The Best Supplements to Fight Fatigue
03/19/2014 - 7:30pm by Dr. Spencer Nadolsky
This post was written by Dr. Spencer Nadolsky, Director of Examine.com, an independent encyclopedia on supplements and nutrition that aggregates the latest scientific research on a multitude of supplements. Dr. Nadolsky is an osteopathic family physician and former wrestler with a B.A. in exercise science. To learn more, visit Examine's website.
Being fatigued sucks. You stumble through the day, your brain slow, your body aching; you’re tired, you’re groggy, and everything feels awful. Fatigue isn’t just tiredness—it’s a generalized lack of energy and motivation that can sometimes be a symptom of serious issues like depression, anemia, or thyroid problems (which is why chronic, pervasive fatigue definitely warrants a visit to the doctor). In some cases, however, fatigue is simply the result of poor—but fixable!—habits.
When you've ruled out any medical issues and developed positive habits but are still struggling with fatigue, it may be time to turn to supplementation. We took a look at the most common causes of fatigue—sleep, stress, and exercise—and put together a list of simple, supplemental fixes to address each one. Check out the list to eliminate fatigue and get back in the game.
Note: The contents of this article are not intended to serve as medical advice. If you have questions about incorporating supplements into your life, it's always smart to consult a medical professional.
It’s not uncommon to want five more minutes of sleep in the morning (guilty!), but if rolling out of bed feels like torture every single day—or if your love for the afternoon nap is bordering on obsessive—it may be time to add some new supplements to your routines.
Potential Fixes
1. Whole Foods (Iron and Magnesium)
The right foods can go a long way toward managing fatigue. If you’re always low on energy, try increasing the amount of iron and magnesium in your diet. These two minerals don’t just help with energy levels; they’ll also help you maintain healthy blood pressure, keep the blood well oxygenated, and ensure the muscles function properly.
Most people should shoot for 8 to 18 milligrams of iron and 310 to 420 milligrams of magnesium per day. Before shopping for supplements, head to the grocery store: There’s plenty of iron to be found in beans and meat (For example, a cup of white beans has about eight milligrams of iron, and six ounces of beef contains six milligrams.). Magnesium is also found in leafy green vegetables (cooked spinach has 157mg per cup), pumpkin seeds (156mg per ounce), black beans (120mg per cup) and oatmeal (63mg per cup), to name a few. (Just note that vegetarian sources of iron are not absorbed very well unless they’re accompanied by a source of vitamin C—yet another reason to add fruits or vegetables to all your meals ((Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. Vaucher P, Druais PL, et al. Canadian Medical Association Journal, 2012 Aug 7;184(11):1247-54.)) ((Iron absorption from NaFeEDTA-fortified oat beverages with or without added vitamin C. Trinidad TP, Kurilich AC, et al. International Journal of Food Sciences and Nutrition, 2014 Feb;65(1):124-8.))!).
2. Melatonin
Too much light in the bedroom can make the body unwilling to sleep or unable to sleep very well. This is thanks to melatonin, a hormone responsible for sending us off to sleep, which is very sensitive to light. In general, the darker the room, the more melatonin our bodies produce, and the better we sleep ((Out of the lab and into the bathroom: evening short-term exposure to conventional light suppresses melatonin and increases alertness perception. Wahnschaffe A, Haedel S, et al. International Journal of Molecular Sciences, 2013 Jan 28;14(2):2573-89.)). This explains why it’s important to minimize exposure to bright light during the half hour before bedtime ((Out of the lab and into the bathroom: evening short-term exposure to conventional light suppresses melatonin and increases alertness perception. Wahnschaffe A, Haedel S, et al. International Journal of Molecular Sciences, 2013 Jan 28;14(2):2573-89.)).
