Everyone feels tired sometimes, but if fatigue follows you everywhere, your body may be telling you to take a closer stock of your life or that there is a deeper health issue to be addressed.

Fatigue is a symptom rather than a disease, even if it is chronic. Chronic fatigue may be defined as a significant drop in overall energy for at least three months. While chronic fatigues is not necessarily associated with physical or mental exertion, a chronically fatigued person may also feel particularly exhausted after exertion, out of proportion to the level of energy that is exerted. Although it is frequently associated with other physical or psychological conditions, chronic fatigue may also be a signal to modify some everyday lifestyle habits in order to improve the body's "energy economy" and decrease the likelihood of disease. One way to improve everyday habits is through the choice of foods that you eat. Making healthy food choices is an important step toward regaining energy and combating the symptoms of chronic fatigue.

"Chronic fatigue" should not be confused with "Chronic Fatigue Syndrome" (also called CFS or CFIDS, Chronic Fatigue, and Immune Dysfunction Syndrome). Chronic Fatigue Syndrome is a defined health condition whose symptoms include changes in immune function as well as chronic fatigue.

Eat more

• Organically grown fruits and vegetables
• Garlic and onions
• Cold pressed, extra virgin olive oil
• Cold water fish including salmon, tuna, herring, mackerel and halibut for their beneficial omega 3 fatty
• Nuts and Seeds

Avoid high-glycemic index carbohydrate-containing foods, such as sweets, pastries, soft drinks and candy; stimulants, such as coffee, espresso, caffeinated soft drinks, black tea; and saturated and trans fats.

What is chronic fatigue?

Fatigue is a symptom rather than a disease, even if it is chronic. Chronic fatigue may be defined as a significant drop in overall energy for at least three months.

Chronic fatigue is fatigue that is not necessarily associated with physical or mental exertion, though a chronically fatigued person may also feel particularly exhausted after exertion, out of proportion to the level of exertion.

Chronic fatigue is not necessarily indicative of a disease, but may signal a need for modification of some everyday lifestyle habits in order to improve the body's "energy economy" and decrease the likelihood of disease.

"Chronic fatigue" should not be confused with "Chronic Fatigue Syndrome" (also called CFS or CFIDS, Chronic Fatigue, and Immune Dysfunction Syndrome). Chronic Fatigue Syndrome is a defined health condition whose symptoms include changes in immune function as well as chronic fatigue.

Early symptoms

• Pervasive tiredness or lethargy that interferes with normal life activities
• Easy fatigability with even mild mental or physical exertion
• Pronounced and/or extended fatigue after exercise
• Needing to take frequent rest breaks or naps during the day
• Never feeling you've had enough sleep, regardless of how many hours you've actually slept

Later symptoms

• Difficulty getting to sleep or staying asleep
• Increased pain sensitivity

Tests

There are numerous tests for health conditions that may be implicated in fatigue:

• Red blood cell evaluation (anemias)
• White blood cell or other immune factor evaluations (infectious, inflammatory, or other immune changes)
• Blood sugar, red blood cell glycation, and blood lipid evaluations (changes in carbohydrate metabolism)
• Blood chemistry panel (changes in vital organ function)
• Thyroid hormone evaluations (changes in thyroid function or thyroid hormone metabolism)
• Adrenal hormone evaluations (changes in adrenal function)
• Sex hormone evaluations (changes in gonadal function or sex hormone metabolism)
• Cardiovascular evaluations (changes in heart or circulatory function)
• Food elimination/challenge diet and/or food allergen panels (food sensitivities)
• Complete digestive stool analysis (digestive function)
• Cancer screening
• Screening for chemical sensitivities and toxic burden (for example, solvents or mercury)
• Evaluation for mood disorders like depression
• Muscle biopsy (changes in muscle tissue or mitochondria) (an uncommon test)

Disease Process

What we call "energy" largely depends on the function of mitochondria, microscopic chemical engines in every cell, that produce muscular and mental energy from the food, air, and water we consume.

However, mitochondrial function is influenced by the quality of one's diet, digestion, physical activity, hormones, chemical exposures, the stresses of life, vital organ function, genetic makeup, and many other health variables.

Chronic fatigue may often be attributable to multiple health influences together resulting in the feeling that there is less "available energy." You might guess that your body's transformation of food, air, and water into energy involves many steps, and you are certainly right!

The creation of energy requires that:

1. You receive all the substances necessary and in the right proportions (food, air, and water)

2. You absorb them effectively from all the surfaces of your digestive tract and from your skin

3. They are broken down (digested) properly

4. They are transported efficiently (through the actions of your heart, blood vessels, and cell membranes) to their intermediate processing areas (such as the brain or the muscles)

5. They are absorbed (in the mitochondria) and transformed into the final energy-giving substances

6. All of the waste products from these steps are effectively removed (excreted or exhaled) from your body

A problem in any of these areas can decrease your feeling of energy.

