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Tired all the time?

Tiredness and fatigue. What might be causing it? Joanne Hart, Registered Nutritional Therapist, BSc(Hons) & yoga teacher (BWY Dip).

Tiredness or Fatigue

A lot of people come to see me for nutrition advice and mention tiredness or fatigue as a problem for them. It might be their main problem or come alongside some other issues. We tend to describe tiredness as a normal part of life that is relieved by sleep, whereas fatigue is an ongoing issue. Fatigue also describes symptoms with chronic fatigue syndrome (CFS) and fibromyalgia, or post viral fatigue.

It can be useful to monitor when you are feeling tired or fatigued and then use this in conversation with me in a consultation. For example are you waking up tired, is it an afternoon or early evening dip or a constant fatigue every day? Then we can start to look at the underlying issues and create an action plan for you. To help you along the way I’m going to give you some information about how we create energy in this article and which nutrients are involved.

This doesn’t replace medical advice. If you are on medication or have a health condition then we need to take that into account during the consultation and you are advised to consult your GP before you change your diet or take supplements.

How do we create energy?

We create energy from food. The food that we eat is broken down into raw materials for energy by passing through our digestive system and then into our cells where we produce energy in the mitochondria. That immediately gives us three areas to consider (1) Amount of food, (2) Type of macronutrients e.g. carbohydrates and (3) What we need to produce energy in the mitochondria.

Amount of food

We all have a BMR or Basal Metabolic Rate, this is the amount of calories we need to just breathe, then we have a level of activity called a PAL or Physical Activity Level (a number you can find online). We multiply the two together and get an EAR which is Estimated Average Requirement of daily calories. If we do not eat enough then we are more likely to be tired. If you’re on a plan at the gym or using your App which has calculated your EAR then this is your starting point to check out. Are you eating enough? You will probably have heard of calorie deficit at the gym and it could be planned for weight loss, or it might be unintentional. Read on.

Unintentional calorie deficit or malabsorption

You may be eating the best diet in the world but your digestion might not be working optimally and so you do not get the benefit from the nutrients in your food. Think of stressed people, eating on the go, endurance athletes, people with inflammation, and digestive conditions such as Crohn’s disease and ulcerative colitis where the gut lining isn’t absorbing well or producing the chemicals needed. In some of the health conditions fat absorption is a problem and given that a g of fat is 9 calories that could be a lot that someone is missing out on.

In a stressed person eating on the go, the body probably isn’t producing the digestive enzymes and stomach acid to break down the food properly, you might have bloating too.

In the sports world we also need to look out for RED-S (Relative Energy Deficiency Syndrome) when athletes aren’t eating enough food for the amount of exercise they are doing. Yes they might be training and competing well but in the long term it will catch up. In terms of tiredness, it would seem more likely that these athletes are going to get overtraining syndrome too. That’s different to just training, achieving and recovering. It is more likely a few months’ of recovery and is a form of fatigue.

Energy is created in our cells

We create energy in out mitochondria which are found in our cells. Glucose for example (from carbs) is moved into the mitochondria by using insulin. This is then processed through something called the electron transport chain which is the final part of respiration. Key nutrients in this process include magnesium, carnitine and CoQ10. Certain medications impair the absorption of nutrients such as magnesium and CoQ10, the food we eat is not as rich in magnesium as it was in years gone by and we all have uniqueness that means some of have enzymes that are just better or worse at some processes in our bodies. Some of us need more fine tuning!

The process through the electron transport chain produces a chemical called ATP this is our energy currency. Energy is stored here in a double bond, there are three phosphate chemicals. When these bonds are broken we get an energy release.

What might go wrong?

Iron deficiency can be a problem for many women. About 70% is found in the red blood cells called haemoglobin. This transfers oxygen in our blood and we need oxygen to produce energy from cellular respiration. One sign of iron deficiency or anaemia is fatigue.

Another key nutrient involved with energy production is B12. It is mainly found in animal products so a vegan diet will probably need some attention on B12. People with digestive issues and that doesn’t just mean diagnosed issues, may need input because the digestive system provides stomach acid which is involved with part of the B12 process, as well as parietal cells that produce a chemical called intrinsic factor which is needed for B12 absorption. Signs of B12 deficiency can include a sore tongue.

In the cases of conditions such as CFS and fibromyalgia it is though that there may be some dysfunction with how the mitochondria works, and abnormal processing of the nervous system. Triggers may be unknown but may be linked to bacteria or viral infections, stress and inflammation.

Stress can be a factor for tiredness too, waking up tired or just not having motivation are common signs. Do you recognise this? After a period of running on adrenaline, life can catch up. The raw materials needed for the stress hormone are ones that are linked to energy production. B vitamins, magnesium, vitamin C (helps absorb iron from plant sources, and a minor affect on iron absorption from animal sources).

Anxiety and other mental health conditions may also cause tiredness because again you’re using up nutrients to deal with this and diverting them away from energy production. Getting your sleep tip-top could be a good starting point as that can help with resilience for the next day. That might require some food or supplement input too, magnesium for example supports GABA which is our relaxing neurotransmitter.

Post viral fatigue is not an uncommon issue in the complementary health area and a nutritional therapist might be a valuable ally in moving forward here. A good tailored diet, specific supplements for energy and inflammation may be useful.

What now?

This just touches the surface of what is needed to produce energy. If you want to understand what your underlying issues are, are a bit tired or really tired and need some help navigating this then get in touch and get some help. I'd love to help you!



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