by Dr Fred Hui, MD

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.

My Approach to Fatigue

Dr. Jacob Tietelbaum, author of the bestseller “From Fatigued to Fantastic” has a comprehensive approach towards diagnosing and treating fatigue, and it’s called the “SHINE” protocol. A slightly modified version has been adopted by me. The SHINE 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:


(1) Sleep

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.

An article explaining my approach to improving your sleep in detail will be given to you.

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 night time 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.

Drugs. 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.

Hypoglycemia. Late evening consumption of pure carbohydrates such as 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.


  • Melatonin is a non-addictive, natural sleeping pill. There is no lingering effect/ daytime drowsiness. Melatonin also has anti-oxidant, anti-aging and immune system boosting properties.
  • Dosage — Start with a 3mg pill on Night 1 ——-> 2 pills on Night 2 ——-> 3 pills on Night 3 and gradually increase the dosage until you discover the right dosage for your body. You can take a maximum of 10 pills a night (30mg).
  • Use an eye cover – In order to increase the effectiveness of this hormone, ensure complete darkness over the eyelids because light deactivates the action of melatonin.


  • This is another natural supplement for sleep that is composed of herbal ingredients like Valerian root extract, passionflower extract, lemon balm extract and griffonia seed. It also contains 5-HTP, melatonin and GABA, which are known to relax the body and mind. Dosage: 2 caps/ night.


This is a precursor of Serotonin derived from African seeds. It serves as a “foot brake” optimizing sleep and helps reduce mind-racing. It can be taken initially at 100 mg/ night. In cases that a higher dose is required, it can be increased to 200 mg.


  • This is an inhibitory neurotransmitter that serves as a “hand brake”. Conventional sleeping pills are designed to be GABA imitators. Why not use the “real McCoy?”, for the very reason that it is not addictive and mimics your own secretion. This can be taken initially at 2 pills (1200 mg)/night. Dose can be titrated higher per night as the need arises until maximal benefit is obtained.

(2) Hormones

Thyroid Hormones

  • 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.
  • I pay particular attention to the active thyroid hormone (FT3). I like to optimize my patient to the higher end of the range.
  • Having decreased thyroid function can cause low energy, sluggishness, increased sleep, weight gain etc.
  • Low Temperature – If the basal body temperature is <1°C than normal, the thyroid or adrenal hormone production may be low. [Normal temp. = 37°C or 98.6°F]
  • Desiccated thyroid – Depending on how low you may be, you would be prescribed desiccated thyroid, which is better than synthetic alternatives like Eltroxin and Synthroid. Desiccated thyroid is actual dried and powdered porcine thyroid glands.

Adrenal Hormones

(a) Cortisol

  • Deficiency of cortisol can cause symptoms like morning tiredness, cold hands and feet, low energy levels all day, low blood sugar, emotional hypersensitivity etc.
  • Saliva cortisol test – This test is done to see if you are deficient in cortisol levels. It measures your cortisol levels at 4 different times of the day.
  • This result will then be interpreted by me – and on the basis of your levels and symptoms, a treatment plan will be drawn out for you.


  • Licorice drops
  • Cortef ( bioidentical low dose cortisone)
  • Intravenous Chronic Fatigue Drip –
  • This treatment contains the Adrenal support injection, along with several minerals and vitamins like Ca, Mg, Zn, Cr, Se, Cu, Vit B’s, Vit C etc. The minerals and vitamins serve as the raw materials to rebuild the gland.
  • Usually about 20 sessions are advised depending on the level of fatigue.
  • All the treatment options, their risks and benefits are discussed in detail in another article by me, called “CHRONIC ADRENAL FATIGUE”.

(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.

 Florinef – This may be prescribed to those patients who are severely deficient.

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.
  • Most of these tests are OHIP-covered, and depending on the results, you may be supplemented with:
  • DHEA 25 mg daily

Testosterone cream

Triple hormone cream (This cream is prescribed mostly for menopausal patients. It contains bioidentical estrogen, progesterone and a hint of testosterone)

Progesterone cream (This cream is mainly prescribed for patients who also currently have heavy periods and PMS symptoms. The dose is 0.1cc twice a day, to be applied from Day 15 to Day 28 of the menstrual cycle. This dose may be increased up to 0.2cc if hot flashes are not controlled)

– These bio identical hormone creams are specially compounded as per my prescription and are available at all my clinics.

(3) Infection

  • 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. Nothing else in the world will give you chills other than infections.
  • 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 OHIP- 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.

Treating the infection

  • Antibiotics or antifungals (as required)
  • IV H2O2 treatments

H2O2 is a well-known killer of germs –Its action is against viruses, bacteria, fungi and semi bacteria. It mostly works by creating a high oxygen environment in which the germs can’t survive. I had good clinical success using this treatment, but now, I have a more powerful treatment that does not irritate the veins which is High dose Ozone therapy. I prefer this approach.

  • High dose (10 pass) Ozone therapy

It delivers more ozone in a shorter amount of time and better saturation of red blood cells with oxygen without damaging it.

-The 10-Pass method describes an ozone therapy treatment during which 200 ml to 220 ml of a patient’s blood are drawn under negative pressure. The blood is then mixed under positive pressure with 200 ml of ozone at a concentration of 70 ug/ml, and then re-infused into the patient’s vein, also under positive pressure. This is repeated 10 times and can be administered 1-2x/week for 10 sessions initially.

– The 1st 5 treatments: The patient may develop flu-ish symptoms (die-off effect) because the Ozone would initially break down and flush out the infectious agents and toxins into the blood stream.

– 6th to 10th treatment: This effect will gradually subside and will not require additional treatments. You can use symptoms like chills, low grade fever, achiness as a yardstick of improvement.

– After 10 treatments: A follow up consultation needs to be booked with me, so I can analyse your progress and revise your treatment plan if necessary.

(4) Nutrition

Deficency 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) and Mercury (from seafood and dental fillings). High mercury levels due to amalgam fillings are one 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 brain fogging, tiredness, circulatory issues etc.

– Heavy Metal Challenge Test – For patients who have had long-term exposure to heavy metals, I strongly recommend this test. It’s a 2-hour IV treatment with EDTA and DMPS (which are chelating agents), following which a urine sample will be collected and sent away to the US for analysis.

Depending on the results, I can recommend chelation treatments like:

  • DMPS treatment – To chelate mercury. Must have amalgam fillings removed prior to starting treatments. Can be done once in 2 weeks only.
  • EDTA treatment – To chelate lead, cadmium, aluminum etc. Can be done up to thrice a week.

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”. It also comes with a diet booklet that guides you through the allergy elimination process.


– For patients who have food allergies, I also recommend taking digestive enzymes to aid the digestive process. This natural supplement contains bromolein, chymotrypsin, amylase, lipase, trypsin, papain, lysozyme etc.

– Taking it with 1 tbsp apple cider vinegar or any vinegar or pickle would prime the body’s own secretion of digestive enzymes.

(5) 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 recommend Intravenous 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. I do recommend patients to undergo Emotional freedom technique (EFT) which utilizes light tapping technique combined with verbalizing the identified problem followed by a general affirmation phrase. This balances the energy system and appears to relieve psychological stress and physiological pain.

– 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 re-balancing 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 realized you may have had, can bring you from FATIGUED to FANTASTIC!!