Causes

Optimal energy results from cooperation among almost every body system, down to each cell in your body. Examples of conditions that can hamper effective cooperation include:

• Heart, lung, or circulatory problems
• Changes in sleep patterns
• Decreased efficiency in mitochondrial function
• Chronic low-grade inflammatory conditions or infections
• Decreased ability to efficiently metabolize dietary carbohydrates
• Chronic allergies
• Poor eating habits
• Digestive problems
• Changes in thyroid, adrenal, and/or sex hormones
• Cumulative toxicity from household, industrial, or environmental toxins
• Depression or other mood disorders
• Smoking and other addictions
• Cancer
• Too much or not enough exercise
• Prescription and recreational drugs (a common side effect)
• Too much stress with not enough stress management

Potential dietary causes (or contributions) to fatigue are as numerous as they are common! They are generally due to consuming too much of something, consuming too little of something, or imbalances in nutrition.

Dietary causes of fatigue can also include consuming foods or drinks that zap your energy, eating particular foods at the wrong time, or eating in a way that contributes to poor digestion.

Carbohydrate-containing foods and the glycemic index of foods

Imbalance in the consumption of carbohydrate-containing foods is a common culprit in fatigue, and learning about the effects of different types of carbohydrates can make a major contribution towards resolving fatigue.

Carbohydrate-containing foods may be considered as one of the following:

• Low-glycemic index food, which releases food energy more slowly, resulting in smaller changes in an individual's blood sugar levels, with a steadier feeling of energy. Chief among these foods are legumes, nuts, and seeds, but also included are root vegetables like celery root and rutabagas; leafy green vegetables; asparagus; artichokes; gourd family vegetables like pumpkin and cucumber; mustard family vegetables like broccoli and cabbage; and onion family vegetables like leeks and scallions.
• Medium-glycemic index food, which release food energy at an intermediate pace, resulting in moderate changes in an individual's blood sugar levels, with moderate changes in energy.
• High-glycemic index food, which release food energy very quickly, resulting in large changes in an individual's blood sugar levels, with strong peaks and valleys in energy. These are the foods that can zap energy levels! Generally speaking, these include soft drinks, candy, pasta and pastries made from refined white flour, fruit juices, and even very sweet juicy fruits (such as oranges) for some individuals. Excessive intake of high-glycemic index foods is a major dietary contributor to fatigue.

It is not possible to indicate exactly which foods fall into each category for every individual, because many individual factors affect how quickly or steadily foods release their energy. The only way to know exactly is to take a specialized, hours-long test for every food. For more detailed information on this subject, please read the article What is the Glycemic Index?.

Dietary fiber-containing foods

Fiber is an indigestible part of many foods, so one might be inclined to downplay its importance in the creation and maintenance of energy. However, fiber is indispensable for the "energy economy" of the body, because it:

• Gets turned into fuel that can be used by cells lining the intestine
• Can help slow the absorption of energy from carbohydrate-containing foods
• May possibly reduce the glycemic index of foods, when eaten together
• Supports healthy fat metabolism and blood lipid levels (especially "soluble" fibers, like those in legumes, grains, nuts, and seeds)

Sources of dietary fiber include legumes, grains, nuts, seeds, many root vegetables, fibrous fruits like berries, and leafy green vegetables. You may notice that these foods fall under the category of low-glycemic index foods, and it is no accident!

Protein-containing foods and amino acids

The quality of protein in your diet is reflected in the quality of protein in your body; your muscles, your skin, your joints, and your brain! One key factor determining the quality of protein in foods is how well that food supplies the amino acids (building blocks of protein) you need in order to transform the food protein into yourself.

All protein-containing foods provide a different profile of the essential amino acids as well as others that may be valuable. Another important consideration is eating protein-containing foods when your body can most efficiently use them to provide the energy you need when you need that energy.

To make sure you get a good quality of protein when your body needs it the most:

• Be sure to include a good source of protein at your first meal of the day
• Be sure to include a good source of protein at your mid-day meal
• Avoid eating large portions of protein-containing foods late in the day
• Avoid protein-containing foods to which you may be sensitive (see Food sensitivities section below)

Sources of protein include:

• Legumes, including soybeans, garbanzo beans, lentils, kidney beans, navy beans, split peas, etc. (as a bonus, legumes also provide generous amounts of beneficial dietary fibers!)
• Animal sources of protein, such as fish, yogurt, meat, eggs, and cheese-but make sure they are organic!
• All nuts and seeds (as a bonus, nuts and seeds also provide essential fats!)

Stimulants and alcohol

Stimulants (especially coffee, espresso, and other strongly caffeinated beverages) and alcohol can contribute to chronic fatigue because they represent a "metabolic distraction" to a tired-out body already doing its best to cope with energetic challenges.

The quick (but false) energy, nervous system stimulation, and diuretic (dehydrating) effects of coffee tend to draw further on stressed energy reserves. Alcohol places an extra burden of detoxification on the liver, a vital organ that may already be very busy processing other toxins (from foods, the environment, chemicals you may be exposed to at home, at work, or in traffic) as well as all of the fats you consume.