Before heading to the supplement aisle, try these “natural” fixes to improve melatonin production: Keep the lights low, avoid fluorescent sources like TV screens (Ta-ta, Real Housewives marathons!), and, if you absolutely have to use your computer, try to add a red tint to the screen—red light is more friendly to melatonin synthesis, possibly because of its similarity to the sunset ((Melatonin as a principal component of red light therapy. Yeager RL, Oleske DA, et al. Medical Hypotheses, 2007;69(2):372-6.)). You can also check out F.lux, a program that can make your computer screen adapt its luminescence to the time of day.
If these changes don’t cut it, melatonin is also available in supplement form ((Meta-analysis: melatonin for the treatment of primary sleep disorders. Ferracioli-Oda E, Qawasmi A, et al. PLoS One. 2013 May 17;8(5):e63773.)). Start experimenting with a low dose of 500 micrograms (0.5 milligrams), then slowly increase your dosage until you find your minimum effective dose. Bonus: Melatonin is pretty cheap; a month’s supply can cost only about five bucks.
3. Glycine
Glycine is an amino acid which, when taken about an hour before going to bed, can help people fall asleep. Extra bonus: It may improve cognitive performance the next day ((The effects of glycine on subjective daytime performance in partially sleep-restricted healthy volunteers. Bannai M, Kawai N, et al. Frontiers in Neurology, 2012 Apr 18;3:61.))!
While the compound can be found in most foods, a particularly good source is collagen, a protein that forms connective tissue in animals. But if chewing on sinew doesn’t sound particularly appealing, check out your local supplement store. The recommended dosage is 3 grams, and a month’s supply costs around 10 bucks ((The effects of glycine on subjective daytime performance in partially sleep-restricted healthy volunteers. Bannai M, Kawai N, et al. Frontiers in Neurology, 2012 Apr 18;3:61.)).
4. Theanine
Theanine is another amino acid that can help with sleep. It’s not sedative; rather, it improves sleep quality and should help you feel more rested in the morning.
The best source of theanine is tea, but there’s a Catch-22: Since most teas also contain caffeine, a steaming cup probably won’t improve sleep quality ((L-Theanine: properties, synthesis and isolation from tea. Vuong QV, Bowyer MC, et al. Journal of the Science of Food and Agriculture, 2011 Aug 30;91(11):1931-9.)). White tea tends to have less caffeine than green or black tea, so if you’re a coffee drinker with a high caffeine tolerance, white tea could be a relaxing way to get some theanine before bed. Or just try decaf!
Another way to take theanine is in pill form. The optimal dosage for improving sleep is between 150 to 200 milligrams, taken 30 to 60 minutes before bedtime. You can get a month’s supply for a little less than 10 bucks.
Metabolic burnout is a form of fatigue which builds up over a long period of time as a result of chronic stress ((Biomarkers in burnout: a systematic review. Danhof-Pont MB, van Veen T, et al. Journal of Psychosomatic Research, 2011 Jun;70(6):505-24.)). Yep, one more reason why stress isn’t good for us! While there are scores of non-pharmaceutical ways to relieve anxiety, from meditation to exercise, there are also some proven stress-fighting supplements.
POTENTIAL FIXES
1. L-Tyrosine
L-Tyrosine is an amino acid that can counteract stress before it happens. Yep, you read that right: When taken before an event that’s anticipated to be stressful (say, an exam or big presentation at work), it can head off stress hormones at the pass ((Tyrosine improves cognitive performance and reduces blood pressure in cadets after one week of a combat training course. Deijen JB, Wientjes CJ, et al. Brain Research Bulletin, 1999 Jan 15;48(2):203-9.)) ((Treatment with tyrosine, a neurotransmitter precursor, reduces environmental stress in humans. Banderet LE, Lieberman HR. Brain Research Bulletin, 1989 Apr;22(4):759-62.)).
