Fatigue is a common complaint. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome should be considered.
   Fatigue may be due to depression, lack of exercise, poor diet with lack of adequate protein, anemia, diabetes, hepatitis, thyroid disorders, cancer, occult infections, autoimmune disorders, sleep apnea or sleep disturbances, or adrenal insufficiency.
   If a full medical evaluation is completed and no major causes are found, certain supplements may be tried to increase energy levels.  

There are many nutrients and herbs that help reduce fatigue, including:

B Vitamin and coenzyme complex which you can find Vitamin-B-Coenzyme here.
Carnitine can fight fatigue, see Carnitine for more information.
Creatine can fight muscle fatigue
Pantothenic acid is a b vitamin that can help reduce fatigue
Trimethylglycine tmg can fight fatigue and improve mood
Ginseng is an herb used to improve fatigue
Maca is an herb from South America that helps fight fatigue, you can find Maca supplement here for sale.
Royal jelly can improve fatigue, see Royal-Jelly supplement for purchase.
Spirulina can benefit fatigue

Cause of fatigue
Anemia - Anemia is a common cause of fatigue in women who have heavy menstrual cycles, have fibroid tumors or uterine polyps. The blood loss may cause anemia due to the loss of iron. Other causes of anemia include iron deficiency, low levels of folic acid, or vitamin B12.

Low thyroid (hypothyroidism) - If you are generally sluggish, run down, and even a little depressed, the cause could by a poorly functioning thyroid gland.

Poor quality sleep is a common cause of fatigue

Lack of exercise can cause fatigue

Overeating and obesity

Hidden food allergies

Excess use of caffeine or stimulants

Heart disease

Difference between fatigue and tired
"It's important to recognize the difference between tiredness and fatigue, because fatigue is a marker that the body is not able to keep up," says Dr. Karin Olson, with the faculty of nursing at the University of Alberta. Olson has studied fatigue in cancer patients, people diagnosed with chronic fatigue syndrome and depression, as well as shift workers and athletes. These populations were chosen because they experienced fatigue for different reasons -- illness, work, or leisure activities. People who are tired still have a fair bit of energy but are apt to feel forgetful and impatient and experience muscle weakness following work, which is often alleviated by rest. People who have fatigue experience difficulty concentrating, anxiety, a gradual decrease in stamina, difficulty sleeping, and increased sensitivity to light. They also may skip social engagements once viewed as important to them. People who suffer from exhaustion report frank confusion that resembles delirium, emotional numbness, sudden loss of energy, difficulty in staying awake as well as in sleeping and complete social withdrawal. While exercise may relieve tiredness, it may decrease the ability to adapt in people who are suffering from fatigue or exhaustion. If it's fatigue or exhaustion, caffeine and other stimulants should be avoided as these substances fool the body into thinking it has more energy that it actually does. Oncology Nursing Forum 2007.

Fatigue study
L carnitine administration in elderly subjects with rapid muscle fatigue: effect on body composition, lipid profile and fatigue.
Pistone G,. University of Catania, Catania, Italy. Drugs Aging. 2003;20(10):761-7.
AIM: L carnitine is an important contributor to cellular energy metabolism. This study aims to evaluate the effects of carnitine supplementation on body composition, lipid profile and fatigue in elderly subjects with rapid muscle fatigue. This was a placebo-controlled, randomised, double-blind, two-phase study. Eighty-four elderly subjects with onset of fatigue following slight physical activity were recruited to the study. Prior to randomisation all patients entered a 2-week normalisation phase where they were given an 'ad libitum diet, according to the National Cholesterol Education Program (Step 2). Subjects were asked to record their daily food intake every 2 days. Before the 30-day treatment phase, subjects were randomly assigned to two groups (matched for male/female ratio, age and body mass index). One group received carnitine 2g twice daily (n = 42) and the other placebo (n = 42). Efficacy measures included changes in total fat mass, total muscle mass, serum triglyceride, total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein (apo)A1, and apoB levels. The Wessely and Powell scale was used to evaluate physical and mental fatigue. Subjects were assessed at the beginning and end of the study period. At the end of the study, compared with placebo, the carnitine-treated patients showed significant improvements in the following parameters: total fat mass, total muscle mass, total cholesterol, LDL-C, HDL-C, triglycerides, apoA1, and apoB. Wessely and Powell scores decreased significantly by 40% (physical fatigue) and 45% (mental fatigue) in subjects taking carnitine, compared with 11% and 8%, respectively, in the placebo group. No adverse events were reported in any treatment group. Administration of carnitine to healthy elderly subjects resulted in a reduction of total fat mass, an increase of total muscle mass, and appeared to exert a favourable effect on fatigue and serum lipids.

Fatigue vitamins and supplements questions
Q. What supplements do you suggest to help my adrenal fatigue symptoms? I am tired of taking anti-depressants, ADD meds, etc., and would prefer products more natural.
   A. Firstly, the underlying cause of the fatigue has to be determined, some people think their fatigue is due to the adrenal glands, but there could be other causes. We suggest you discuss the natural treatment options and supplements discussed on this page with your doctor.

