This article is for informational purposes only. None of the information here should be taken as medical advice. If you are struggling with fatigue, seek medical help.
Stress and fatigue are closely and reciprocally linked, meaning they often co-occur and can influence each other. Stressful life events can cause not only PTSD, but also chronic fatigue syndrome. Similarly, occupational exposure to traumatic events of others (e.g., by healthcare workers) causes physical and mental fatigue, and may reduce empathy [1, 2, 3, 4, 5].
Cognitive-behavioral therapy (CBT) for stress management has been reported to reduce fatigue from chronic fatigue syndrome, fibromyalgia, and multiple sclerosis in several studies. Similarly, its combination with mindfulness meditation (mindfulness-based stress reduction) may help with fatigue from fibromyalgia and cancer [6, 7, 8, 9, 10].
Relaxation therapy with breathing practices and muscle relaxation exercises has also been reported to help with fatigue from conditions such as chronic fatigue syndrome, multiple sclerosis, cancer, heart failure, and stem cell transplantation. However, CBT was more effective in those studies that compared both treatments [11, 12, 13, 14, 15, 16, 17, 18, 19].
Sleep is essential for optimal health. Failing to get enough quality sleep is associated with fatigue among many other health issues. People who perform shift or night work (such as healthcare professionals) are at increased risk of sleep disturbances and fatigue [20, 21, 22, 23, 24].
Sleep disturbances are frequent in people with chronic fatigue syndrome, cancer, multiple sclerosis, IBD, and allergic rhinitis, and can further worsen fatigue associated with these conditions [25, 26, 27, 28, 29].
Some clinical research suggests that therapy for sleep disturbances may improve fatigue from some of these conditions (such as cancer and multiple sclerosis). In turn, CBT for chronic fatigue syndrome has been inconsistently suggested to improve sleep quality [30, 31, 32].
A sedentary lifestyle is a common cause of persistent fatigue. Several studies have reported that practicing more exercise may reduce fatigue in healthy people. Paradoxically, being ‘too tired’ was the most common excuse for not exercising in a study on middle-aged and elderly people [33, 34, 35, 36].
People with chronic fatigue syndrome are at especially high risk of not meeting physical activity requirements. In people with this condition, engaging in regular physical exercise may help reduce fatigue — even more than in healthy controls according to one meta-analysis [37, 38, 39].
Multiple studies have reported that exercise may help with fatigue from other conditions such as multiple sclerosis, cancer, rheumatoid arthritis, COPD, lupus, ALS, fibromyalgia, muscle disease, and heart failure [40, 41, 42, 43, 44, 45, 46, 47, 48].
However, over-exercising can lead to fatigue and several health issues. Experts recommend moderate exercise such as brisk walking, swimming, or cycling.
This practice has been most widely investigated regarding fatigue from multiple sclerosis and breast cancer. The most recent meta-analyses concluded that yoga may be effective as an add-on to conventional therapies [67, 68].
Yoga has also been reported to help with fatigue from chronic fatigue syndrome, fibromyalgia, Parkinson’s disease, depression, low-back pain, IBS, COPD, end-stage kidney disease, HIV, and arthritis in a few preliminary trials [69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79].
A handful of clinical trials found massage effective at reducing post-exercise localized muscle fatigue and soreness. However, cold water immersion seems to be more effective for generalized fatigue [80, 81, 82, 83, 84, 85, 86].
A meta-analysis concluded that massage, especially myofascial release, may reduce fatigue from fibromyalgia. In a clinical trial on women with this condition, massage was more effective when combined with physical exercise [88, 89].
Although another meta-analysis found massage interventions effective at reducing fatigue from breast cancer, a Cochrane review concluded that there was insufficient evidence to support massage for cancer-related fatigue due to the low quality and small size of most studies [90, 91].
More limited evidence suggests that massage may also help with fatigue from chronic fatigue syndrome, rheumatoid arthritis, multiple sclerosis, low-back pain, hemodialysis, spinal cord injury, bone marrow transplantation, and Parkinson’s disease [92, 93, 94, 95, 96, 97, 98, 99, 100].
Multiple studies found cold water immersion prior to exercise effective at increasing performance. During exercise, only external cooling (e.g., by wearing cooling garments) may reduce fatigue from anaerobic exercise, while both external and internal cooling (e.g., by ingesting cold beverages) seem to improve aerobic performance [101, 102, 103].
Similarly, cold exposure after exercise has been suggested to reduce fatigue perception after 48-72 hours in multiple trials. Whole-body immersion in cold water seems more effective than cryotherapy [104, 105, 106, 107, 108].
A healthy exposure to sunlight, which provides 50-90% of our vitamin D requirements, is the best way of replenishing this vitamin. In addition, you can eat food sources of this vitamin (such as fatty fish, liver, egg yolks, and dairy) or take supplements .
Acupuncture has been mainly applied to fatigue from chronic fatigue syndrome, cancer (especially breast cancer), and fibromyalgia. Meta-analyses concluded that it may be effective but warned about the low quality of most studies [114, 115, 116].
