Fatigue Causes: #1—Stress

Chronic stress often leads to dysregulation of the body’s stress systems and is a common underlying cause of chronic fatigue._[1] The popular term “adrenal fatigue,” with its focus on the adrenal glands and cortisol production, is often used to describe this unhealthy reaction to chronic stress.

Adrenal fatigue, however, does not take into account the complex system of interconnected events involved in the stress response. The brain, nervous system, endocrine (hormonal system), and immune system are all key components, as are adrenal glands. In particular, the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS) are the primary regulatory centers. Fatigue is a common consequence of excessive, prolonged, or inadequate regulation of these stress response systems._[2] (Find tips on beating stress here.)

Fatigue Causes: #2—Poor Nutrition/Digestion

Nutrition and digestive issues such as nutritional deficiencies, food allergies, blood sugar dysregulation, and excessive permeability in the lining of the intestines can all cause fatigue. Those suffering from fatigue are commonly eating a poor-quality diet (low in fruits and vegetables; deficient in vitamins, minerals, and phytonutrients; excessive in high-glycemic, high-fat, high-inflammatory foods).

In addition, fatigue sufferers have been found to have more digestive symptoms linked to altered intestinal bacteria (such as not enough acidophilus) and abnormal function of the intestinal lining (a.k.a. “leaky gut”) compared to non-fatigued individuals._[3] (Learn more about leaky gut syndrome here: 5 Top Reasons You Might Have Leaky Gut Syndrome and Feel Tired All the Time or Have Depression Symptoms.

Fatigue Causes: #3—Hormone Imbalances

Fatigue may result from low or imbalanced levels of common hormones such as thyroid, testosterone, estrogen, and progesterone. Low thyroid hormone levels resulting from autoimmune thyroid disease is one of the most common hormone-related disorders, and fatigue is the main symptom of hypothyroidism. In women, menopausal symptoms such as night sweats are notorious for causing fatigue _[4], while in men testosterone deficiency as a cause of fatigue is now being recognized more than ever before._[5]

Fatigue Causes: #4—Anxiety and Depression

Mood disorders such as depression and anxiety, the most common mental health disorders in the United States, either cause or are strongly associated with fatigue and daytime sleepiness. The majority of people with depression suffer from fatigue.

In fact, fatigue is one of the most common symptoms of depression that patients complain to their healthcare providers about. In one recent study, more than 90 percent of patients with major depression had severe fatigue despite the fact that more than 80 percent of these patients were already taking antidepressant medications._[6] Depression-related fatigue is often associated with impaired concentration, irritability, and reduced productivity.

Fatigue Causes: #5—Sedentary Lifestyle and Deconditioning

Being highly sedentary increases the risk of chronic fatigue. Not getting enough exercise and physical activity causes deconditioning of the body’s musculoskeletal and cardiovascular systems and depresses mood, all of which lead to fatigue. Studies show that the more regular physical activity you get, the more likely you are to feel energetic.

Exercise has been shown to help reverse fatigue associated with all kinds of medical conditions, from cancer to autoimmune diseases to depression._[7] (Find more reasons to exercise here.)

To overcome fatigue, break the cycle of a sedentary lifestyle and start a regular exercise program

So if you’re “feeling sleepy all the time,” which of the above fatigue causes might apply to you? You may need to engage the services of a qualified integrative physician to help you sort through the various fatigue causes, run the necessary tests, and develop a strategy that deals with the root cause of your persistent tiredness. Understanding the root causes, as we hear so often, is the first step to recovery.

[1] Silverman MN, Hein CN, et al. Neuroendocrine and immune contributors to fatigue. PM R. 2010 May; 2(5): 338-346.
[2] Papadopoulos AS, Cleare AJ. Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome. Nat Rev Endocrinol. 2011 Sep 27;8(1):22-32.
[3] Lakhan SE, Kirchgessner A. Gut inflammation in chronic fatigue syndrome.  Nutrition & Metabolism 2010, 7:79.
[4] Alexander JL, Neylan T, et al. Assessment and treatment for insomnia and fatigue in the symptomatic menopausal woman with psychiatric comorbidity. Expert Rev Neurother. 2007 Nov;7(11 Suppl):S139-55.
[5] Moncada I. Testosterone and men’s quality of life. Aging Male. 2006 Dec;9(4):189-93.
[6] Ferrentinos P, Kontaxakis V, et al. The Fatigue Questionnaire: standardization in patients with major depression. Psychiatry Res. 2010;177(1):114–119.
[7] O’Connor PJ, Puetz TW. Chronic physical activity and feelings of energy and fatigue. Med Sci Sports Exerc. 2005 Feb;37(2):299-305.

Originally published in 2012, this post is regularly updated. 

The post 5 Common Fatigue Causes: Understanding Why You’re So Tired appeared first on University Health News.

Many health care providers also ignore the well-documented fact that lack of vitamins and minerals is a surprisingly common malady. This is true even in the developed world, where we are known as the “overfed but undernourished.”

Nutrients and Vitamins for Tiredness and Energy

A high percentage of adults in the United States eat less than the minimum daily allowance of many essential vitamins and minerals._[1,2] A study published in the Journal of Nutrition in 2011, for example, found that even when including vitamin intake from supplements and fortified foods, 97 percent of Americans don’t get enough potassium, 65 percent don’t get enough vitamin K, 60 percent don’t get enough vitamin E, 70 percent don’t get enough vitamin D, and around 30 percent don’t get enough vitamins A and C._[3]

Nutrient deficiencies are among the causes of low energy and fatigue because they slow energy production inside cells. This can result in excessive tiredness and lack of energy as well as many other symptoms. Here, we’ll take a closer look at three of the most important nutrients related to fatigue, low energy causes, and what energy supplements you can take.

1. B Vitamins

B vitamins are necessary for converting food into energy. The B vitamins are B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6, B12, folic acid, and biotin. If you’re lacking in B vitamins, either because your needs are increased or you’re not taking in sufficient amounts, the ability of your cells’ mitochondria to generate energy will be compromised. The mitochondria are the energy power houses of the cell. Due to their critical role in producing the energy that drives every physiologic process, mitochondrial function is an area of intense interest and study.

Lack of even just one B vitamin can compromise an entire sequence of biochemical reactions necessary for transforming food into energy. Vitamin B12 deficiencies, in particular, are highly significant fatigue causes, and 10 to 15 percent of aging adults have a B12 deficiency._[4] B vitamins can also prevent memory loss and even prevent stroke.

How to use B vitamins for fatigue: It’s safe, easy, and inexpensive to experiment with B vitamin supplements in order to determine whether B vitamin supplementation will help with your fatigue. Try at least 6 weeks of a high potency B complex supplement, along with an additional 2000 micrograms of sublingual (under the tongue) B12 every day.

2. Magnesium

Magnesium is an essential mineral to the human body. It is involved in more than 300 metabolic reactions, a key reaction being energy production. Magnesium is required to form and store the energy molecule ATP. Magnesium deficiency impairs the energy production pathway required by mitochondria to generate ATP.

Deficiency of magnesium also reduces the mitochondria’s ability to resist to free-radical damage and results in excessive production of oxygen-derived free radicals and low grade inflammation._[5] Chronic inflammation and oxidative stress have both been identified as causative factors in several fatigue-related conditions such as depression and chronic fatigue syndrome.

As many as 23 percent of adults in the United States have low magnesium levels and fail to meet the recommended dietary intake of magnesium._[6] Almost half (48 percent) of the US population consumed less than the required amount of magnesium from food in 2005–2006._[7]

Low magnesium levels have been linked to an increased risk of chronic fatigue._[8,9] Repletion of magnesium in chronic fatigue patients shows clinical improvement in energy levels.

How to take magnesium for fatigue: Magnesium is another safe, inexpensive supplement for energy to treat your fatigue naturally. Look for magnesium bound to citrate or malate for superior absorption. Both magnesium and malic acid have been found to reduce fatigue. Take 300 mg magnesium citrate or magnesium malate twice a day.

3. Antioxidants

Antioxidants are chemical compounds that neutralize free radicals by preventing oxygen from reacting with other compounds. Examples include vitamins C and E, the mineral selenium, and the nutrient coenzyme Q10. Like the B vitamins, antioxidants are involved in mitochondrial energy production.

The ability of the mitochondria to function properly is compromised when they become damaged by reactive oxygen species (free radicals) produced as a consequence of increased oxidative stress and insufficient antioxidant defenses. This damage results in a decrease in energy production by some of the cells’ mitochondria.

Antioxidants like vitamins C and E, the mineral selenium, and the important nutrient coenzyme Q10 are needed to support healthy mitochondrial energy production. Antioxidant deficiencies, in a way similar to the B vitamin deficiencies, are therefore fatigue causes worthy of addressing. Supplementing with an antioxidant formula which contains high levels of these and other antioxidant nutrients can help with fatigue._[10,11,12]

Tips on supplementing with antioxidants: Make sure the antioxidant supplement you take contains natural vitamin E in the form of “mixed tocopherols” instead of just “alpha-tocopherol.” In addition to the combination antioxidant formula, try adding a separate CoQ10 supplement, aiming for a total of 300 mg CoQ10 per day.

The Bottom Line

You now understand why three common nutritional deficiencies that cause fatigue. For more discussion on fatigue and low energy causes as well as more powerful natural treatments for fatigue, see “Understanding Why You’re So Tired,” “Why Am I Tired All the Time?” and our entire Energy & Fatigue archive for an energy boost.

[1] Krebs-Smith SM, Guenther PM, et al. Americans do not meet federal dietary recommendations. J Nutr. 2010 Oct;140(10):1832-8.

[2] Sebastian RS, Cleveland LE, et al. Older adults who use vitamin/mineral supplements differ from nonusers in nutrient intake adequacy and dietary attitudes. J Am Diet Assoc. 2007 Aug;107(8):1322-32.

[3] Fulgoni VL 3rd, Keast DR, et al. Foods, fortificants, and supplements: Where do Americans get their nutrients? J Nutr. 2011 Oct;141(10):1847-54.

[4] Baik HW, Russell RM (1999) Vitamin B12 deficiency in the elderly. Annu Rev Nutr 19: 357–377.

[5] Barbagallo M, Dominguez LJ. Magnesium and aging. Curr Pharm Des. 2010;16(7):832-9.

[6] Beckstrand RL, Pickens JS. Beneficial effects of magnesium supplementation. J Evid Bas Comp Alt Med. 2011;16(3):181-189.

[7] Rosanoff A, Weaver CM, Rude RK. Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutr Rev. 2012 Mar;70(3):153-64.

[8] Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic fatigue syndrome. Lancet. 1991 Mar 30;337(8744):757-60.

[9] Moorkens G, Manuel Y et al. Magnesium deficit in a sample of the Belgium population presenting with chronic fatigue. Magnes Res 1997;10:329-337.

[10] Mizuno K, Tanaka M et al. Antifatigue effects of coenzyme Q10 during physical fatigue. Nutrition 2008;24:293-299.

[11] Suh SY, Bae WK, et al. Intravenous vitamin C administration reduces fatigue in office workers: a double-blind randomized controlled trial. Nutr J. 2012 Jan 20;11:7.

[12] Coombes JS, Rowell B, et al. Effects of vitamin E deficiency on fatigue and muscle contractile properties. Eur J Appl Physiol. 2002 Jul;87(3):272-7.

This article was originally published in 2012 and is regularly updated.

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Primarily, your body needs four chief nutrients to sustain your energy levels throughout the day:

Fatigue Causes: Lack of Vitamin B12

B vitamins are often referred to as the “energy vitamins” because they help your body’s natural process of obtaining energy from the food you eat.  When consumed, they literally provide your body with a “boost” of energy. But among all the B vitamins, none is more critical when it comes to fighting fatigue than B12.

A deficiency in B12 can occur gradually over a period of years.  At first, you may not notice any effects other than simple day-to-day fatigue.  But, over time, the severity of the deficiency worsens, and can lead to further symptoms: lightheadedness, memory loss, difficulty concentrating, depression, headaches, obsessive-compulsive behavior, irritability, and impotence. Reversing vitamin B12 deficiency as soon as possible is vital for improved energy and overall health and wellness.

Fatigue Causes: Lack of Magnesium

Magnesium is another key nutrient, participating in more than 300 enzymatic reactions in the body. It plays a critical role for the energy metabolism in every cell. Magnesium deficiency has been linked to fibromyalgia (muscle fatigue), chronic fatigue syndrome and adrenal fatigue.

• Fibromyalgia and chronic fatigue syndrome: If you suffer from fibromyalgia or chronic pain in addition to fatigue, a magnesium deficiency could be the reason why. Muscles require magnesium for proper functioning, so a lack of this important mineral often results in muscle pains and aches as well as generalized weakness and malaise.
• Adrenal fatigue: Additionally, having a sufficient intake of magnesium is needed for adrenal recovery. Besides being exhausted, if you feel chronically stressed, a lack of magnesium could be taxing your adrenal glands. Often, magnesium is referred to as the “relaxation mineral” because it has a calming effect on the body; this is due to its ability to boost adrenal function. Simply put, magnesium acts like a spark plug for the adrenal glands.

Up to half of Americans are deficient in this important mineral and they don’t even know it. What’s more, you are unlikely to know if a lack of magnesium is the root cause of your fatigue because most doctors do not notice the symptoms of magnesium deficiency and they rarely even look for it! So, how can you know if you’re deficient in magnesium? Aside from low energy levels, see if you have any of the other magnesium deficiency symptoms here: What You Must Know About Low Magnesium Symptoms.