Q. I am a 43-year-old female. For the last six months, I have suffered from debilitating fatigue, hot and cold sweats, insomnia and terrible headaches. These symptoms presented after a considerable shock to my system following a glucose tolerance test. My blood sugar dropped significantly low, and I was diagnosed with reactive hypoglycemia. For some reason, I have not recovered from this test. I have subsequently followed a healthy hypoglycemic diet, and have even checked my glucose levels regularly during the last few months with a blood glucose monitor, and my blood sugar levels are always in good range. However, I still suffer from fatigue and these debilitating symptoms. Under the care of an endocrinologist and, later, an Internal Medicine doctor specializing in chronic fatigue syndrome, I have undergone comprehensive diagnostic tests for these persistent symptoms. Everything has come back within normal range except a slightly low but normal cortisol level and a significantly low pregnenolone level. I was told that the "normal" range for Pregnenolone is 10 - 230, and my blood work came back as 28 for this hormone. My Internal Medicine doctor suggested pregnenolone supplementation at 100mg / day to bring up this low level, but I immediately discovered that this is too much for my system. Please note, as well, that in my case, pregnenolone absolutely knocks me out. I must take it at night because it makes me incredibly sleepy.

Q. Could you recommend herbs for fatigue. I can't loose weight, I've joined a gym, I have the blood pressure of a 20 year old I'm told, the medical profession have given up on me. I have IBS but can live with it. I'm 48 but feel 88 at times.
I have no energy and feel like crawling into bed all the time. I would be extremely grateful if you could advise me on herb medication in this regard.
   A. We can't give any specific advice but you could ask your doctor to read this page on fatigue and consider some of the supplements that are mentioned.

Q. I am experiencing extreme emotional, mental, and physical fatigue. Please inform me of your products that will treat all of these symptoms without using excessive supplements. I am aware that Acetyl-l-Carnitine if for mental and emotional fatigue and on the other hand L-Carnitine is for physical fatigue. Please inform me of the appropriate product that you provide and dosage to treat this issue.
   A. There are many causes of fatigue and it is important for a doctor to find out the cause or causes before starting therapy. If there are no serous causes, and if your doctor approves, a good supplement to begin with is MultiVit Rx.

Q. I have been diagnosed with adrenal fatigue by Dr. Lee St. Petery and the results of the saliva test. The problem is that I have mitral-valve prolapse, so I don't want to be over stimulated. This doctor wanted me to take ADR by Pure which has licorice, 2 types of ginseng, and adrenal glandulars. Another consultant said to take drops of pregnenolone and dhea. I once had a very bad reaction when taking 25mg. or preg. and DHEA, which was suggested by a doctor for fatigue.

Q. I (male 41) feel sometimes (but not always) extreme fatigue, so tired that the whole body feels painfully uncomfortable and its extremely difficult to remain functional. This partial or complete energy collapse lasts for a few hours to a few days, then for a few days, sometimes longer i feel ok until the next crisis. What could be the cause of this extreme fatigue?
   A. Extreme fatigue has many causes and a full evaluation by a doctor is required to rule out serious causes.

Q. I am suffering from low motivation, fatigue and depression. Which of these supplements would you recommend to be the most effective? Mind Power Rx or SAM-e.
   A. It is very difficult to predict which formula or individual supplement will help with fatigue or depression. Sometimes it take trial and error to find the best option or sometimes alternating different products works for some people. Please discuss with your doctor. Yoga certainly helps with both fatigue and low mood.

Q. I am a 40 year old male. I lived approximately 9 miles away from a nuclear plant for about 3 years (unknowingly). Over those three years my health deteriorated, I was diagnosed with osteopenia which after countless amounts of testing by a endocrinologist he attributed to hypocalcurria (he put me on a water pill that was supposed to hold vitamin d in my system). After a year of taking the water pill I got a new scan of my back which revealed that my condition got worse. I also went to my family doctor, after explaining to the doctor about my problems he thought I might have depression. He perscibed me with anti-depressants (this made me worse). That is when I discovered the nuclear plant through a friend. When I read about the nuclear plant and the chemicals that were being released, I thought it was possible that this could be the problem. I have since moved away from there and tried a natural approach. Through the advice of a family friend I started taking Sun Chlorella, Zell Oygen W/Royal Jelly, Wobenzym, Gaba Powder, Coral Mix, Zinc, Folic Acid, Jarrow Bone-Up, Magnesium, Capricin, L-Phenylalanine and Pau D' Arco. His belief was that my main problems were revolving around being unhealthy and having a low immune system. Within days I started noticing a difference my bone and muscle aches went away. My stomach which was a mess also improved dramatically. I was so impressed at how quickly things improved. I also started taking L-Tyrosine, L-Arginine, Pycogenol, Selenium, Ginkgo Bilboa and Korean Ginseng (to increase my sexual desire). That also has helped alot. Which leaves me with the only thing that I can not seem to kick: fatigue, tired, unmotivated and like staring into space. Do you see any potential problems with the supplements I am presently taking?
   A. We can't give individual advice but to say that one cause of fatigue is taking too many supplements that disrupt sleep patterns. It is a good idea to learn how each supplement works by itself.