My approach to fatigue / tiredness

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 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

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.


This is our body’s natural sleep hormone. As we age, our melatonin levels drop. For those patients whose melatonin baseline levels are low, its supplementation would improve the depth and quality of sleep.

  • 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.


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.


his is another natural supplement for sleep that is composed of herbal ingredients like Valarian 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.

2. Hormones

Deficiency of certain hormones can also bring about the associated symptoms and hence I would first need to rule out such deficiencies.

• 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.
– 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:
– This is dealt in detail under the heading CHRONIC ADRENAL FATIGUE

• Sex hormones

  1. DHEA
  2. Testosterone
  3. Estrogen
  4. 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 in order to bring down your biological age. – Most of these tests are OHIP-covered, and based 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 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


4. 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) 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. Max: 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.

5. Emotions

  • 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 rebalancing the body. Here is a link that can help you start meditation.