B vitamins and C
Numerous studies have linked low levels of What it does: Strengthens immune system – fights infections. Makes collagen, keeping bones, skin and joints firm and strong. Antioxidant, detoxifying pollutants and protecting against… with increased fatigue. For example, a study at the University of Alabama Medical Center assessed the vitamin C intake of 411 dentists and their spouses, then, using a questionnaire, determined their ‘fatigability’ score. The researchers concluded, ‘These limited data suggest that individuals consuming the generally accepted RDA for vitamin C report approximately twice the fatigue symptomatology as those taking about sevenfold the RDA.’
Supplementing vitamin C alongside B vitamins can also have a marked impact on how you feel and your energy levels. A 2011 randomised, placebo-controlled, double-blind trial gave 198 men between the ages of 30 and 55 in full-time employment either a supplement containing vitamin C, B complex and minerals or a placebo. After assessments at 14 and 28 days, those receiving the supplement were found to have greater physical and mental stamina, concentration and alertness than those taking the placebo.1
Coenzyme Q10 is a vital link in the energy equation. In cell studies it improves energy, reduces stress and acts as an Antioxidants are substances that protect cells within the body from damage caused by free radicals. They help to strengthen the body’s ability to fight infection….2 Technically, Co-Q cannot be classified as a vitamin since it can be made by the body, although it isn’t made in large enough amounts for optimum health and energy. It is therefore known as a semi-essential nutrient. The older you get the less you make so cellular levels drop unless you supplement it. The form that humans use is called Co-Q10, which is what you’ll find in supplements, sometimes in the ‘reduced’ form called ubiquinol. Co-Q’s magical properties lie in its ability to improve the cell’s capacity to use oxygen.
I recommend 50 to 200mg of Co-Q10 a day for an energy boost although there is no known harm in taking more. No studies have reported toxicity of Co-Q10, even at extremely high doses taken over many years. So there is no reason to think that continued supplementation with Co-Q10, as I advise for many vitamins, should have anything but extremely positive results.
The three Ginsengs – Korean, American and Siberian
Ginseng is the most renowned energy boosting herb of all. It is a shrub native to the woodlands of Northern China, Korea and Siberia, whose roots have been revered in China for some 5000 years as a general tonic – increasing your energy and sense of well-being.
There are actually several related herbs commonly called ginseng, but the two most commonly used are Korean ginseng (Panax ginseng) and Siberian ginseng (Eleutherococcus senticosus). The latter, while related, is technically not a ginseng, though its functions are so similar that it is now regarded equally. There is another sub-species of Panax ginseng called Panax quinquefolium, known as American ginseng. This is established as an energy booster in animal studies.3 Korean ginseng has been shown to lessen fatigue in those with chronic fatigue,4 fibromyalgia5, multiple sclerosis6 and cancer-related fatigue.7
Siberian ginseng is the best researched of the ginsengs. For example, in one study with Russian telegraph workers, subjects were asked to transmit the same piece of text rapidly and continuously for 5 minutes, and while everyone transmitted similar numbers of characters in the allotted time, those who were taking Siberian ginseng made significantly fewer errors.8 Two reviews of dozens of experiments involving over two thousand people taking Siberian ginseng for up to three months confirmed its ability to improve mood and intellectual performance with almost no side effects.9
A recent study found that Siberian ginseng plus stress-management training, was highly effective at reducing fatigue and improving alertness and quality of sleep.10 While it can raise Cortisol has been nicknamed ‘the stress hormone’ as it is released in higher levels during the body’s flight or fight response to stress. Levels of…, it seems to work as an ‘adaptogen’, helping you to adapt by stabilising the stress response and reducing fatigue.11
Doses that work in studies vary but quite a few studies suggest that 2,000mg is the most effective dose, although some have reported effects from as little as 100mg. The quality is important and you want to have a ginseng extract that guarantees 4% ginsenosides, or at least 1% eleutherosides for Siberian ginseng, which are the active components. If you have good quality ginseng, a daily dose of 200mg is enough for a beneficial effect.