Fatigue Causes: Lack of Iron

According to the World Health Organization, iron deficiency is the number one nutritional disorder in the world. And, fatigue is often the first symptom of this deficiency (also known as iron-deficiency anemia). Aside from fatigue and loss of energy, symptoms of iron deficiency include weakness, brittle fingernails or toenails, and poor appetite. Severe iron-deficiency anemia sometimes causes craving for strange items such as dirt or plastic. And, like B vitamins, iron plays an important role as a co-factor for the synthesis of serotonin. This means having low iron levels can lead to depression, anxiety and panic attacks._[1]

Fatigue Causes: Lack of Omega-3 Fatty Acids

Do you feel sleepy and forgetful? If so, you may not be getting an adequate daily intake of omega-3’s. Omega-3 fatty acids are healthy fats that your body requires for proper growth and development, and normal brain function. Your body cannot produce these fats, so you must obtain them from the food you eat. If you are deficient in omega-3 fats, aside from feeling tired and having memory problems, you may experience dry skin, mood swings and depression, immune system weakness (sick all the time), hair loss, and poor circulation.

If you’re experiencing these symptoms, it’s time to start increasing your consumption of foods high in omega-3’s or begin taking fish oil capsules. Aside from reversing fatigue and memory issues, getting enough omega-3s can also reduce inflammation, decrease joint pain, fight obesity, reduce exercise-induced asthma, lower blood pressure and cholesterol, and reduce your risk for heart disease and diabetes.

8 Energy Boosting Foods & Beverages to Naturally Fight Fatigue

Now that you know which nutrient deficiencies are the primary fatigue causes, it’s time to discover the foods that are highest in these nutrients. So, instead of reaching for a dangerous energy drink or soda, try boosting your energy levels with these 8 energy boosting foods and beverages.

For related reading, visit these posts:

• Iron Deficient But Not Anemic: A Simple Solution for Fatigue
• The Role of Inflammation in Fatigue
• Low Energy Causes May Be Rooted in These 3 Nutritional Deficiencies

This article was originally published in 2013. It is regularly updated. 

[1] Acta Med Okayama. 2013;67(2):99-104.

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Nevertheless, the following specific actions will address some of the more common underlying fatigue causes and may apply to you.

If you adopt the following practices faithfully but still experience fatigue, you’ll have to go back to a more comprehensive approach to address the specific cause of your fatigue.

Five Things, Three Weeks

These common-sense, easy-to-adapt habits could have you feeling less fatigued surprisingly quickly. Commit to them for a three-week period and see if they make a difference.

1) Eliminate sugars and white flour

This means eliminating or sharply reducing sodas and other sweetened beverages, breads and other foods made with flour, most cereals, pastas, tortillas, and candy.

Replace the above items with fruits and vegetables and a host of healthy fats from raw nuts, seeds, olives, olive oil, coconuts, coconut oil, avocados, cold-water fatty fish like salmon, and grass-fed meats.

2) Get moving!

If you live a couch-potato lifestyle, remember that one of the most effective energy boosters is exercise. Start slowly and carefully—if you’ve been sedentary, it’s a good idea to review an exercise plan with your doctor. But typically, walking for 30 minutes every day can build a routine that you’ll begin to anticipate, and that’ll get you ready to ramp up intensity over the next three weeks.

3) Consider vitamins and supplements

You might begin taking a high-quality multivitamin, multi-mineral nutritional supplement.

Begin a regimen of these ­energy-targeted nutritional supplements:

• D-ribose (5 grams three times daily), which will dramatically boost your ATP levels.
• Rhodiola (200 mg twice a day), an adaptogen that will help your stress response and boost your energy levels.
• Vitamin B12 (sublingual, 2,000 mcg per day). Even conventional doctors give B12 shots with excellent results, but you can also take it yourself at home.

4) If you have unexplained fatigue

Consider making an appointment to see your doctor for an evaluation and some simple blood tests. Thyroid disorders and anemia are common problems that can be easily addressed with medication and supplements.

5) Fix your sleep routine

If you routinely don’t sleep well and if you wake up feeling unrefreshed, you’ll never get your energy stores back in order. Sleep is the time of restoration for the body. You probably already know if you have a sleep issue—and some of these other actions definitely will help your sleep improve. But getting on a regular sleep schedule and allowing yourself seven to eight hours of sleep every night is key to overcoming fatigue. If you need help getting to sleep, try 3 mg of melatonin about 30 minutes before bed.

So there you have it: a small set of action steps you can take now. No, they won’t cover all the possible causes of your fatigue, but they’re well worth trying as a starting point.

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Stress as a Cause of Fatigue

Chronic or severe stress is a very common cause of fatigue. Stress is a real or interpreted threat that results in physical and be-havioral responses that are designed to help the body adapt. Situations that are new, unpredictable, or that appear threatening or uncontrollable activate the body’s stress response systems, which are controlled by the brain, the nervous system, and the ad-renal glands. The purpose of these responses is to mobilize the energy necessary for your body to adapt to the demands of a stressful situation.

In the short term, stress can be positive, because it can help you to grow, to learn, and to adapt. In the long term, however, when stress becomes chronic, uncontrollable, unpredictable, and difficult to cope with, it begins to take a toll on your health.

Stressors may be physical, chemical, and emotional. They may be real or exist only in your mind. Sources of acute stress are usually fairly obvious, but it is vital for you to identify and address your unique sources of chronic stress to overcome your fatigue.

There are many forms of chronic stress. Mental and emotional stress are the most obvious, but sleep disorders, blood sugar dysregulation, oxidative stress, and chronic inflammation are all forms of chronic stress.

Your overall stress load is made up of multiple factors, including your genetic predispositions; recent and distant history (especially trauma, abuse, or major life events); coping behaviors; habits and lifestyle; and exposure to environmental toxins.

When your body is bombarded by repeated stress triggers and prolonged stress, your overall well-being pays the price. Your stress response systems can become sluggish, ineffective, or prolonged, or they may not start or stop correctly. This, in turn, taxes your body’s nervous, hormonal, immune, metabolic, and cardiovascular systems, causing fatigue among a variety of other physical and psychological problems.

Fatigue is one of the primary symptoms that can result from chronic stress and a dysfunctional stress-response system. If you perceive yourself to be highly stressed, studies show that you are much more likely to suffer from not only greater fatigue, but from daytime sleepiness, poor sleep quality, and decreased sleep duration. You are also at higher risk for sleep apnea. Which of these apply to you?

• Work-related stress
• Stress caused by over-commitment
• Lack of social support
• High demands
• Lack of control
• Lack of rewards

All of these have been shown in studies to drain energy resources and cause fatigue.

Stress, Adrenal Fatigue, and HPA Axis Dysfunction

In order to understand how stress causes fatigue, it’s helpful to understand a little about what’s known as the the hypothalamic pituitary adrenal (HPA) axis.

The HPA axis makes up your body’s hormonal system for responding to stress. “HPA” refers to three hormone-secreting glands:

• The portion of the brain known as the hypothalamus
• The pituitary gland in the brain
• The adrenal glands, which sit on top of the kidneys

The HPA axis can be activated by an array of mental and physical stressors. Activation occurs when the brain interprets a threat, causing nerve cells in the hypothalamus to secrete a hormone called “corticotropin-releasing hormone” (CRH).

The CRH travels to the pituitary gland, which responds to its presence by secreting a pulse of another hormone called “adre-nocorticotropin hormone” (ACTH).

ACTH is then carried to the adrenal glands, where it stimulates the secretion of cortisol. In a properly functioning HPA axis, chemicals in the hypothalamus are sent to the pituitary gland, which triggers the production of a hormone that is sent to the the adrenal cortex, triggering the production of cortisol.

Cortisol

Of all the hormones involved in the HPA axis, the adrenal stress hormone cortisol receives the most attention. This is because of the direct relationship cortisol has with energy levels and fatigue. Cortisol regulation is intricately related to both physical and psychological well-being and aids in the healthy functioning of a wide variety of systems throughout the body.

• In the nervous system, cortisol is involved in learning, memory, and emotion.
• In the metabolic system, cortisol helps regulate blood sugar.
• In the immune system, cortisol regulates inflammation and the development of immune cells.

Cortisol measurements can be used to determine whether your HPA axis is functioning properly (i.e., whether your body and your mind have the energy they need to adequately adapt to challenges and stressful situations).

HPA axis activity may be assessed by measuring levels of cortisol in samples of saliva taken at different times of the day. When an HPA axis is functioning properly, cortisol levels are highest approximately 30 to 40 minutes after waking and decline over the course of the day, when levels reach a trough, prior to sleep onset. Many labs now offer salivary cortisol testing in a take-home kit.

Healthy HPA axis functioning requires HPA resilience, which refers to the ability of the HPA system to react appropriately to stressful conditions. Either one big stressful event or chronic stress over time can cause the HPA axis to lose resilience and function incorrectly.

It is thought that high levels of stress experienced early on in life can interfere with the successful development of a child’s HPA axis.

Childhood stress may negatively affect the way a child develops his or her ability to deal with subsequent stresses that occur later on in life. Studies have confirmed that childhood trauma is a direct risk factor for HPA axis dysfunction as measured via cor-tisol levels, for fatigue in adulthood, and for chronic fatigue syndrome.

Once it has lost resilience, the HPA axis may either overreact or “under-react” to stressful events. In other words, stress can both increase and decrease HPA axis activity, depending on the individual and on the nature of the stress.

Both overactivity and underactivity of the HPA axis can result in fatigue, although it is underactivity of the HPA axis with which fatigue is most frequently associated. When the HPA axis is under-
reactive and cortisol levels become chronically reduced, fatigue and other symptoms worsen.

The main symptoms of low cortisol levels are:

• Fatigue
• Pain
• Increased sensitivity to stress

As the body’s main stress hormone, cortisol is the first thing you may want to check off your list of potential fatigue factors. In patients with chronic fatigue syndrome, dysfunction of the HPA axis characterized by low cortisol levels is one of the hallmark features.

Studies have shown that the lower the cortisol levels in those with CFS, the more severely one may experience fatigue and other symptoms.

A number of other fatigue-related conditions, in addition to CFS, also are associated with stress, hypoactivity of the HPA axis, and low cortisol. These conditions include fibromyalgia (a disease that causes chronic and widespread pain and fatigue), post-traumatic stress disorder (PTSD), and certain types of depression.

Even those considered healthy by conventional standards can suffer from low cortisol. In one study, healthy adults who felt significantly sleepier during the day, were more likely to feel anxious or exhausted, and were more likely to experience poor health when they had low cortisol levels upon awakening

In some people—fibromyalgia patients, for example—studies have found that, while cortisol levels appear normal, the cells’ receptors for cortisol (glucocorticoid receptors) do not function properly. This renders the cortisol ineffective and results in a situation that mimics low cortisol.

On the opposite end of the spectrum of HPA axis dysfunction, cortisol levels are chronically elevated rather than low. This also can cause fatigue. A “burnt out” feeling and certain types of depression are often associated with high cortisol levels during the day.

DHEA

In addition to cortisol, the adrenal glands are responsible for secreting the steroid hormones dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEAS). DHEA is converted into testosterone and estrogen in body tissues.

DHEA and DHEAS also are made and used directly by the brain.

In fact, DHEA and DHEAS are the most abundant steroid hormones in the human body. Surprisingly, in spite of this, their part in the human body is not well understood by scientists.

It is known that DHEA secretion declines steadily with age and in conjunction with chronic stress, inflammation, and illness. DHEA plays an important role in:

• Maintaining overall health
• Protecting the nervous system
• Proper immune function
• Helping prevent diabetes
• Preventing blood sugar imbalance
• Preventing obesity and cancer
  Preventing memory loss
• Slowing the effects of aging

Research into the role of DHEA in fatigue is conflicting. Some studies have found that high DHEA levels predict the length of life in men, while other studies have found that low DHEA levels were associated with fatigue, anxiety, depression, and overall low mood. However, there is a lack of solid evidence that DHEA supplementation reduces fatigue or stress. Small studies show potential benefits in fatigue associated with depression and Addison’s disease (a rare adrenal disorder).

Testing for DHEA is not common and the results can be difficult to interpret, but tests can be useful in investigating HPA axis dysfunction.

Depression and Anxiety as Causes of Fatigue

Depression is a treatable medical illness characterized by prolonged intense feelings of sadness. Fatigue is the symptom of depression that is most commonly reported to family practitioners and the symptom that correlates most strongly with a lack of so-cial functioning, days of lost work, and low work productivity.

The severity of fatigue in those suffering from depression depends on the severity of the depression itself. Depression also may be accompanied by anxiety and insomnia, which may increase the amount of fatigue.

While fatigue is often a symptom of depression, the reverse is also true: Depression is often a symptom of fatigue.In addition, if you’re fatigued but not currently depressed, you’re at a higher risk for developing depression later on in life.

The insomnia, chronic sleep loss, poor sleep quality, and reduced amounts of rapid eye movement (REM) sleep that are typically associated with depression may be partly responsible for the fatigue and excessive daytime sleepiness frequently experienced by those with depression.

On the opposite end of the spectrum, people with depression also may tend to oversleep—and too much sleep is also a major cause of fatigue and excessive daytime sleepiness.

In some cases, sleep disturbances are a side effect of anti-depressant medications, rather than the depression itself.