Additionally, alcohol can appear to your body much like a very high-glycemic index carbohydrate, which can exhaust an energetically-challenged body (see Carbohydrate-containing foods section above). Stimulants and alcohol can be like a rollercoaster you can't get off, and they are best avoided by chronically fatigued individuals.

Fat-containing foods and essential fats

Because excess dietary fat is so common among Americans, trimming excess fats from your diet has a good chance of helping you find more energy, regardless of your specific health condition. Strangely enough, even though we get plenty of fat in our diets, we usually come up short on the only fats we actually need-essential fats.

Sources of essential fats include cold-water fish (like salmon, cod, herring, sardines, sole, pike, perch, flounder, halibut, mackerel, and pollock) and all nuts and seeds.

Guidelines for fats in the diet:

• Strive to eat small amounts of essential fats with each meal (in addition to providing necessary fats for your body, they may also help keep your energy level more stable)
• Avoid eating large portions of fat-containing foods (which can overstress your digestive ability)
• Especially avoid eating large portions of fat-containing foods towards the end of the day (which can decrease the quality of your sleep as well as overstress your digestive ability)

Deficiencies in essential nutrients

How ironic it is that we commonly eat more than we need, yet we still don't receive the essential nutrients we need! This common imbalance is further accentuated in those with fatigue, who may have additional difficulty transforming food into energy and healthy bodies.

Nutrient deficiencies are common, particularly for essential fats, dietary fiber, B-complex vitamins, antioxidants like vitamins C and E, magnesium, zinc, iron, and trace minerals such as zinc and chromium. Chronically fatigued people may actually need more of the essential nutrients, because chronic fatigue can hamper the body's ability to efficiently use the nutrients it receives. Please refer to the Nutrient Needs section below for further detail on individual nutrients.

Food sensitivities

There is great individual variation in the ability to turn particular foods into energy and healthy bodies. One culprit that often remains hidden due to its effective disguise is food sensitivities. Food sensitivities can transform a seemingly healthful food into an energy zapper.

Examples of some of the more common food sensitivities include wheat, dairy products, soy products, and eggs. Symptoms of food sensitivities are sometimes vague and can occur many hours after eating the culprit food, which can make them difficult to track down. Two methods for tracking down food sensitivities are The Food Elimination/Challenge Diet and food allergen panels (see Tests section above).

Eating habits

The way you eat may also determine how much energy you are able to get from your food. Basic guidelines for chronic fatigue include:

• Get enough of what you need, but not too much
• Get what you need when you need it
• Don't eat or drink things you are sensitive to or unable to digest effectively

More specific instructions include:

• Eat lightly, only until you begin to feel satisfied. Because light eating places less of a burden on your digestion, you will feel lighter and more energetic.
• Eat frequently, if necessary, and keep healthy snacks close at hand.
• Try to eat a good source of protein with each meal, especially during the first half of the day.
• Stick to low-glycemic index carbohydrates, particularly during the first half of the day. Good examples for most people include root vegetables (e.g., yams, sweet potatoes, turnips, Jerusalem artichokes, celery root), whole-grain products.
• Try to eat small amounts of sources of essential or monounsaturated fats with each meal-e.g., whole raw almonds, walnuts, pecans, flaxseed, sesame seeds, sunflower seeds, or pumpkin seeds or their oils; salmon, sardines, cod, halibut, sole, perch, turbot, or orange roughy or cold-water fish oils; olive oil.
• Eat slowly, deliberately, and thankfully.
• Eat real food in which you can identify the actual source of the ingredients. Is it from whole grains or processed? Is it from fresh fruits and vegetables? Was it overcooked? Does it actually appear wholesome to you?
• Enjoy herbs and spices that support digestion-e.g., ginger, pepper, cinnamon, fennel, rosemary, garlic, curry spices, chili spices, etc. There is truly a world of variety!
• Limit your alcohol intake to low levels enjoyed not-too-regularly. If your fatigue may be related to carbohydrate metabolism, avoid alcohol completely.
• Avoid foods or drinks you are sensitive to.
• Limit foods or drinks having a high glycemic index.
• Avoid the temptations of stimulants and sweet snacks, especially soft drinks, coffee, and candy.
• Consider establishing your own "happy hour" - a relaxing and enjoyable hour before dinner that primes your mood and digestion. The origin of "happy hour" was simply a social hour spent enjoying bitter herbal (and not necessarily alcoholic!) beverages that warmed digestive fires.
• Consider a gentle after-dinner walk, respecting your own limits.

There are no essential vitamins and minerals that do not play a role in the creation of energy! Keep in mind that "energy" and its lack may relate to changes in mitochondrial, hormonal, digestive, cardiovascular, and/or other areas of function. Particular nutrients may relate more closely to one area of function than another.

Essential fats / essential fatty acids (EFAs)

With the exception of a very few specialized types of fats, called essential fatty acids (EFAs), it is not necessary for humans to consume fat! However, humans require EFAs, which are necessary for healthy cell membrane structure and to facilitate normal chemical communication throughout the body.

