Are You Tired?

by Dr Fred Hui, M.D.


According to the various health surveys that have been conducted on the general population, “Tiredness” or “Fatigue” seems to always top the list. It could be a relatively new concern or an issue that the patient has been fighting over many years.




Dr. Jacob Tietelbaum, author of the bestseller “From Fatigued to Fantastic” has a comprehensive approach towards diagnosing and treating fatigue, and its called the “SHINE” protocol. A slightly modified version has been adopted by me. The SHIN protocol rules out the most common causes and lesser known causes, and also allows one to address multiple issues at the same time, because they are often linked to one another.


The SHINE protocol stands for:









Sleep is the time when we recharge our batteries.A good sleep releases endorphins, which is endogenous morphine, also called the “Feel- Good Hormone”.Poor sleep is one of the simplest but common reasons for tiredness, decreased concentration etc.



Factors affecting sleep:


Proper sleep hygiene.

• Wearing an eye cover can prevent the inhibition of light-sensitive Melatonin.

• Avoid daytime napping that is more than half an hour.

• Avoid caffeine in the second half of the day.

• For people who have bladder or prostate problems, restrict your fluid intake after dinner, so that frequent nighttime urination would not be a constant nuisance.

• The waking part of the rhythm can be enhanced by natural light or having full spectrum light exposure. Significant light exposure at noontime can help establish the day and night cycle.



Many medications even when taken at night do not disappear from the blood completely even in the daytime and can cause daytime fatigue. These include drugs such as anti-anxiety pills, antidepressants, codeine or narcotic containing analgesics, antihistamines and anti-seizure drugs. Even prescription sleeping pills, can in fact, contribute to daytime lingering sleepiness. Once the distinction between day and night cycle programming is disrupted, chronic insomnia will linger.


High Cortisol.

Some individuals find themselves more energetic at night even during a stressful period. This can be due to a higher secretion of Cortisol due to continuous release of Corticotropin releasing hormone. Lactium and L-Theanine can help lower down Cortisol production by enhancing neurohormonal feedback.



Late evening consumption of pure carbohydrates suchas sugar or starch can induce excessive insulin secretion. Overshooting of insulin can lead to hypoglycemic episodes which can lead to sleep interruptions. I recommend consumption of food that is more on protein and fats in the evening.


Neurotransmitter imbalance.

This is highly probable for individuals who have difficulty initiating sleep and have mind-racing. Our brain is wired with regulatory neurotransmitters that can either stimulate or inhibit thus affect our wakefulness. GABA and Serotonin are inhibitory neurotransmitters that can be supplemented and both can act, as hand brake and foot brake respectively, to calm an overactive mind.


Sleep apnea.

Snoring is a tip off that one may have sleep apnea. Airway obstruction can cause deoxygenation of the brain. When the brain gets deoxygenated to a dangerous level, Cortisol and Adrenaline can be triggered as alarms. Such alarms can result to frequent disruption from deep sleep and therefore, people often wake up with non-rejuvenating sleep. One simple approach is to wear an anti-snoring mouth guard that can open up the airway during sleep. For severe cases, a CPAP machine is more recommended.






– TSH, Free T3 and Free T4 – A routine blood work only checks for TSH but I take a more detailed look into your thyroid function by checking your Free T3 and Free T4 as well.

–  ADRENAL HORMONES: (a) Cortisol - Deficiencyof cortisol can cause symptoms like morning tiredness, cold hands and feet, low energy levels all day, low blood sugar, emotional hypersensitivity etc. 


 (b) Aldosterone - Your aldosterone levels may be low if you are unable to retain salt and water. - Having to urinate often, low blood pressure, light headedness and sunken eyes are some symptoms of low aldosterone levels.

 • SEX HORMONES (a) DHEA (b) Testosterone (c) Estrogen (d) Progesterone - DHEA is a hormone produced by the adrenal glands that converts into other hormones like Testosterone and Estrogen. The deficiency of these hormones may cause tiredness, low libido, menopausal symptoms, erectile dysfunction etc. - It is good to top up these levels to the level of those of the younger biological age. 




- Do you have symptoms like achiness, chills and rigors, low-grade fevers, night sweats or a chronic “under the weather” feeling? - These, according to me, are signs of a chronic ongoing infection that you are unable to get rid of. It could be bacterial, viral, fungal or even parasitic. 