Anxiety, Depression, and Fatigue

Anxiety disorders are characterized by excessive worrying. Fatigue is one of the many symptoms that often accompany anxiety, along with restlessness, feeling “keyed up” or on edge, difficulty concentrating, forgetfulness, irritability, muscle tension, and sleep disturbances (including difficulty falling or staying asleep, restlessness, or unsatisfying sleep). Headaches, muscle aches, and digestive symptoms are also common.

Anxiety disorders, such as generalized anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder, are the most common mental health problems in the U.S.

Over your lifetime, you have a 16.6 percent chance of experiencing an anxiety disorder. General anxiety that does not quite meet the criteria of an anxiety disorder is even more common.

When anxiety is treated conventionally, drugs are often the sole method, but clinical trials have shown that drugs alone are not effective on a long-term scale. Moreover, anxiety medications have side effects that are often as equally disruptive as the disor-der itself. Some of the most common side effects of traditional anxiety medications are:

• Drowsiness
• Dependency
• Impaired cognition
• Memory loss
• Sexual dysfunction

If you have anxiety or depression, you are suffering from a real illness. Healing is possible, but it takes time, commitment, and practice. In addition to therapy (and, in some cases, medication), lifestyle changes, nutritional support, and natural therapies can be immensely helpful in overcoming fatigue, depression, and anxiety. These natural treatments are covered later.

Thyroid Imbalance as a Cause of Fatigue

The thyroid gland and the hormones it produces play a critical role in your metabolism and your ability to achieve and maintain normal physical and mental energy.

A low-functioning thyroid can lead to a long list of chronic symptoms, often subtle and ignored, with fatigue usually near the top of that list. “Hypothyroidism” is the technical name for an underactive thyroid. It’s an extremely common hormone disorder, especially in women.

The thyroid gland is located in your neck and it produces two key hormones: T4 (thyroxine/thyroid hormone) and T3 (triiodo-thyronine hormone), which are crucial for metabolism and keeping your energy levels up.

Here are a few important definitions to refer back to in this section:

• Thyroid—The hormone-releasing gland located in your neck that acts as the metabolic accelerator in your body
• Hypothyroidism—The condition that results when your body is not producing enough thyroid hormone
• Autoimmune thyroid disease—A disorder in the body that causes the immune system to mistakenly attack the body’s thyroid gland and the most common cause of hypothyroidism
• T4—The “reserve” form of the thyroid hormone that must be converted by the body to the metabolically active thyroid hormone T3
• T3—The hormone that goes into body cells and performs the marvelous energy-producing metabolic work

Hypothyroidism is most commonly caused by autoimmune thyroid disease, a disorder in the body that causes the immune system to mistakenly attack the body’s thyroid gland.

The attack renders the thyroid incapable of producing enough thyroid hormone to keep your metabolism working at a normal pace, leading, ultimately, to fatigue and other symptoms.

Almost 5 percent of the United States population has been diagnosed with hypothyroidism, while 4 to 20 percent of people have what doctors call “subclinical hypothyroidism,” which, most experts agree, is the equivalent of the early stages of mild thyroid failure.

Symptoms of Hypothyroidism

Hypothyroidism causes your brain and body to slow down. Those affected feel tired, “heavy,” and slow, both physically and men-tally. It is important to determine whether you carry many of the symptoms of hypothyroidism.

Typical symptoms of hypothyroidism include:

• Fatigue
• Weight gain or obesity
• Depression
• Sensitivity to cold
• Thin and friable (easily crumbled) nails
• Muscle aches
• Headaches
• Decreased libido
• Low basal body temperature (consistently below 98.6°F)
• Weakness
• Cold intolerance
• Water retention
• Dry skin
• Thinning of the lateral 1/3 of the eyebrows
• Menstrual irregularities
• Memory loss and cognitive impairment
• High cholesterol levels
• Decreased tolerance for exercise

What Causes Fatigue in People with Hypothyroidism?

The general fatigue associated with hypothyroidism is caused by a number of different mechanisms but is primarily the result of an overall decrease in metabolism.

Cells throughout the entire body rely on thyroid hormone to perform their basic metabolic functions. A lack of thyroid hormone results in a slower basal metabolic rate. When metabolism is low, activity of the mitochondria within cells is impaired, which leads to low levels of ATP (adenosine triphosphate—an energizer in the cells) and, ultimately, to generalized fatigue. In addition to general fatigue, low ATP levels also contribute to muscle symptoms such as increased muscle tension, pain, and weakness.

Furthermore, patients with hypothyroidism are known to produce more lactic acid, which also contributes to muscle pain, muscle cramps, and fatigue.

Many individuals with hypothyroidism may notice fatigue especially with physical exertion. This is caused in part by the direct effects of thyroid hormone on heart tissue. Without enough thyroid hormone, the heart slows down and decreases the amount of blood pumped, reducing the flow of oxygenated blood to the tissues.

Because thyroid hormone also influences blood sugar metabolism and blood flow to the brain, thyroid hormone deficiency also can cause fatigue by decreasing the amount of glucose and oxygen available to the brain. This leads to the lethargy, forgetfulness, and depression common to those with hypothyroidism.

Diagnosis of Hypothyroidism

TSH, or thyroid stimulating hormone, is a hormone released by the pituitary gland in the brain. Its function is to stimulate thyroid hormone production by the thyroid gland. TSH can be measured in a simple blood test. This test is the most important factor for diagnosing hypothyroidism.

TSH levels within the normal range indicate a healthy thyroid. However, when the TSH level is high, your clinican will request a blood test for T4 levels. Many conventional clinicians will diagnose hypothyroidism when TSH is abnormally high and T4 is abnormally low. This combination indicates that the brain is trying very hard to stimulate the thyroid gland to make T4 thyroid hormone, but the thyroid gland is not able to do it.

Anyone who feels constantly tired, “in a fog,” cold, and unable to lose weight or keep weight off despite dieting should be checked for hypothyroidism.

If your thyroid gland is not producing enough thyroid hormone, you will continue to feel debilitating fatigue, despite whatever positive steps you might take in response to the suggestions highlighted in this book.

Subclinical and Sublaboratory Hypothyroidism

If you have an elevated TSH but your thyroid hormones (T4 and T3) are in the normal range, you have what is referred to as sub-clinical hypothyroidism.

The term subclinical hypothyroidism often gets misused and is, indeed, confusing, given that the signs and symptoms (fatigue, depression, weight gain, and high cholesterol) are very often clinically significant and can reduce your quality of life.

Furthermore, even though subclinical hypothyroidism is considered a mild form of hypothyroidism, studies show that if left untreated, it poses serious risks, including:

• Increased risk of other serious diseases, such as heart disease and insulin resistance
• Increased risk of dying from any cause

On the other hand, studies have proven that treatment for subclinical hypothyroidism can:

• Significantly reduce fatigue
• Decrease risk factors for cardiovascular disease, including high cholesterol, waist-to-hip ratio, and endothelial dysfunction, an early marker of atherosclerosis (hardening of the arteries)

Sublaboratory hypothyroidism, which is very similar to subclinical hypothyroidism, refers to the condition in which the signs and symptoms of hypothyroidism are present, even though standard TSH, free T4, and free T3 tests produced normal results.

Why Does Sublaboratory Hypothyroidism Occur?

There are various reasons hypothyroidism may not be recognizable.

There’s currently a wide range for normal TSH and other thyroid hormone values, and these ranges are controversial. A threshold of 4 to 5 has been conventionally used to diagnose an elevated TSH, but data from large population studies have suggested a much lower TSH cut-off, with an upper limit of 2 to 2.5. If you have had your TSH measured and it fell somewhere be-tween 2 and 5, your doctor likely assumed your TSH was normal and, therefore, that you did not have hypothyroidism.

The time of day, the season, and your genetics all cause considerable variations in thyroid hormone levels. Levels fluctuate throughout the day, so it is possible you were tested at a time when your levels were within the normal range, missing the fact that more often they are abnormal.

Tissue levels of thyroid hormone may be low. Emerging evidence shows that, although standard blood test results might be normal, levels of thyroid hormones, specifically T3 (the more metabolically active thyroid hormone), in body tissue might still be low.

T3 functions inside the cells of your tissues, rather than in your blood. It is in the tissues that T3 stimulates energy production via its ability to act as a “key” on cellular receptor sites and increase the production of ATP from the cell. In medical terms, this phenomenon is sometimes referred to as “cellular resistance to thyroid hormone.”

Normally, once the thyroid gland produces and releases T4, the T4 travels to various tissues in the body, via the blood, where it is converted to the more metabolically active T3. However, in a number of conditions ranging from depression to obesity, the enzyme that is responsible for the conversion of T4 to T3 may be suppressed.

This suppression occurs everywhere in the body except the pituitary, where the enzyme doesn’t function in the same way. The pituitary is still able to perceive normal T3 levels, even though T3 is low throughout the rest of the body’s tissues, and continues to produce a normal amount of TSH, resulting in a normal TSH blood test.

T4 may be converting into a molecule called reverse T3 (rT3) instead of active T3. Reverse T3 acts as a metabolic “brake” during periods when a system requires less energy. Reverse T3 is called the “anti-thyroid” hormone because, during times of signifi-cant bodily stress or illness, it blocks T3 from having an effect. Increased levels of rT3 reduces metabolism, suppresses T4 to T3 conversion, and reduces T3 levels inside of cells. Reverse T3 can be measured in the serum. An abnormally high serum level of reverse T3 indicates low T3 activity inside of cells, even if serum TSH and T3 are normal.

With significant stress, chronic illness, inflammation, and aging, TSH tends to decrease, as does conversion of T4 to T3 inside the cell. In these conditions, instead of converting to T3, T4 is converted to reverse T3 and TSH production becomes suppressed, though it still appears to be within the “normal” range.

There is no easy way to measure tissue level of hormones directly. Health-care providers must rely on serum testing, despite the fact that it reflects only the levels of thyroid hormones in the blood. However, studies indicate that measuring the ratio of two subsets of T3 (rT3 and free T3) can be a useful indicator of tissue thyroid levels. Free T3 and rT3 tests can be ordered at most major clinical laboratories. Even though this method is still just a measure of the amount of T3 in the serum and not of what is in-side cells, it is a more accurate reflection of the amount of T3 that is “available” for the body to use.

Kent Holtorf, MD, who specializes in alternative treatments for hypothyroidism, chronic fatigue syndrome, and complex hor-mone disorders, states that a free T3/rT3 ratio of less than 1.8 picoggram/nanogram (pg/ng) is consistent with low tissue thyroid activity. Dr. Holtorf notes that patients with a free T3/rT3 ratio of less than 1.8 and symptoms of hypothyroidism who test normal for TSH and T4 levels often notice significant improvement with their symptoms when treated with T3 replacement.

Because the normal process of converting T4 to T3 can be diminished, it’s not surprising that T4 supplementation has little ef-fect on some people who find treatment with T3 or T4 and T3 combinations significantly more effective.

Central Hypothyroidism

Another culprit of deceptively normal thyroid testing is central hypothyroidism. This condition develops when the thyroid gland produces too little thyroid hormone, which results because of the malfunction of one or both of the structures in the brain that regulate the thyroid gland (the hypothalamus and the pituitary gland).

The deficiency results in insufficient production of thyroid stimulating hormone (TSH) despite an otherwise normally functioning thyroid gland, which renders it unable to produce sufficient thyroid hormone.

Central hypothyroidism is much less common than primary hypothyroidism and is usually caused by brain cancer (pituitary ad-enomas) or traumatic brain injury. The main symptom of central hypothyroidism, as with all types of hypothyroidism, is fatigue.

Lab tests typically reveal normal to low-normal TSH levels, along with low-normal T3 and T4 levels. Diagnosis is confirmed by the TRH stimulation test.

Conventional therapy is usually levothyroxine (T4). The dose is typically slowly increased until fatigue and other symptoms im-prove. Health-care practitioners also may utilize some form of T3 replacement, as we’ll discuss later.

Thyroid Hormone Deficiency? How to Find Out

How do you know if you do have a thyroid hormone deficiency? And how can someone suffering from debilitating fatigue deter-mine whether a dysfunctional thyroid is an underlying cause?

First, look at your symptoms and compare them to the typical symptoms listed earlier in this chapter and repeated, for quick reference, in the sidebar on this page. The more symptoms you have from this list, the more likely it is that you have a thyroid imbalance.

If your symptoms appear to match those of a typical thyroid patient, ask your doctor to run blood tests that include the meas-urement of free T3 and rT3.

Remember, this test can be ordered from most clinical laboratories. If the ratio of free T3/rT3 is low (less than 1.8 pg/ng, de-pending on the laboratory’s methods) your condition is consistent with low tissue thyroid activity regardless of whether your TSH levels are in the standard lab range or not.

The good news is that patients with low tissue thyroid levels and normal TSH levels often experience significantly reduced symptoms of fatigue, depression, weight gain, and other problems when treated with thyroid hormone replacement that includes T3.

If you do in fact have a thyroid problem, correcting it will produce remarkable improvements: You’ll have a new spring in your step and a new zeal for life.

Fatigue and Sex Hormone Decline or Imbalance

As we hit middle age, there’s a slow but gradual decline in all physiological functions. Energy loss, loss of muscle mass, and in-creased fat mass are tied to declining hormone levels. This age-related drop in hormone levels is referred to as menopause in women and andropause in men.

Hormone loss is the result of deteriorating hormone-secreting glands like the thyroid, pancreas, adrenals, testes, ovaries, and pituitary glands. Testosterone in men and estrogen and progesterone in women are the primary sex hormones covered in this chapter, but a lack of thyroid hormone, DHEA, growth hormone, melatonin, and other pituitary hormones are important to consider.