Side effects at the doses above are extremely rare, though overuse of ginseng can cause overstimulation leading to insomnia, irritability and anxiety. Unconfirmed reports of excessive doses raising blood pressure and increasing heart rate have been largely discredited, though high doses of Korean ginseng might be wise to avoid if you have high blood pressure unless advised by a health practitioner. Korean ginseng in high doses is generally recommended only for men, as it can cause menstrual irregularities and breast tenderness in some women. Lower doses, below 200mg, should not be any problem. All ginsengs, including Siberian, should be taken for no more than 3 months at a time, and after that, used as a tonic when needed. Some take it for three months, then have a one month break.
Some herbalists recommend ginseng during pregnancy, and others warn against it, so as with all herbs, consult a qualified herbal practitioner prior to use during pregnancy.
Reishi mushrooms (Ganoderma lucidum) is a wood-rotting fungus used to strengthen and calm the nerves, improve memory, and prevent or delay senility. It is often used to modify or enhance the effects of other stress-fighting herbs. It also helps to lower Insulin is a hormone made by the pancreas. It is responsible for making the body’s cells absorb glucose (sugar) from the blood…. levels.12
Not only is it believed to heal physical ailments, it is said to bring about a peaceful state of mind, and to increase spiritual energy.
In one clinical trial with 37 people reporting general weakness, insomnia, poor memory and tiredness, symptoms were improved by 56% in 4-6 weeks.
Reishi has been shown to improve sleep quality, particularly deep sleep, and exert a calming effect on the central nervous system when given to humans in observed studies. It also lowers blood pressure, cholesterol and improves immunity, which is why it is often recommended in relation to cancer.
Reishi mushrooms are available dried and in capsules. As a general health tonic 0.5 to 4 grams daily is recommended in three equal portions, with meals. The lower doses being effective if you combine with other Adaptogens are herbs that have a normalising influence on the body. They help the body adapt to stress, support its normal functions and restore balance….. You can get high potency ‘extracts’ which multiply its potency. For example, if you take a 10:1 extract 100mg is equivalent to 1g.
People with allergies to moulds or fungi should use care with Reishi mushrooms, although allergic reactions to them are generally rare. In clinical studies, Reishi mushrooms have been shown to be non-toxic in high doses, and severe side effects have not been observed. Mild side effects may include stomach upset, dry mouth, diarrhoea and skin rash, though these generally disappear after several days and when taking high doses.
Rhodiola (Rhodiola rosea) is a succulent herb that grows in the Arctic regions of eastern Siberia, where its roots have been used as an energy elixir for over 3,000 years.
In a Russians study researchers tested the physical and mental performance of 40 medical students during a stressful exam period. Those who took 50 mg of Rhodiola twice daily for 20 days reported decreased mental fatigue and need for sleep and scored 8 percent better on their exams than those in the control group.13 However, a recent study gave 364mg, a decent dose, versus placebo to 48 nurses doing shift work over a 42 hour period and found no benefit.14 Overall, trials show mixed results on fatigue.
There are many plant varieties of Rhodiola, but the one that works best is called Rhodiola rosea. Of its many active ingredients, the key components are rosavin and salidroside. It is best to take Rhodiola supplements that are standardised, and therefore guarantee that you are getting at least 2 per cent rosavin and 1 per cent salidroside. You need between 200mg and 300mg of such a standardised extract, taken 1-3 times per day with meals, though reduce the dose if you start to feel unmotivated due to too little stress.
At these kinds of levels Rhodiola is very safe, and has no reported side-effects. However, excessive amounts have been reported to raise blood pressure, and it may therefore be unsuitable in higher doses for those with Hypertension is more commonly known as high blood pressure….. Rhodiola is not recommended by some herbalists during pregnancy. If in doubt, consult your health practitioner.
Traditional Chinese Medicine uses liquorice to replenish your ‘Ki’ , or vital energy, and modern science is now showing us how. Chronic stress can lead to the adrenals becoming exhausted – a precursor to chronic fatigue – and liquorice can give you the lift you need. While I generally talk about the adrenal hormone cortisol as a bad thing (which it is if it’s too high for too long), it is essential in the short-term handling of stress. Liquorice elevates cortisol by preventing its breakdown, so if you take liquorice, the cortisol you make lasts longer.15 This is not ideal if you are already in stage 2 (adaptation) of the stress cycle, as it can fast-track you to the final, ‘exhaustion’ stage. However, if you are already in stage 3 (exhaustion) – and your cortisol is low– then it can help to slow down the breakdown of cortisol. Choose liquorice powder in capsules, rather than eating a highly sugared liquorice sweet.
