Do you want more energy? Do you have days or weeks of feeling tired all the time?
According to the Royal College of Psychiatrists, 20% of people at any given time feel unusually tired and 10% of UK individuals have ongoing, prolonged fatigue. It can be dangerous too, with an estimated 20% of road accidents on major UK roads being attributed to diver fatigue. This is more than the number of accidents caused by drug-driving.
Fatigue can manifest in many different guises. Some individuals feel permanently exhausted, needing regular naps, while others have peaks and troughs of energy. Some feel they can’t function until a caffeine boost, but then find it hard to switch off in the evening. The fatigue may feel like a physical heaviness, or it may show itself as ‘brain fog’, as if the head is stuffed with cotton wool. And the diagnoses of Chronic Fatigue Syndrome are increasing, where physical and mental exhaustion can be so unrelenting and debilitating that normal everyday life can become impossible.
Fatigue is common. In most cases, it can’t be ‘cured’ by simply taking a medicinal drug. But, because fatigue is a sign of underlying problems, sufferers can experience real improvement when they try a personalised nutrition approach. Fatigue can be caused by any number of underlying imbalances in body functions, and personalised nutrition works precisely to identify the particular pattern of imbalance in each individual case, and then resolving these by supporting the associated body systems. Let’s look at some of these underlying imbalances.
Common underlying causes of excessive tiredness
Many types of medical conditions can drain energy levels. These include anaemia, an inflammatory autoimmune disorder, cancer, diabetes, hypothyroidism, an infection, obesity, anorexia, depression, sleep apnoea or a chronic conditions of the liver, heart or lungs.
But whether or not you’ve been diagnosed with one of these, there are some relatively common causes of both physical and mental fatigue that can be easily identified and addressed, with the help of a Nutritional Therapist:
Insufficient iron levels
Even if anaemia has been ruled out, your iron levels may still not be high enough for optimal energy levels. Run a serum ferritin test and look for levels to be 50-70ng/mL. Anything less may contribute to fatigue.
This is because not only is iron required for haemoglobin to carry oxygen around the body, but it is also vital for the batteries of our cells (the mitochondria) to turn food into energy; and it also helps your thyroid gland to make energy-giving hormones.
Blood glucose imbalances
If your diet regularly includes sugar, white starch, caffeine or alcohol, you could be suffering from peaks and troughs in blood glucose levels. This situation is known as ‘reactive hypoglycaemia’, where insulin mobilizes glucose into the cells fast enough to cause energy crashes shortly after eating and drinking. To make matters worse, these sharp dips in energy tend to trigger cravings for more sugary or caffeinate ‘pick-me-ups’ – leading to what is often referred to as a ‘blood sugar roller-coaster’. Later stages of the problem, such as insulin resistance and diabetes, can also cause fatigue.
Inflammation
Inflammatory cytokines from any cause, including undiagnosed, chronic infections, sap the brain and body of energy, causing brain fog, apathy and muscular weakness.
Mitochondrial function
The batteries of our cells work hard every second of the day to turn the food we eat into adenosine triphosphate (ATP) – the energy for our bodies to use. If these mitochondria start to flag, we become starved of ATP for energy levels. What’s more, dysfunctional mitochondria tend to produce excessive levels of free radicals. Free radicals damage cells, causing inflammation, which is another cause of fatigue.
Adrenal imbalance
The adrenals produce stress hormones like adrenalin, noradrenalin, cortisol and DHEA. It’s common for adrenals to become over-active if you’ve had a long period of stress. You may be running on adrenalin but still feel exhausted – you’ll probably be feeling ‘tired but wired’. Less commonly, the adrenal glands can struggle to produce sufficient levels of these hormones, leading to ongoing fatigue and exhaustion, and feeling unrefreshed even after a long night’s sleep. A salivary cortisol and DHEA test can plot the pattern of output on a typical day, to gain a better understanding of what’s happening.
Low thyroid function
Fatigue and other symptoms of low thyroid function can manifest even where standard thyroid blood results fall within the ‘normal’ reference range. Some individuals need higher levels of thyroid hormones in order to feel at their best. A basal temperature test and more in-depth bloods can provide greater insight than simply measuring serum TSH and T4.
Gut microflora balance and gut lining integrity
‘Brain fog’ and generalised feelings of apathy and fatigue are well-acknowledged symptoms of yeast or bacterial imbalances in the gut. Symptoms tend to worsen if the integrity of the gut lining is compromised. Consider testing for the presence of gut dysbiosis and leaky gut.
Toxic overload
Carrying excessive levels of toxic chemicals or metals, whether from the environment or produced inside the body, can be a cause of physical and mental exhaustion, and feeling ‘hungover’. Are you regularly exposed to higher levels of toxins? Or is the problem because the detoxification systems are flagging and need more support? Body systems like ‘methylation function’ and ‘glutathione production’ are important to consider here and your Nutritional Therapist can explain this to you in more detail.