Natural sources of EFAs include cold-water fish oils (especially salmon), most nuts and seeds and their oils (especially flax, canola, pumpkin, borage, black currant, and evening primrose oils), dark green leafy vegetable oils, and the oils of marine algae.

Proper metabolism of EFAs requires adequate intakes of zinc, magnesium, B-complex vitamins, and vitamin C, all of which are frequently deficient in diets. Consumption of hydrogenated fats, certain artificial colors and preservatives, and a high intake of saturated fats may also interfere with normal EFA metabolism.

EFAs are generally highly perishable and should be stored under refrigeration. The proportion of essential fats to non-essential fats in the modern diet is much lower than in the diets humans evolved eating, and this imbalance is thought to be related to many modern health problems, including cardiovascular disease, diabetes and other conditions of altered carbohydrate metabolism, and cancer.

Thiamin (vitamin B1) Thiamin is necessary for carbohydrate metabolism, and a high dietary intake of carbohydrates necessitates a higher intake of thiamin. It may also play a supportive role in insulin production by the pancreas, but further research is necessary to confirm this.

Sulfites, moist heat, and alkalis such as baking soda decrease food thiamin content. Average American intakes are 1.75 mg for men, 1.05 mg for women, and 1.12 mg for children. Chronically fatigued people should try to get 2 to 10 mg daily. The leading cause of thiamin deficiency is chronic alcoholism, which necessitates a thiamin intake of 10 to 100 times the RDA for the maintenance of healthy heart function.

Riboflavin (vitamin B2) Riboflavin is used in energy production, chemical detoxification processes, lipid metabolism, and antioxidant protection, and is one key to mitochondrial function and protection. It is also active in folic acid, niacin, pyridoxine, and vitamin K metabolism.

Mitochondrial oxidative stress and the need for riboflavin increase with exercise. Riboflavin is easily destroyed by alkali and light and its bioavailability is reduced by antacids, alcohol, caffeine, theophylline, and saccharin. Symptoms of deficiency include mucosal inflammation, dry skin, fatigue, muscle weakness, and red eyes. Average daily American intakes are 2.08 mg for men, 1.34 mg for women, and 1.57 mg for children. Chronically fatigued people should try to get about 2 to 10 mg daily.

Niacin and niacinamide (vitamin B3) Niacin is extremely important for mitochondrial function, energy production from carbohydrates and fats, and blood lipid levels. It is necessary for bodily production of carnitine. Flushing may occur with as little as 25 mg of niacin when used to treat hypercholesterolemia, but this reaction does not occur with niacinamide. Timed-release niacin may be employed to avoid flushing. Liver toxicity may occur with high-dose niacin.

Symptoms of deficiency include anorexia, nausea, oral mucosal inflammation, confusion, depression, dermatitis, fatigue, headache, indigestion, insomnia, irritability, weakness, and poor detoxification. Average daily American intakes are 41 mg for men and 27 mg for women. Chronically fatigued people should try to get about 30 to 100 mg daily. Niacin is also now available as a supplement called "NADH," which may be particularly helpful for fatigue.

Pantothenic acid (vitamin B5)

Though not the highest-profile nutritional factor in bodily energy production, pantothenic acid does support protein and carbohydrate metabolism. Its more important role in fatigue is to support the function of the adrenal glands, particularly during times of stress. The average daily American intake is 4 to 10 mg. Chronically fatigued people should try to get 10 to 50 mg daily.

Pyridoxine (vitamin B6)

In relation to chronic fatigue, pyridoxine is most notable for its necessity in protein metabolism and in the synthesis of the amino acid l-carnitine. Substances that interfere with pyridoxine include amphetamines, cigarettes, dopamine, Isoniazid, oral contraceptives, and tartrazine.

Symptoms of deficiency include oral inflammation, fatigue, stomatitis, and mood disorders. Average daily American intakes of vitamin B6 are 1.87 mg for men, 1.16 mg for women, and 1.22 mg for children. Dietary intakes of vitamin B6 may be below RDA levels in up to 90 percent of older adults. Chronically fatigued people should try to get about 10 to 25 mg daily.

Cobalamin (vitamin B12) Vitamin B12 is necessary for the formation of oxygen-carrying red blood cells. Absorption of vitamin B12 from the digestive tract requires adequate stomach acid as well as a stomach-produced substance called "intrinsic factor." Vitamin B12 deficiency increases with age, as intestinal function decreases.

Symptoms of deficiency include anemia, numbness, mood disorders, cognitive dysfunction, fatigue, and atherosclerosis. The current RDA for vitamin B12 may be inadequate to meet the nutritional needs of older people, and some researchers have recommended systematic supplementation or food fortification with vitamin B12. Average American daily vitamin B12 intakes for men, women, and children are 8, 5, and 4 micrograms, respectively. Chronically fatigued people should try to get about 30 to 100 micrograms daily.

Biotin

Biotin-dependent enzymes are active in carbohydrate, fatty acid, and protein metabolism. Biotin helps maintain energy levels and keep hair, skin, and nails healthy. It may also improve insulin sensitivity in those with insulin resistance. Symptoms of biotin deficiency include fatigue, weakness, cradle cap, hair loss, dermatitis, depression, and nerve abnormalities. Chronically fatigued people should try to get about 100 to 300 micrograms daily.