Andropause

Testosterone deficiency affects at least 20 percent of men in the United States over the age of 50 and at least 25 percent of men over 70. Fatigue is a key symptom.

Men with low testosterone levels report lower energy and vitality compared to men of the same age with normal testosterone. Low testosterone levels also have been associated with poor general health, poor cognitive function, and poor sexual health.

The following symptoms are associated with low testosterone levels:

• Fatigue
• Inability to perform vigorous activity
• Depression
• Reduced sex drive
• Erectile dysfunction
• Memory loss
• Weight gain (especially around the waist)
• Anemia
• Decreased muscle mass and strength
• Decreased bone mineral density

As you can see, testosterone is about more than just sexual health or muscle strength. If you have fatigue accompanied by a decreased desire for sex or problems with erections, low testosterone levels may be to blame.

The most common way to measure testosterone is with a blood test. A total measurement of testosterone in the serum of less than 200 to 250 nanograms per decilite is considered low in most laboratories; values between 250 and 350 ng/dL are usually considered borderline low, although standards may vary.

Just as with thyroid blood tests, the total testosterone level doesn’t give the full picture: It’s possible to have a normal total testosterone level but, at the same time, have low levels of testosterone available to the body’s tissues.

“Free testosterone” is the portion of the total testosterone that’s not bound to proteins and, therefore, is available for the body to utilize. Free testosterone makes up about 2 percent of the body’s total testosterone and is considered the “active” version of the hormone.

Menopause and Perimenopause

In women, the drop in hormones (progesterone and estrogen in women) occurs much more suddenly than in men, which is why menopause can lead to more extreme and obvious symptoms.

Menopause is the process that marks the end of menstruation in women and usually occurs in women between 45 and 55 years old. Hot flashes and fatigue are two of the most common complaints associated with menopause. Perimenopause refers to the interval just before menopause, during which ovarian function begins a steadier decline.

Menopause and perimenopause symptoms include the following:

• Fatigue
• Hot flashes
• Thinning of the vaginal mucosa (which can cause burning, itching, bleeding, and painful intercourse)
• Thinning of the urinary mucosa (which can lead to frequent
  urinary tract infections or painful urination)
• Incontinence
• Thinning and loss of elasticity of the skin
• Insomnia
  Difficulty concentrating
• Anxiety
• Headaches

Estrogen deficiency associated with menopause can contribute to a decrease in bone density and an increased risk of osteo-porosis and bone fractures.

A deterioration of cholesterol levels also occurs, characterized by decreased levels of “good” cholesterol (HDL) and increased levels of “bad” cholesterol (LDL) and triglycerides—and, as a result an increased incidence of cardiovascular disease.

Sleep Disturbances and Fatigue

Sleep disturbances in menopausal and perimenopausal women are mainly attributed to hot flashes during the night, or “night sweats.” Frequent menopausal sleep disturbances have been found in other studies to be related to the following negative side effects:

• Psychological symptoms
• A diminished self-perceived health status
• A prevalence of unhealthy behaviors
• Arthritis

Research shows that fatigue in older women also can be related to stress, depression, and excessive weight gain.

Even genetic differences that determine the way women process and metabolize estrogens have been found to make a difference in menopausal symptoms. As with all genetic factors, however, keep in mind that your genes are not your destiny. Just because you may have a genetic predisposition toward menopause-related fatigue doesn’t mean you have to continue to experience it, or that you will.

Your actions and your environment play a large role in determining which genes are expressed. Smokers, for instance, are known to have more serious problems with menopausal symptoms because of interactions between genes that metabolize estrogens and toxins from cigarettes.

The decisions you make now have very real consequences over your general health—even the genetic aspects of it that can seem outside of your control.

Poor Sleep and Fatigue

Sleep is the most important restorative process for your body and your mind. The regeneration that occurs during deep sleep renews your energy and helps to determine your long-term health. Not surprisingly, sleep issues can lead to fatigue and excessive daytime sleepiness. Three of the most common sleep-related causes of fatigue are:

• Not being able to fall sleep or stay asleep (insomnia)
• Not allowing yourself enough sleep time (sleep deprivation)
• Having a sleep disorder related to breathing (sleep apnea)

Each of these conditions produces sleep disturbances and results not just in fatigue, but other symptoms such as depression, tension, mood disturbances, and reduced attention, motivation, vigilance, and concentration.

Adequate quantity and quality of sleep are necessary not just to keep you energized during the day, but to regulate the proper functioning of your immune, inflammatory, nervous, and hormonal systems. For this reason, sleep disorders and sleep deficiency either directly cause or aggravate many health problems, and yet they’re often overlooked causes of adverse health effects and increased mortality rates. The poorer you sleep, studies show, the more health issues you tend to experience.

Part of the reason that these negative effects of sleep deprivation occur is because growth hormone, the “anti-aging” hormone, is secreted during sleep. Growth hormone helps support you in terms of:

• Regenerating tissue
• Cleansing the liver
• Building muscle
• Breaking down fat stores
• Normalizing blood sugar

The fatigue and health issues that arise from poor sleep also are related to free radicals and inflammation. Many physiological and pathological processes, such as infections and environmental toxins, increase the body’s concentrations of oxidizing sub-stances, known as free radicals. During sleep, free radicals are removed from the brain, reducing oxidative stress and minimizing cell aging.

Sleep loss also is known to result in a state of low-level systemic inflammation, which can further exacerbate fatigue. This is why focusing on decreasing inflammation is one of the natural strategies for treating fatigue, as we will see later.

In the next three sections of this chapter, we’ll look more closely at three prevalent sleep-related causes of fatigue.

Sleep Apnea

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder, affecting 3 to 7 percent of the population.

In obstructive sleep apnea, the airway narrows or collapses, causing sufferers to stop breathing for brief, repeated periods throughout the night, and reductions in the body’s oxygen levels. People with sleep apnea usually snore loudly and may experi-ence apnea “episodes,” or lapses of breathing that interrupt snoring and end with snorts. (See sidebar for a list of other common sleep apnea symptoms.)

An overnight sleep study, called a polysomnograph, is required to diagnose obstructive sleep apnea. It is a recording of sleep breathing patterns that usually involves in-laboratory measurement of brain waves and arousals, eye movement, chin movements, airflow, respiratory effort, oxygen levels, electrocardiographic (ECG) tracings, body position, snoring, and leg movements.

If you think you might have sleep apnea, it’s imperative that you get diagnosed and treated, given the severe health risks associated with this disorder. (Sleep apnea may increase your risk of atrial fibrillation, cancers, chronic kidney disease, stroke, ather-oschlerosis, high blood pressure, glaucoma, metabolic disorders, according to the National Institutes of Health.)

Sleep Deprivation

Sleep deprivation is the most common cause of excessive daytime sleepiness. The medical term for sleep deprivation is “insufficient sleep syndrome.” It is considered a disorder that occurs in individuals who persistently fail to obtain the sufficient amount of sleep required to achieve normal, alert wakefulness.

Most people require around seven hours of sleep during their main sleep episode to feel refreshed and alert during the day-time. Yet many people experience shorter amounts of sleep to meet work, family, social, and educational demands. This habit comes at a high price. People who suffer from insufficient sleep syndrome struggle with impaired functioning associated with excessive daytime sleepiness and fatigue and put their overall health at risk.

Restricting sleep time to six hours a night for 14 consecutive nights has been shown in studies to significantly impair functioning.

In fact, symptoms of sleep deprivation can occur after only one night of sleep loss. Often, those who are sleep-deprived are not even aware of their impaired functioning. Studies have found that people who are chronically sleep deprived are often una-ware that they are demonstrating increased deficits in performance and brain function.

Sleep is a process the body uses to help maintain balance and regulation of the immune system. Sleep deprivation or disturbance of sleep cycles also have been found to suppress immune function, in part by increasing release of inflammation-producing chemicals, known as cytokines.

Having a good night’s sleep is now understood to be crucially important for weight control.

Lack of sleep can lead to weight gain, increased belly fat, and obesity. The increased fatigue and tiredness associated with sleeping too little makes the maintenance of a healthy lifestyle more difficult, weakening your resolve to take care of yourself by eating healthy foods and exercising.

Studies have shown that sleep restriction also leads to a set of hormonal changes related to appetite control. Not getting enough sleep decreases your body’s ability to regulate blood sugar, elevates cortisol concentrations, disrupts the stress and HPA axis, decreases the “satiety hormone” leptin, increases the appetite-stimulating hormone ghrelin, and increases hunger and appetite.

Insomnia

Almost all of us have experienced the occasional night of sleeplessness, had difficulties falling or staying asleep, or had non-restful sleep.

But, insomnia is chronic sleeplessness that is defined as difficulty initiating or maintaining sleep or experiencing non-restorative sleep for at least one month, causing significant daytime impairment. An estimated 10 to 30 percent of the population experiences insomnia.

Fatigue is the most consistent daytime symptom associated with insomnia. Studies suggest, however, that poor sleep may not be the only reason for fatigue in individuals with insomnia.
Sleep studies on people with chronic insomnia have shown that the severity of sleep disturbance is not the only factor in determining the severity of fatigue. Other factors, such as depression and the subjective feeling of poor sleep quality, are more related to fatigue in insomniacs than actual sleep loss.

However, most people with chronic insomnia actually do not have daytime sleepiness. In fact, most insomniacs are unable to sleep during the day when provided with opportunities to do so, despite feeling excessively tired or fatigued.

Chronic insomnia decreases your quality of life and productivity, and increases your chances of becoming ill. Insomnia can cause mood disturbances (such as anxiety and depression) that can lead to employment and relationship problems. Poor stress-coping strategies have been linked with an increased risk of developing insomnia.

If you’re suffering from insomnia, getting this sleep disorder under control is imperative for overcoming your fatigue. Curing insomnia takes more than a just a pill; it requires a comprehensive approach that almost always involves lifestyle changes. Thou-sands of individuals have overcome insomnia by making these kinds of changes to their lifestyle, and so can you.

Fatigue Causes: Poor Nutrition, Poor Digestion

The relationship between your energy levels and the quality of your diet cannot be understated. In fact, making dietary changes can be profoundly effective, and even curative, in many cases of fatigue.

There isn’t a single diet that’s best for treating fatigue or fatigue-related medical conditions, but there are some general nutritional practices that do stand out. Research shows that standard American (or Western) diet lacks the nutrients necessary for the energy that people need to function healthily everyday. This diet leads to many fatigue-inducing problems, such as inflammation, blood sugar dysregulation, and insulin resistance, food allergies, and poor digestive health.

The Role of the Western Diet on Fatigue

The all-too-typical U.S. eating patterns of the Western diet include almost 40 percent refined grains and sugars and almost 20 percent refined vegetable oils.

Numerous studies show that Western diets rich in fried foods, processed meats, and commercial baked goods are associated with fatigue and fatigue-related illnesses, whereas diets rich in fruits, vegetables, whole grains, lean proteins, and healthy fats are associated with higher energy levels. Why does the Western diet cause more instances of fatigue?

• Western diets provide plenty of calories but insufficient nutrients, phytochemicals (chemical compounds that occur naturally in plants), and antioxidants, all of which are necessary for proper functioning of the thousands of biochemical and physiological processes that keep you balanced and energized.
• Western diets wreak havoc on your blood sugar metabolism, causing blood sugar highs and lows and insulin resistance, which result in fatigue.
• Western diets promote inflammation, another major cause of fatigue.

We’ll explore each of these topics now in greater depth.

Nutritional Deficiencies and Imbalances

Fatigue is an early symptom of vitamin and mineral deficiencies. Cells rely on vitamins and minerals to generate energy. Deficiency in one’s diet is a surprisingly common malady in today’s over-fed and under-nourished population.

A high percentage of adults in the U.S. consume less than the minimum daily allowance of many essential vitamins and minerals. Adequate amounts and the proper balance of the essential vitamins and minerals, along with the right phytonutrients and essential fats, are important for disease prevention and optimal health.

Let’s take a closer look at some of the most important vitamins and minerals related to fatigue.

Vitamin C

Vitamin C (ascorbic acid) regulates many genes, some of which are responsible for energy metabolism. The recommended daily allowance for vitamin C is between 60 to 75 milligrams (mg) per day for women and 90 mg per day for men. However, 20 to 30 percent of American adults consume less than 60 mg of vitamin C daily.

According to the National Institutes of Health, “Vitamin C deficiency is much more common than is generally recognized, especially because the first symptom of deficiency is fatigue, a nonspecific and common complaint.”

Studies have tested the ability of vitamin C (taken orally with other vitamins, minerals, and/or antioxidants) to combat fatigue. In one randomized, placebo-controlled, double-blind study, the effects of a daily effervescent tablet containing 500 mg vitamin C, B vitamins, calcium, magnesium, and zinc was tested in 215 healthy males ages 30 to 55 years. After 33 days, when compared to those who were given a placebo, participants taking these daily vitamins reported:

• Increased energy and “vigor”
• Less mental tiredness
• Improved general mental health
• Lower subjective stress
• Significantly higher scores on a series of mental tests designed to detect sluggishness

Healthy individuals should be able to get enough vitamin C from a diet rich in fruits and vegetables. However, people who smoke, are exposed to second-hand smoke, and have a restricted diet, cancer, kidney disease, or malabsorption may struggle to get adequate vitamin C from diet alone and may benefit from supplements.

Traditionally, supplements have been taken orally, but today there’s an increasing trend to give vitamin C and other vitamins and nutrients intravenously. Early research into the effectiveness and safety of this method is promising in treatment for fatigue in both healthy adults and those with a history of cancer.