Addressing the causes – Dietary and lifestyle measures
Get the basic diet right
For blood glucose control, adrenal support, digestive health and as a powerful anti-inflammatory tool, it’s important to ditch processed foods, white starch, sugar and excess caffeine and alcohol, in favour of a low-glycaemic load, wholefoods diet. Focus on broadening the diet, rather than restricting it, including more vegetables (10 portions a day if possible), 2-3 fruits, nuts and seeds, natural oils like avocado and olive oils, some whole grains (gluten free to start with where possible), pulses if tolerated, and fish, seafood, eggs, poultry and grass-fed red meat. This picture sums it up well (the ANH Food4Health plate): https://anhinternational.org/wp-content/uploads/old/sites/default/files/150122-ANH-Intl_Food4Health-Plate.pdf.
Review all medications
Some prescribed medications can cause fatigue. These include some types of statins, beta blockers, antidepressants, antihistamines, opioids, sleeping tablets and radiotherapy / chemotherapy. So you may want to have a chat with your doctor about reducing, swapping, or even trialling a holiday from some of your medications.
Improve sleep
Humans need between 7 and 9 hours of good quality sleep every night. There is strong evidence that people who believe they need less are kidding themselves and cannot be functioning at their full potential. Try some of these strategies to improve sleep:
- Go to bed and get up at the same time every day
- Get daylight outside every morning
- Include a wholefood carbohydrate at the evening meal, such as brown rice or sweet potato
- Dim lighting in the evenings and avoid tech devices
- Practice relaxation techniques like meditation, reading, yoga, breathing
- Set a bedtime ritual for the brain to recognise
- Ensure the bed is comfortable and that the bedroom is a cool temperature, pitch black and quiet. Hot baths reduce core body temperature to aid sleep
- Avoid daytime napping if this prevents sleep later
- Exercise sufficiently
- Avoid caffeine and alcohol after midday
Be physically active
Formal exercise isn’t necessary but daily physical activity is. This could be housework, gardening, walking the dog, cycling to and from work or school. Aim for 10,000 steps (4.5 – 5 miles) a day. Start slowly and build up to this if you’ve been sedentary for a while. Wearable technologies can help with motivation and tracking.
Live with a sense of purpose
Evidence from population studies shows that having a sense of purpose in life is one of the best ways to feel more energized and happier, and to have a healthier, longer life. Do you have sufficient meaning in your day to motivate getting up in the morning? Even simple commitments, if they are meaningful, can be energizing, like fulfilling your promise to bake a cake for the local fete. Consider joining groups and communities if this is an option in your area.
Deal with stress
Ongoing stress is a great energy-sapper. It’s important to talk about your stress levels and the causes with trusted friends or family. If this isn’t possible, consider engaging in a talking therapy, such as cognitive behavioural therapy. People tend to become happier once they have worked out ways to either remove the stressor or learn to change the way they think about it, which can reduce its negative effects.
Micronutrients that promote good energy levels
B vitamins
B vitamins act as co-factors for almost every process in the body and are vital for energy:
Vitamins B1, B2 and B3 are used in the mitochondria to release energy from food. B5 supports the adrenal glands, meaning that it may be helpful if you have a demanding lifestyle and stress-related fatigue.
Meanwhile, B2, folate, B6 and B12 are involved in the process of methylation. Methylation combats fatigue by producing appropriate adrenal hormones and ‘energy’ compounds like CoQ10 and L-carnitine, as well as by supporting detoxification and in reducing free radical damage (by optimizing homocysteine and glutathione levels). B6, folate and B12 are also crucial for the synthesis of red blood cells and haemoglobin that carries oxygen around the body for energy.
Iron
Low iron intakes are surprisingly common in the UK and official data shows that 89% of young women consume less than the daily RNI of 14.8mg.
If you’re menstruating or if you eat a vegetarian or vegan diet, or very little red meat, you could consider a serum ferritin test to help determine whether to talk to your GP or to a Nutritional Therapist about supplementing iron. Optimizing levels can significantly improve both physical and mental fatigue.
If supplementing, use a form that is easily absorbed, in order to increase iron stores efficiently and reduce the risk of gastro-intestinal side effects.
Vitamin C
An important energy nutrient, vitamin C is used in the mitochondria to produce energy; it scavenges free radicals that cause fatigue from oxidation stress and inflammation; and it supports normal adrenal gland function to reduce stress-related fatigue. It also improves the absorption of iron from plant foods and supplements. And as it supports immune system health, it can help to ward off infections that can sap energy.
Magnesium
Magnesium is required for almost every biochemical pathway involved in keeping us energised. It’s used to produce energy from food; it supports adrenal gland function; and it aids blood glucose metabolism to prevent hypoglycaemic energy crashes. It may also help prevent inflammatory-related exhaustion by opposing excessive calcium levels.
Magnesium also helps to reduce fatigue by improving sleep quantity and quality. In fact, as little as 500mg/day for eight weeks was found to improve insomnia in a trial of elderly subjects.
Adrenal ‘adaptogens’
Certain herbs have a long history of traditional use in combating stress-related exhaustion and fatigue. They enable the body to adapt to stress by helping to normalise adrenal hormones like cortisol and DHEA.
