountains, we suffer from chronically low D3. Most all of my patients suffer from D3 in the low 30's;  our optimal target is between 60 and 90 ng/dL. However, D3 is a pro-hormone and not a vitamin so it is necessary that you have your level measured and that you periodically measure it once starting supplementation. Low D3 can cause fatigue, depression, irregular menstrual cycles, and an increased risk of cancer. 

One of my all time favorite ways to eat kale is this delicious salad. This recipe comes from "Feeding the Whole Family" by Cynthia Lair. 

In natural medicine, beets are considered a liver support food, important for renewing the liver's vital functions of keeping the body free of toxins. This vivacious salad boosts the body's immune system as well by offering a high dose of antioxidant power via carrots and kale. Intensely colorful, flavorful, and so healthful, you may call this your "Vitality Salad" once you've tried it!

Salad

• 4 large beets
• 1/4 cup toasted pumpkin seeds
• 1 bunch kale
• 3 scallions
• 1 medium carrot

• 3 tablespoons extra virgin olive oil
• 2 tablespoons balsamic vinegar
• 3/4 teaspoon dijon mustard
• 1/4 teaspoon freshly ground pepper
• 1 tablespoon chopped fresh basil
• 1 teaspoon finely diced garlic

Wash beets and bring to a boil in a large pot. After boiling bring to a simmer, continue to simmer for one hour, until tender. Let cool, then peel beets and cut into 3/4 inch pieces.

In the meantime, lightly toast the pumpkin seeds by placing them in a dry skillet and cooking over medium heat. Constantly stir the seeds to ensure even cooking. When they begin to pop and give off a nutty aroma, they are ready. Set aside to cool.

Wash kale and place in a large pot of boiling water for 30 seconds. Place in strainer and cool with cold water, cut into bite size pieces. Finely dice the green onions and peel the carrot. Slice into 1/8-inch rounds.

Place all dressing ingredients in a bowl and mix well with a wire whisk. In a separate bowl place chopped beets, chopped kale, diced green onions, sliced carrots and pumpkin seeds. Add dressing and toss gently. Serve chilled. Makes approximately six servings.