Investigators in one study evaluated the effect of intravenous vitamin C on fatigue in 141 healthy office workers ages 20 to 49 in a randomized, double-blind, controlled clinical trial. Volunteers received either 10 grams of vitamin C with saline or saline only intravenously. Fatigue scores were measured before intervention, two hours after intervention, and one day after intervention. The fatigue scores measured after one day varied significantly different between the two groups: Fatigue scores decreased in the vitamin C group after two hours and remained lower the following day.

Vitamin E

Vitamin E is actually a group of eight antioxidants:

• Four tocopherols (alpha, beta, gamma, and delta)
• Four tocotrienols (alpha, beta, gamma, and delta)

Alpha-tocopherol is the form of vitamin E found in the largest quantities in the blood and tissues and appears to have the greatest nutritional value.

The main function of alpha-tocopherol is its role as an antioxidant (a molecule that inhibits the oxidation of other molecules). Fats, which are an integral part of all cell membranes, are especially vulnerable to destruction through oxidation by free radicals.

Because alpha-tocopherol is a fat-soluble vitamin, it is uniquely suited to intercept free radicals and prevent a chain reaction of lipid destruction that would destroy cell membranes throughout the body.

Another function of alpha-tocopherol not related to its antioxidant capacity include its role in controlling molecules and enzymes in immune cells and inflammatory cells. The generation of excessive free radicals, otherwise known as reactive oxygen species, contributes to exercise-induced skeletal muscle damage, which results in muscle fatigue and soreness.

Antioxidants like vitamin E have been shown in some (but not all) studies to reduce the oxidative damage that occurs as the result of skeletal muscles contracting. Although some studies have shown that lower levels of vitamin E were associated with in-creased severity of fatigue and muscle pain in CFS, there is limited, inconclusive evidence of the benefits of taking vitamin E supplements for the treatment of fatigue.

Probably the best way to improve your vitamin E levels is to eat more vitamin E–rich foods, including: green leafy vegetables, whole grains, fortified cereals, vegetable oils, and nuts.

B Vitamins
The B vitamins include:

• B1 (thiamine)
• B2 (riboflavin)
• B3 (niacin)
• B5 (pantothenic acid)
• B6 (pyridoxine)
• B7 (biotin)
• B9 (folic acid)
• B12 (cobalamins)
• Biotin

These vitamins help facilitate the body’s ability to receive or create energy from food. Vitamin B deficiency, due to increased needs or a poor diet, compromises the ability of mitochondria in the cells to generate energy.

A lack of even just one of the B vitamins can compromise the entire sequence of biochemical reactions necessary for trans-forming food into energy. Vitamin B12 deficiency, in particular, is associated with fatigue. Ten to 15 percent of aging adults have a B12 deficiency.

Patients with CFS have been found to have low levels of B vitamins in some but not all cases. One group of researchers found a 50 percent prevalence of folate deficiency in CFS patients, while another group found high homocysteine levels in cerebrospinal fluid (which they attributed to lack of B12). Both the low B12 and high homocysteine levels were found to correlate to the severity of the patients’ fatigue.
Researchers from King’s College in London found what they called “functional deficiencies” of three other B vitamins: B6 (pyr-idoxine), B2 (riboflavin), and B1 (thiamine). The term “functional deficiency” refers to how nutrients actually function inside the body’s cells. Instead of measuring the actual amount of the vitamins found in the blood, these researchers used a specialized la-boratory that measures how vitamins function inside cells—specifically white blood cells.

Some patients with fatigue report greatly improved energy with the introduction of B vitamin supplements, whether they have a deficiency or not. However, as with many natural therapies, there are few studies testing whether B vitamin supplementation can actually help reduce fatigue.

Of the studies that have been conducted, results are mixed and often difficult to interpret, since so many different forms and methods of using B vitamins are available. Injections seem to work better than oral supplements for some, while other studies show that, at least with vitamin B12, tablets that dissolve under the tongue increase levels just as effectively as injections.

Only you can determine whether B vitamin supplementation will reduce your fatigue. It may be helpful to undergo at least a six-week trial with a high-potency B complex supplement, along with an additional 2,000 micrograms of sublingual (under the tongue) B12, if you believe you may be suffering from a deficiency.

Magnesium

Magnesium is an essential mineral. It is involved in more than 300 metabolic reactions, including energy production. In addition to being needed to produce ATP (the energy on which the body runs), magnesium is important for:

• Bone health
• Protein
• Fatty acid formation
• Making new cells
• Activating B vitamins
• Relaxing the muscles

Magnesium deficiency impairs the energy production pathway required by mitochondria to generate ATP and reduces the mitochondria’s ability to resist free-radical damage. It can result in excessive production of oxygen-derived free radicals and low-grade inflammation. Chronic inflammation and oxidative stress have both been identified as causative factors in several fatigue-related conditions, such as depression and CFS.

Twenty-three percent of adults in the U.S. fail to meet the recommended dietary intake of magnesium. Low magnesium levels have been linked to an increased risk of chronic fatigue as well as numerous other health-related conditions, including:

• High blood pressure
• Stroke
• Heart disease
• Glucose intolerance
• Insulin resistance
• Type 2 diabetes
• Obesity
• Metabolic syndrome
• Inflammation
• Oxidative stress
• Asthma
• Osteoporosis
• Migraines
• Colon cancer
• Depression

Magnesium deficiency is best determined by looking at the level of magnesium present in red blood cells, rather than in se-rum. In some studies, patients with chronic fatigue syndrome were found to have significantly lower red blood cell magnesium levels than the general population.

Even in CFS patients without apparent magnesium deficiency, supplementation with magnesium has been found to significantly improve oxidative stress. Foods that are rich in magnesium include spinach, black beans, nuts, and seeds.

Iron Deficiency and Anemia

Anemia, a common cause of fatigue, is characterized by a reduced number of red blood cells and a reduced concentration of hemoglobin (the iron-containing protein in red blood cells that transports oxygen). There are many causes of anemia, including nutrient deficiencies. Iron deficiency is a common cause of anemia, but deficiencies of folate or vitamin B12 are also causes.

Here are a few key facts about anemia:

• Even mild anemia is linked to fatigue and a lesser quality of life.
• Your chance of being mildly anemic increases with age.
• Mild anemia affects more than one in 10 elderly individuals.
• In older women, anemia is associated with depressive mood, which may further exacerbate feelings of fatigue.

Anyone with unexplained fatigue should be tested for anemia. Anemia is diagnosed with a simple and inexpensive blood test known as a complete blood count, or CBC. To determine the cause of anemia, further testing may be needed. Anemia occurs when the concentration of hemoglobin in the blood is lower than 12 g/dL in women and 13 g/dL in men. Mild anemia is typically defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men.

Anemia can occur at any age. In people over 65 years of age, the underlying cause of mild anemia remains unexplained in about a quarter of cases.

It is possible, especially in menstruating women, to become deficient in iron without becoming fully anemic. Like anemia, iron deficiency has been shown to cause fatigue and is associated with less vitality and poor mental health. It has also been shown to negatively affect physical work performance and cognitive functioning and to decrease immune function.

Besides heavy menstruation, other common causes of low iron levels include:

• Regular blood donation
• Pregnancy
• A diet low in bioavailable sources of iron

The best way to determine whether you have an iron deficiency is by measuring your ferritin levels rather than your actual iron levels. 
Ferritin is a protein found inside cells that stores iron so your body can use it later. If your ferritin level is low but still within the “normal” range, it is likely that you do not have enough iron.

A recent study in France found that iron supplementation for 12 weeks decreased fatigue by almost 50 percent from base-line—a significant difference compared with a placebo—in menstruating, iron-deficient, non-anemic women with unexplained fatigue and low ferritin levels.

Iron Excess

You may be surprised to know that high iron levels (a condition referred to as “iron overload”) are relatively common and may also induce fatigue. In fact, fatigue is the most commonly reported symptom of excess iron. In one European study, researchers found iron overload in 1.8 percent of the population (whereas they found iron deficiency and anemia in 0.5 percent of males and 6 percent of females).

In the U.S., one out of every 200 to 300 people has hereditary hemochromatosis, the most common cause of excess iron. White men over 40 are most at risk.

Besides fatigue, other common symptoms of iron overload include:

• Joint pain
• Low libido
• Erectile difficulties

Liver disease and diabetes also may occur in the later stages of the disease because the excess iron accumulates in these organs.

The treatment for excess iron is relatively simple and typically consists of regular blood removal (“therapeutic phleboto-my”—like a blood donation, only your blood is discarded). Ingesting less iron and watching your alcohol intake to protect your liver is also typically recommended.

Vitamin D

Vitamin D is a hormone now known to control more than 200 genes and to be important for much more than just bone health. Research on the wide-reaching affects of vitamin D has exploded over the past decade. It has been established that vitamin D deficiency—a global epidemic estimated to affect more than a billion people—is highly prevalent in people with fatigue and CFS.

In studies, low vitamin D levels have been linked to numerous other symptoms and chronic diseases, including:

• Muscle weakness
• Chronic pain
• Lower-back pain
• Metabolic syndrome
• Type 2 diabetes
• High blood pressure
• Breast cancer
• Colon cancer
• Prostate cancer
• Poor stress resilience
• Depression
• Hypothyroidism
• Cognitive decline
• Reduced work productivity
• Lung disorders such as COPD (chronic obstructive pulmonary disease) and asthma
• Increased risk for falls and disability among the elderly
• Death from all causes

Vitamin D deficiency and borderline deficiency (or “insufficiency”) is surprisingly common, even among those who live in areas with year-round sunshine. Therefore, it’s worth having a blood test to determine whether you’re deficient. Some studies have shown significant improvement in patients’ energy levels with vitamin D supplementation.

L-Carnitine

L-carnitine is a naturally occurring nutrient made in the body from the amino acids lysine and methionine. L-carnitine is required for energy production in the powerhouses of the cells (the mitochondria) through the release of energy from fats. It transports fatty acids into the mitochondria and is especially important for energy generation in heart and skeletal muscle tissue.

In situations of high-energy needs, the body can run out of this important nutrient. Therefore, L-carnitine is considered a “conditionally essential” nutrient.

Acetyl-L-carnitine is similar in form to L-carnitine and has some like functions, including its involvement in metabolizing food into energy. The acetyl group that is part of acetyl-L-carnitine contributes to the production of the neurotransmitter acetylcho-line, which is required for normal mental functioning.

L-carnitine deficiencies have been found in some CFS sufferers, as have abnormalities in the way acetyl-L-carnitine is used by the brain. Elderly people also are more likely to have low L-carnitine levels and to benefit, in terms of energy levels, when taking L-carnitine as a supplement.

Coenzyme Q10

Coenzyme Q10 (CoQ10) is present in the membrane of every cell in the body. CoQ10 has two crucial functions in cells:

• It plays a critical role in the production of energy as ATP within the mitochondria of cells.
• It is a powerful free radical scavenger (or antioxidant) that can mitigate damage caused by oxidative stress.

Though CoQ10 is produced naturally in the body, aging and various diseases or pathological mechanisms can disrupt its synthe-sis, leading to CoQ10 deficiency. CoQ10 deficiency is associated with decreased energy (due to lower ATP levels) and increased oxidative stress. Low levels of CoQ10 in the blood have been detected in chronic fatigue syndrome, fibromyalgia, and depression.

Blood Sugar Dysregulation

The Western diet, high in simple sugars and processed foods, is notorious for causing issues with blood sugar regulation. If you eat a meal loaded with sugar and refined carbohydrates, you can experience wild swings in blood sugar that make you feel tired, anxious, irritable, and hungry for more quickly absorbed sugars. This type of eating pattern is also known as a high-glycemic-load diet, meaning it contains high amounts of the kind of carbohydrates that release glucose into the blood very quickly.

High-glycemic-load diets have been shown in studies to cause:

• Sleepiness
• Nighttime sleep disruptions
• Slow reaction times in tests of cognitive performance

When you repeat the process, day in and day out, of eating a diet full of empty calories, refined and simple carbohydrates (bread, pasta, rice, potatoes), sugars, and sweetened beverages (sodas, juices, sports drinks), your cells start to become resistant, or unresponsive, to insulin. As a result, your pancreas ends up secreting more and more insulin in an attempt to lower your blood sugar. Insulin resistance is a pre-diabetic condition that has reached epidemic levels.

Experiencing fatigue and other low blood sugar symptoms two to four hours after a high-carb meal may be a warning sign that you have insulin resistance or are in the early stages of diabetes. Despite how common it is to feel sleepy following a high-glycemic-load meal, it’s not normal, nor is it healthy. This type of sleepiness is the classic sign of what is known as reactive hypoglycemia—and an early symptom of prediabetes or insulin resistance.

Reactive hypoglycemia is characterized by low blood sugar symptoms after eating large amounts of sugar or refined carbohydrates. Common symptoms:

• Fatigue
• Weakness
• Tiredness
• Dizziness
• Sweating
• Shakiness
• Palpitations
• Anxiety
• Nausea
• Hunger
• Difficulty concentrating

Take a typical breakfast these days: Swigging a large, sweetened coffee drink and grabbing something from the pastry case will give you a big energy surge by causing your sugar and insulin levels spike. What follows, however, is the inevitable “crash,” when your blood sugar level plummets. With this crash comes low blood sugar symptoms, like fatigue.