With repeated stress, the body becomes tired and less responsive to the effects of cortisol. This calls for more of it to be produced. Since the hormone DHEA can be turned into cortisol, the body makes the extra cortisol at the expense of DHEA, so levels of the former rise while levels of the latter fall. If you have an adrenal stress index test that indicates low DHEA, you might be tempted to supplement it although DHEA supplements are not available in the UK. They are available over the counter in the US.
Since DHEA levels decline with prolonged stress, and also with ageing, the assumption that supplementing DHEA will therefore relieve stress and slow ageing, has not been borne out by several studies. DHEA, being a hormone, is something you want to be more cautious about than supplementing nutrients.
I do sometimes recommend DHEA for short-term use at a relatively low dose such as 25mg for a month if someone is burnt out and have taken it myself on a number of occasions. It can really help kick-start recovery.
However, one of the most effective ways of raising low DHEA levels is the HeartMath exercise, a simple breathing and focusing technique.
DHEA can have side-effects, possibly related to its ability to raise Testosterone is a male sex hormone important for sexual and reproductive development…. and Oestrogen is one of the main female sex hormones…. levels. These include oily skin and acne, hair loss, facial hair in women and high blood pressure. Medical experts caution that little is known about the long-term effect of the elevated hormone levels. DHEA supplements should not be taken long-term without consulting with a health care professional.
I first came across Moringa in Africa where it is taken, either as a powder or in teas or chewing ‘pods’, for a general health and energy boost. It does have a noticeable effect literally in minutes. Studies show that it is incredibly highly concentrated in nutrients ranging from Amino acids are commonly known as the building blocks of protein. There are 20 standard amino acids from which almost all proteins are made. Nine… to carotenoids and flavonoids, as well as vitamins and minerals. It is also a very potent antioxidant and looks and smells a lot like barley grass. It also helps to stabilise blood sugar and helps boost immunity.16 I am not sure simply the presence of all its nutrients explains its remarkable effect however I can find nothing harmful or suggestive of a caffeine-like constituent. It is certainly the ‘new kid on the block’ and warrants more research. While drinking tea from the whole leaves, or chewing the pods, which have a slightly liquorice-like after taste, is good, I prefer having the ground powder. If you try it let me know what you think.
I cover energy in more depth in my books which can be found at HOLFORDirect. You’ll also find the Patrick Holford range of supplements including those for specific energy support – COQ plus Carnitine and Awake Food.
- D. Kennedy et al., ‘Vitamins and psychological functioning: a mobile phone assessment of the effects of a B vitamin complex, vitamin C and minerals on cognitive performance and subjective mood and energy’, Human Psychopharmacology: Clinical and Experimental (2011), vol 26(4–5), pp. 338–347.