Vitamin C

Vitamin C plays important protective roles for many energy-producing cells and systems in the body. Body tissues with particularly high vitamin C requirements include the adrenal glands, ocular lens, liver, immune system, connective tissues, and fats circulating in the blood. However, because it is non-toxic and water-soluble, vitamin C passes through the body quickly, and maintaining vitamin C levels necessitates frequent intake.

Numerous influences decrease vitamin C, including smoking, pollution, many cooking and food storage methods, dietary choices, many disease states, and many drugs. Scurvy occurs when the body pool of vitamin C falls to about 300 mg, and signs include fatigue, easy bleeding, poor healing, joint pain, frequent infections, loose teeth, and cardiovascular disease.

Low body or intake levels may also associated with allergies, anemia, asthma, bowel disease, cancer, cataracts, cervical dysplasia, cognitive dysfunction, depression, diabetes, gallstones, glaucoma, irritability, periodontal disease, mental disorders, rheumatoid arthritis, ulcers, and urticaria. Vitamin C supplementation may also improve insulin sensitivity in humans.

Usual daily intakes of vitamin C range from 25 to 75 mg. Smokers have vitamin C requirements two to three times the RDA. Some research supports increasing the RDA for vitamin C to 100 to 200 mg per day. Chronically fatigued people should try to get about 500 to 1000 mg daily. Flavonoids, which are found in foods like citrus fruit, berries, nut skins, onions, peppers, and tea, strongly support the actions of vitamin C. Perhaps this is why nature combined them in so many colorful foods!

Vitamin E

Vitamin E is the body's major fat-soluble antioxidant and like vitamin C, vitamin E it is irreplaceable for protecting the body. It is especially important for protecting unsaturated fatty acids in cell membranes of the lungs, nerves, immune system, blood cells, and fats circulating in the blood. Vitamin E technically includes alpha-, beta-, gamma-, and delta- tocopherols as well as tocotrienols.

Vitamin E supplementation improves blood sugar regulation, and improves muscular insulin sensitivity in humans. Caution may be advised for daily intakes of over 800 IU for those with high blood pressure, smokers, and those taking anticoagulant drugs. Average daily intakes of alpha-tocopherol are 9.8 IU for men, 7.1 IU for women, and 5.5 IU for young children. Chronically fatigued people should try to get about 400 to 600 IU daily.

Magnesium

Magnesium is necessary for a wide variety of energy processes in the body, including muscular function, mitochondrial function, and protein, fat, and carbohydrate metabolism. Bones and muscles hold about 87 percent of the body's magnesium. Magnesium is necessary for helping maintain the normal function of insulin, which helps the body use carbohydrates for energy.

Magnesium deficiency is very common and may result in cardiovascular disease, glucose intolerance or frank diabetes, fatigue, hypertension, muscle cramping, vascular spasms, insomnia, irritability, migraine, osteoporosis, premenstrual syndrome, or kidney stones. Average daily American intakes of magnesium have declined from 408 mg in 1910 to 329 mg in men, 207 mg in women, and 193 mg in children in 1985. Chronically fatigued people should try to get about 400 to 600 mg daily.

Iron

Iron is necessary for normal blood cell formation and function and deficiency results in anemia, fatigue, decreased immune function, and learning problems. Iron competes with other minerals for absorption and excess iron is stored rather than excreted. The average daily intake of iron among Americans is 10.7 mg. Men and non-menstruating women should try to get about 10 mg daily, while menstruating women should try to get about 15 to 20 mg daily.

Zinc

Zinc is important in carbohydrate and hormone metabolism, cell growth and protection, and in immune function.. Zinc intake and absorption decrease with age. The average North American adult diet furnishes 10 to 15 mg of zinc daily, but the elderly consume only 7 to 10 mg daily. Chronically fatigued adults should try to get 15 to 30 mg daily.

Chromium

Chromium is a trace mineral necessary for normal carbohydrate and fat metabolism, and most people's diets are deficient in chromium. Factors that increase the need for chromium include high intake of simple sugars, diabetes, strenuous exercise, and physical trauma. Chromium deficiency can change how effectively the body responds to simple carbohydrates in the diet as well as affect blood sugar and blood lipid levels. Chronically fatigued adults should try to get 50 to 200 micrograms daily.

Selenium

Selenium does not play a major role in bodily energy production, but it is of major importance as an antioxidant, particularly in regards to thyroid function. Selenium may be of benefit in rheumatoid arthritis, heavy metal toxicity, asthma, and the prevention of heart disease and some cancers. Individual daily intakes vary greatly, according to local soil content and supplementation, but the American average is approximately 108 micrograms. Chronically fatigued adults should try to get about 70 to 200 micrograms daily.

Iodine

Iodine is required for thyroid hormone production and balance, and aids detoxification functions. Though iodine is added to many table salts, the incidence of deficiency is creeping up again, and symptoms can include goiter, fatigue, constipation, weight gain, edema, recurrent infections, and depression. Chronically fatigued adults should try to get 100 to 200 micrograms daily.