A high insulin level in your blood, which can easily be measured by your doctor, is the classic sign of insulin resistance. High insulin causes your body to lose muscle and create belly fat while also causing inflammation and oxidative stress. The downstream effects of insulin resistance, in addition to an expanding waistline and fatigue, are worth considering.

• High insulin levels and insulin resistance are linked to:
• High blood pressure
• High cholesterol
• High triglycerides
• Low HDL (high density lipoprotein, or “good cholesterol”)
• Low sex drive
• Infertility
• Depression
• Heart disease
• Stroke
• Dementia
• Cancer

A person crosses the line from insulin resistance and prediabetes to diabetes when the cells become so resistant to insulin that the insulin can’t do its job (i.e., it can no longer get the sugar out of the bloodstream and into the cells). This causes blood sugar levels to remain elevated and the pancreas to go into overdrive to produce enough insulin to fight against high blood sugar and resistant cells. At some point, the pancreas becomes unable to produce enough insulin.

If you do cross the line and become diabetic, studies show that you’re even more likely to have general, physical, and mental fatigue, as well as excessive daytime sleepiness.

Should You Eat Meat?

In terms of fatigue, there is no single right answer to the question of whether one should consider adopting a meat-free lifestyle. Studies have shown that both meat-including diets and vegetarian (or vegan) diets can work against fatigue. The key, of course, is the quality of the diet and the inclusion of plenty of vegetables and fruit.

A diet that consists largely of fruits and vegetables is associated with significantly less fatigue as measured by the SF-36, a commonly used, standardized, health-related quality-of-life questionnaire that measures fatigue.

A study of college-age women found that fatigue was associated with not eating enough fruits and vegetables, eating meals at irregular intervals, missing breakfast, eating more “instant” foods, and eating candy. Compared to meat eaters, vegetarians and vegans report significantly less fatigue. Studies show that switching to a vegan diet can improve fatigue and increase feelings of vitality.

In one study at George Washington University, overweight and/or type 2 diabetics received either weekly group instruction on a low-fat, vegan diet or received no diet instruction for 22 weeks. Results determined that the vegan group reported significant improvements in vitality (a measure of fatigue), as well as in general health, physical functioning, and mental health. They also reported that their productivity at work and in regular daily activities was significantly improved.

If you do choose to eat meat, studies show that the quality of the meat matters. A diet that includes high-quality (naturally raised, grass-fed) lean meat, as well as fruit, vegetables, and whole grains, may decrease the fatigue associated with depression and anxiety.

A large study conducted by researchers at the University of Melbourne in Australia found that women who regularly consume a whole-foods-based diet (a diet consisting of foods that are unprocessed and unrefined or processed and refined as little as pos-sible) and high-quality meat were more than 30 percent less likely to experience depression and anxiety compared to those with a Western diet.

In addition, those eating a Western diet (again, heavily processed foods, fried foods, refined grains, sugary products, and beer) tended to be approximately 50 percent more likely to experience depression.

Dr. Felice Jacka, the study’s primary researcher, explained in an interview that high-quality meat is more difficult to come by in the United States, where most cattle are raised in feed lots and given a corn-based diet. This increases their saturated fat and omega-6 fatty acids and decreases very important anti-inflammatory omega-3 fatty acids.

Grass-fed cattle, on the other hand, have healthier levels of omega-3 fatty acids and their meat is generally healthier and less inflammatory.

Digestive Problems and Leaky Gut

The link between digestive problems and fatigue has been noted for years, but it wasn’t until recently that researchers began to really put together the pieces of the puzzle to determine how abnormalities in the digestive system are related to fatigue and what can be done to resolve these issues. It is likely that you have a “leaky gut,” an overgrowth of “bad” microbial flora, and not enough healthy flora if you feel chronically tired and experience digestive symptoms like:

• Abdominal pain
• Bloating
• Loose stools
• Diarrhea
• Alternating diarrhea and constipation
• Gas
• Reflux

Leaky gut is a term for increased intestinal permeability and is known to be at least partly to blame for fatigue and symptoms similar to irritable bowel syndrome (IBS). Leaky gut is caused by a loosening of the tight junctions in the gut lining that form a barrier between the inside and outside of the digestive tract.

Leaky gut can be caused by:

• Any type of inflammatory process, including yeast infections, viruses, and bacteria
• Long-term or very frequent use of antibiotics
• Repeated use of pain-killers, NSAIDs (nonsteroidal anti-inflammatory drugs), or alcohol
• Long-standing psychological stress
• Extended exercise (athletes)
• Food allergies or sensitivities (such as gluten sensitivity)
• Insufficient intake of antioxidants

When any of these factors increase the permeability of the intestinal wall, unwanted bacteria, proteins, and other compounds can leak through. To deal with these foreign compounds, the body mounts an immune response, which leads to inflammation.

Researchers have found that if you have chronic fatigue syndrome, your body likely produces high levels of immune cells in order to battle the toxins given off by unhealthy stomach bacteria. This high level of immune cells is a sign of leaky gut and a cause of inflammation.

In fact, the severity of both chronic fatigue symptoms and digestive symptoms was found to directly correlate with the number of these immune cells that are directed against toxin-generating stomach and intestinal bacteria.

Food Allergies and Intolerances

Like millions of Americans, you may be suffering from the symptoms of food allergy or intolerance and not know it. Consuming foods to which you have an allergy or intolerance can result in a variety of physical and mental symptoms including headaches, heartburn, and fatigue. Other reactions can occur suddenly, are generally more serious, and can produce symptoms as severe as:

• Difficulty breathing
• Hives, itching, or rash
• Shock, with a drop in blood pressure

People who react in this way to certain foods usually know that they have a food allergy. More often, unsuspected food intol-erances, sensitivities, or allergies produce a variety of milder, annoying symptoms, which may not occur until hours or days after the food is ingested. These symptoms typically linger and recur.

The concept of food intolerances, sensitivities, and “delayed food allergies” is still deemed controversial by many conventional physicians. However, studies have shown significant improvements in a variety of symptoms and conditions when these types of food reactions are identified via blood testing and the reactive foods are eliminated from the diet.

Celiac Disease/Gluten Sensitivity

Fatigue is a symptom of two conditions related to the ingestion of gluten-containing foods: celiac disease and gluten sensitivity.

Celiac disease is an autoimmune disorder affecting nearly one out of every 133 Americans. In people with celiac disease, gluten sets off an autoimmune reaction that causes the flattening of the villi (a finger-like projection of the lining) in the small intes-tine. People with celiac disease produce antibodies that attack the intestine, causing damage and illness throughout the body.

People with untreated celiac disease typically experience major fatigue that disrupts their quality of life. The fatigue experienced in those with celiac disease can come and go, as can gastrointestinal symptoms. In fact, some patients with celiac disease suffer from debilitating fatigue but do not have any gastrointestinal symptoms at all.

If you have hypothyroidism due to autoimmune destruction of your thyroid gland (also known as Hashimoto’s thyroiditis, the most common cause of hypothyroidism), your chances of developing celiac disease and some other autoimmune diseases are significantly increased.

The reverse is also true: If you have celiac disease, you are more likely to develop autoimmune thyroid disease. A gluten-free diet has been shown in some studies to prevent people with celiac disease from developing autoimmune thyroid disease. This link between celiac disease, hypothyroidism, and fatigue means it’s important to get tested for celiac disease if you’ve been found to have Hashimoto’s thyroiditis.

Diagnosis of celiac disease is based primarily on blood tests that detect and measure two specific antibodies:

• Immunoglobulin A (IgA) anti-tissue transglutaminase (tTG) antibody
• Immunoglobulin A (IgA) antiendomysial antibody (EMA)

The tests are complex, and sometimes other blood tests are used in conjunction with them. If your test results are positive, your doctor may perform a biopsy of the small intestine to confirm the diagnosis.

As for gluten sensitivity, it’s just what it sounds like: a less severe negative reaction to ingesting gluten. It is sometimes also referred to as gluten intolerance or “non-celiac gluten sensitivity.”

Research at the University of Maryland Center for Celiac Research shows that gluten sensitivity is different from celiac disease in that it typically does not result in the intestinal inflammation that leads to a flattening of the villi of the small intestine (a characteristic of celiac disease).

In addition, auto-antibodies called tissue transglutaminase (tTG), used to diagnose celiac disease, are not present in subjects with gluten sensitivity.

The immune system is activated in gluten sensitivity, and symptoms can arise throughout the body, ranging from fatigue and foggy mind to diarrhea, depression, and joint pain.

The best way to determine whether you have gluten sensitivity is to do a three-month trial on a strict gluten-free diet, monitoring your symptoms as you go along. If your fatigue and other symptoms improve, you likely have gluten sensitivity.

At the end of the three months, you can perform a “challenge” by eating a few normal-sized servings of a gluten-containing food during the day.

Monitor your symptoms on the day of the challenge and for another day or two after. If you notice your symptoms returning, you have confirmation that you’re gluten-sensitive.

Obesity

Individuals who are overweight, obese, or simply have too much belly fat experience more fatigue and excessive daytime sleepiness, according to studies.

It was long believed that one of the primary reasons obese individuals experience higher rates of excessive daytime sleepiness is the increased rate of sleep apnea and sleep disruption in people who are overweight. It is, after all, well known that obesity is the number one risk factor for obstructive sleep apnea.

However, recent research shows that increased daytime sleepiness occurs in obesity regardless of sleep loss or sleep apnea. The new hypothesis is that obesity-related daytime sleepiness and fatigue are associated primarily with metabolic disturbances like insulin resistance and psychological factors.

The interaction of inflammation (characterized by increased cytokines) and cortisol also may play a role in obesity-related fatigue.

Dehydration

Water is the most essential component of your body and the most essential nutrient in your diet. Water comprises about 60 per-cent of your body weight. Without it, you can survive for two to four days. Water is necessary for circulation, biochemical reactions, metabolism, transportation of substances into and out of cells, temperature regulation, and numerous other bodily processes.

Inadequate water intake leads to dehydration, a well-known cause of decreased physical and mental function and mood. The decrements in physical and mental performance typically become apparent when 1 to 2 percent of total body weight is lost.

How do you know if you’re dehydrated? Common signs of dehydration include:

• Reduced skin elasticity
• Dry lips and mouth
• Headache
• Constipation
• Dark urine (straw-colored urine indicates adequate hydration)
• Infrequent urination

Studies indicate that even mild dehydration can cause the following symptoms:

• Increased fatigue
• Decreased physical endurance
• Reduced motivation
• Increased perceived effort
• Disruptions in mood (including confusion and anger)
• Disruptions in cognitive function (including concentration, alertness, and short-term memory)

As you age, the likelihood of becoming dehydrated increases. In aging individuals, the body’s regulation of thirst and fluid in-take undergoes small changes. Older people tend to feel less thirsty and hence drink less than younger individuals.

Studies also show that older individuals, when dehydrated, tend to drink insufficient water to replenish the body’s water defi-cit. Because of this, researchers now believe it may be best for older adults to practice drinking water regularly, even though they
may not feel thirsty.

Caffeine

The most popular stimulant drug in the world is caffeine. The worldwide popularity of tea, coffee, soft drinks, and—now more than ever before—energy drinks is due at least in part to caffeine’s ability to make us feel alert.

Coffee has been proven to enhance alertness and performance in studies of non-tolerant (non-habitual) users. In habitual users, however, caffeine has downsides.

Daily caffeine drinkers who abstain from caffeine experience fatigue and drowsiness as side effects of caffeine withdrawal. And there’s a lesser-known but even more important downside to regularly ingesting caffeine: Although habitual caffeine drink-ers feel like caffeine makes them more alert, evidence suggests that overall there is no total increase in alertness.

The feeling of becoming more alert by drinking caffeinated beverages is merely the reversal of the fatigue that’s caused by acute caffeine withdrawal. In other words, with frequent consumption of caffeine, we don’t experience a net benefit.

When we abstain from consuming caffeine, we’re less alert; consumption of caffeine at this point merely returns your alertness to baseline.

According to some studies, additional negative effects of caffeine include:

• Increased anxiety
• Increased cortisol levels
• Impaired blood sugar management
• Increased cholesterol

Caffeine has been shown in functional MRI studies to activate the part of the brain that perceives threats and that correlates with anxiety levels. Certain individuals are more genetically susceptible to the anxiety-inducing effects of caffeine.

But with modest, regular intake, even those who are more susceptible can develop a tolerance to the anxiety-provoking effects.

Symptoms of caffeine withdrawal begin 12 to 24 hours after the last dose of caffeine. In addition to fatigue and sleepiness, caffeine withdrawal symptoms include:

• Headache (experienced by about 50 percent of users)
• Depressed mood
• Difficulty concentrating/decreased cognitive performance
• Irritability
• Nausea/vomiting
• Muscle aches/stiffness

It is also important to note that caffeine withdrawal symptoms may intensify with the use of energy drinks and shots. This is be-cause energy drinks vary widely in caffeine content, ranging from 50 mg to a dangerous 505 mg per can or bottle. (For compari-son, the caffeine content of a large cup—16 ounces—of brewed coffee is about 188 mg.)

Energy drinks also contain other substances such as B vitamins and amino acids (like taurine and tyrosine). But caffeine typically is the main active ingredient in energy drinks. Plus, they may contain various herbal extracts—some that also contain caffeine,usually in “proprietary” amounts that are not disclosed on the label. Thus, despite their popularity, energy drinks and shots should be avoided.

