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Fatigue

Do you feel that you don’t have as much energy as you would like? If so, you have company. Fatigue is one of the most common complaints that people bring to their physicians. It seems that almost everyone today feels low-energy, stressed, and worn out much of the time.
Unfortunately, there are no easy solutions to this common problem. While many medical conditions can cause fatigue, 1 the overwhelming majority of people who experience fatigue do not have any illness that can be diagnosed. It seems most likely that the true cause of this widespread problem is modern life itself.
The body was not designed for a sedentary life. While today most of us might consider one hour of exercise daily to be ideal, in the past, eight hours of daily exercise was not uncommon. Our ancestors lived much of their lives outdoors and walked many miles every day. Today, we live indoors, sit in chairs, and seldom walk more than a mile. Not only that, instead of peaceful outdoor surroundings, we live in a fast-paced, noisy world that interrupts us constantly with its demands and requires that we multitask our way through nerve-frazzling challenges. This way of life simply violates the body’s design principles.
Furthermore, with the invention of the electric light, the body’s normal sleep habits were replaced by progressively longer periods of wakefulness. Few people today get eight hours of sleep regularly, much less the 10 to 12 hours that some experts believe our ancestors ordinarily enjoyed (at least in winter).
Tiredness, in other words, is a consequence of numerous factors that confront us all, and for that reason it isn’t easy to fix.

Low Energy: A Common Sense Approach

If you frequently feel tired, you should begin with a medical exam to rule out identifiable medical conditions such as hypothyroidism , depression , fibromyalgia , chronic fatigue syndrome , chronic viral hepatitis , and anemia. Problems such as these need to be addressed specifically in order to make any headway.
If you do not prove to have any identifiable illness, the next steps to take involve common sense principles. People with inadequate energy should increase the time they give themselves to sleep, exercise daily (as much as possible), and reduce bad habits, such as cigarette smoking and excessive consumption of alcohol . Cutting down on coffee consumption may help too by improving sleep and decreasing stress. In addition, it is important not to neglect such fundamentals as enjoyable work, healthy relationships, and adequate recreation. Even very unhealthy people tend to have more energy when they love what they’re doing with their lives.
Nutrient deficiencies can also cause fatigue, and for this reason it may be useful to take supplements. For more information on this topic, see the article on General Nutritional Support .
One nutrient requires a bit of special attention: iron . Iron deficiency can cause anemia, which in turn can cause fatigue. Certain manufacturers of iron supplements made a leap from this fact to the conclusion (unsupported at the time) that iron supplements were useful treatments for general fatigue. This recommendation worried many experts, because there is at least some evidence that taking too much iron can be harmful. 9-11
On this basis, many physicians recommended that their patients avoid iron supplements if they were not anemic. More recent evidence, however, suggests that the iron promoters may have been at least partially right. Several studies indicate that marginal deficiency of iron, too slight to cause anemia, may decrease physical performance capacity. 2-7
In addition, a double-blind, placebo-controlled study of 144 women with unexplained fatigue who also had low or borderline-low levels of ferritin (a measure of stored iron) found that use of an iron supplement enhanced energy and well-being. 8 Nonetheless, it is not advisable to take iron just because you feel tired. Make sure to get tested to see whether you are indeed deficient. With iron, more is definitely not better.

Other Alternative Approaches

Many alternative practitioners recommend reducing intake of sugar and other simple carbohydrates or going on a low-carbohydrate diet , but there is no scientific evidence as yet to show that this will increase your energy. Similarly, it is unclear whether eating organic or pesticide-free foods or becoming a vegetarian (or its opposite, going on a so-called caveman diet) will make a difference. Still, there is nothing wrong with trying these methods, and some people feel that they help.
Despite widespread claims, there are no herbs or supplements proven to enhance overall energy and well-being . Some of the natural products claimed to have this effect include: The supplements tyrosine and NADH have shown promise for enhancing wakefulness under conditions of sleep deprivation, but they have not been investigated for treating ongoing fatigue.
Most systems of alternative medicine claim to be able to improve overall health and enhance energy, including Chinese medicine , chiropractic , Ayurveda , homeopathy , and naturopathy . Therapies such as massage , Reiki , and Therapeutic Touch , and exercise systems such as yoga and Tai Chi make the same claim. Furthermore, based on the theory that toxins in the environment are a major cause of illness, some alternative practitioners recommend detoxification methods. However, there is as yet no meaningful supporting evidence to indicate that these approaches actually improve overall energy.
People who are tired because they don’t sleep well might find benefit by trying natural therapies for insomnia . Similarly, people who feel overwhelmed by life may benefit from natural treatments for stress .
In addition, many people with low energy report that they feel better when they use natural treatments for food allergies , candida , or low immunity ; whether this is merely due to a placebo effect, however, remains unclear.

The Bottom Line

In most cases, fatigue is a complex problem that doesn’t respond to simple treatment approaches. However, don’t be discouraged. Simply making it a priority to feel better may eventually lead to improvement.

References

1 Tinsley RH, ed, et al Harrison’s Principles of Internal Medicine . 14th ed. New York, NY: McGraw-Hill Higher Education; 1997.

2 Hinton PS, Giordano C, Brownlie T, et al. Iron supplementation improves endurance after training in iron-depleted, nonanemic women. J Appl Physiol . 2000;88:1103-1111.

3 Brutsaert TD, Hernandez-Cordero S, Rivera J, et al. Iron supplementation improves progressive fatigue resistance during dynamic knee extensor exercise in iron-depleted, nonanemic women. Am J Clin Nutr . 2003;77:441-448.

4 Rowland TW, Deisroth MB, Green GM, Kelleher JF. The effect of iron therapy on the exercise capacity of nonanemic iron-deficient adolescent runners. Am J Dis Child . 1988;142:165-169.

5 Celsing F, Blomstrand E, Werner B, et al. Effects of iron deficiency on endurance and muscle enzyme activity in man. Med Sci Sports Exerc . 1986;18:156-161.

6 Klingshirn LA, Pate RR, Bourque SP, et al. Effect of iron supplementation on endurance capacity in iron-depleted female runners. Med Sci Sports Exerc . 1992;24:819-824.

7 LaManca JJ, Haymes EM. Effects of iron repletion on VO2max, endurance, and blood lactate in women. Med Sci Sports Exerc . 1993;25:1386-1392.

8 Verdon F, Burnand B, Fallab-Stubi CL, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ . 2003;326:1124.

9 Sempos CT, Looker AC, Gillum RE, et al. Serum ferritin and death from all causes and cardiovascular disease: the NHANES II Mortality Study. Ann Epidemiol . 2000;10:441-448.

10 Davolos A, Castillo J, Marrugat J, et al. Body iron stores and early neurologic deterioration in acute cerebral infarction. Neurology . 2000;54:1568-1574.

11 Lao TT, Tam K, Chan LY. Third trimester iron status and pregnancy outcome in non-anaemic women; pregnancy unfavourably affected by maternal iron excess. Hum Reprod . 2000;15:1843-1848.

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