Vanadium

Vanadium is a trace mineral that supports glucose metabolism. Daily dietary intakes range from 10 to 100 micrograms, and the bodily pool is estimated at between 100 and 200 micrograms. Chronically fatigued adults should try to get 10 to 50 micrograms daily. Some dietary sources include grains, seeds, olive oil, soy, green beans, carrots, cabbage, garlic, beer, and wine.

L-Carnitine

L-carnitine is an amine that is conditionally essential in humans. In addition to dietary intake (an average of 100-300 mg daily, primarily from animal foods), l-carnitine is produced within the body from lysine with methionine, vitamins B3, B6, and C, and iron. L-carnitine is necessary for transporting fatty fuels into the mitochondria, assists in removing waste products of energy production, and may also play a role in blood sugar and blood lipid levels.

Factors that increase the need for l-carnitine include a high level of physical activity or metabolic stress, a high-fat diet, and some anticonvulsant drugs. L-carnitine deficiency can impair lipid metabolism and result in fatty accumulation in muscle tissues and vital organs, especially the heart. Chronically fatigued adults should try to consume about 1 to 3 grams daily. Dietary sources include meat and dairy products.

Coenzyme Q10

Coenzyme Q10 (CoQ10) is a fat-soluble substance that strongly supports mitochondrial function and may also have antioxidant properties. CoQ10 is found in many foods (including meats, fish, beans, spinach, and nuts), but production of CoQ10 by the body (which requires amino acids, B vitamins, and trace minerals) may be necessary for adequate body levels. The average daily dietary intake is about 2 to 5 mg.

Substances that increase the need for CoQ10 include iron, adriamycin, zidovudine, lovastatin, simvastatin, pravastatin, mercury, high intake of dietary fats, organic solvents, and alcohol. CoQ10 mitigates the cardiotoxic effects of many drugs, and supplementation and is therefore a prime consideration for those taking statin drugs, beta-blockers, quinone antibiotics, and some psychotropic drugs, all of which interfere with CoQ10 metabolism. Chronically fatigued adults should try to consume about 50 to 200 mg daily.

The most important dietary excesses to keep in mind are:

• High-glycemic index carbohydrate-containing foods, such as sweets, pastries, soft drinks, and candy (please refer to Carbohydrate-containing foods section above for further detail)
• Stimulants, such as coffee, espresso, caffeinated soft drinks, black tea (and, to a lesser degree, green tea and chocolate) (please refer to Stimulants and alcohol section above for further detail)
• Non-essential fats, which include almost anything you may recognize as fat (please refer to Fat-containing foods and Essential fats sections above for further detail)

Other nutrient excesses are much less prevalent among those with chronic fatigue, but may include:

• Iron (particularly if you are a man or a non-menstruating woman and if you eat red meats regularly or take a multivitamin that provides iron)
• Iodine (particularly if you consume very large amounts of sea vegetables or iodized salt)
• Nutrient excesses that might result from taking multiple dietary supplements (or taking too much of a dietary supplement) that provide the same nutrient

Those with fatigue may want to try the following eating plan:

1. After rising, a medium-to-light meal that includes a good source of protein, a small amount of essential fats, a light serving of low-glycemic index carbohydrates, and a beverage.

• EXAMPLE 1: steel-cut oatmeal with soymilk and a handful of pecans, and herbal chai tea.
• QUICK EXAMPLE 2: Blender smoothie with soymilk or soy beverage powder, fresh or frozen raspberries, cinnamon, and one-half of a banana, and herbal tea.

2. Mid-morning, a light snack of fresh fruit, nuts, and a beverage.

• EXAMPLE: whole almonds, dried apricots, and sparkling water.

3. Mid-day, a moderate meal that emphasizes a good source of protein but also provides a small amount of essential fats and a moderate serving of low-glycemic index carbohydrates, and a beverage.

• EXAMPLE 1: Miso soup, broiled fish, green salad with vinaigrette and walnuts, and decaffeinated green tea.
• QUICK EXAMPLE 2: Tuna salad sandwich with tomato and greens, and peppermint tea.

4. Mid-afternoon, if necessary, a light snack providing protein and carbohydrates, and a beverage.

• EXAMPLE: Hummus dip with whole-grain rye crackers and sparkling water.

5. Evening, a medium-light meal that emphasizes a good source of low-to-medium-glycemic index carbohydrates but also provides a small amount of essential fats, and a beverage.

• EXAMPLE 1: Baked yam topped with ginger, pine nuts, and flaxseed oil, and herbal tea.
• QUICK EXAMPLE 2: whole-grain pasta with stir-fried vegetables, garlic, spices, and avocado, and chamomile tea.

6. Later, if necessary, a very light snack of fruit or milk (or soymilk, etc.)

(Keep in mind that the EXAMPLES in this eating plan are just that - e.g., if you are sensitive to soy foods, substitute another wholesome food that you are not sensitive to.)

