Fatigue and exhaustion are often used interchangeably, but there can be slight differences in their meanings:
Fatigue typically refers to a general feeling of tiredness, lack of energy, or weariness. It can be physical, mental, or both. Fatigue can be caused by various factors such as lack of sleep, overexertion, stress, or certain medical conditions.
Exhaustion, on the other hand, implies a more extreme state of depletion and complete lack of energy or strength. It often results from prolonged or intense physical or mental exertion, chronic stress, or a combination of factors. Exhaustion may lead to a state of extreme fatigue where even simple tasks become challenging. Put simply, fatigue is a general feeling of tiredness, while exhaustion represents a more severe and complete state of depletion.
Fatigue can have numerous potential causes, which can be simplified into three main categories:
Lifestyle factors: These encompass inadequate sleep, excessive physical or mental exertion, poor diet, lack of physical activity, and chronic stress.
Physical health conditions: Certain medical conditions such as anaemia, thyroid disorders, chronic pain, infections, hormonal imbalances, and respiratory or cardiovascular issues can contribute to fatigue.
Mental health issues: Conditions like depression, anxiety, chronic stress, and sleep disorders can result in persistent fatigue and low energy levels[i].
Naturopathic approach to fatigue and exhaustion:
From a naturopathic perspective, fatigue can be attributed to factors such as nutritional deficiencies, adrenal dysfunction due to chronic stress, gut health issues, hormonal imbalances, and detoxification impairments. Naturopathic approaches involve addressing these underlying causes through dietary changes, herbal remedies, supplements, stress management, and lifestyle modifications. Consulting a qualified naturopathic nutritionist other professional under other naturopathic specialisms can provide more unique guidance for addressing fatigue as well promoting overall wellness on the whole[ii].
Medicinal mushrooms and adaptogenic herbs: Cordyceps has historically been used for its adaptogenic properties and may support endurance, healthy energy metabolism, exercise tolerance and oxygen utilisation[iii]. Rhodiola has significant adaptogenic properties and may support healthy energy metabolism and nerve function[iv]. One of the most researched of adaptogens, American Ginseng may help support healthy adrenal function and energy metabolism[v]. Holy Basil, rhodiola and ashwagandha have a similar effect[vi][vii] [viii]. Try: Terranova Cordyceps Rhodiola & Ginseng Super-Blend Powder (30g) or A Vogel Siberian Ginseng Eleutherococcus Drops (50ml) or Terranova Holy Basil 400mg (50 caps) or Viridian Ashwaghanda Extract - Organic (60 caps) or Pure Encapsulations Rhodiola Rosea
B Vitamins: B complex supplements can help reduce fatigue by supporting energy metabolism, aiding in the production of ATP (the body's energy currency), and playing a role in the synthesis of neurotransmitters involved in mood and energy regulation. Studies claim they are effective for fatigue if deficiency or sufficiency is the cause[ix]. Try: Cytoplan Nicotinamide Riboside (60 caps) and Terranova Vitamin B Complex with Vitamin C
Vitamin C: Vitamin C can help reduce fatigue by supporting the production of carnitine, a molecule involved in energy metabolism, and by acting as an antioxidant to protect against oxidative stress, which can contribute to fatigue[x]. Try: Pure Encapsulations Buffered Ascorbic Acid
Coenzymes: Ubiquinol, a reduced form of Coenzyme Q10, can help reduce fatigue by supporting cellular energy production and acting as a powerful antioxidant, thereby protecting against oxidative damage and improving overall energy levels[xi]. Try: Pure Encapsulations Ubiquinol-QH 100 MG (60 caps)
Malic Acid: Malic acid, a compound found in apples and other fruits and vegetables, is believed to have potential benefits for fatigue and exhaustion. It plays a crucial role in energy production by participating in the Krebs cycle, which converts nutrients into ATP, the body's energy currency. Malic acid also supports mitochondrial function, the cellular "powerhouses" responsible for ATP production. Studies have explored its use in conditions like fibromyalgia, where it may help reduce pain and fatigue. Additionally, malic acid supplementation has shown promise in improving exercise performance and reducing fatigue[xii]. Try: Viridian Malic Acid 550mg Veg Caps (90 Capsules)
de Mamiel Fatigue Fix: Fatigue Fix targets stress-induced dullness and dehydration which occurs when long-term elevated cortisol slows down cellular turnover and disrupts the protective skin barrier which in turn reduces the skin’s ability to retain moisture.