- Oxid Med Cell Longev. 2012;2012:835970. doi: 10.1155/2012/835970. Epub 2012 May 9. A combination of lipoic acid plus coenzyme Q10 induces PGC1α, a master switch of energy Metabolism is a term that is used to describe the chemical reactions that take place within the body’s cells. The body gets the energy it…, improves stress response, and increases cellular glutathione levels in cultured C2C12 skeletal muscle cells. Wagner AE , Ernst IM, Birringer M, Sancak O, Barella L, Rimbach G. http://www.ncbi.nlm.nih.gov/pubmed/22655115
- J Ethnopharmacol. 2014 Apr 28;153(2):430-4. doi: 10.1016/j.jep.2014.02.045. Epub 2014 Mar 4. Anti-fatigue effects of proteins isolated from Panax quinquefolium. Qi B1, Liu L1, Zhang H1, Zhou GX1, Wang S1, Duan XZ1, Bai XY1, Wang SM1, Zhao DQ2. http://www.ncbi.nlm.nih.gov/pubmed/24607495
- PLoS One. 2013 Apr 17;8(4):e61271. doi: 10.1371/journal.pone.0061271. Print 2013. Antifatigue effects of Panax ginseng C.A. Meyer: a randomised, double-blind, placebo-controlled trial. Kim HG1, Cho JH, Yoo SR, Lee JS, Han JM, Lee NH, Ahn YC, Son CG. http://www.ncbi.nlm.nih.gov/pubmed/23613825
- Rev Bras Psiquiatr. 2013 Mar;35(1):21-8. Effects of Panax ginseng extract in patients with fibromyalgia: a 12-week, randomized, double-blind, placebo-controlled trial. Braz AS1, Morais LC, Paula AP, Diniz MF, Almeida RN. http://www.ncbi.nlm.nih.gov/pubmed/23567596
- Int J Neurosci. 2013 Jul;123(7):480-6. doi: 10.3109/00207454.2013.764499. Epub 2013 Feb 11. Ginseng in the treatment of fatigue in multiple sclerosis: a randomized, placebo-controlled, double-blind pilot study. Etemadifar M1, Sayahi F, Abtahi SH, Shemshaki H, Dorooshi GA, Goodarzi M, Akbari M, Fereidan-Esfahani M. http://www.ncbi.nlm.nih.gov/pubmed/23301896
- J Natl Cancer Inst. 2013 Aug 21;105(16):1230-8. doi: 10.1093/jnci/djt181. Epub 2013 Jul 13. Wisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2. Barton DL1, Liu H, Dakhil SR, Linquist B, Sloan JA, Nichols CR, McGinn TW, Stella PJ, Seeger GR, Sood A, Loprinzi CL. http://www.ncbi.nlm.nih.gov/pubmed/23853057
- Farnsworth et al., 1985, ‘Siberian ginseng: current status as an adaptogen’, in Wagner H et al (eds.), Economic and Medicinal Plant Research 1, New York, NY, Academic Press, p156-215.
- Ploss E, 1988, ‘Panax ginseng’, Kooperation Phytopharmaka, Cologne; and Sonnenborn U & Proppert Y, 1990, ‘Panax ginseng’, Z. Phytoptherapie 11, p35-49. Both papers are quoted in Schultz V et al., 1998, ‘Rational Phytotherapy’, Springer, USA.
- Pharmacopsychiatry. 2013 Jul;46(5):181-90. doi: 10.1055/s-0033-1347178. Epub 2013 Jun 5. No benefit adding eleutherococcus senticosus to stress management training in stress-related fatigue/weakness, impaired work or concentration, a randomized controlled study. Schaffler K1, Wolf OT, Burkart M. http://www.ncbi.nlm.nih.gov/pubmed/23740477
- M. Davydov and A.D. Krikorian, ‘Eleutherococcus senticosus (Rupr. & Maxim.) Maxim. (Araliaceae) as an adaptogen: a closer look’, Journal of Ethnopharmacology (2000), vol 72, pp. 345–393.
- T. T. Chu et al., ‘Study of potential cardioprotective effects of Ganoderma lucidum (lingzhi): results of a controlled human intervention trial’, British Journal of Nutrition (2012), vol 107(7), pp. 1017–1027.
- Spasov AA et al., 2000, ‘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’, Phytomedicine 7(2), p85-9.
- PLoS One. 2014 Sep 30;9(9):e108416. doi: 10.1371/journal.pone.0108416. eCollection 2014. Rhodiola rosea for mental and physical fatigue in nursing students: a randomized controlled trial. Punja S1, Shamseer L2, Olson K3, Vohra S4. http://www.ncbi.nlm.nih.gov/pubmed/25268730
- MacKenzie MA et al., 1990, ‘The influence of glycyrrhetinic acid on plasma cortisol and cortisone in healthy young volunteers’, J Clin Endocrinol Metab 70(6), p1637-43; also see P. Methlie et al., ‘Grapefruit juice and licorice increase cortisol availability in patients with Addison’s disease’, European Journal of Endocrinology (2011), vol 165, pp. 761–769.
- AF Razis et al, ‘Health benefits of Moringa oleifera’ Asian Pac J Cancer Prev, 15 (20), 8571-8576