• Anderson R. Chromium metabolism and its role in disease processes in man. Clin Physiol Biochem. 1986;4:31-41. 1986.
• Anderson R. Chromium as an essential nutrient for humans. Regul Toxicol Pharmacol. 1997;26(1 Pt 2):S35-S41. 1997.
• Benbrik E, Chariot P, Bonavaud S, et al. Cellular and mitochondrial toxicity of zidovudine (AZT), didanosine (ddI) and zalcitabine (ddC) on cultured human muscle cells. J Neurol Sci. 1997;149(1):19-25. 1997.
• Bender DA. Optimum nutrition: thiamin, biotin and pantothenate. Proc Nutr Soc. 1999;58(2):427-433. 1999.
• Bland JS, Levin B, Liska D, et al. Clinical Nutrition: A Functional Approach. 1999 Institute for Functional Medicine, Gig Harbor, WA p.84 1999.
• Block G. Antioxidant intake in the US. Toxicol Ind Health. 1993;9(1-3):295-300. 1993.
• Blumberg J. Changing nutrient requirements in older adults. Nutrition Today. 1992;September/October:15-20. 1992.
• Brevetti G, Chiariello M, Ferulano G, et al. Increases in walking distance in patients with peripheral vascular disease treated with l-carnitine: a double-blind, cross-over study. Circulation. 1988;77:767-773. 1988.
• Broquist HP, Borum PR. Carnitine biosynthesis, nutritional implications. Adv Nutr Res. 1982;4:181-204. 1982.
• Broquist HP. Carnitine. In: Modern Nutrition in Health and Disease, 8th ed. Malvern, PA: Lea & Febiger; 1996:459-465. 1996.
• Burnet FM. A possible role of zinc in the pathology of dementia. Lancet. 1981;1(8213):186-188. 1981.
• Cacciatore L, Cerio R, Ciarimboli M, et al. The therapeutic effect of l-carnitine in patients with exercise-induced stable angina: a controlled study. Drugs Exp Clin Res. 1991;17(4):225-235. 1991.
• Carmel R. Cobalamin, the stomach, and aging. Am J Clin Nutr 1997 Oct 66(4):750-759 1997.
• Cerretelli P, Marconi C. L-carnitine supplementation in humans. The effects on physical performance. Int J Sports Med. 1990;11(1):1-14. 1990.
• Clark LC, Combs GF, Turnbull BW, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. JAMA. 1996;276:1957-1963. 1996.
• Crane FL, Sun IL, Sun EE. The essential functions of coenzyme Q. Clin Investig. 1993;71:S5-S59. 1993.
• Das UN. Essential fatty acid metabolism in patients with essential hypertension, diabetes mellitus and coronary heart disease. Prostaglandins Leukot Essent Fatty Acids. 1995;52(6):387-391. 1995.
• De Leeuw I, Vansant G, Van Gaal L. Magnesium and obesity: influence of gender, glucose tolerance, and body fat distribution on circulating magnesium concentrations. Magnes Res. 1992;5(2):183-187. 1992.
• De Palma A. Vitamins and Supplements. Rocklin, CA: Prima Publishing; 1999:32, 190. 1999.
• Diplock AT. Selenium, antioxidant nutritions, and human diseases. Biol Trac Elem Res. 1992;33:155-156. 1992.
• Erasmus U. Fats that Heal, Fats that Kill. Burnaby, British Columbia, Canada: Alive Books; 1993:21-22, 338-388. 1993.
• Folkers K, Langsjoen P, Langsjoen P. Nutrition and cardiac health. A deficiency of coenzyme Q10 is a dominant molecular cause of heart failure. Journal of Optimal Nutrition. 1993;2(4):264-274. 1993.
• Gaby AR. The role of coenzyme Q10 in clinical medicine: part II. Cardiovascular disease, hypertension, diabetes mellitus and infertility. Alt Med Rev. 1996;1(3):168-175. 1996.
• George GA, Heaton FW. Changes in cellular composition during magnesium deficiency. Biochem J. 1975;152(3):609-615. 1975.
• Goldfine A, Simonson D, Folli F, Patti M, Kahn R. Metabolic effects of sodium metavanadate in humans with insulin-dependent and noninsulin-dependent diabetes mellitus in vivo and in vitro studies. J Clin Endocrinol Metab. 1995;80:3311-3320. 1995.
• Grandi M, Pederzoli S, Sacchetti C. Effect of acute carnitine administration on glucose insulin metabolism in healthy subjects. Int J Clin Pharmacol Res. 1997;17(4):143-147. 1997.
• Heinle K, Adam A, Gradl M, Wiseman M, Adam O. Selenium concentration in erythrocytes of patients with rheumatoid arthritis. Clinical and laboratory chemistry infection markers during administration of selenium. Med Klin. 1997;92(Suppl 3):29-31. 1997.
• Herbert V, Bigaouette J. Call for endorsement of a petition to the Food and Drug Administration to always add vitamin B-12 to any folate fortification or supplement. Am J Clin Nutr. 1997;65:572-573. 1997.