How? Well, when we’re stressed, the body secretes a lot of the neurotransmitters adrenaline and dopamine, which help keep the typical symptoms of stress at bay. But we’ve only got a finite amount of those two chemicals, so when we run out of them, that’s when we experience symptoms of stress like fatigue, sweatiness, and a serious decrease in motivation and attention. No fun, right? That’s why it can be helpful to make sure there’s plenty of L-tyrosine in the blood, since it helps the body produce adrenaline and dopamine and thereby protects us from the effects of stress ((Neurochemical and behavioral consequences of acute, uncontrollable stress: effects of dietary tyrosine. Lehnert H, Reinstein DK, et al. Brain Research 1984 Jun 15;303(2):215-23.)).
It’s ideal to take 500 to 2,000 milligrams of L-tyrosine an hour before the stressful event is supposed to occur, although some studies have shown that more (up to 10g over the course of a few hours, in divided doses) can be taken without any issues ((Treatment with tyrosine, a neurotransmitter precursor, reduces environmental stress in humans. Banderet LE, Lieberman HR. Brain Research Bulletin, 1989 Apr;22(4):759-62.)) ((L-tyrosine ameliorates some effects of lower body negative pressure stress. Physiology & Behavior. 1995 Feb;57(2):223-30.)). Ten bucks can buy you enough for at least 50 scary work presentations.
2. Rhodiola Rosea
Rhodiola rosea is another adaptogen, i.e., something that can help desensitize someone to a stressful event before it happens ((Rhodiola rosea: a possible plant adaptogen. Kelly GS, Alternative Medicine Review, 2001 Jun;6(3):293-302.)). Derived from an herb that grows in the chillier parts of Northern Europe, Rhodiola is safe and effective at treating metabolic burnout, and there’s some evidence that it’s effective at combating mild depression and improving cognition, to boot ((Therapeutic effects and safety of Rhodiola rosea extract WS® 1375 in subjects with life-stress symptoms--results of an open-label study. Edwards D, Heufelder A, Zimmermann A. Phytotherapy Research, 2012 Aug;26(8):1220-5.)) ((The effectiveness and efficacy of Rhodiola rosea L.: a systematic review of randomized clinical trials. Hung SK, Perry R, et al. Phytomedicine. 2011 Feb 15;18(4):235-44.)) ((Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression. Darbinyan V, Aslanyan G, et al. Nordic Journal of Psychiatry, 2007;61(5):343-8.)) ((A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen. Spasov AA, Wikman GK, et al. Phytomedicine. 2000 Apr;7(2):85-9.)).
While researchers aren’t completely sure how the herb works, they do know that it helps maintain proper serotonin levels in the brain, which can affect our moods and hormones—but further research is needed to determine exactly how this adaptogen functions ((Serotonin involvement in Rhodiola rosea attenuation of nicotine withdrawal signs in rats. Mannucci C, Navarra M, et al. Phytomedicine. 2012 Sep 15;19(12):1117-24.)). In any event, Rhodiola is thought to be safe and effective, and can even be taken once a day without any decrease in effectiveness ((A randomized trial of two different doses of a SHR-5 Rhodiola rosea extract versus placebo and control of capacity for mental work. Shevtsov VA, Zholus BI, et al. Phytomedicine. 2003 Mar;10(2-3):95-105.)).
A single dose of between 288 to 680 milligrams is effective, but for daily usage, 150mg should do the trick—just make sure the pills are one percent salidroside and three percent rosavins, as this is the formula that’s shown the most benefits in studies ((A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen. Spasov AA, Wikman GK, et al. Phytomedicine. 2000 Apr;7(2):85-9.)) ((Acute Rhodiola rosea intake can improve endurance exercise performance. De Bock K, Eijnde BO, et al. International Journal of Sport Nutrition and Exercise Metabolism, 2004 Jun;14(3):298-307.)). If you plan on taking Rhodiola rosea daily, 10 bucks will get you a month’s supply.