Rhodiola rosea was first referred to as an adaptogen by Russian scientists in 1968 and since then many studies have shown it to improve both mental and physical fatigue caused by stress and anxiety. Most recently, a 2017 study of 100 subjects with prolonged fatigue found a significant improvement, after 8 weeks, in mood, stress, anxiety and sleep quality. It also helps cognitive function that has been diminished by stress-related fatigue.
Rhodiola may also help with fatigue by keeping adrenalin and dopamine in circulation for longer; and by helping to protect the mitochondria from excessive free radical production in times of stress.
Other adrenal adaptogens include the ginsengs, both Korean and Siberian.
Korean ginseng, also known as Panax ginseng, is one of the most extensively studied herbs in use today. It tends to be used either on a short-term basis, for stamina and concentration, or longer-term for well-being, especially from middle-age onwards. Studies show that the active compounds, known as ginsenosides, have anti-fatigue effects that give a boost to cognitive functions like memory, focus and attention. Non-fatigued subjects have not been found to benefit cognitively from Korean ginseng.
Siberian ginseng (or Eleutherococcus) is sometimes regarded as having a more subtle effect than Korean ginseng. The active ingredients are compounds known as eleutherosides.
Research on Siberian ginseng has found that it may improve physical performance and cognition through its anti-fatigue effects.
L-Theanine
L-theanine is an amino acid found naturally in green tea. It may significantly reduce fatigue caused by stress and anxiety, by promoting a state of relaxation and by improving both the quality and quantity of sleep. With daytime use, it improves mental energy and focus, in a similar way to meditation, guided breathing and ‘power napping’. This makes L-theanine worth considering if you’re trapped in a cycle of feeling ‘tired but wired’, or if you tend to become exhausted by regular worry and rumination.
L-theanine’s mechanisms include increasing the relaxing alpha waves in the brain and the calming brain chemical GABA. This supports the ability to move out of the ‘fight or flight’ stress mode, and into the parasympathetic state of calm yet alert focus.
Human studies show L-theanine to improve mental clarify and performance in memory and attention tasks.
Glycine
This amino acid has been found to aid the sleep of people with insomniac tendencies and also to reduce daytime sleepiness the next day and improve memory and mental performance.
Glycine may increase inhibitory brain chemicals, helping to turn down a hyperactive brain at night. It may also reduce core body temperature, which aids sleep.
Phosphatidyl Serine (PS)
High concentrations of PS are found in brain and nerve cell membranes and maintaining these delicate structures is essential for normal neurotransmission. It may be harder to maintain good levels if you’re avoiding animal foods.
Increasing PS levels can help to combat mental fatigue: in older individuals, PS has been found to improve memory and cognitive capacity; and increased processing speed and accuracy have been found in subjects who were tested in a fatigued state. PS’s ability to improve concentration may be due to it reducing stress and neuronal excitabilty. It’s also been found to improve physical energy during intense exercise (measured by an increase in time to exhaustion).
Microbial balancers
Fatigue and brain fog can be two of the most debilitating symptoms of microbial imbalances in the gastro-intestinal tract and/or increased permeability of the gut lining (‘leaky gut’). Diet and lifestyle measures can do a lot to resolve such gut issues. With the help of a Nutritional Therapist, energy levels can often be restored more quickly by adding in one or more plant-based antimicrobials like oregano, allicin (from garlic), cinnamon, olive leaf and fennel seed; live bacteria like Lactobacilli Acidophilus and Bifidobacterium; live yeast like Saccharmocyes Cerevesiae Boulardii; and gut lining support like L-glutamine.
The exact combination of supplements will depend on the individual aspects of your case.
CoQ10
Co-enzyme Q10, also known as ubiquinone, is synthesized in the liver from tyrosine (using vitamin B6). It is crucial for the production of the energy molecule (ATP) because protects the mitochondria from damage and helps the mitochondria work more efficiently.
Sufferers of chronic fatigue syndrome, statin- and beta blocker-related fatigue, are often low in CoQ10.
L-Carnitine and Acetyl L-Carnitine (ALCAR)
L-carnitine is an important amino acid for improving our ability to burn fat for energy.
L-carnitine has also been found to reduce physical fatigue in elderly people with poor muscle function and; and it may improve both physical and mental energy in sufferers of chronic fatigue syndrome. It is believed to support optimal blood flow and to reduce muscle damage from exercise.
ALCAR is an altered form L-Carnitine, which may be better absorbed and also get into the brain more easily. ALCAR can increase alertness and is often used as a ‘brain booster’, especially in people with declining cognitive function.
The information in this briefing note should not be used as an alternative to seeing your doctor, nor should it be used as a diagnostic tool for any condition. You should visit your doctor if you suspect that you may have a medical condition or if you have undiagnosed symptoms. It advisable only to take nutritional supplements under the care of an appropriately qualified health professional, such as a doctor or a Registered Nutritional Therapist, who can also advise on potential drug-nutrient interactions. You should not discontinue, nor alter the dosage of, any medication without the knowledge of your doctor.