• Hoffer A. The relationship of nicotinic acid to cholesterol metabolism. J Clin Exper Psychopath & Qtrly Rev Psychiat Neurol. 1961;22(3):165-179. 1961.
• Kallner A, Hartmann D, Hornig D. Steady-state turnover and body pool of ascorbic acid in man. Am J Clin Nutr. 1979;32:530-539. 1979.
• Levine M, Conry-Cantilena C, Wang Y, et al. Vitamin C pharmacokinetics in healthy volunteers: Evidence for a recommended dietary allowance. Proc Natl Acad Sci. 1996;93:3704-3709. 1996.
• Li M, Ma G, Boyages SC, Eastman CJ. Re-emergency of iodine deficiency in Australia. Asia Pac J Clin Nutr. 2001;10(3):200-203. 2001.
• Link G, Saada A, Pinson A, Konijn AM, Hershko C. Mitochondrial respiratory enzymes are a major target of iron toxicity in rat heart cells. J Lab Clin Med. 1998;131(5):466-474. 1998.
• Loop RA, Anthony M, Willis RA, Folkers K. Effects of ethanol, lovastatin and coenzyme Q10 treatment on antioxidants and TBA reactive material in liver of rats. Mol Aspects Med. 1994;15(Suppl):S195-S206. 1994.
• Manuel y Keenoy B, Moorkens G, Vertommen J, Noe M, Neve J, De Leeuw I. Magnesium status and parameters of the oxidant-antioxidant balance in patients with chronic fatigue: effects of supplementation with magnesium. J Am Coll Nutr. 2000;19(3):374-382. 2000. PMID:10872900.
• McCarty MF. Complementary measures for promoting insulin sensitivity in skeletal muscle. Med Hypotheses. 1998;51(6):451-464. 1998.
• Murray M. Encyclopedia of Nutritional Supplements. Prima Publishing 1996 1996.
• National Research Council. Recommended Dietary Allowances, 10th ed. Washington, DC: National Academy Press; 1989. 1989.
• Paolisso G, Barbagallo M. Hypertension, diabetes mellitus, and insulin resistance. Am J Hypertens. 1997;10:346-355. 1997.
• Paolisso G, D'Amore A, et al. Pharmacologic doses of vitamin E improve insulin action in healthy subjects and non-insulin-dependent diabetic patients. Am J Clin Nutr. 1993;57:650-656. 1993.
• Plioplys AV, Plioplys S. Amantadine and l-carnitine treatment of chronic fatigue syndrome. Neuropsychobiology. 1997;35:16-23. 1997.
• Rosolova H, Mayer O, Reaven G. Effect of variations in plasma magnesium concentration on resistance to insulin-mediated glucose disposal in nondiabetic subjects. J Clin Endocrinol Metab. 1997;82:3783-3785. 1997.
• Rudin DO. The major psychoses and neuroses as omega-3 essential fatty acid deficiency syndrome: substrate pellagra. Biol Psychiatry. 1981;16(9): 837-850. 1981.
• Salonen JT, Salonen R, Lappetelainen R, Maenpaa PH, Alfthan G, Puska P. Risk of cancer in relation to serum concentrations of selenium and vitamins A and E: matched case-control analysis of prospective data. Br Med J. 1985;290:417-420. 1985.
• Schmidt MA, Bland JS. Thyroid gland as sentinel: interface between internal and external environment. Altern Ther. 1997;3(1):78-81. 1997.
• Schwille PO, Schmiedl A, Herrmann U, Wipplinger J. Postprandial hyperinsulinaemia, insulin resistance and inappropriately high phosphaturia are features of younger males with idiopathic calcium urolithiasis: attenuation by ascorbic acid supplementatio. Urol Res. 1997;25(1):49-58. 1997.
• Sher L. Role of thyroid hormones in the effects of selenium on mood, behavior, and cognitive function. Med Hypotheses. 2001;57(4):480-483. 2001.
• Stabler SP, Lindenbaum J, Allen RH. Vitamin B-12 deficiency in the elderly: current dilemmas. Am J Clin Nutr. 1997;66:741-749. 1997.
• Stoll BA. Essential fatty acids, insulin resistance, and breast cancer risk. Nutr Cancer. 1998;31(1):72-77. 1998.
• Vinogradov V, Vodoyevich V, Rozhko A, Vinogradov S. Concept of the noncoenzymatic thiamine effect. Med Hypotheses. 1997;49:487-495. 1997.
• Vitti P, Rago T, Aghini-Lombardi F, Pinchera A. Iodine deficiency disorders in Europe. Public Health Nutr. 2001;4(2B):529-535. 2001.
• Werbach MR. Nutritional Influences on Illness. New Canaan, CT: Keats Publishing;1988. 1988.
• Werbach MR. Nutritional strategies for treating chronic fatigue syndrome. Altern Med Rev. 2000;5(2):93-108. 2000.
• Winters LR, Toon JS, Kalkwarf HJ, et al. Riboflavin requirements and exercise adaptation in older women. Am J Clin Nutr. 1992;56(3):526-532. 1992.