Fatigue

There are very few simple off-the-shelf solutions to helping with fatigue. Treating this problem requires a more concerted approach than simple medicines on their own (see Traditional remedies for fatigue below).

For safe use of over-the-counter medicines, herbal remedies and supplements, consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement:
– if you have a serious medical condition
– if you are breast-feeding, pregnant or planning to become pregnant
– if you suffer from allergies

Registered herbal medicines (bearing the THR logo) will have a package insert. Read this before taking the product.

Avoid taking the product if you think you may be allergic to any of the ingredients.

Do not combine over-the-counter medicines, remedies or supplements with prescribed medicines unless you have first checked with your prescriber or a pharmacist.

Seek advice from your doctor or pharmacist:
– If your symptoms do not get better
– if your symptoms get worse
– if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

Many modern drugs started as medicinal plants and people have been using herbs to treat illnesses for thousand of years. Some of these remedies have been tested against the toughest health conditions, and plants with the strongest reputations across many cultures deserve a close look.

From the way they have been described in old texts, and from what we now know of the action of many plant constituents, it is possible favourite plant remedies work particularly by nudging better function in digestion, circulation, and eliminatory processes: helping the body help itself rather than directly attack a disease. Women also favoured plants in managing their health and childrearing needs.

Researchers are now discovering that many herbal medicines have useful benefits for the body, including in healing and repair, in stabilising hormonal responses (including stress hormones, insulin and sex hormones), and in reducing long-term inflammation.

There are no standard medicines, which you can buy from a chemist without a prescription, that are likely to help with fatigue. Mild painkillers may help with pain but should only be used for a short time (see our section on MUSCLE ACHE)

Summary
Eleutherococcus senticosus, otherwise known as Siberian ginseng, is a Russian relative of Panax ginseng. It was developed as a support for stress and fatigue in the Soviet armed forces and space programme and has become widely used around the world. Doses of between 600-1000mg per day are generally used in fatigue.

Evidence
There are limited and mixed research reports to support the traditional use of eleutheroccocus.

Safety
No safety concerns have been raised. However there are few regulatory controls of the supply of this remedy and it is important to use only reliable and trustworthy sources.

Cost
Eleutherococcus can be obtained for around £10-15 for a month’s supply.

Summary
Evening primrose is a yellow, flowering plant that blooms in the evening. The seed oil (EPO) contains gamma-linolenic acid (GLA), an omega-6 essential fatty acid required by the body for growth and development. The body can’t make GLA so we need to get it from our food. The usual dose recommended for benefits is at least 500mg oil per day.

Evidence
Two small studies showed different results so it is not clear whether evening primrose oil is helpful for fatigue.

Safety
EPO is generally safe in recommended doses. Reported side-effects are rare and mild. Stomach pain and loose stools may mean you are taking too much.

If you get seizures (e.g. epileptic fits) be careful with omega-6 supplements such as EPO. They may make seizures more likely. EPO should be taken cautiously if you have bleeding problems or a blood disorder.

Cost
EPO capsules can be obtained for around £10-15 for a month’s supply.

Summary
Ginseng is a plant whose root is traditionally used as a tonic in Eastern cultures. According to traditional Chinese medicine, different types of ginseng have different healing properties. Chinese (and Korean) ginseng is said to help the body fight stress, boost energy and activate the immune system. According to herbalists, these herbs can be powerful. The full recommended dose of between about 1,000-1,200mg  per day: it is therefore recommended that when taking ginseng for CFS, you start off with half these levels.

Evidence
Ginseng has been found to be helpful in treating fatigue in people with medical conditions such as cancer. However, research on the use of ginseng for CFS found that due to small sample sizes the evidence was too poor to confirm any effect.

Safety
Correct dosage is probably an important factor in using ginseng. The more fatigued you are, the less likely that higher doses will be helpful, and they may even be too stimulating. Ginseng does not mix well with caffeine.

Do not use Chinese ginseng if you have high blood pressure, or heart disease. If caffeine and other stimulants affect you easily, consult a qualified herbalist before using ginseng.

Cost
Korean ginseng of assured quality is available for less than £10 per month.

Summary
Rhodiola (Rhodiola rosea) is used in traditional medicine across northern Europe and Russia to increase endurance and work performance, longevity, tolerance to high altitude sickness, and to treat fatigue, weakness, impotence, and other nervous system disorders.

Evidence
There is contradictory evidence for the benefits of rhodiola in fatigue, conclusions being hampered by methodological flaws in research reports.

Safety
Rhodiola is increasingly used as a prescription medicine in Europe and has been found to be safe with minimum interactions.  To be sure of correct dose and quality standards it is also wise to use only those with independently confirmed quality (as provided by registered traditional herbal medicines or THR’s).

Cost
Rhodiola THRs can cost around £15 per month.

Summary
Many of us don’t eat a properly balanced diet with all the right vitamins and minerals. A lot of people take a multivitamin supplement each day because they think it helps. Some people may have chronic fatigue because they lack enough vitamins and minerals, but this is probably quite unusual.

Evidence
There is some research suggesting that some people have CFS because they are low in vitamins or minerals. However, when researchers have given supplements to people with CFS they have seldom benefited much, so taking supplements doesn’t seem to help everyone. There is some suggestion that people with low magnesium levels benefit from this supplement.

Safety
Taking vitamin and mineral supplements is generally safe when taken at the recommended dosage. High doses of vitamin and mineral supplements can upset the body and cause side-effects. Get advice if you intend to take large doses.

