Running on Empty

By: Alidad Zadeh, D.O.

Every fall, the same sentence walks into my exam room: “I’m just tired.” Summer ends, school starts, work compresses, and people who felt fine in July can’t keep pace by October. Most of them have already decided why — it’s age, or stress, or a personal failing. 

It usually isn’t. Fatigue, poor stress tolerance, and slipping focus are symptoms, and symptoms have causes. Most of the common ones are measurable. 

What we look for first

• Iron. Ferritin, the storage form, can be low while a routine blood count looks normal. Common in women who still menstruate, in athletes, and after any period of blood loss. 

• Vitamin D, B12, and magnesium. Quietly common, straightforward to correct, and easy to miss if nobody orders the test. 

• Thyroid. An underactive thyroid produces this exact picture: fatigue, cold intolerance, weight gain, mental fog. 

• Blood sugar. Insulin resistance causes afternoon crashes years before anyone is told they have diabetes. 

• Hormones. Testosterone declines with age in men. Perimenopause disrupts sleep, mood, and energy in women, often beginning in the early forties. Both are questions a blood test and a careful history can answer, rather than something to guess at. 

• Sleep. Untreated sleep apnea is the most common reason I hear “I slept eight hours and woke up exhausted.”

Where peptides fit

Peptides are short chains of amino acids that act as signals in the body. Some have been approved medications for years. Others, sold online for energy, recovery, and focus, have not been approved by the Food and Drug Administration, and the marketing has moved faster than the evidence. For the right patient — prescribed and monitored by a physician who has reviewed their labs and their history — this class of therapy has a legitimate place. Ordered from a website by someone who has never examined you, it is a gamble. If a seller doesn’t want your medical history, they aren’t practicing medicine. 

And IV therapy

Intravenous nutrition is useful when it is aimed at something specific: a documented deficiency, poor absorption, dehydration, recovery from illness. It is not a substitute for a diagnosis. Test first, then treat. The order matters more than the ingredients. 

Before you accept it as normal

If your energy, focus, or stress tolerance has changed, get evaluated. “Normal for your age” is a conclusion, not a starting point, and it should only be reached after the ordinary causes have been ruled out. 

At Zadeh Performance Medical Center in El Centro, we start with measurement — bloodwork, body composition, and cardiorespiratory fitness testing — and build the plan around what we find. To schedule an evaluation, call (760) 997-7990 or visit zadehperformance.com. 

Alidad Zadeh, D.O., is board-certified in internal medicine and practices in El Centro, California.