The Organic Pharmacy Liver & Kidney Drops 50ml: The Organic Pharmacy Liver & Kidney Drops are designed to support liver and kidney health through natural ingredients and detoxification. The liver is responsible for detoxifying harmful substances and metabolising nutrients, while the kidneys filter waste products from the blood. When liver and kidney function is compromised, toxins can accumulate in the body, leading to fatigue and other symptoms[xiii].
Exhaustion can have a significant impact on the adrenal glands. The adrenal glands produce hormones, including cortisol, which regulate the body's response to stress. Prolonged physical or mental exertion, chronic stress, and insufficient rest can lead to adrenal fatigue or exhaustion.
When the body is constantly under stress or experiences excessive fatigue, the adrenal glands may struggle to produce enough cortisol. This can result in decreased cortisol levels and disruption of the body's stress response system. Symptoms of adrenal exhaustion may include chronic fatigue, difficulty coping with stress, sleep disturbances, and hormonal imbalances[xiv].
Managing exhaustion and supporting adrenal health involves prioritising rest, adopting stress management techniques like meditation or deep breathing, ensuring sufficient sleep, maintaining a balanced diet, and incorporating adaptogenic herbs or supplements that support adrenal function.
Adrenal exhaustion is a complex condition, and it is advisable to consult with a healthcare professional, such as a naturopathic doctor or functional medicine practitioner, for personalised guidance and support in addressing adrenal health.
Diet plays a crucial role in managing fatigue and promoting overall energy levels.
Here are some ways a healthy diet can help combat fatigue:
Balanced macronutrients: Consuming a well-balanced diet that includes adequate amounts of carbohydrates, proteins, and healthy fats provides the body with the necessary fuel for energy production and helps prevent energy crashes[xv].
Iron-rich foods: Iron deficiency is a common cause of fatigue, especially in women. Including iron-rich foods such as lean meats, legumes, leafy greens, and fortified cereals can help combat fatigue associated with iron deficiency[xvi].
Complex carbohydrates: Choosing complex carbohydrates like whole grains, fruits, and vegetables over refined sugars and processed foods provides a steady release of energy and helps prevent blood sugar spikes and crashes[xvii].
Hydration: Dehydration can contribute to feelings of fatigue. Staying properly hydrated by drinking enough water throughout the day can help maintain energy levels[xviii].
B vitamins: B vitamins, such as B12 and folate, play a vital role in energy production. Including foods rich in B vitamins like leafy greens, legumes, whole grains, and fortified cereals can support energy metabolism[xix].
Omega-3 fatty acids: Foods rich in omega-3 fatty acids, such as fatty fish, flaxseeds, and walnuts, have anti-inflammatory properties and can support brain health and energy production.
Avoiding excessive caffeine and alcohol: While caffeine and alcohol may provide temporary energy or relaxation, excessive consumption[xx].
Functional testing can be helpful in identifying underlying factors contributing to exhaustion and fatigue:
Adrenal function testing: This can involve saliva or urine tests to assess cortisol levels throughout the day and evaluate adrenal gland function. It helps identify adrenal fatigue or dysfunction related to chronic stress[xxi]. Adrenal Stress Index
Hormonal imbalance testing: Hormone panels can evaluate levels of reproductive hormones, such as oestrogen and progesterone, as well as other hormones like testosterone or cortisol, to identify hormonal imbalances that may contribute to fatigue[xxiv]. Female Hormone Cycle Mapping
Gut health testing: Stool tests can assess gut microbiome composition, identify potential infections or imbalances, and evaluate digestive function, as poor gut health can contribute to fatigue[xxv]. Complete GastroIntestinal and Microbiome Test/ Food Sensitivity Test (Dietary Antigen Test)/ Coeliac & Gluten Sensitivity Panel
Inflammatory markers: Blood tests measuring markers of inflammation, such as C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), can help identify chronic inflammation that may be causing fatigue[xxvi].