More limited evidence suggests that acupuncture may also help with fatigue from conditions such as insomnia, Parkinson’s disease, multiple sclerosis, osteoarthritis, and end-stage kidney disease [117, 118, 119, 120, 121, 122, 123, 124].
Several trials report that tai chi may reduce fatigue, especially from cancer, fibromyalgia, and COPD. However, meta-analyses usually pointed to the low quality, small size, and short follow-up period of most studies [125, 126, 127, 128, 129, 130, 131].
Reflexology has also been reported to help with fatigue from cancer and chemotherapy, hemodialysis, rheumatoid arthritis, multiple sclerosis, and acute coronary syndrome in preliminary clinical trials [134, 135, 136, 96, 137, 93, 138, 139, 140].
Aromatherapy with lavender essential oil reduced fatigue and anxiety caused by hemodialysis in some but not all clinical trials. The scent of lavender also reduced fatigue in healthy people challenged with an anxiety-provoking task [141, 142, 143, 144, 145].
Calories measure the amount of energy supplied by food, which the body uses to sustain its functions. Multiple studies show that severe calorie restriction may result in not only weight loss, but also mental and physical fatigue. Importantly, a very reduced food intake increases the risk of nutrient deficiencies [149, 150, 151, 152, 153].
The average adult needs 2,000 calories per day, which can widely vary depending on age, gender, or physical activity. One estimate suggests that 15- to 18-year-old men need about 3,000 calories a day. Eating less than 1,200 calories can cause a metabolic slowdown that may result in fatigue [154, 155].
Interestingly, a study on weightlifters found that low-calorie diets caused less fatigue, stress, and dissatisfaction when their protein content was high .
When caffeine delays fatigue, the body’s muscles can contract more forcefully and allow people to exercise longer. Aerobic exercise such as running, jogging, cardio workout, swimming, and biking can benefit the most from increased training volume [158, 159].
Caffeine may also improve alertness while reducing mental fatigue, especially in sleep-deprived people. Several studies report reduced fatigue from mentally-demanding tasks after taking caffeine-containing beverages. However, frequent users seem to develop tolerance to the effects of caffeine [160, 161, 162, 163, 164, 165, 166].
The digestion of dietary carbohydrates causes a spike in blood glucose, followed by a drastic fall due to insulin production. This effect is particularly high and fast when eating foods such as sugar-sweetened drinks, baked goods, candy, white bread, and rice. Several studies have associated their frequent consumption with mental and physical fatigue [169, 170, 171, 172].
One of the most common causes of fatigue is iron deficiency. Most of the iron in the body is found in hemoglobin, where it helps to carry oxygen to cells for energy production. Iron is also needed for oxygen storage in the muscles, brain function, and immune system development and response [173, 174, 175, 176].
Vitamin B12 is needed to make red blood cells, making it a crucial nutrient for energy production. Its deficiency causes megaloblastic anemia, a condition characterized by fewer and larger blood cells and whose main symptom is fatigue [181, 182, 183, 184, 185].
Vitamin B12 deficiency often takes years to develop, as the body is able to store large amounts in the liver. However, vegans, pregnant women, elderly people, and those with gut issues are at a higher risk [186, 187].
Vitamin B9 (folate) is another nutrient required to make red blood cells. Its deficiency causes megaloblastic anemia, a condition characterized by fewer and larger blood cells and whose main symptom is fatigue. A study found that chronic fatigue syndrome can be linked to low blood vitamin B9 levels [190, 191, 192, 193].
Folate deficiency is rare but can happen in people not eating enough fruits and vegetables. Alcoholics and lactating mothers also have an increased risk of this deficiency .
The name folate comes from the Latin word ‘folium’ meaning ‘leaf’, since it is mainly found in green leafy vegetables such as spinaches, broccoli, cabbage, and kale. Other dietary sources of folate include citrus fruit juices, legumes, and liver .
Ingestion of blackcurrant juice reduced physical and mental fatigue in healthy volunteers. Similarly, blackcurrant anthocyanins reduced shoulder fatigue and stiffness from typing in a small trial [196, 197, 198].
In cyclists, blackcurrant fruit powder reduced blood lactate buildup during exercise and improved cardiovascular function at rest. In climbers, blackcurrant extract increased hanging and total climbing times [199, 200].
If you suspect that your low energy levels may be due to intolerance to certain foods, consider working with an allergist or dietitian to test for food sensitivities. They will prescribe an elimination diet to help identify the cause of intolerance, followed by avoidance of the problematic food.
Creatine may also improve cognitive function and reduce mental fatigue. It had these effects in people challenged with mentally-fatiguing tasks and sleep deprivation, as well as in vegetarians (whose diet lacks the main food sources of this compound). In a study on elderly people, supplementation with creatine helped revert cognitive decline [212, 215, 216, 217, 218].
Daily supplementation with coenzyme Q10 has also been reported to improve fatigue and other symptoms in people suffering from fibromyalgia, multiple sclerosis, muscle wasting, and bipolar disorder [221, 222, 223, 224, 225, 226, 227, 228, 229].