3. L-Ornithine
Chronic stress can result in too much ammonia in the blood, which can cause fatigue and foggy thinking ((Ammonia metabolism, the brain and fatigue; revisiting the link. Wilkinson DJ, Smeeton NJ, et al. Progress in Neurobiology, 2010 Jul;91(3):200-19.)). Taking L-ornithine can help alleviate the fatigue ammonia causes; some studies have also shown that it can help reduce the severity of a hangover (L-ornithine and a strong cup of coffee, anyone?) ((A randomized, double-masked, placebo-controlled crossover trial on the effects of L-ornithine on salivary cortisol and feelings of fatigue of flushers the morning after alcohol consumption. Kokubo T, Ikeshima E, et al. Biopsychosocial Medicine, 2013 Feb 18;7(1):6.)) ((L-ornithine supplementation attenuates physical fatigue in healthy volunteers by modulating lipid and amino acid metabolism. Sugino T, Shirai T, et al. Nutrition Research, 2008 Nov;28(11):738-43.)).
The trouble is that it’s hard to know if fatigue is being caused by high ammonia levels without first getting a blood test, so there’s no guarantee that L-ornithine will help the issue. But if you’ve tried everything (or if you’d like a backup hangover cure!), two to six grams of L-ornithine hydrochloride is the standard dose ((L-ornithine supplementation attenuates physical fatigue in healthy volunteers by modulating lipid and amino acid metabolism. Sugino T, Shirai T, et al. Nutrition Research, 2008 Nov;28(11):738-43.)) ((The effect of L-ornithine hydrochloride ingestion on performance during incremental exhaustive ergometer bicycle exercise and ammonia metabolism during and after exercise. Demura S, Yamada T, et al. European Journal of Clinical Nutrition, 2010 Oct;64(10):1166-71.)). A month’s supply will run you about 20 bucks.
We’re not talking about the well-earned muscle fatigue that sets in after a few sets of an exercise. Here, we’re referring to the involuntary reduction in workout intensity and motivation that can set in after 45 minutes of heavy lifting, running, or competitive sports. While it may be tempting to turn to pre-workout stimulants, many of them are a double-edged sword: While some can reliably increase energy and performance, habitual use can lead to reliance and some—like 1,3-DMAA—can lead to high blood pressure ((Effects of 1,3-dimethylamylamine and caffeine alone or in combination on heart rate and blood pressure in healthy men and women. Bloomer RJ, Harvey IC, et al. Physician and Sportsmedicine, 2011 Sep;39(3):111-20.)). Here are a few safer and non-stimulatory alternatives for keeping up with longer (45 minutes or more) workouts.
POTENTIAL FIXES
1. Creatine
Creatine is a dietary supplement that’s well known for its ability to increase muscle size, but it’s also effective at reducing fatigue and promoting effective energy usage. It works primarily by creating a large store of creatine phosphate in the body, which replenishes ATP—a molecule that stores and provides energy to the body. By promoting the usage of creatine phosphate, the body’s cells can better preserve glucose for later use, essentially staving off fatigue ((Low-dose creatine supplementation enhances fatigue resistance in the absence of weight gain. Rawson ES, Stec MJ, et al. Nutrition. 2011 Apr;27(4):451-5.)). While creatine’s safety has been the subject of some controversy, for the most part it’s deemed safe for long-term use by those without pre-existing health conditions.
2. BCAAs
Branched chain amino acids (BCAAs) are a group of amino acids that includes valine, leucine and isoleucine. BCAAs are great at preventing fatigue during intense, exhaustive exercise ((Influence of ingesting a solution of branched-chain amino acids on perceived exertion during exercise. Blomstrand E, Hassmén P, et al. Acta Physiologica Scandinavica, 1997 Jan;159(1):41-9.)) ((Effects of branched-chain amino acids supplementation on physiological and psychological performance during an offshore sailing race. European Journal of Applied Physiology, 2008 Nov;104(5):787-94.)).