Exhaustion and fatigue can be considered red flags medically when they persist or significantly impact daily functioning. While occasional tiredness is a normal part of life, persistent or chronic fatigue that persists for an extended period of time and does not improve with rest or sleep may indicate an underlying medical condition. Additionally, if fatigue is accompanied by other concerning symptoms such as unexplained weight loss, severe weakness, fever, or persistent pain, it should be evaluated by a healthcare professional.
Exhaustion and fatigue are often identified during medical evaluations when individuals seek help for these symptoms or during comprehensive health assessments. Healthcare providers ask questions about the onset, duration, severity of fatigue, associated symptoms, medical history, lifestyle factors, and triggers. This helps in identifying possible underlying causes and deciding on necessary tests or referrals to specialists, if required.
[i] Maisel P, Baum E, Donner-Banzhoff N. Fatigue as the Chief Complaint–Epidemiology, Causes, Diagnosis, and Treatment. Dtsch Arztebl Int. 2021 Aug 23;118(33-34):566-576.
[iii] Xiaoming Chai, Mengyue Pan, Jingjie Wang, Mingmei Feng, Yupeng Wang, Qi Zhang, Yang Sun, Cordycepin exhibits anti-fatigue effect via activating TIGAR/SIRT1/PGC-1α signaling pathway, Biochemical and Biophysical Research Communications, Vol 637 2022 127-135.
[v] Arring NM, Millstine D, Marks LA, Nail LM. Ginseng as a Treatment for Fatigue: A Systematic Review. J Altern Complement Med. 2018 Jul;24(7):624-633. doi: 10.1089/acm.2017.0361. Epub 2018 Apr 6. PMID: 29624410.
[vi] Lopresti AL, Drummond PD, Smith SJ. A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha ( Withania somnifera) in Aging, Overweight Males. Am J Mens Health. 2019 Mar-Apr;13(2):1557988319835985. doi: 10.1177/1557988319835985.
[vii] Lopresti AL, Smith SJ, Metse AP, Drummond PD. A randomized, double-blind, placebo-controlled trial investigating the effects of an Ocimum tenuiflorum (Holy Basil) extract (HolixerTM) on stress, mood, and sleep in adults experiencing stress. Front Nutr. 2022 Sep 2;9:965130.
[viii] Lekomtseva Y, Zhukova I, Wacker A. Rhodiola rosea in Subjects with Prolonged or Chronic Fatigue Symptoms: Results of an Open-Label Clinical Trial. Complement Med Res. 2017;24(1):46-52. doi: 10.1159/000457918. Epub 2017 Feb 17. PMID: 28219059.
[ix] Yin Bin Chen, Yu Fang Wang, Wei Hou, Ying Ping Wang, Sheng Yuan Xiao, Yang Yang Fu, Jia Wang, Si Wen Zheng, Pei He Zheng, Effect of B-complex vitamins on the antifatigue activity and bioavailability of ginsenoside Re after oral administration, Journal of Ginseng Research, Volume 41, Issue 2, 2017
[x] Sim, M., Hong, S., Jung, S. et al. Vitamin C supplementation promotes mental vitality in healthy young adults: results from a cross-sectional analysis and a randomized, double-blind, placebo-controlled trial. Eur J Nutr 61, 447–459 (2022). https://doi.org/10.1007/s00394...
[xi] Tsai IC, Hsu CW, Chang CH, Tseng PT, Chang KV. Effectiveness of Coenzyme Q10 Supplementation for Reducing Fatigue: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Pharmacol. 2022 Aug 24;13:883251.
