Always Tired ? A Checklist to Discuss With Your Doctor

The following is a reproduction of a Millennium Health Centre editorial article which appeared in the Seaway News newspaper in Cornwall, Ontario, Canada. The content is shortened to accommodate a newspaper space allotment. As such, it is not academically cited with references. These are available, so please feel free to email your questions.


Dr. Stephen F. Jones B.Comm., N.D.
Doctor of Naturopathic Medicine

It is indicated by several medical associations that the number one reason that people will go to see their doctor is because they are tired. Being tired, however, can be the result of numerous medical conditions, as well as lifestyle circumstances. It is the job of the family doctor to create a 'list' of possible causes of the fatigue (tiredness) in the case of each individual patient. With this 'shopping list' of possible causes, the doctor can then begin 'scratching off' each possibility from the shopping list through proper testing (blood work etc.). In doing so, the actual cause of the fatigue can be determined and can then be appropriately treated.

Now, this process can be considerably more complex than many patients would imagine. Unfortunately, all possible tests and considerations are often not explored and all the patient knows is that some blood tests were done and said to be normal. With this in mind, the intention of this column is to provide some considerations to discuss with your doctor. As each item listed could be a column in its own right, the focus will be to simply bring the considerations to light.

The first course of action if a patient is tired is to gather some important blood work. The blood work required, however, should be more than the 'Complete Blood Count' (C.B.C.) which is the routine (and frequently only) test conducted. Other critical considerations include tests for thyroid function, adrenal function, iron utilization, allergies, hormonal deficiencies (like estrogen or testosterone) and blood sugar utilization.

With respect to the thyroid, critical hormones that are rarely tested do, in fact, need to be tested. When patients are told they had a 'thyroid test' this is only a test called the 'T.S.H.'. The 'problem' is that this hormone (ie. the 'T.S.H.') is NOT the active thyroid hormone that actually controls your metabolism (and energy). In fact it can be completely normal in several thyroid conditions that will cause fatigue ('secondary hypothyroidism', 'euthyroid sick syndrome' etc.). You really need to have the active hormone called 'T3' checked (and ideally a hormone called T4). This is a very detailed subject. If interested I would encourage reader to go to the website of Mary Shomon at Another good resource is a book entitled "Thyroid Balance" by Dr. G. Rothfeld M.D. and Deborah Romaine.

Adrenals are also a significant cause of fatigue and almost never checked on routine blood work. Prolonged stress, trauma (physical or emotional), shift work, poor diet, over consumption of coffee, caffeine and alcohol and insufficient sleep (to name a few factors) can cause a decrease in hormones such as D.H.E.A., testosterone and even estrogen. All of these can make you tired. As such, they should be measured to see if there is a problem.

Next, one should have something called 'Ferritin' checked as this can cause outright anemia and/or chronic fatigue if it is low. A personal preference is to also check the 'Total Iron' of a patient.

Lastly with simple blood work, patients should have their blood sugar checked. The standard test is called a 'Fasting Glucose'. The problem is that this test can be normal in as much as 60% of patients who have a condition called 'dysglycemia' and / or 'hypoglycemia'. The translation is that they don't have diabetes, but their bodies do not utilize blood sugar well. They get tired after eating, tired/irritable/headachy and moody if they are between meals and 'wired' if they have too much coffee. These people should have tests called 'Fating Insulin' (which is never run routinely) and 'Fructosamine' to help the doctor determine if a patient's fatigue is due to blood sugar 'swings'.

After this core blood work is done, your doctor may then wish to look into food allergies, how much and the type of exercise your getting, your diet, your weight and even your sleep patterns (to rule out a condition called 'Sleep Apnea'). Space does not allow for a review of these in detail, but my hope is that these ideas will provide readers with information to discuss with their doctors. Being tired has numerous personal, workplace and societal implications and needs to be taken serious by you and your doctor.

Best of health to you.

Readers may write the EMC newspaper or email Dr. Jones at with any inquiries.