For most people, a routine medical checkup can be an anxiety-ridden experience. Anticipating being told that something is "wrong" can conjure up stressful feelings. When a checkup comes back normal, we rejoice and, for the most part, continue life as usual.

And why not? My daily health decisions appear to be working, and everything seems OK, we tell ourselves. But is everything OK, and are you really healthy?

When it comes to health, it's important to consider that the absence of disease does not necessarily constitute health. Quite often, I will see patients come to my office and say, "My doctor says I passed my physical. I'm healthy, but I just do not feel right." Or, "I seem to do all the right things, but I feel really tired." Or, "There is no explanation for my pain." Or, "I have been taking these pills, yet my symptoms continue to worsen." These are just a few examples that indicate declining health in the presence of a normal routine checkup.

An important principle that I tell my patients is that health, or being "healthy," is a process, not an event. Therefore, the annual routine health checkup, while certainly important for ruling out disease, is not a mechanism for attaining or claiming good health.

A second important principle to understand is that attaining good health requires an individual or customized approach tailored to our body's unique characteristics, strengths and weaknesses. What works for one person may not work for another. By understanding your unique body, we are able to create a health plan with the goal of steering you away from disease and moving you towards health and wellness.

So, how would I work through these general and often vague symptoms to determine health and help to restore it?

I would begin with a comprehensive health history that includes several questionnaires designed to spot undesirable stresses. These might include nutritional deficiencies, digestive imbalance, and toxicity issues. Next I would do a complete physical exam tailored to the presenting symptoms. I would then order a comprehensive blood test that measures 40+ health parameters (such as a complete blood cell count, liver and kidney function, risk factors for heart disease, etc) and assess them for abnormal values and for any nutritional implication they might offer. If at this point the patient's findings remain normal, I would begin a detailed functional analysis of the patient as it relates to the symptoms.

Let's take an example. A patient describes symptoms of waking up at night several times with difficulty getting back to sleep (insomnia), fatigue and symptoms of mild depression like an inability to cope at work and withdrawing from social interactions.

Symptoms like these can be very confusing and create a chicken and egg phenomenon. Is the depression created by a chemical imbalance in the brain or is it because the person is not capable of properly resting and is now so run down that they feel depressed? Another possibility is that fatigue may be causing all of the symptoms (insomnia and depression).

Answers to some of these questions may be discerned by the health history but I would definitely want to better understand those organ functions that are so critical to energy in this case. For instance, the adrenal glands are our stress glands, and if they get weakened to the point that they can not compensate for stress very well, we can get fatigued, or depressed, or have difficulty sleeping due to the high cortisol levels in the blood at night time. This viscous cycle of low energy leading to poor sleep and depression repeats itself. I would order either a 24-hour urine test to ascertain cortisol levels or do an adrenal stress index test that involves the patient collecting saliva four times at specific times throughout the day and night. This information is then sent to a laboratory and the stress hormone profile of your adrenals are calculated. Dysfunctional adrenal gland function may be determined by this test.

As we know, every human being is unique and that the causes of one person's depression or fatigue may be totally different from another. Let's look at the above example further. In addition to looking at organ stresses as we did above, I may have determined that this person consumes very few green leafy vegetables and whole grains and typically enjoys processed breads and meats. Given that green leafy veggies are rich in folic acid and that whole grains are rich in B vitamins, I may be concerned that this individual is not getting adequate B6, B12 and folic acid — all of which are important for healthy serotonin levels in the brain. Serotonin induces sleep and makes us feel good.

To make serotonin, the brain uses the amino acid tryptophan plus vitamins B6, B12 and folic acid. I would either order a blood test for these levels or treat the patient with a more healthy diet plan and prescribe the supplements B6, B12, and folic acid. In addition, if the adrenal stress test comes back abnormal, I would select a treatment to strengthen the adrenal glands, which may include some combination of a homeopathic remedy, a supplement such as vitamin C or pantothenic acid (vitamin B5), or a botanical such as ginseng. Often the best remedy takes into account the entire health status of the patient and that remedy may then help more than one symptom.

In this example, I have treated insomnia, mild depression, and fatigue holistically ruled out any obvious causes for the symptoms and assessed diet, nutritional deficiencies, and organ stresses. I treated the patient with natural therapies respecting that more conventional drug therapy may be necessary in the future. Could there be other causes of these symptoms? Absolutely. You may need to look at protein deficiency such as the amino acid tryptophan, or environmental toxicity burdens in which mercury or lead burdens on the body can significantly affect our mood and energy, or even more general burdens like under-active digestion, food intolerances and psycho-emotional issues. All of these stress our body in a manner that can create these symptoms.

Wellness and optimum health are the goal. To achieve this you need a plan and a commitment that enables your road to wellness. Actively participate in your health and be relieved of a "good checkup," but don't be complacent. You don't have to wait to be unhealthy to utilize the strategies outlined in this article. By engaging in this approach before you feel sick, you'll have a jump start on reaching a goal of optimal health. Remember, health is a process, so enjoy the journey.

Lorne Swetlikoff is a licenced naturopathic physician in Nelson, B.C. He is the current president of the College of Naturopathic Physicians of British Columbia.

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