[xii] Ferreira I, Ortigoza Á, Moore P. Magnesium and malic acid supplement for fibromyalgia. Medwave. 2019 May 28;19(4):e7633. Spanish, English.
[xiii] Swain MG. Fatigue in liver disease: pathophysiology and clinical management. Can J Gastroenterol. 2006 Mar;20(3):181-8.
[xiv] James L. Wilson, Clinical perspective on stress, cortisol and adrenal fatigue,Advances in Integrative Medicine,Volume 1, Issue 2, 2014, Pages 93-96.
[xv] Melaku YA, Reynolds AC, Gill TK, Appleton S, Adams R. Association between Macronutrient Intake and Excessive Daytime Sleepiness: An Iso-Caloric Substitution Analysis from the North West Adelaide Health Study. Nutrients. 2019 Oct 5;11(10):2374.
[xvi] Piskin E, Cianciosi D, Gulec S, Tomas M, Capanoglu E. Iron Absorption: Factors, Limitations, and Improvement Methods. ACS Omega. 2022 Jun 10;7(24):20441-20456.
[xvii] Fritschi C, Park C, Quinn L, Collins EG. Real-Time Associations Between Glucose Levels and Fatigue in Type 2 Diabetes: Sex and Time Effects. Biol Res Nurs. 2020 Apr;22(2):197-204.
[xviii] Liska D, Mah E, Brisbois T, Barrios PL, Baker LB, Spriet LL. Narrative Review of Hydration and Selected Health Outcomes in the General Population. Nutrients. 2019 Jan 1;11(1):70.
[xix] Tardy AL, Pouteau E, Marquez D, Yilmaz C, Scholey A. Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence. Nutrients. 2020 Jan 16;12(1):228.
[xx] Maes M, Mihaylova I, Leunis JC. In chronic fatigue syndrome, the decreased levels of omega-3 poly-unsaturated fatty acids are related to lowered serum zinc and defects in T cell activation. Neuro Endocrinol Lett. 2005 Dec;26(6):745-51.
[xxi] James L. Wilson, Clinical perspective on stress, cortisol and adrenal fatigue,Advances in Integrative Medicine, Volume 1, Issue 2, 2014, Pages 93-96.
[xxii] Azzolino D, Arosio B, Marzetti E, Calvani R, Cesari M. Nutritional Status as a Mediator of Fatigue and Its Underlying Mechanisms in Older People. Nutrients. 2020 Feb 10;12(2):444.
[xxiii] Fischer S, Markert C, Strahler J, Doerr JM, Skoluda N, Kappert M, Nater UM. Thyroid Functioning and Fatigue in Women With Functional Somatic Syndromes - Role of Early Life Adversity. Front Physiol. 2018 May 23;9:564.
[xxiv] VandeVord PJ, Sajja VS, Ereifej E, Hermundstad A, Mao S, Hadden TJ. Chronic Hormonal Imbalance and Adipose Redistribution Is Associated with Hypothalamic Neuropathology following Blast Exposure. J Neurotrauma. 2016 Jan 1;33(1):82-8.
[xxv] Guo, et al. Deficient butyrate-producing capacity in the gut microbiome is associated with bacterial network disturbances and fatigue symptoms in ME/CFS. Cell Host & Microbe, February 8, 2023.
[xxvi] Karshikoff B, Sundelin T, Lasselin J. Role of Inflammation in Human Fatigue: Relevance of Multidimensional Assessments and Potential Neuronal Mechanisms. Front Immunol. 2017 Jan 20;8:21
Please note that the information contained within this website does not and should not replace medical advice, and is not intended to treat or diagnose. We always recommend you consult with your doctor. Our Nutritional Therapy team is highly trained and we offer one to one Nutritional Therapy Consultations, which are designed to be complementary to any medical treatment from a functional medicine approach, as well as offering a preventative & optimal health focus.