In people with chronic fatigue syndrome, supplementation with L-carnitine for 2 weeks improved the symptoms and was well tolerated. Its derived compounds acetyl-L-carnitine and propionyl-L-carnitine were also effective for mental and general fatigue, respectively [232, 233].
A few trials found L-carnitine effective at improving fatigue from conditions such as fibromyalgia, hypothyroidism, and hepatic encephalopathy, dialysis-associated anemia, and medication for kidney cancer and hepatitis C [238, 239, 240, 241, 242, 243, 244].
Although L-carnitine has been widely investigated for fatigue from multiple sclerosis and cancer with mixed results, two meta-analyses concluded that it has little or no effectiveness in both cases [245, 246].
Taurine is an amino acid found in almost all body tissues and required for the normal functioning of the muscles. Taurine supplementation can be used to restore taurine levels in the muscle that are decreased after exercise [252, 253, 254].
Taurine supplementation reduced fatigue and improved physical performance in patients with heart failure and team-sport players doing a sprint cycling exercise. However, it was ineffective in another study on triathletes [255, 256, 257].
In multiple studies, both oral and infused N-acetylcysteine (NAC) given before exercise reduced post-exercise muscle fatigue, oxidative stress, and inflammation [263, 264, 265, 266, 267, 268, 269, 270, 264].
Guarana has been used as a stimulant for centuries by indigenous people of the Amazon and is often included in high-energy drinks for its potential energy-boosting effects and high levels of caffeine .
A multivitamin and mineral complex with guarana reduced perceived physical fatigue after a moderate-intensity run and mental fatigue after sustained mental effort. Similarly, a mouth rinse with guarana improved cognitive performance during physical exercise [282, 283, 284].
In several preliminary trials, supplementation with this coenzyme or its reduced form NADH helped reduce fatigue from exercise and chronic fatigue syndrome. The treatment was more effective when combining NADH and coenzyme Q10 [298, 299, 300, 301, 230, 231].
Beta-alanine delayed fatigue (by up to 36.5%) in multiple studies on people of all ages, possibly by reducing acid buildup during high-intensity anaerobic exercise [302, 303, 304, 305, 306, 307, 308, 309].
However, it’s important to note that its safety has been insufficiently examined. Moreover, high levels of this compound have been measured in the urine of people with chronic fatigue syndrome. Whether this means that high blood levels of beta-alanine (e.g., from supplementing) can cause chronic fatigue syndrome remains unproven [310, 311].
In a study on male athletes, eleuthero increased the amount of time each athlete could maintain an effort by 23%, as well as improving maximum heart rate (a measure of exercise intensity), glycogen sparing (shifting energy use from carbs to fats), and blood flow to the muscles (which speeds up recovery) .
In a clinical trial of teenage athletes, melatonin administration after late-evening exercise improved perceived fatigue, sleep quality, cognitive performance, and wellbeing .
Melatonin only reduced fatigue in cancer patients with sleeping problems. Similarly, it helped reduce both fatigue and sleep disturbances in people with traumatic brain injury or undergoing surgical procedures [325, 326, 327, 328, 329, 330, 331].
Supplementation with the branched-chain amino acids leucine, isoleucine, and valine may be better than rest alone for recovery after exercise due to their ability to reduce muscle soreness, damage, and perceived fatigue [332, 333].
However, their excess may cause fatigue by increasing ammonia production .
In 3 small clinical trials, supplementation with spirulina reduced physical and mental fatigue, and oxidative damage caused by exercise. In overweight and obese people, spirulina reduced time to fatigue during a physical exercise program, body fat, and blood lactate buildup [345, 346, 347, 348].
However, spirulina was ineffective in 4 preliminary trials on people with chronic fatigue syndrome .
An oral astragalus supplement improved fatigue, cognitive function, and quality of life in a clinical trial of people recovering from a stroke. In a preliminary study of advanced cancer patients, infused astragalus extract helped relieve fatigue [350, 351].
A multi-herbal Chinese formulation with astragalus increased physical endurance and reduced recovery time in athletes .
An oral formulation containing a compound isolated from andrographis increased swimming time to exhaustion in rats .
A commercial oak wood extract (Robuvit) increased physical and mental energy in healthy adults and elderly people. In triathlon athletes, it improved athletic performance and sped up recovery [358, 359, 360, 361].
This product also improved fatigue from chronic fatigue syndrome, mood disorders, flu convalescence, burnout syndrome, hangover, and heart failure in a handful of preliminary clinical trials [362, 363, 364, 365, 366, 367].
D-ribose has also been reported to improve physical and mental fatigue in elderly people .
Similarly, reishi spore powder decreased fatigue, anxiety, depression, and immune markers while improving the subjective well-being of women with breast cancer .
American ginseng improved cancer-related fatigue in 2 preliminary trials of patients with all types of cancer (except brain tumors and brain lymphoma). However, it was ineffective in another trial on head and neck cancer survivors [372, 373, 374].
In a clinical trial of people with occupational stress-related anxiety and fatigue, a highly bioavailable combination of curcumin and fenugreek fiber improved the symptoms better than a standard curcumin formulation .
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