Cost
Vitamin and mineral supplements are generally inexpensive.

Summary
In the past long-term fatigue was most often associated with the consequences of illness or injury. It was generally assumed that there were two equally important phases in any treatment: the acute phase of direct attention to the illness or injury, and the recovery phase (sometimes called convalescence or recuperation) where the patient was encouraged to rest and take restorative measures.  Fatigue was a common symptom during this second phase and was often the main reason to work on it.

In other words what we call chronic fatigue was once a familiar reason for treatment. In our modern rushed world we have forgotten how care and time was once the usual approach to correcting fatigue. We may learn useful lessons from the old principles of convalescent care.

Taking many historical accounts and traditional texts together it is possible to distil four main parts of convalescence that can be adapted to chronic fatigue today.

1. Rest
This is by far the most important element in convalescence. It includes optimum sleep, as the body’s time for repair. In the early stages almost constant sleep might be encouraged. Later focus might be on quality more than quantity. Going to bed early is generally to be encouraged, however restless the sleep in the early morning. To make up sleep needs at this time, taking naps whenever possible is usually important. Rest also means less activity: any work should be done only in brief bouts, switching frequently between different activities (‘change is as good as a rest’).  Above all – take ‘doctor’s orders’ and tell people you cannot do as much at this stage: ‘don’t volunteer’! Rest becomes a mental priority: all other considerations are secondary. That hour or more sleep is more important than a film on TV, a late-night conversation or a night out.

2. Activity
This is the flipside and necessary complement to rest, the equivalent to ‘turning the engine over’, to prevent congestion and stagnation. Essentially the body needs to be exercised at least briefly each day, enough to encourage productive rest, but not so much as to damage recovery. There is a self-adjusting way to determine how much exercise is safe: the pulse. When you are run down the pulse will rise quickly with activity: you will do less activity to reach the same pulse rate. Safe top levels are between 80 and 140 pulses per minute (depending on age, the elderly in the low range and adolescents being able to tolerate higher rates). Duration of exercise is determined by stamina: only a minute or so if very weak, rising to more than 15 minutes sustained activity once a day if stronger. If exercise is followed by more fatigue, it is too much. Exercise should be steady and gentle to avoid straining the joints or muscles (these may be sore anyway if there is aslo fibromyalgia). Timing one’s exercise for late afternoon will encourage better sleep that night.

3. Diet
The principle of the convalescent diet is that it should simply nourish. It should not stimulate or impose demands. Subject to individual dispositions, a convalescent diet is based on vegetables, especially root vegetables, cereals and pulses (if tolerated), fish and eggs, as the most easily assimilated protein sources, and chicken and other fowl if acceptable (chicken stock and soup remain one of the most universal and puzzling convalescent recommendations of history!). Free-range is better than battery meat for this purpose. Milk and mill products were often used in Europe as easy convalescent foods although this may be less appropriate for some modern constitutions. There should be no stimulants, caffeine, nicotine, alcohol or sugar, and a minimum of convenience foods and food additives. Convalescents should thus be encouraged to take a simple peasant diet, sharing also with the peasant a simple respect for the food, taking time over it, building their daily rhythm around it.

4. Medicine
Old medicines were often applied to convalescence, to aid recovery and build strength. In English-speaking  traditions these were often called ‘tonics’. There are many herbal remedies that come down to us as former convalescent tonics and may still be best used in this way.

Valerian (Valeriana officinalis),  from the Latin valere for strength, this was a classic European remedy to encourage sleep and rest during convalescence.

St John’s Wort (Hypericum perforatum), consistently understood to be a tonic remedy, especially in convalescent recovery from illness or injury.

Ashwagandha (Withania somnifera) – a very popular remedy in India and around Asia, including as restorative tonic and tissue healer and specifically to aid sleep.

Brahmi (Bacopa monnieri) – another widely used calming tonic from India

Oats  (Avena sativa) – the cereal and the fresh grass medicine were convalescent remedies of choice across much of northern Europe

Safety
There are few known risks in taking most of the herbs above. St John’s wort may interact with conventional antidepressants and other medicines.

It is also advisable not to buy herbs online unless from suppliers with prominent reputation (they will be concerned to protect this by ensuring quality for their products). Unfortunately there are few controls on herbal sales and many cases of adulterated or wrong products. It is always a good policy to look for a registered herbal medicine, with the THR logo on the pack. This will have its quality independently assured.

A good approach in choosing traditional approaches for convalescence  is to see a qualified herbal practitioner. You will find well trained practitioners from a number of traditions from the website of the main umbrella body the European Herbal and Traditional Practitioners Association. This will entail extra costs but will allow you to have herbs you might not find elsewhere, and tailored to your needs.

Cost
Most herbs should be inexpensive and can be bought from specialist suppliers. A registered herbal medicine (THR) if available, will cost more – round £15 per month.  Seeing a practitioner may cost around £50 for a first visit.

Further information
The term ‘adaptogens’ are applied to remedies like ginseng and others in this section that are used for stress management and in the traditional treatment of fatigue. The term implies an improvement in adaptation to stress and an action on the adrenal cortex: many ‘adaptogenic’ medicines turn out to contain high levels of plant steroids. There is a review paper here.

Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity
Panossian A, Wikman G. 2009  Curr Clin Pharmacol. 4(3):198-219

Link to Abstract