Lack of Exercise as a Cause of Fatigue

Physical inactivity is consistently associated with fatigue. In U.S. adults ages 20 to 59, those who report feeling tired are almost twice as likely to get insufficient physical activity. Those who report feeling exhausted are almost four times more likely to get insufficient physical activity. In teens, an average of nine hours per day using electronic media doubles the risk of persistent fatigue.

In people who have been exercising regularly (at least 30 minutes three times a week), fatigue begins to appear about one week after they abandon exercise.

Studies show that, in people who do not exercise, even relatively small amounts of routine physical activity within a normal lifestyle are associated with more energy and less fatigue.

Being sedentary may increase fatigue for a number of reasons, including the following.

• Prolonged periods of inactivity cause decreased muscle mass. As muscle is reduced, the number of mitochondria inside muscle tissue also decreases. Within every cell, mitochondria generate the energy used to power all metabolic activities. As muscles lose mito-chondria, they become less efficient (they experience a reduction of strength, tone, and size). This leads to the feeling of a lack of power or energy, stiffness, heaviness (because of blood pooling in the lower limbs), weakness, and pain after normal exercise and activity.
• Prolonged inactivity causes fatigue by deconditioning the cardiovascular system. This causes reduced blood volume, lowered oxygen levels, and less aerobic fitness as measured by VO2 max (the maximum capacity of an individual’s body to transport and use oxygen during incremental exercise). Deconditioning of the cardiovascular system reduces heart and lung function and is associated with dizziness and breathlessness.
• Being sedentary dulls the brain and alters your biological clock (circadian rhythms). It also changes your perception of temperature, noise, and light. These changes lead to impairments in:
• Coordination
• Concentration
• Memory
• Sleep
• Appetite
• Immune function
• Hormone production
• Lack of exercise decreases levels of dopamine, norepinephrine, and serotonin—energy-promoting and mood-enhancing neurotrans-mitters in the brain.

To stay healthy and energetic, you need to be physically active on a regular basis. There is no way around it. The type and duration of physical activity doesn’t matter nearly
as much as the mere act of doing something. Research shows
that any amount or kind of movement is better than none
for improving self-reported energy levels, raising energy-inducing neurotransmitter lev-els, and increasing the number of energy-producing mitochondria inside your cells.

Inflammation, Oxidative Stress, and Mitochondrial Dysfunction

Medical researchers are mapping out the network of connections among inflammation, oxidative stress (caused by free radical damage), and mitochondrial dysfunction. These three processes have been found to either be linked to or lead to fatigue and fatigue-associated chronic conditions, such as:

• Chronic fatigue syndrome
• Depression
• Fibromyalgia
• Insulin resistance/metabolic syndrome

Mitochondrial Dysfunction

Mitochondria are the organelles inside cells that are responsible for supplying upwards of 95 percent of the body’s energy needs. They are often called “the cell’s power plants,” since they convert the energy from food into a form that the body can use.

When the total number, structure, or functioning of the mitochondria decreases or becomes impaired, fatigue is the result. Researchers have found that in people with chronic fatigue syndrome, the structure and function of the mitochondria is dam-aged, and their ability to produce energy is diminished.

How and why does this happen? One way the function of mitochondria becomes compromised is through the generation of reactive oxygen species, known as free radicals.

Free radicals are atoms or groups of atoms with an odd (unpaired) number of electrons that can be formed when oxygen in-teracts with certain molecules. When too many free radicals are generated for the body to handle efficiently, a situation called “oxidative stress” develops.

Oxidative Stress

The process of oxidation—removing electrons from an atom or molecule—can be destructive (think of rusting iron). Oxidation occurs during normal mitochondrial function producing harmful free radicals as a byproduct.

Free radicals are unstable. In order to gain stability, they rob electrons from any other molecules they meet. This creates a domino effect wherein other molecules are left unstable in their wake. A free radical chain can cause extensive cellular damage and even kill cells altogether before eventually fizzling out.

Oxidizing activity from the environment—like radiation, toxins, “bad” foods, and tobacco smoke—further damages cells. Oxida-tive stress is the total burden of this oxidizing activity.

Luckily, your body has developed a number of strategies for containing and minimizing the damage. One such strategy is anti-oxidants, which neutralize free radicals by donating electrons to them.

You consume antioxidants, such as vitamins C and E, in your diet.Your body also has complex mechanisms that repair damage that has already occurred. You even have a system of oxidative stress responses that include a programmed cell au-to-self-destruct, for when the damage becomes too great.

The mitochondria especially depend on these defenses. If free radical production is too great or if antioxidant defenses be-come depleted, oxidative damage occurs and accumulates, resulting in oxidative stress.

The energy-generating mitochondria are some of the first parts of the body to suffer the effects of oxidative stress. Reactive oxygen species focus their attack on the DNA of mitochondria. The resulting damage leads to mitochondrial dysfunction, which is characterized by deficiencies in the mitochondria’s ability to produce energy. Furthermore, oxidative stress can result in inflammation.

Inflammation

You just learned how oxidative stress reduces the ability of the mitochondria within cells to function, resulting in fatigue.

Mitochondrial dysfunction and oxidative stress also lead to fatigue by causing low-grade activation of the immune system in a manner that provokes inflammation. With mitochondrial dysfunction and oxidative stress, the body produces excessive amounts of inflammatory compounds called cytokines.

Cytokines are substances secreted by cells of the immune system that carry signals locally between cells. Some cytokines are pro-inflammatory, meaning they promote inflammation, while others are anti-inflammatory. Over time, the chronic production of pro-inflammatory cytokines leads to a state of chronic, low-grade, body-wide inflammation that causes fatigue.

Two specific pro-inflammatory cytokines—tumor necrosis factor alpha (TNF‑) and interleukin-6 (IL‑6)—are known to cause sleepiness and fatigue. Related illnesses, including depression, obesity, metabolic syndrome, and sleep apnea, have been shown in studies to result in higher levels of IL‑6 and TNF‑, which indicates abnormally high levels of inflammation.

Exactly how the inflammatory cytokines cause fatigue is still under investigation. Researchers believe there are probably nu-merous direct and indirect mechanisms by which chronic inflammation triggers fatigue.

Some of the fatigue is due to the effects of inflammation on the nervous system. And in people with chronic fatigue syndrome, inflammation may be the cause of decreased activation of “the brain’s reward center,” a group of nuclei known as the basal ganglia.

The basal ganglia help to control motion and motivation and are exceptionally vulnerable to the effects of certain pro-inflammatory cytokines. A reduced response in this part of the brain is seen in patients with CFS.

Levels of pro-inflammatory cytokines like TNF-alpha and IL-6 can be measured in the blood and often are used for research purposes. However, they are rarely measured by the average physician.

A much simpler, more widely available, and less expensive way to measure chronic, systemic inflammation is through a blood test called C-reactive protein (CRP). CRP is a non-specific protein, the levels of which increase in the blood in response to inflammation or tissue injury.

Blood levels of CRP are typically higher in those who have CFS or experience chronic fatigue than in people who don’t feel fatigued.

In a sample of 70-year-old women, CRP levels were 40 percent higher in those with fatigue, compared to those without it. A host of fatigue-related conditions besides CFS also are associated with higher CRP levels. Among them:

• Fibromyalgia
• Type 2 diabetes
• Cancer and post cancer
• Infections
• Heart disease
• Arthritis
• Autoimmune diseases
• Inadequate sleep (less than six hours)

The foundational treatment for fatigue must include the reduction of inflammation and oxidative stress and the repair and production of new mitochondria. The good news is that these crucial processes are possible with natural therapies involving nu-trition, exercise, lifestyle changes, and supplements.

Understanding is only the first step. Later in this report, you’ll learn simple, effective strategies for decreasing inflammation, preventing oxidative damage from free radicals, and improving the healthy processes of the mitochondria.

Other Causes of Fatigue

In addition to the causes of fatigue discussed in this chapter, there are others worth mentioning. Among them:

• Cancer treatments
• Chronic pain
• Medications
• Poor detoxification mechanisms
• Toxic exposures

Still another possible cause of fatigue: infections, which we’ll examine below.

Infections

Infections can result indirectly from fatigue and vice versa. In some cases, in fact, patients end up in a vicious cycle of fatigue and infection.

Viruses, bacteria, fungi, and parasites can all cause infections and fatigue. Invasion of body tissues by disease-causing microor-ganisms, like the viruses listed below, are especially notorious for causing fatigue among other symptoms.

• Cytomegalovirus (CMV)
• Enteroviruses
• Epstein-Barr virus (EBV)
• Hepatitis C
• Human herpesvirus-6 (HHV-6)
• Human immunodeficiency virus (HIV)

In most cases, the body is eventually able to contain infection, and the fatigue and other symptoms are resolved. In other cases, such as with hepatitis C or HIV, the infection is not curable, although antiviral treatments can slow the course of the disease and may lead to a near-normal life expectancy.

Many times, chronic fatigue syndrome (CFS) follows a period of viral infection. If fatigue is not cured quickly enough, it may af-fect the body’s ability to fight off infection, providing viruses the chance to remount an attack.

CFS is sometimes considered a “post-viral fatigue.” Indeed, the syndrome sometimes does tend to follow a viral infection, such as a gut infection, or one of the others we’ve listed. Some patients with CFS clearly recall symptoms of an infectious illness before their fatigue took hold—fever, chills, body aches, sore throat, rash, or swollen glands—while other CFS patients recall no such symptoms.

In any case, once chronic fatigue sets in, there is usually no laboratory evidence of an active infection, although disturbances in immune function may be apparent. Some researchers believe these immune disturbances are triggered by chronic viral infections.

Inflammation is another part of the infection–fatigue connection. Specific types and ratios of inflammatory cytokines found in the blood of CFS patients (IL‑10 and TNF‑) may indicate the presence of persistent bacterial, fungal, or viral infections. The underlying presence of a viral infection may be the cause of the fatigue and excessive inflammation.

The Vicious “Infection–Stress–Fatigue” Cycle

Are you caught in a vicious cycle of stress, fatigue, and infection? While it’s easy to see how fatigue can result from chronic stress or infection, you may not be aware of how fatigue also may cause stress.

You also may be unaware of the fact that both fatigue and chronic stress can compromise the immune system, making you more susceptible to infections. A frustrating cycle of fatigue and illness can occur, with one contributing constantly to the other.

Researchers hypothesize that fatigue itself is a significant body stressor that makes you more susceptible not only to new infec-tions but to reactivation of latent viral infections to which you were exposed years ago.

Studies in fatigued and sleep-deprived medical patients show that under stressful conditions, the herpesviruses Epstein-Barr (“mono” or herpesvirus 4) and the common cold sore (herpes simplex I) are reactivated, and the amount of the virus measured in the patients’ bloodstream significantly increases.

The infections that play a role in many cases of chronic fatigue are part of an even wider interconnected web of fatigue, stress, inflammation, and nervous system dysfunction.

The key is to break the cycle and treat the underlying infection while using natural medicines and treatments to support the underlying immune, inflammatory, and stress-response systems.

Health-care practitioners all over the world understand these connections and are helping patients with chronic fatigue to break the cycle and regain their energy. Energy systems are being restored and rebalanced using:

• Natural therapies (the use of nutritional medicine, vitamins, vitamins, minerals, and other nutrients)
• Botanical medicine (the use of medicinal plants such as herbal extracts)
• Lifestyle changes (such as diet, exercise, and stress reduction)

Treatment of an underlying infection begins with diagnosis. Lab tests can help confirm current, recent, and past infections by checking for various antibodies (which indicate exposure to a virus) and various viral titers, or traces of the virus (which can con-firm current viral activity).

However, in the end—even with the most sophisticated lab testing—it may not be entirely possible to determine whether an infection is to blame for your fatigue.

If the presence of an infection cannot be determined, most fatigued individuals still find help via the recommendations provided in this book: improving diets, fixing nutrient deficiencies, decreasing stress, treating oxidative stress and inflammation, and improving the overall functioning of the immune system.

Putting It to Practice

We have gone over so many causes of fatigue by now that you may be feeling overwhelmed trying to determine which specific cause or causes apply to you. But don’t give up!

The next step is to use laboratory testing to find your cause of fatigue, and then employ one or more of the natural healing techniques to boost your energy levels and feel alive again.

The post 2. What Causes Fatigue? appeared first on University Health News.

If you’re reading this book, you likely know first-hand what it feels like to experience relentless, day-after-day fatigue. Or may-be someone you care about is suffering from a constant feeling of low energy or exhaustion.

Anyone who’s dealt with long-standing fatigue knows it takes a toll on every aspect of your body and mind. Prolonged fatigue slowly erodes your health and your ability to cope with life, and it can interfere at home, at work, and in your relationships.

What can you do to regain your energy? Fatigue can have multiple potential underlying causes and, therefore, may be complex to diagnose and permanently overcome. But be encouraged! The guidance found here will help you discover:

• Specific solutions to the underlying causes of your fatigue
• Your body’s marvelous ability to heal itself
• The raw materials your body requires to start enjoying bountiful energy again

Making changes in your lifestyle and taking supplements may sound like subtle and not-so-scientific steps to take. But the latest research supports the powerful and dramatic effects these and other natural treatments can have on your ability to regain your energy.

We wish you the best as you begin this journey!

The post From the Editor appeared first on University Health News.

How Many Blood Types are There?

According to the American Red Cross, “there are eight common blood types and many rare ones.” The main human blood group is ABO, which is genetic and determined by genes A and B.

Each of the blood types is determined by the presence or absence of certain antigens (i.e. a toxin or foreign substance that can trigger an immune response) on the surface of red blood cells. To make things even more confusing, there is also a protein, known as the Rh factor, which can be present or absent on the cells. If it’s on the cells, you’ll add a + after your blood type. If it’s absent, you’ll add a –.