 Several patients are able to go back in time, and find that the onset of the above symptoms coincides with an infection or invasive procedure they had in the past. - Several examples are: Gynecological infection/procedures (Caesarean section/endometriosis/biopsy etc) Urinary tract infections/ Colitis, amoebiasis, parasites and other GI tract infections History of root canal/ tender gums/ hypersensitivity/ other dental procedures  History of sinusitis/ pneumonia/ any chronic infections History of arthritis/ other joint diseases. Lingering infectious mononucleosis - These infections gradually enter the blood stream and spread to other organs. There, they multiply and silently form pockets of infection in different parts of the body including the joints. - Areas like the joint spaces are inaccessible to the white blood cells (our germ fighting squad) because of no blood flow beyond the cartilage. In spite of being unsuccessful in eradicating the intra-articular infection, the immune system never gives up attacking the joints. • Tracing the culprit – Depending upon the suspected source of infection, tests can be carried out.  Urine culture and microscopy  Sputum culture / stool culture Throat swab / vaginal swab  Stool and saliva test (to check for several parasites and yeast) The above tests only check for bacteria, and therefore, are not comprehensive enough.  Bacterial DNA test This test can find organisms that are not traceable by any insurance covered test. It can detect virus, fungi and semi-viruses too. This is because this test does not rely on actually “seeing” the organism, but it tests for the presence of its DNA! Examples include Chlamydia spp, Mycoplasma etc. 


NUTRITION • DEFICIENCY OF NUTRIENTS - Deficiency of certain nutrients can also cause tiredness and aches. - In order to rule out such nutritional deficiencies, I may test the following levels: Vitamin D,  Vitamin B12 Serum iron, Serum folic acid - The conventional recommended daily dosage of Vit. D is 1000IU/day. This is far from being adequate. The dosage I usually advice is 5000IU/day. - Vitamin B12 levels above 600 is ideal in my opinion. In order to keep it at such a high level, sometimes oral supplementation will suffice. For others, a subcutaneous injection of 1cc Vit B12 may be prescribed. •

TOXIC NUTRITION (HEAVY METAL INTAKE) - Over many years, everyone tends to accumulate heavy metals in their bodies. - The source - The heavy metals may have entered your body through various sources like Cadmium (from cigarettes), Lead (from old water pipes) andMercury (from seafood and dental fillings). High mercury levels due to amalgam fillings areone of the most common cases I come across. Other heavy metals include Aluminum, Cesium and Gadolinium. - The accumulation - These metals don’t have an escape plan in our body. They don’t get broken down or flushed out. They accumulate in our cells and circulation and over time, causes toxicity. This consequently produces symptoms like brainfogging, tiredness, circulatory issues etc. 


FOOD ALLERGY - Most patients struggle with some sort of food allergy on a daily basis –and most are unaware of it.The allergy can be mild, moderate or severe. - Severe allergies are the obvious ones- where one can swell up and have extreme difficulty in breathing, or have rashes and itching. - Mild-moderate allergies – these are the ones that just give you gas,reflux, bloating, belching, heartburn, abdominal cramps, diarrhea or constipation. - What many people don’t understand is that food allergies harm you over time. Every time you eat something you are allergic to, your body needs to produce antibodies against it. - Your body therefore, is constantly in fight mode as the ”enemies” keep pouring in – this weakens the immune system and distracts the body from the real issues like a possible underlying infection.This, in turn, causes or aggravates most of the symptoms. Food Allergy Test - If you have any of the above mentioned symptoms, then I would strongly recommend a food allergy test. - This is a simple test that uses 3 drops of blood to identify IgG antibodies against 96 different foods. It covers all food groups like dairy, poultry, seafood, meats, fruits, vegetables, legumes, wheat etc. - The results even tell you what degree of reaction you have towards that food – ranging from “No reaction” to “Severe”.


MOOD/EMOTION  Neurotransmitter imbalance. Biochemical imbalances of Serotonin, GABA and Dopamine can be helped by natural supplements such as St. John’s Wort, 5-HTP, or SAMe. Since it is hard to accurately determine which neurotransmitter is deficient, offering an intravenous buffet of neurotransmitter precursors allows the body to utilize what it needs. 

In my practice, I recommendIntravenous amino acid. I had observed amazing results on restorative balancing of patient’s mood such as anxiety or depression. - Emotional trauma. These are events or situations that overwhelm the individual’s ability to cope, and eventually feel emotionally, cognitively, and physically overwhelmed. 


Work Overload is one of the commonest reasons for tiredness in modern society: taking on more than one can handle; taking on a bigger mortgage than one can comfortably afford; being a working mother with not enough resting time, etc. No amount of medicine can erase the fatigue until a person does some fundamental lifestyle changes. - Meditation. If one can learn meditation technique, it would be extremely wonderful for recharging and rebalancing the body.

 IN SUMMARY…. A fatigued person can be compared to a car with no horsepower. As you already know, a car needs constant maintenance – it has to be tuned up often, fluid levels need to be topped up, and the rechargeable battery must get a full overnight charge to ensure the best performance the next day. If the maintenance is well taken care of, the car will then return to the original factory settings – and it will perform as promised. In short, paying attention to all aspects of your health, and diagnosing & troubleshooting the issues you never realised you may have had, can bring you from FATIGUED to FANTASTIC!!

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