Fatigue is a symptom which is common and particularly debilitating in environmental illnesses, as well as in many other chronic diseases (e.g. heart disease).

Fortunately there are a number of nutritional supplements, herbs, and medications which in many cases can significantly improve your energy levels and therefore improve your ability to function normally so you can enjoy life once again.

Fatigue or lack of energy can be the result of a number of factors. Physical fatigue may be the result of mitochondrial dysfunction or a poor supply of oxygen to the cells. The mitochondria are the part of the cell which generate energy aerobically (with oxygen). Fatigue may also be mental. Mental fatigue can often be hard to distinguish from physical fatigue as they more often than not occur together. However, mental fatigue can result from an imbalance in the levels of certain energising neurotransmitters in the brain or may be caused by chronic stress and consequent hormonal imbalances. When these things are treated you may rapidly improve and feel bright, alive and full of energy again...as if someone flipped a switch in your head. I know this is possible as I have experienced it myself.

So let's take a look at some of the things which might improve your energy levels:

D-Ribose
D-ribose is a simple sugar that the body uses to manufacture a number of important substances such as DNA, RNA and hormones. D-ribose is also a major building block for many chemicals vital for the production of energy by the mitochondria within the cells; these chemicals include NADH, FADH, co-enzyme A, and most importantly ATP which is commonly referred to as the body's 'energy currency'. Every cell uses ATP as its source of energy. Without sufficient D-ribose in the cells ATP cannot be synthesised, and without ATP the body's energy pool cannot be restored.

The body can manufacture new ATP rapidly when D-ribose is supplied. Studies have demonstrated the effectiveness of D-ribose supplementation in heart disease and a number of doctors treating chronic fatigue syndrome patients use it to improve energy levels. ME/CFS patients are known to suffer from mitochondrial dysfunction, low cardiac output and poor oxygenation.

Carnitine
Carnitine is an amino acid-like substance that is important for the metabolism of fats, specifically it transports long-chain fatty acids into the mitochondria where they can be used as fuel to produce energy. Slight deficiencies of carnitine have been noted in ME/CFS patients and things have often improved when supplements have been given.

Coenzyme Q10
Coenzyme Q10 is vital for the process of oxidative phophorylation through which the body generates most of its energy as part of aerobic energy production within the mitochondria. Research and clinical experience of doctors treating ME/CFS and fatigue disorders suggests patients have a deficiency or increased requirements for this vital substance. ME/CFS specialists including Dr. Teitelbaum, Dr. Cheney, and Dr. Myhill all recommend patient's take Co-Q10 along with other nutrients vital for energy production including d-ribose, l-carnitine, and magnesium.

NADH
Nicotinamide adenine dinucleotide (NADH), like Co Q10, is vital for aerobic energy production within the mitochondria. It has a similar role to Co Q10, acting as an energy carrier in the process that ultimately produces ATP (energy) for the body to use. NADH has only become available as a supplement in recent years. Early studies however have shown that NADH improves energy levels in a significant number of ME/CFS patients and is also useful for jetlag, sleep deprivation and for improving athletic performance.

Magnesium
Magnesium is extremely important for energy production, it's role revolving primarily around its ability to activate many enzymes. This mineral participates in more than 300 enzymatic reactions in the body including those responsible for energy and fatty acid metabolism. Without sufficient magnesium within the cells the production of ATP cannot progress efficiently. Researchers at the Human Nutrition Research Center in the US showed that inadequate magnesium is associated with a need for increased oxygen during exercise. They found that during moderate activity, those with low magnesium levels in muscle are likely to use more energy-and therefore to tire more quickly-than those with adequate levels. Not surprisingly, environmental illness patients are frequently deficient in magnesium and do well when properly supplemented. Dr. Jacob Teitelbaum recommends that ME/CFS and fibromyalgia patients take magnesium in the form of magnesium malate and magnesium aspartate. Malic and aspartic acids are important for mitochondrial energy production in their own right and help the absorption of magnesium.

Tyrosine
Tyrosine is an amino acid which may help to increase energy levels via two distinct routes. It is a building block for both the catecholamine neurotransmitters such as dopamine and noradrenaline (norepinephrine) and also for thyroid hormones. The catecholamines have an energising effect on the brain and a lack of these important chemicals can lead to fatigue, mental sluggishness, lack of motivation and depression. The role of thyroid hormones is to control the body's rate of metabolism. The cells may be capable of producing all the energy the body needs but will only do so if instructed to by the presence of thyroid hormones. A deficiency of tyrosine therefore may lead to deficiency of both catecholamines and thyroid hormones and result in fatigue.

SAMe
S-adensoyl-L-methionine (SAMe) is a substance produced from the amino acid methionine. It is important for many processes within the body through its action as a 'methyl donor'. Like tyrosine it is required in sufficient amounts for the synthesis of the energising catecholamine neurotransmitters.

Thyroid Hormone Replacement
A number of doctors feel that hypothyroidism (underactive thyroid) is underdiagnosed, particularly in those with environmental illness. It is felt by some that low thyroid function is often missed because levels of the T3 hormone are usually not assessed by standard medical tests. T3 is actually the most active form of thyroid hormone so low levels have profound affects on energy levels. T3 deficiency can be corrected with T3 medication or with natural alternatives such as Armour Thyroid which use tissue from animal thyroids containing thyroid hormones. Treating an underactive thyroid can often result in amazing improvements in energy levels.

Licorice
This herb contains a chemical called glycyrrhizin which acts to increase the activity of the adrenal hormone cortisol. It is thought to achieve this by blocking the breakdown of cortisol in the body and perhaps increasing the sensitivity of cells to the hormone. Cortisol helps us respond to stress and increases energy levels. Cortisol is often found to be low in ME/CFS and fibromyalgia.

DHEA
Dehydroepiandrosterone (DHEA) is another hormone produced by the adrenal glands. It is thought to provide a balance to cortisol, and together they help us respond to stress. Stress can be a significant contributor to fatigue and low energy levels so maintaining healthy levels of DHEA can help to combat these symptoms. DHEA is associated with feelings of well-being and energy and is being investigated as a treatment for numerous diseases including adrenal insufficiency, depression, chronic fatigue syndrome, and obesity.

Ginseng
Probably the best known of the herbal energy enhancers. Ginseng has been used in the Far East for centuries as a tonic to increase energy and help people overcome stress and illness. Recent scientific studies have identified the active ingredients as the steroid-like ginsenosides and confirmed that the ginseng family of herbs improve endurance and increase energy. The most potent form of ginseng is Panax with Siberian ginseng having milder effects.

All of these may help you overcome fatigue and improve your energy levels. It is best to work with your doctor (or nutritionist etc) to have the best chance of discovering the underlying causes of your fatigue and therefore having the best chance of choosing the right treatment options. It is also worth considering other factors which might contribute to fatigue including impaired liver function, digestive issues such as dysbiosis, and blood sugar imbalances (i.e. hypoglycaemia).