Confused? This blood types chart should help:

Now that you (kind of) understand the ABO blood types, there are over 600 more known antigens which can create what the American Red Cross calls, “rare blood types.” Some blood types are unique to a specific racial or ethnic group, which can make it difficult to find suitable blood donors.

Can A Type O Donate Blood to Everyone?

Just because you’re healthy doesn’t mean you can give your blood to just anyone. Certain blood types don’t mix. Types As can’t share with Type Bs, for instance and vice versa.  And no one can share with an O unless he, too, is a member of that blood group. That said, type O is the most universal, meaning it can be shared with all blood types.

“Type O is considered a ‘universal donor’ because the type O blood group antigen does not engender a transfusion reaction by the antibodies possessed by the other blood groups,” explains Dr. Peter D’Adamo, Distinguished Professor of Clinical Medicine at the University of Bridgeport and Director of the Center of Excellence in Generative Medicine. “The true universal donor type is O-, as this then also rules out antibody reactions by the Rhesus (Rh) system.” However, if you’re in need of plasma (the liquid necessary to transport red and white blood cells and platelets throughout the body), type AB blood is considered the universal plasma donor.

Which Is the Most Common Blood Type?

Type O positive is the most common of all blood types. The percentage of those with this (and all other blood types), however, varies depending on ethnicity. According to the American Red Cross, about 45 percent of Caucasians have type O, for instance, while nearly 51 percent of African-Americans and almost 40 percent of Hispanics share this common blood type.  The rarest blood type is AB, which is only shared by about 4 percent of the overall population.

What Do Blood Types Say About Your Health?

Blood types can determine your risk of certain illnesses such as cancer and cardiovascular disease. Blood types can also help pinpoint your likelihood of suffering from inflammation and neurodegenerative ailments, says Dr. D’Adamo. “In general, the studies (some going back to the 1940s) have shown an increase in cancer and cardiovascular disease in people with blood types A and AB, inflammation and depression in type O, and neurodegenerative ailments in blood types B and AB.” Most often, your risk of getting these conditions, though, will depend also on external factors such as diet, fitness, and lifestyle.

Blood Types and Their Associated Disease Risks

Blood Types in the U.S. Population

The following chart represents the percentage of those with a certain blood type in the US, according to the American Red Cross.

For related reading, please visit these posts:

• Anemia Causes, Symptoms, and Treatment
• Top 5 Fatigue Causes: Understanding Why You’re So Tired
• What Is Bone Marrow? We Dig In on This Efficient Producer of Stem Cells
• Iron Deficient But Not Anemic? A Simple Solution for Fatigue

This article was originally published in 2018. It is regularly updated. 

The post Blood Types Provide Important Clues About Our Health appeared first on University Health News.

There may be medical reasons causing your fatigue (see “Fatigue Causes: How to Tackle Both Serious Ailments and Easy Fixes“). If you’ve ruled out more serious conditions, then there may be lifestyle habits at play. As such, consider these research-supported strategies to boost your energy level throughout the day—and all week long.

How to Improve Energy Levels Tip #1: Get your magnesium.

Why magnesium? Because this important mineral factors into hundreds of biochemical reactions in your body, reactions that regulate blood glucose control, nerve function, blood pressure, bone strength, heart rhythm, metabolism, and more. According to the National Institutes of Health, magnesium “is required for energy production, oxidative phosphorylation, and glycolysis.”
So ensure that your diet has enough magnesium (see sidebar below). Just remember not to overdo it. According to NIH, “Too much magnesium from food does not pose a health risk in healthy individuals because the kidneys eliminate excess amounts in the urine. However, high doses of magnesium from dietary supplements or medications often result in diarrhea that can be accompanied by nausea and abdominal cramping.”

Despite that disclaimer, make no mistake about the positive, energy-maintaining effects of magnesium. Essentially, too little magnesium makes your body work harder. During moderate activity, people with low magnesium levels in their muscles are likely to exert more energy and tire out more quickly than those who have adequate levels.

How to Improve Energy Levels Tip #2: Eat right.

Besides getting enough magnesium through your food and beverage intake, make sure that your diet, in general, is rich in foods that give energy. They can play a major role in helping you break the cycle of fatigue. Start your day with a healthy breakfast to boost your metabolism; it should include carbohydrates and protein from such sources as whole-wheat toast, peanut or almond butter, fruit with cereal or yogurt, or oatmeal flavored with nuts and raisins.

Almonds, peanuts, and cashews are among the worthy sources of foods that can boost your energy level.

Lunch and dinner menus can’t go wrong if they include such items as brown rice, sweet potato, eggs, salmon, lean meats, and a rainbow of vegetables (broccoli, carrots, peppers, and more) and fruits. Mid-morning and mid-afternoon snacks can give you a healthy boost as well; easy-to-access favorites like bananas, apples, almonds, cashews, and lean yogurt all work as energy-boosting foods. (See our posts Natural Energy Boosters? Keep These Snacks Close By and “Healthy Snacking Habits.”)

See our sidebar box below to view the National Institutes of Health’s recommendations for dietary allowance for magnesium.

How to Improve Energy Levels Tip #3: Be water-wise.

It’s a simple strategy that’s easy to take for granted: Staying hydrated is a must for anyone wondering how to improve energy levels. Dehydration is known to bring on lethargy and listlessness. A 2012 study at the University of Connecticut’s Human Performance Laboratory showed that being even slightly dehydrated alters our energy level as well as our ability to think clearly and our mood. Drinking between eight 8-ounce glasses of water per day will do the trick, so keep a fresh source of water nearby during your daily routine. Add slices of lemon, lime, or oranges for a little variety.

The color of your urine is one clue that you may not be getting enough water. When we’re well hydrated, we produce very pale urine; if it’s a dark yellow, you may not be getting enough water.

And by all means, push away the sugary sodas and juice drinks. The buzz they provide comes and goes quickly; water is far more effective in keeping us hydrated.

How to Improve Energy Levels Tip #4: Get a walking start to regular exercise.

It’s the classic “vicious circle”: You’re lacking in energy, and you know exercise will help you restore it—but you can’t find the energy to get started. Advice: Don’t think in terms of working out like a triathlete in training. (At least not yet!) If you’ve been sedentary for too long, find a 45-minute window of time every day—or at least every other day—to just walk. Start slow and work your way up to a brisk walk. If weather prohibits you from getting outside, a treadmill or stationery bike will do the trick.

A well-publicized study at the University of Georgia in 2008 dug into the idea of treating fatigue with exercise. As the New York Times reported, the research proved that “regular, low-intensity exercise may help boost energy levels in people suffering from fatigue.” And a director from the university’s lab published this pointed observation: “Exercise is a way for people to feel more energetic. There’s a scientific basis for it, and there are advantages to it compared to things like caffeine and energy drinks.”

How to Improve Energy Levels Tip #5: Sleep well.

Insomnia, sleep apnea, restless leg syndrome…. There are multiple conditions that prevent us from getting a good night’s sleep. And when we try to get by on a few hours of sleep (rather than eight or at least seven hours) for an extended stretch of time, our energy level suffers.

Lacking in energy? One solution may involve the sleep you allow yourself. If it’s less than seven hours, you likely find yourself dragging at times.

So if you find yourself lying awake in the middle of the night, or awakening suddenly several times during the night, take steps to correct the problem. Keep your bedroom uncluttered, don’t watch TV before sleeping, and don’t drink alcohol or caffeinated drinks before bed.

The National Heart, Lung, and Blood Institute (NIH) observes, “You may not notice how sleep deficiency affects your daily routine. A common myth is that people can learn to get by on little sleep with no negative effects. However, research shows that getting enough quality sleep at the right times is vital for mental health, physical health, quality of life, and safety.”

How to Improve Energy Levels Tip #6: Become a stress-handler.

There’s no doubt that stressful situations, anxiety, and depression can sap our energy. Being stressed or emotionally drained is known to tax our adrenal glands, which produce cortisol (the stress hormone). After an initial adrenaline rush during stressful situations, we come crashing down, exhausted.

Experts point out that every one of us will encounter stress throughout life, and the resulting symptoms can expend energy. (See our post 30 Stress Symptoms You May Recognize for a list of 30 common ones.) The key is to manage stress. A U.K. organization called the Stress Management Society notes, “The symptoms of stress act as an early warning system. They signal a developing imbalance between our energy and the demands of our life. They tell us that we are getting out of balance. If the imbalance continues or gets worse we run the risk of getting sick in the future.”

Tip No. 4 above—no surprise—goes a long way in combating stress; regular exercise is a proven defense against symptoms of stress. Likewise, staying hydrated, eating right and sleeping well combine to give you a fighting chance to handle stressful situations—and to keep your energy at a good level.

How to Improve Energy Levels Tip #7: Consult your physician.

Being overtired could be related to an illness; it’s a symptom that shows up commonly in patients who have arthritis, diabetes, heart disease, celiac disease, emphysema, bronchitis, and chronic obstructive pulmonary disease (COPD), not to mention Lyme disease, sleep apnea, depression, and a litany of other conditions.

If your fatigue feels chronic, consult your doctor, who may want to initiate testing to rule out one or more of the illnesses above, among others. If you’ve already been diagnosed with one of these conditions, consider that medications can make you feel fatigued. Your physician can review your needs to determine whether you’re taking the right dosage.

Originally published in 2016, this post is regularly updated.

The post How to Improve Energy Levels: 7 Strategies for the Overtired appeared first on University Health News.

That means that if your life is disrupted to the point where you’re not functioning like yourself, you’re stressed. And that’s a worry because stress is associated with an increased risk of cardiovascular disease, chronic health issues, and mortality.

A good stress quiz will help you determine whether stress is harming you physically. It also will determine whether the stress is chronic (a gradual buildup, such as a marriage slowly falling apart) or acute (the death of a loved one).

In short, chronic, long-term stress can cause health-threatening physical changes. But by the end of a useful stress quiz, you should have ideas on how to control your stress and determine whether you need professional help.

Effects of Stress

The reality of stress has been well documented. As psychologist Russ Newman, PhD, JD, American Psychological Association (APA) executive director, puts it, “Stress in America continues to escalate and is affecting every aspect of people’s lives—from work to personal relationships to sleep patterns and eating habits, as well as their health. We know that stress is a fact of life and some stress can have a positive impact; however, the high stress levels that many Americans report experiencing can have long-term health consequences, ranging from fatigue to obesity and heart disease.”

Can a Stress Quiz Reveal Your Stress Level?

The APA website offers some stress-quiz options that allow you to evaluate your life and determine your ability to handle everything from family stress to work stress to health risks.

Stress quiz choices include:

• Stress 360. This stress quiz looks at your lifestyle, work, attitude, and diet to determine your stress load.
• Stress Sensitivity Scale. While this stress quiz is still under analysis for clinical validation, it presents an interesting look at how vulnerable you are to stress.
• Workplace Stress Survey. This one presents a screening measure that focuses on your employment to determine whether further assessments are needed.
• Holmes-Rahe Life Stress Inventory. More of an assessment than a stress quiz, this is a way to take a numerical look at the possible stresses in life. You write down the points associated with what you’ve endured, such as a change in your finances, and add up the score to determine your risk of a stress-induced health breakdown in the next two years.
• Stress and Well-Being Survey. Somewhat of a stress quiz/assessment, this option measures your stress management, adaptability, resilience, and emotional vitality. At the end, it offers management solutions to improve your well-being.
• But my favorite stress quiz wasn’t about whether I’m stressed or not. It helped me learn the true symptoms of stress. You can test your knowledge of symptoms by taking the APA’s Stress Smarts quiz.

Symptoms of Stress

The symptoms of stress are many. You may recognize more of these 25 symptoms than you’d care to admit:

• Anxiety, worry, guilt, or nervousness
• Anger, frustration, hostility, irritability, or edginess
• Changes in appetite (weight gain or loss)
• Chest pain, palpitations, or rapid pulse
• Cold, clammy, or sweaty hands or feet
• Constant tiredness, weakness, or fatigue
• Depression or wild mood swings (crying spells, suicidal thoughts)
• Difficulty concentrating
• Dry mouth or problems swallowing
• Feeling overloaded or overwhelmed
• Frequent blushing or sweating
• Headaches
• Heartburn, stomach pain, nausea, or other stomach upset
• Inability to make decisions
• Increased smoking, alcohol, drug use, compulsive behaviors, like gambling or shopping
• Lightheadedness, faintness, or dizziness
• Low libido
• Muscle aches and spasms (usually neck and back)
• Nervous habits like fidgeting, feet tapping, or tooth grinding
• Panic attacks
• Reduced work efficiency or productivity
• Ringing, buzzing, or “popping” sounds in the ears
• Sleeping too much or too little
• Social withdrawal and isolation
• Tremors

Coping with Stress

So stress is unavoidable—and again, some stress is good. (See our post Adrenaline: The Driver of “Fight or Flight” Response.) The trick is to manage your stress levels. The good news: With simple, inexpensive techniques, you can improve your ability to cope with daily problems.

The most powerful and effective stress-reducing tools include meditation, yoga, and mindfulness. These ancient stress relievers can calm your mind calm and refresh your body, releasing physical and emotional tension.

If you truly can’t wrap your self around these practices, go simple. Close your eyes and breathe deeply or take a walk. Even 10 minutes in the fresh air can help you cope. And the more exercise you incorporate in your life, the more stress you’ll release.