Why? Well, one of the factors that leads to fatigue during exercise is extra serotonin in the brain, which is caused by an increase in L-tryptophan, another amino acid ((Exercise and fatigue. Ament W, Verkerke GJ. Sports Medicine, 2009;39(5):389-422.)). BCAAs compete with L-tryptophan and prevent its uptake into the blood, thereby preventing the fatiguing effects of serotonin ((A role for branched-chain amino acids in reducing central fatigue. Blomstrand E. Journal of Nutrition. 2006 Feb;136(2):544S-547S.)). Like creatine, they have the added benefit of increasing muscle size and strength. The price is a bit steep: a month’s supply can run you up to 40 dollars. A typical daily dose of BCAAs varies depending on bodyweight, but is around 20 grams of the three amino acids combined, taken 1-3 times throughout the day.
3. ALCAR
Acetyl-L-Carnitine (ALCAR) is a type of L-carnitine, an amino acid that’s great at preventing fatigue during intense exercise. This is because carnitine is can enhance the rate at which oxygen is delivered to muscles and help prevent the build-up of lactic acid, which may cause muscle soreness ((L-Carnitine L-tartrate supplementation favorably affects markers of recovery from exercise stress. Volek JS, Kraemer WJ, et al. American Journal of Physiology - Endocrinology and Metabolism, 2002 Feb;282(2):E474-82.)) ((Effects of L-carnitine L-tartrate supplementation on muscle oxygenation responses to resistance exercise. Spiering BA, Kraemer WJ, et al. Journal of Strength and Conditioning Research, 2008 Jul;22(4):1130-5.)) ((L-Carnitine l-tartrate supplementation favorably affects biochemical markers of recovery from physical exertion in middle-aged men and women. Ho JY, Kraemer WJ, et al. Metabolism. 2010 Aug;59(8):1190-9.)).
Supplementing with Acetyl-L-Carnitine (ALCAR) can also provide a cognitive boost—that is, it can help users think more clearly by increasing energy availability in the brain ((Chronic acetyl-L-carnitine alters brain energy metabolism and increases noradrenaline and serotonin content in healthy mice. Smeland OB, Meisingset TW, et al. Neurochemistry International, 2012 Jul;61(1):100-7.)) ((Effect of in vivo L-acetylcarnitine administration on ATP-ases enzyme systems of synaptic plasma membranes from rat cerebral cortex. Villa RF, Ferrari F, Gorini A. Neurochemical Research. 2011 Aug;36(8):1372-82.)). A month’s supply, assuming a daily dose of 1,000 milligrams, will cost you about 10 bucks.
4. Glucose
On the other end of the stimulant spectrum is the body’s primary energy source: Glucose. Whip up a simple solution of water (it doesn’t matter how much) and 20 to 40 grams of glucose and sip it during your 45-minute (or longer) workout to keep a small stream of glucose in the blood and enjoy a subtle (but still noticeable) increase in performance. As a bonus, it may increase muscle synthesis over the long term (and if you really want bigger muscles, try spiking your glucose drink with some BCAAs) ((Carbohydrates and fat for training and recovery. Burke LM, Kiens B, Ivy JL. Journal of Sports Sciences, 2004 Jan;22(1):15-30.)) ((Glycemic carbohydrates consumed with amino acids or protein right after exercise enhance muscle formation. Suzuki M. Nutrition Reviews, 2003 May;61(5 Pt 2):S88-94.)). Glucose is often sold at supplement stores as “dextrose,” and you can buy a pound for around two dollars.
The Takeaway
If you feel like your life is being hampered by fatigue, supplements shouldn’t be the first step. It’s most important to analyze your stress management skills, nutrition, and sleeping habits—with the help of a medical professional, if necessary—and then make the appropriate lifestyle changes (Doing so is probably also cheaper than supplementation!). But if you’ve eliminated unhealthy habits, ruled out underlying disorders, and are still struggling with fatigue, then these supplements may be effective in helping you get back up on the horse so you can keep on truckin’.
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